Mains Marathon

Mains Marathon-Reference material- August 30-Current Affairs

1. Most lives are saved and most pain is alleviated by the primary care physician. Discuss how far the draft National Medical Commission Bill will be able to tackle the problem of primary healthcare in rural India. What policy alternatives should be considered by bill?

Rural health-care system in India is composed of three tiers.

Sub-centres are manned by trained health workers and auxiliary nurse midwives, with each centre covering up to 5000 people.

Primary health centres, which act as the first point of contact between village communities and a medical officer, are supposed to have a doctor supported by 14 paramedics and other staff.

Community health centres are meant to have four medical specialists (a surgeon, physician, gynaecologist, and paediatrician) supported by 21 paramedic and other staff as well as 30 beds and facilities such as an operating theatre and radiology room.

Problems of Primary health care in rural India:-

  • Although numbers of health facilities in rural areas of India have increased during the past decade, convincing doctors to work in them remains a challenge.
  • As of March 31, 2015, more than 8% of 25 300 primary health centres in the country were without a doctor, 38% were without a laboratory technician, and 22% had no pharmacist.
  • Nearly 50% of posts for female health assistants and 61% for male health assistants remain vacant.
  • These shortages exist despite India having one of the largest medical education systems in the world, with more than 410 government and private medical schools.
  • India also accounts for the largest number of maternity deaths. A majority of these are in rural areas where maternal healthcare is poor.

How unethical practices effected healthcare system:-

  • MCI is said to be hugely responsible for the prevailing pathetic state of health care and low standard of conduct among a large section of medical practitioners and hospitals.
  • MCI was found to be highly represented by the members of either from corporate hospitals or in private practices, that makes it less rural bent or welfare driven authority.
  • Most of these members indulge in unethical practices such as carrying out unnecessary diagnostic tests and surgical procedures in order to extract money from hapless patients and meet revenue targets.
  • Due to above mentioned reasons MCI has said to be promoting culture of corporate and private healthcare system and professionals, keeping themselves distant from less profitable and more service oriented rural healthcare.

Provision that will indirectly benefit rural healthcare:-

Medical education is directly linked with the quality of healthcare system of the country, and to tackle the health problems faced by India, a transparent and impartial leadership is required.

Bill proposes setting up of several autonomous boards that will be bestowed with wide powers to maintain high ethical standards in medical education and professional services.

Provisions that go against the rural healthcare:-

  • Bill has recommended that for-profit organizations be permitted to establish medical colleges as against the present norm where only not-for-profit organizations are permitted.
  • To permit “for profit” colleges will severely damage the stated objective of providing a cadre of medical professionals able and willing to work in small towns and villages.
  • Private colleges charge huge amounts for medical education, leads to producing a group of doctors who begin their careers under pressure to earn very high incomes.

Some alternative policy measures:-

  • Government should make more efforts to make primary care the first option of most medical graduates in India.
  • There is severe shortage of suitably qualified teachers in certain absolutely essential specialties (for example, in forensic science, community medicine, tuberculosis and radio diagnosis), government should develop a pool for of qualified teachers before setting up new colleges.
  • There should be mix of nominated and elected members in the commission, as Bodies with only nominated members tend to become narrow-minded with all members overly concerned with pleasing the government of the day.
  • The fundamental objective of medical education should be creating a cadre of medical professionals trained and equipped to work effectively given the social conditions of the country.


Other suggestions of the bill

  • Current electoral process of appointing regulators for medical education should be replaced by a broad-based search-cum-selection committee.
  • Creation of a Medical Advisory Council by the central government, with one nominated member from every state government and two members to represent Union territories, to be nominated by the home ministry.
  • On the issue of the National Eligibility cum Entrance Test (NEET), the committee recommended a statutory basis for common entrance examinations for admission to undergraduate and postgraduate.


2. South China Sea has become diplomatic battle ground for world powers. What is South China sea dispute. And discuss the implications of Hague ruling on it. How effective have been the international arbitrators in dealing with international conflicts?

The South China Sea is a marginal sea that is part of the Pacific Ocean, encompassing an area from the Karimata and Malacca Straits to the Strait of Taiwan of around 3,500,000 square KM

Disputes in South China sea

  • China claims Nine-dash line area, which covers most of the South China sea and overlaps exclusive economic zone claims of Brunei, Indonesia, Malaysia, the Philippines, Taiwan, and Vietnam.
  • Territorial disputes still persist, primarily over the Spratly and Paracel Islands as well as the Scarborough Shoal.
  • Vietnam hotly disputes China’s historical account, saying China had never claimed sovereignty over the islands before the 1940s.
  • Vietnam says it has actively ruled over both the Paracels and the Spratlys since the 17th Century.
  • Philippines invokes its geographical proximity to the Spratly Islands as the main basis of its claim for part of the grouping.


  • This ruling arguably closes loopholes and counters temptations to engage in exceptionalism on the part of some countries like China.
  • The decision undoubtedly represents a sweeping victory for the Philippines. It is, however, unenforceable.
  • Although award is legally binding on China as a party to UNCLOS, China has refused to recognise the tribunal’s jurisdiction.
  • Decision may led to intensification of China’s island-building campaign in new locations and an increase in enforcement actions within the nine-dash line.
  • It indicates historic claims cannot be readily sustained. This undermines the unilateral claims of certain countries – such as Canada’s historical claims related to its Arctic archipelago.
  • Even though the ruling is technically only binding on China and the Philippines, it carries considerable legal weight as an authoritative and unanimous ruling by an international judicial body.
  • The clarity on definitions of islands and rocks will have ripple effects on other claimants (as well as other disputes).
  • Ruling will be a test of whether states are willing to do their part to uphold the rules-based international order.

Effectiveness of the international arbitrators

  • Without a global police force, international courts and arbitration panels do not have the same ability to enforce legal rulings as domestic governments.
  • Legal dispute mechanisms are significantly more successful at resolving international territorial, maritime, and river disputes than other bilateral and third-party conflict management mechanisms.
  • While arbitration and adjudication have proven to be highly effective at resolving disputes, states are reluctant to use these procedures.
  • Each party to a dispute will be reluctant to give up decision control to an arbitration panel or court that it believes is biased against its interests.


  1. History is no longer enough to entice Africa to take India seriously that too in the presence of China. Discuss in the light of present India-Africa relations.

India and Africa share a long and rich history of interaction that dates back to ancient civilisations, including the trade ties between the Nile and Indus valleys.

India’s shared colonial heritage with many African countries has significantly contributed to this connection, as has the migration of many Indian workers to Southern and Eastern Africa, establishing large diasporas in these areas.

India’s attitude towards its general relations with Africa in the post–World War II era has been informed by principles of South–South cooperation, such as respect for state sovereignty, non-interference, mutual benefit and equality.

Comparison between presence of India and China in Africa:-

Although India has strong historical links with Africa, but where it stands in front of China at present:-

India China
India is Africa’s fourth largest trading partner with a trade turnover of $70 billion in 2014-15. China is Africa’s largest trading partner with a trade turnover of $220 billion and the continent is also its largest source of imports.
India provided much-need affordable medicine to the continent by selling generic drugs China has provided about one-sixth of the external infrastructure financing for the continent so far

It imports commodities and exports manufactured products

China mostly exports manufactured products to Africa, such as textiles, electronics, and machinery, and imports mostly oil, but also metals such as iron and copper.
While India is providing assistance like Developing human resources through education, vocational training and skill development Africa is the biggest recipient of China’s foreign aid, which amounted to roughly $30 billion from 2000 to 2013.
Indian firms have invested heavily in natural gas projects in Mozambique and are exploring the potential for others in Tanzania. Chinese companies have focussed their investments in energy (such as the oilfields in South Sudan), in African mining (in infrastructure and manufacturing.


Although China weighs heavier in front of India as far as present relations with Africa are concerned but it is believed that if India would take some strong steps, it would be more then welcomed by Africa, due to India’s historical relations, big diaspora and more friendly relations.

Way ahead for India:-

  • India will have to leverage its own strengths in making a lasting compact with Africa and regain its lost presence on the continent.
  • While at present India cannot match up China in investments or aid to Africa, it should ramp up it’s efforts to develop human resources through education, vocational training and skill development.
  • Indian diaspora in Africa numbers nearly 2.5 million and is spread across 46 countries. Most of them migrated as indentured labour during the colonial period. India should take advantage of it’s Diaspora by integrating them.
  • India also needs to cultivate the powerful African bloc to support its growing aspirations at various fora and institutions, for example its bid to the UNSC and NSG.
  • India promised a joint monitoring mechanism to ensure implementation of projects, it should be done on priority as India has been criticized enough for non-implementation.
  • India should try to leverage on the criticism that China is facing for not hiring Africans, due to poor compliance with safety and environmental standards and for fuelling conflicts and should come up strongly with pro African attitude.
  • India and Africa should work together on addressing climate change and sustainable development of blue economy.
  • Africa has 60% of the arable land in the world, but produces 10% of the global food output, India can help Africa with it’s experience in the field of agriculture.

India can help Africa in developing climate resilient agriculture and adaptation to climate change.


  1. Groundwater depletion is gradually becoming a major problem in India. Discuss the causes of ground water depletion and the steps taken by government to deal with it.

Ground water overuse or overexploitation is defined as a situation in which, over a period of time, average extraction rate from aquifers is greater than the average recharge rate.

Groundwater is a critical resource in India, accounting for over 65% of irrigation water and 85% of drinking water supplies.

However, on current trends it is estimated that 60% of groundwater sources will be in a critical state of degradation within the next twenty years.

According to a report by Central Ground Water Board (CGWB), 55 percent of the wells in India have registered declining trend of ground water level.

Wells in Delhi and Andhra Pradesh have registered highest declining trend of ground water level during 2007-2012.

Causes of depletion

  • Owing to the decentralised availability of groundwater, it is easily accessible and forms the largest share of India’s agriculture and drinking water supply
  • Poor service delivery from public water supply systems has prompted many farmers, and rural and urban households, to turn to their own private supply for irrigation and for drinking water.
  • New pump technologies meant that even farmers and households with very modest incomes could afford to sink and operate their own tube well.
  • Government electricity subsidies have shielded farmers from the full cost of pumping, creating a modality of groundwater use that has proved very difficult to change.
  • The flexibility and timeliness of groundwater supply presented an attractive alternative to the technically and institutionally less responsive provision of surface water through public systems.
  • Currently, the Easement Act, 1882 provides every landowner with the right to collect and dispose, within his own limits, all water under the land and on the surface. 12 This makes it difficult to regulate extraction of ground water.
  • Further the law excludes landless ground water users from its purview.
  • Decisions such as cropping pattern and cropping intensity are taken independent of the ground water availability in most areas.

Government measures:-

Draft National Water Framework Bill

  • Draft law, prepared by the Water Resources Ministry, is being proposed as a model legislation that can be adopted by states, since water is in the jurisdiction of the state governments.
  • Bill also sets a binding national water quality standard and pushes for a national water security plan.

Model Bill for the conservation, protection, regulation and management of groundwater

  • The model bill for conservation, protection, regulation and management of groundwater aims to ensure groundwater security and proposes a penalty for its misuse.
  • The proposed law wants to introduce a “graded pricing system” for domestic water supply, with full cost recovery pricing for high-income groups, “affordable pricing” for middle-income, and a “certain quantum of free supply” to the poor.
  • It also has provisions to charge a fee for industrial and bulk use of groundwater.

National Groundwater Management Improvement Program

  • The proposed National Groundwater Management Improvement Program (NGMIP) aims to build on current national and state efforts targeted at the long term goal of reducing groundwater level decline.
  • Its objective is to “improve the management of groundwater resources in selected states.”


  1. What is king tide. How it was linked to climate change. Discuss the effects of climate change on Pacific island nations.

The king tide is the highest predicted high tide of the year at a coastal location. It is above the highest water level reached at high tide on an average day. King tides are also known as perigean spring tides.

King tides occur when the orbits and alignment of the Earth, moon, and sun combine to produce the greatest tidal effects of the year. King tides are a normal occurrence once or twice every year in coastal areas.

Link to climate change

  • King tides bring unusually high water levels, and they can cause local tidal flooding. Over time, sea level rise is raising the height of tidal systems. Average daily water levels are rising along with the oceans. As a result, high tides are reaching higher and extending further inland than in the past.
  • Although king tides are natural and cyclical, the extra-high tides give a glimpse of the future when global warming causes sea levels to rise. According to experts it’s roughly equivalent to what a normal tide would look like under sea level rise in 50 years.
  • King tides preview how sea level rise will affect coastal places. And hence scientist are taking clue from king tides to predict the future of Pacific Islands.

Effects of climate change on Pacific island nations:-

  • The Pacific is in fact without a doubt one of the world’s most vulnerable regions when it comes to risk of disaster due to climate change, particularly several of the low-lying coral islands.
  • Facing with 2 % temperature increase, tropical cyclone intensities in the north-west Pacific are expected to increase by 12-15% and average rainfall to decrease by 12-28%.
  • Ocean warming, frequent tropical cyclones, flash floods and droughts are likely to have dramatic impact on food production system in Pacific Islands.
  • Climate change is expected to cause serious degradation of the coastal environment and natural resources on which poor rural people depend.
  • More intense tropical cyclones and rise in sea surface will negatively impact inshore fisheries and food supply, especially in rural areas.
  • Higher rates of erosion and coastal land loss are expected in many Pacific Islands as a consequence of the projected increase in sea level.
  • Low-lying island states and atolls are likely to experience increased sea flooding, inundation and salinization as a direct consequence of sea level rise.
  • 10% reduction in average rainfall by 2050 is likely to correspond to a 20% reduction in the size of freshwater lens on Tarawa Atoll, Kiribati.
  • Furthermore, decline in the size of the islands, resulting from land loss accompanying seal-level rise, is expected to reduce the depth of the freshwater lens on atolls by as much as 29%.

Positive effects

  • Increased temperatures in high-latitude islands are likely to make conditions more suitable for agriculture.
  • In mid and high-latitude islands, higher temperature and the retreat and loss of snow cover could improve conditions for the spread of invasive species and forest cover.
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