PM IAS SEP 28 – 29 – 30 EDITORIAL ANALYSIS

Permanent membership of the UNSC is another story

Context

• There is a buzz in India about the prospects of the country becoming a permanent member of the United Nations Security Council (UNSC). India’s External Affairs Minister (EAM) Mr Jaishankar has been actively canvassing for the country’s candidature, calling for a text-based negotiation on what has been euphemistically referred to as the reform of the UNSC, i.e., negotiation on a written document outlining the proposed reform instead of just holding forth verbally.
• Until a quarter century ago, the nuclear weapon club had five members, the same five as the P-5. India, Pakistan, North Korea and Israel have since joined the club. The P-5 could do nothing to stop the latter countries from forcing themselves into membership of the nuclear club. But the permanent membership of the Security Council is another story.

About UNSC:

United Nations Security Council (UNSC) is one of the six principal organs of the United Nations (UN). It is the only UN body with the authority to issue binding resolutions on member states. It is headquartered at New York

Mandates of UNSC:

1. Ensuring international peace and security
2. Recommending the admission of new UN members to the General Assembly (UNGA)
3. Approving any changes to the UN Charter
4. Establishing peacekeeping operations
5. Enacting international sanctions
6. Authorizing military action

Members:

• The council has 15 members: 5 permanent members and 10 non-permanent members elected for 2-year terms.
• The 5 permanent members are the United States, Russia, France, China and the United Kingdom.
• Each year, the General Assembly elects five non-permanent members (out of ten in total) for a two-year term. The ten non-permanent seats are distributed on a regional basis. India is currently a non-permanent member of UNSC for two years i.e 2021-22.
• The council’s presidency is a capacity that rotates every month among its 15 members.

Voting Powers:

Each member of the Security Council has one vote. Decisions of the Security Council on matters are made by an affirmative vote of nine members including the concurring votes of the permanent members. A “No” vote from one of the five permanent members blocks the passage of the resolution. This is known as the veto power of the P5 group (Permanent 5 members of UNSC).

Declarations that deserve scepticism

• None of the P-5 wants the UNSC’s ranks to be increased. Each P5 member is confident that someone among them will torpedo the enlargement of the club. Thus the declarations of support for India’s candidature need to be taken with a fistful of salt.
• When delegations of 50 countries were drafting the Charter of the future United Nations at Dumbarton Oaks near Washington DC in 1944-45, the article regarding the Security Council, particularly the right of veto, was the subject of maximum debate and controversy. Many countries opposed it.

Use and misuse of veto power:

• Russia, in its incarnations as the Soviet Union and the Russian Federation, has cast more vetoes (close to half of all vetoes) than the 3 western members of the club. But the western members have used their privileged position any number of times to protect Israel when the Palestinian question was being discussed. They also used veto to prevent sanctions being imposed on the apartheid regime of South Africa.
• India needs to be circumspect about veto. We ought to remember that the Russians have bailed India out on many occasions on the question of Kashmir. Most importantly, Russia helped India by vetoing unfavourable resolutions during the war of Bangladesh liberation in 1971.
• We can never rule out the possibility of the Kashmir issue being raised in the Council at some time in the future. While we might expect, though not be certain of, Russia to come to our help, we must rule out either Britain or America from casting a negative vote against Pakistan. Going by the Chinese position of repeatedly blocking India’s efforts to include confirmed Pakistani terrorists in the sanctions list, we can be sure of Chinese hostility towards us for a long time.

The G-4 grouping:

• There are four declared candidates for permanent membership: India, Japan, Brazil and Germany, called the G-4.
• Africa and Latin America and the Caribbean are unrepresented in the permanent category at present. Africa’s claim for two permanent seats has wide understanding and support, but the Africans have yet to decide which two countries these are to be.
• As for India, we can discount Pakistan’s opposition; China will not support India nor will it ever support Japan. Brazil has regional opponents and claimants. As for Germany, Italy is firmly opposed to its claim. Many of these countries opposing G-4 have formed the ‘Coffee Club’ aka Uniting for Consensus (UfC).
• There are already three western nations among the P-5. Even if India enjoyed near universal support, there is no way that India alone can be elected; it will have to be a package deal involving countries from other groups.

Amending the UN Charter

• Changing the membership of the Council requires amending the Charter. This involves consent of two-thirds of the total membership of the U N, including the concurring votes of P-5. This means that each of the five has a veto. The Charter was amended once in the 1960s to enlarge the Council by additional non-permanent seats.
• Even now, if the proposal was to add a few non-permanent seats only, it would be adopted with near unanimity or even by consensus. It is the permanent category that poses the problem. One can have a good idea of the difficulty of amending the Charter by the fact that the ‘enemy clause’ contained in Article 107 of the Charter remains in it even though some of the enemy states such as Germany, Japan, Italy, etc. are very active members, often serve on the Council, and are close military allies of some of the victors in the war.

Way forward: A proposed new category:

• A distinguished group of experts suggested a few years ago that a new category of semi-permanent members should be created. Countries would be elected for a period of 8 to 10 years and would be eligible for re-election. India ought to give serious consideration to this idea.
• Some experts are of the opinion that India should not accept permanent membership without the right of veto. “We cannot accept second class status”, is what they say. First, nobody is offering India permanent membership. Second, membership with veto power should be firmly ruled out. If by some miracle we are offered or manage to obtain permanent membership without veto, we must grab it. Even a permanent membership without veto will be tremendously helpful in protecting our interests.

Conclusion:

India must examine different ways of achieving its strategic goal of membership of UNSC permanent group. We can examine the Razali reform plan under which the UNSC would have 5 new permanent members without veto powers, besides 4 more non-permanent members taking the council’s strength to 24.

---

The NASA spacecraft-asteroid collision

Context:

• Recently, the DART (Double Asteroid Redirection Test) spacecraft collided with the space rock Dimorphos (a 160 metres wide asteroid). NASA has confirmed that the collision of the 600 kilogram weighing DART, on the football stadium-sized Dimorphos, orbiting around the primary asteroid Didymos, has deflected the trajectory of the pair of space rocks.
• This kinetic impact technique, also known as the ‘kick method’, could one day save humanity from a potential cataclysmic collision by safely deflecting a killer asteroid on its course towards earth. It could also fuel space mining technologies and unleash the space economy in decades to come.

What are asteroids?

• Leftover materials from the formation of the sun, earth and planets, through the accretion and agglomeration of giant gas and rocks, are scattered as comets, asteroids and meteoroids in the solar system.
• Some of these cross their path and collide with earth from time to time, resulting in a meteor shower. Most rocks are so small that they burn up completely in the atmosphere due to frictional heating. If they are large enough, the charred piece falls through as a meteorite.
• The falling piece from a meteoroid 140 metres wide or more will be capable of completely wiping out a city like Chennai. The impact would be devastating if it was one or more kilometres wide.
• About 66 million years ago, an asteroid about 10-15 kms struck earth. The tsunami, volcanic eruptions and thick dust clouds ensuing from the blow decimated dinosaurs and nearly 75% of all species. It led to a mass species extinction.
• What happened in the past can occur in the future. The chances of a giant asteroid striking earth are small; however, if it did occur, the devastation would be cataclysmic, wiping out the entire human civilisation.

What was NASA’s mission?

• NASA keeps a close watch on the nearly 26,115 asteroids whose orbits are dangerously close to earth. NASA undertook the ‘kick’ technique on Dimorphos.
• Compared to the massive Dimorphos, DART is a tiny Goliath. Yet crashing at a breakneck speed of 23,760 kilometres per hour, the momentum is adequate to slash the angular momentum of Dimorphos, making it speed up and move closer to Didymos.
• All of these reduce the orbital period and the time taken for the moonlet to go around the primary asteroid. The pair’s trajectory is thus deflected as the net result of these dynamics.
• Dimorphos is more like a pile of rubble loosely held by gravity. If true, the impact will eject a cascade of debris, each piece carrying away a bit of momentum and energy. And as a net result, the asteroid will suffer a considerable loss. It will speed up more, and the orbit will become nearer to Didymos. The orbital period will then reduce by as much as 10 minutes. Astronomers will now spend weeks and months observing the periodic change in the brightness using the telescopes to tease out the altered orbital period.

Way forward: other possibilities of this technique:

• On the heels of NASA, China is set to deflect a 40m diametre earth-crossing asteroid called 2020 PN1 sometime in 2026. While ostensibly the drive comes from the desire to protect earth from killer asteroids, perhaps the lure of space mining lurks behind.
• Mining rare earth elements (on earth) comes with a high environmental cost. In the coming years, the penalty for polluting could make space mining economically viable. If one can tug a mineral-rich asteroid near the Moon or establish a space mining factory between the orbits of earth and Mars, precious mineral resources needed for decades could be easily sourced.
• The ‘kick’ technique that deflects asteroids can then be used to move a small asteroid into a convenient position for space mining. Now shelved, NASA’s Asteroid Redirect Mission (ARM) aimed at precisely this by bringing a 20-tonne space rock near earth to study and mine. In a way, the DART mission is also part of this frame.
• For developing green energy technologies — electric vehicles, solar panels, wind turbines, and energy storage devices – and ushering in the low carbon economy of the future, rare earth elements such as yttrium, niobium, rhodium, palladium, osmium, iridium and scandium are critical. They are short in supply, and asteroid mining, it is believed, could solve the rare earth supply problem.
• From the robotic Soviet Luna 16 in the 1970s to U.S. Apollo missions and China’s first lunar sample-return mission, Chang’e 5 — all have brought back lunar soil. NASA’s Stardust spacecraft returned a canister full of dust from comet Wild-2 captured by an aerogel-based sample collector in 2004. Japan Aerospace Exploration Agency (JAXA)’s Itokawa, Hayabusa, Ryugu, and NASA’s OSIRIS-Rex to near-earth asteroid Bennu are missions to extract and return samples from asteroids.

Conclusion:

India must try to develop a technology demonstrator on asteroid redirection or destruction and related technologies like space mining, in order to boost our space economy.

In nature’s warning signs, a nudge to riparian states

Context

There has been an increase in the magnitude, the frequency and the intensity of floods in many parts of the world. As an example, nearly a third of Pakistan is experiencing devastation in 2022, with a spread of diseases and severe shortage of potable water after intense flooding. In June 2022, Assam experienced one of its worst floods in living memory which affected over 30 districts. In some districts in Assam and Bihar, flooding is a recurrent feature.

About flood:

A high water level that overflows the natural banks along any portion of a stream is called a flood. Thus, Floods are commonly associated with a stream or river.

Causes of Floods

Natural Causes:

1. Heavy rainfall and cloud bursts – Heavy concentrated rainfall reduces the capacity of rivers to accept any more surface run–offs due to rainfall and as result water spills over to adjoining areas. These can cause extensive damage within short span of time.
2. Heavy melting of ice and snow,
3. Changes in river systems and large catchment areas,
4. Sediment deposition/Silting of river beds,
5. The collapse of dams,
6. Transgression of sea at the occasion of tropical cyclone, and
7. Tsunami in coastal areas and landslides in course of rivers

Man-made/Anthropogenic causes

1. Deforestation – It leads to soil erosion and Landslides. It also leads to silting of river beds.
2. Unscientific use of land utilization and bad farming practices
3. Increased Urbanisation – It has reduced the ability of the land to absorb rainfall through the introduction of hard impermeable surfaces.
4. Concretisation of surface: it prevents excess surface water to percolate down the soil and recharge groundwater.
5. Climate change and pollution

Consequences of Floods

1. The crops get adversely affected by the temporary loss of the agricultural season and fertile soil cover.
2. It leads to changes and destruction of habitats, and loss of biodiversity
3. Disruption of the lines of rail, road communication, and essential services
4. Spread of water-borne and infectious diseases like cholera immediately after floods.

Flood distribution in India

• 125 of Indian land is flood-prone. State-wise study shows that about 27% of the flood damage in the country is in Bihar, 33% in Uttar Pradesh and Uttarakhand, and 15% by Punjab and Haryana.
• The major flood areas in India are in the Ganges – Brahmaputra – Meghna Basin which accounts for nearly 60% of the total river flow of the country.
• Distribution of flood plains –

1. Brahmaputra River Region
2. Ganga River Region
3. North – West River Region
4. Central and Deccan India

• The middle and lower courses of North Indian rivers such as Ganga, Brahmaputra, Kosi, Damodar, Mahanadi, etc. Are prone to floods due to very low gradient. The flat plains do not have enough gradients for the outlet of drainage.
• Peninsular rivers are mature and have hard rock beds, so they have shallow basins. This makes them prone to flooding.
• Parts of the Eastern coasts of India are particularly prone to cyclones during October – November. These cyclones are accompanied by strong winds, storm surges, tidal waves, and torrential rains.

Floods in India

• Floods in India are also the costliest among disasters, accounting for around 68% of economic losses caused by all disasters (Emergency Events Database).
• Floods in India account for over 40% of the deaths out of all natural disasters. Empirical studies have also shown that flood damage has a negative impact on economic growth in the long run and considerably reduces female employment opportunities in the agricultural sector.
• In 1980, Rashtriya Barh Ayog (National Commission on Floods) assessed that the total flood-prone area of India is around 12% of the total area of India. About 80% of this area could be provided with a reasonable degree of protection.
• Government data shows that between 1953 and 2011, on an average, floods claimed 1,653 lives every year and caused losses – including the house, public property and crop damage of Rs. 3,612 crores every year.

Flooding due to cross-border rivers

On sharing of information

Flooding is compounded by the lack of transparency in the sharing of hydrological information and also information relating to activities (such as by one riparian state) that are transboundary in their effect (affecting other riparian states), thus serving as an obstacle in understanding the magnitude of flooding.

On customary international law

• In accordance with customary international law, no state has to use its territory in a manner that causes harm to another state while using a shared natural resource; this amounts to saying that there is a binding obligation on all states not to release water to cause floods in another co-sharer of the river water.
• This obligation gives rise to other procedural norms that support the management of floods, which include notification of planned measures, the exchange of data and information, and also public participation.

The Brahmaputra and India’s concerns

• During the monsoon, flooding has been the recurrent feature in the last several decades in Assam. India faces other woes in the form of the construction of dams by China. China’s excessive water release, as a “dam controller”, in violation of customary international law has the potential to exacerbate flooding in Assam in future.
• India’s main concern is that there is no comprehensive sub-basin or all basin-level mechanism to deal with water management of Brahmaputra. Neither India or China are party to the United Nations Convention on the Law of the Non-Navigational Uses of International Watercourses (UNWC) 1997 or the United Nations Economic Commission for Europe (UNECE) on the Protection and Use of Transboundary Watercourses and International Lakes 1992 (Water Convention). The UNWC contains a direct reference to floods, which covers harmful conditions and emergency situations.
• In the absence of any mechanism, India relies on its memorandum of understanding (MoU) with China in 2013 with a view to sharing hydrological information during the flood season (June to September). The MoU does not allow India access to urbanisation and deforestation activities on the Chinese side of the river basin. With the MoU in the background, India by becoming a party to either the UNWC and the Water Convention could lay the groundwork for a bilateral treaty on the Brahmaputra but subject to the reservation that it should not insist on the insertion of a dispute settlement mechanism provision.

India, Nepal and flood prevention

• Floods are also a recurrent problem in the Koshi and Gandak river basins that are shared by India and Nepal. The intensity and magnitude of flooding is rising because of heavy seasonal precipitation as well as glacial retreat due to global warming and human-induced stressors such as land use and land cover changes in the river basin area of Nepal (Terai) and Bihar.
• It is important that the two neighbours view the river basins as single entities, which will help in facilitating an integrated approach for improved basin and flood risk management. The India-Nepal Koshi agreement 1954 (revised in 1966) is aimed at reducing devastating flooding in the river basin. The treaty-based joint bodies have also tried to refine the early warning systems for flood forecasting.

Way forward:

In contravention of procedural customary international law obligation, India considers data on transboundary rivers as classified information, which is one of the key challenges in developing cross-border flood warning systems. In light of the cataclysmic floods in Pakistan and the visible effects of climate change, it is important that all riparian states must comply with all the procedural duties pursuant to the no harm rule. They must also think of becoming a party to either the UNWC or the UNECE Water Convention.

---

Rediscovering the Bay of Bengal

Context:

The Bay of Bengal (the Bay/ BoB) is experiencing an increase in geo-economic, geopolitical, and geo-cultural activity. Therefore, at the fourth BIMSTEC summit, Prime Minister Narendra Modi announced the opening of the Centre for Bay of Bengal Studies (CBS) at Nalanda University.
 

Rethinking the Bay

• The setting up of a dedicated institution on the bay (BoB) has once again demonstrated India’s commitment to advancing constructive agendas by forging connections and setting up platforms for all those with an interest in the Bay.
• CBS will offer collaborations in areas such as geo-economics and geopolitics, ecology, trade and connectivity, maritime security, maritime law, cultural heritage, and blue economy to generate opportunities for the Bay region. This will strengthen India’s overall framework for maritime engagement, which aims to advance sustainable economic growth for all by fostering closer nautical ties.

Significance of the Bay:

1. The Bay has long been a major commerce hub for the Indian Ocean. About half the world’s container traffic passes through this region, and its ports handle approximately one third of world trade, thus becoming the “economic highway of the world.”
2. It created a conduit between the East and the West in terms for trade and culture. An Indo-Pacific orientation and the realignment of global economic and military power towards Asia have had a considerable impact on the Bay region.
3. The key sea lanes of communication in this area are lifelines for global economic security and are crucial to the energy security that powers the economies of many countries in the region.
4. Non-traditional dangers including terrorism and climate change have become more prevalent.
5. The Bay also provides an opportunity for greater regional cooperation in the environmentally friendly exploration of marine and energy resources.
6. The Bay has a biodiverse marine environment and home to many rare and endangered marine species and mangroves, which are essential to the survival of the ecology and the fishing sector.
    

Disorder at the Bay

• The region’s maritime environment has changed as a result of major powers expanding their economic and geopolitical influence. Political and cultural engagement, together with economic competition, have taken on new dimensions.
• Problems such as population growth, altered land use, excessive resource exploitation, salinisation, sea level rise, and climate change are exerting significant strain on the Bay’s environment.
• Operational discharge from small and medium feeder ships, shipping collisions, unintentional oil spills, industrial waste, pollution, and the accumulation of non-biodegradable plastic litter are all contributing to the deterioration of the Bay. A dead zone has formed as a result, and the mangrove trees that protect the shore from the fury of nature are under more threat than ever.

Way forward:

• For a better knowledge of challenges, and strategies to overcome them for the sustainable development of the region, more focused and interdisciplinary study is required on these issues.
• By founding the CBS, Nalanda University has already started its journey and given the nation a unique interdisciplinary research centre devoted to Bay-focused teaching, research, and capacity building. Additionally, scholars from many countries and academic streams are already participating in CBS’s first certificate programme on the Bay.
• It is essential that nautical neighbours develop a partnership and cooperate because of the maritime domain’s interrelated and interdependent nature. A few concerns that need immediate attention include expanding cooperation in maritime safety, maritime connectivity and the ease of maritime transit.

Case study: Information Fusion Centre (IFC) for the Indian Ocean Region (IOR):

• The IFC has been established at the Indian Navy’s Information Management and Analysis Centre (IMAC) in Gurugram, Haryana.
• IFC is the single point center linking all the coastal radar chains to generate a seamless real-time picture of the nearly 7,500-km coastline.
• All countries that have signed white shipping information exchange agreements with India can now position liaison officers at the IFC. Countries like USA, UK have posted their officers in IFC-IOR.

Objectives of IFC- IOR:

1. Sharing of White Shipping Information (movement of cargo ships) among countries
2. Maritime domain awareness in real time
3. Tackiling threats from non-state actors like maritime terrorism, piracy, arms-running, human trafficking.
4. Tackling threats from state actors (eg, territorial expansionism of some States) and promoting a rules based international order.

• All members of the Indian Ocean Naval Symposium (IONS) are expected to be part of IFC eventually. The IONS, launched in 2008, seeks to increase maritime cooperation in IOR.
• A similar information exchange and analysis centre could be done for the Bay, ie, IFC- BoB; or the mandates of IFC-IOR could be expanded to cover BoB region as well.

Illicit, unreported, and unregulated fishing (IUUF)

Littoral countries around the Bay also need to address non-traditional threats and fostering group efforts to reduce IUUF. Standardising and harmonising data reporting remains a challenge. Furthermore, regional marine entities should strive to balance opportunities and goals on a national, regional, and international scale.
 

Conclusion:

Littoral governments need to support and promote skill-building, research, and training. Countries in the region will need to mobilise incentives and investments, manage oceanic affairs more effectively, and support people as they switch to alternative lifestyles. Working together is important due to shared nautical concerns and the complexity of the marine environment.

After the floods, Bengaluru needs to clean up its act

Context

• Various analyses now attribute Bengaluru’s flooding (2022) to more rainfall and unplanned, overcrowded growth that is destroying the greenery, tanks and wetlands. In the future, rainfall is expected to increase to an average of 1,000 mm per annum from the current 650 mm per annum.
• The State government announced tough measures such as the demolition of unauthorised encroachments impeding drainage streams in the city, but quickly backed away. It now plans to divert drains to avoid already built-up areas. This is not a solution because nature will carry on inundating encroachments until people abandon them of their own volition.

Urban flooding is the inundation of land or property in a built environment, particularly in more densely populated areas (like cities), caused by rainfall overwhelming the capacity of drainage systems. Unlike rural floods (Heavy rain over a flat or low-lying area), urban flooding is not only caused by just higher precipitation but also unplanned urbanisation and concretisation of soil that prevents natural drainage of excess surface water during monsoon.

The ‘grease’ of the system

• One of the major causes of unplanned urbanisation that led to Bengaluru flood is Corruption, which is a matter of convenience, of time saved and of benefits, often through the violation of rules. Some justify corruption as the grease that keeps the fast-growing economic engine (of Bengaluru and other cities) whirring smoothly.
• A good, but misguided government could make narrowly rigid rules, thus giving venal politicians and bureaucrats the leeway to bend them. For example, building bye-laws are so labyrinthine that the strictest law-abiding citizen cannot comply with them. That provides opportunities for agents who bypass the system’s rigidities.
• However, corruption cripples economic growth in ways not readily apparent. Apart from transferring inordinate wealth to the undeserving, it creates a slew of vested interests, who resist anti-corruption process reforms.

The loopholes

• Next, our narrow, legal definition of corruption enables many in a corrupt system to escape culpability. Indian law recognises only corrupt acts by public servants to be ‘acts of corruption’ under the law. As private corruption is not criminalised, many government actions are outsourced to private agents, who collect ‘handling fees’ on behalf of their partners in crime within the government.
• E-Governance is often not the effective solution as claimed. E-enabled systems often only relocate the locus of corruption; they do not solve all of it. Large databases, such as land records, when moved to paperless systems are vulnerable to manipulation. Encroachments are enabled when old records are destroyed and new ones are created. Power shifts from land administrators to the one who possesses the digital signature. The data entry operator becomes an all-important and corruptible cog in the wheel.

Electronic governance or e-governance is the application of information technology for delivering government services, exchange of information, communication transactions, integration of various stand-alone systems between government to citizen (G2C), government-to-business (G2B), government-to-government (G2G), government-to-employees (G2E) as well as back-office processes and interactions within the entire governance framework.

How then do we tackle corruption?

Way forward:

• Successful anti-corruption strategies rely on actions across three fronts.
• First, regular assessments and evaluations of ongoing anti-corruption measures, eliminate the possibility of declaring false victories. They help in red-flagging new corruption opportunities, even as old ones are eliminated. A cycle of ongoing process reforms gets initiated.
• Second, a genuine regime of whistle-blower protection assures honest citizens, politicians, bureaucrats and judges of protection, as they otherwise fear the adverse repercussions for uncovering illegal activities. Swift punishment of the guilty, could instil a sense of fear and reduce the feeling of impunity that the corrupt enjoy.
• Third, there has to be a conscious move towards promoting ethical behaviour. Unfortunately, moral science education has been tainted by religious colours; but we must develop agnostic, religion-neutral ways of educating young people to be empathetic, kind, mindful of their larger responsibilities to the community, be honest, and intolerant of corruption.
• We must decongest the city, plant more trees, save wetlands, even reclaim them, desilt drains, enlarge sewers, deconcretise pavements and stop the clogging of waterways with unsegregated garbage.

Conclusion:

However, there is one necessary ingredient remaining, going by the experience of cities and countries that have cleaned up their acts. If anti-corruption strategies are to be successful, the process needs enlightened leadership.

---

India lacks a complete paediatric cardio-care service

Introduction:

• Congenital Heart Disease (CHD), which the Centers for Disease Control and Prevention (CDC), U.S., acknowledges to be the most common congenital disorder, is responsible for 28% of all congenital birth defects, and accounts for 6 to 10 % of all the infant deaths in India.

Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. CHD is a defect in the structure of the heart or great vessels that is classed as a cardiovascular disease (CVD). The term “congenital” means the condition is present from birth. Congenital heart disease is one of the most common types of birth defect.

Status of CHD:

• Paediatricians say timely medical intervention can save 75% of these children and give them normal lives. The lack of a national policy for the treatment of cardiovascular diseases in children keeps a huge number outside the ambit of treatment. It is estimated that over 1 lakh children keep getting added to the existing pool of children awaiting surgery.
• According to the Pediatric Cardiac Society of India (PCSI), the prevalence of congenital cardiac anomalies is one in every 100 live births; or an estimated 2 lakh children are born with CHD every year. Only 15,000 of them receive treatment.
• At least 30% of infants who have complex defects require surgical intervention to survive their first birthday but only 2,500 operations can be performed each year. A case in point is the premier All India Institute of Medical Sciences (AIIMS), where infants are waitlisted till 2026 for cardiac surgery.
• A 2018 article by the Department of Cardiothoracic Cardiology, AIIMS, states, “paediatric cardiology is not a priority area in the face of competing demands for the resources”.

A distressing perception, ground realities

• There has been more neglect and little improvement in child health care because creating a comprehensive paediatric cardiology care service is usually considered economically unviable.
• There are 22 hospitals and less than 50 centres in India with infant and neonatal cardiac services. Geographically, these centres are not well distributed either. A 2018 cardiology department report of AIIMS, highlighted how South India accounted for 70% of these centres; most centres are located in regions with a lower burden of CHD.

It taxes the vulnerable and the marginalised

• For 600 districts with a 1.4 billion population, there are only 250 paediatric cardiologists available. The doctor to patient ratio is an abysmal one for half-a-crore population.
• Apart from the low number of paediatric cardiologists and cardiac surgeons, and critical care centres, poverty is another barrier before treatment. Transporting sick neonates from States with little or no cardiac care facilities to faraway centres for accurate diagnosis and treatment burdens parents financially.
• It is not just unaffordability but also inaccessibility that constraints paediatric services. In addition, there is the non-availability of crucial equipment that is essential for diagnosis of heart diseases in the unborn. Accentuating the problem is the general lack of awareness about early symptoms of CHD among parents.

Antenatal checks are crucial

• The Child Heart Foundation, an NGO working with underprivileged children with CHD, has been flagging the need for fetal echocardiography- a test that is done usually during the second trimester of pregnancy to check for CVD/ CHD in the fetus. The procedure is similar to that of a pregnancy ultrasound.
• Paediatricians say antenatal detection of congenital anomalies is crucial for neonatal care and management. But certain congenital defects such as accurate heart health assessment are not visible in a normal ultrasonography of an unborn baby. Fetal echocardiography done in a pregnant woman of 18 to 24 weeks allows better visualisation of the structure and function of the heart.
• There are programmes worth emulating such as Kerala’s ‘Hridayam (for little hearts)’, aimed at early detection, management and support to children with CHD or the Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme offering free specialised surgeries.
• The National Health Protection Scheme (Ayushman Bharat), is expected to financially assist 10 crore poor families but has still to take off. So far, a few states like Maharashtra, Karnataka, Gujarat and Andhra Pradesh have started to implement it.

Ayushman Bharat

• Launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC) and to to meet SDG and its underlining commitment, which is “leave no one behind”.
• The mission adopts a continuum of care approach, comprising of two inter-related components, which are:

1. Health and Wellness Centres (HWCs).
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY).

• HWCs are upgraded primary healthcare centres. AB envisages developing 1.5 lakh such HWCs to cater to the healthcare need at the grassroots level.

Key Features of PM-JAY:

The world’s largest health insurance/ assurance scheme fully financed by the government, it provides healthcare cover of 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.

Coverage: Over 10 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.

Provides cashless access to health care services for the beneficiary at the point of service.

Benefits and significance

• Helps reduce catastrophic expenditure for hospitalizations, which pushes 6 crore people into poverty each year.
• Helps mitigate the financial risk arising out of catastrophic health episodes.

PM-JAY is envisaged to reduce India’s Out of Pocket Expenditure (OOPE) on healthcare, which used to be one of the highest in the world. From the levels of 65%, OOPE in India has now come down to around 49%.

Eligibility

1. No restrictions on family size, age or gender.
2. All pre–existing conditions are covered from day one.
3. Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
4. Benefits of the scheme are portable across the country.
5. Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
6. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

There is a need to explicitly include CVD/ CHD under the ambit of PM-JAY and to raise public awareness on people’s entitlement towards these services.
 

Conclusion:

On the World Heart Day (September 29) we need to act fast to help India’s many children in need.