• The author talks about the need for a robust National Health Service-like health model for India.

Editorial Insights:

What’s the issue?

  • In the recent Monsoon Session, the health ministry has claimed that only Punjab has reported four suspected deaths during the 2nd COVID-19 wave due to lack of oxygen.
    • This contradicts every news report, televised SOS pleas of hospitals, overcrowded crematoriums & floating dead bodies on the Ganges.
  • Further, the LG of Delhi rejected the state govts proposal to commission committees to investigate oxygen deaths.
  • As per the volunteer-run Oxygen Shortage Deaths group, at least 629 oxygen-related deaths have happened since May 2021.

The Sorry State of Indian Healthcare System:

  • Even before the pandemic, every single year India has been witnessing similar horrific healthcare tragedies.
    • In 2017, 800 children died in Jharkhand of suspected encephalitis.
    • In 2015 due to power failure after floods, 18 patients died in Chennai hospitals.
    • In 2014, due to illegal sterilization at an overcrowded govt health camp in Chhattisgarh, 13 women died.
  • For decades, Indian hospitals are beleaguered with absentee staff.
  • As per Niti Aayog, in Bihar during 2017-18, 60% of midwives, 50% of staff nurses, 34% of medical officers, & 60% of specialist doctors were vacant.
    • At the same time, the employed staff were subjected to chronically overwork
  • Even after the pandemic, the Indian govt continues to budget less than 1% of GDP for healthcare which is the lowest among developing nations.
    • In contrast China invests 3%, Britain 7% & the USA 17%.
    • Due to the Indian govts inability to increase the health budget, the 62% of health expenses are paid by patients themselves.
      • Due to this, many families are falling into poverty.
  • If the govt had taken effective steps, the COVID-19 oxygen crisis could have been prevented.
    • However, the central govt delayed by eight months a tender to build oxygen plants across 150 district hospitals.

Lessons from Britain’s National Health Service:

  • Every year Britain’s legendary health network cures 15 million patients with chronic ailments at a fraction of the cost spent by the US.
  • The NHS funded by direct taxes is also the 5th largest employer in the world.
    • One of every 20 British workers is employed as a doctor, nurse & technical personnel.
  • In a rapidly aging society, the NHS became as a closest thing to religion

Concluding Remarks:

  • Even in the 21st century, the Indian public healthcare system is lagged behind in many parameters. It lacks basic medicines, equipment & oxygen & more importantly healthcare staff.
  •  It is high time for India to build a robust & efficient healthcare model along the lines of Britain’s National Health Service.

2) Unlocking value in brownfield projects via private sector


  • The author talks about the significance of the National Monetization Pipeline.

Editorial Insights:

What’s the issue?

  • Recently Indian govt has unveiled a four-year National Monetization Pipeline (NMP) worth Rs 6 lakh crore to unlock value in brownfield projects by engaging the private sector.


  • Govt unlock value in brownfield projects by:
    • The engaging private sector,
    • Transferring them revenue rights but not projects ownership,
    • Utilizing the funds so generated for infrastructure creation across the country.
  • It has been announced to provide a clear framework for monetization & give potential investors a ready list of assets to generate investment interests.
  • The govt has stressed that these are brownfield assets that have been de-risked from execution risks & therefore should encourage private investment.

What is Monetization?

  • In this transaction, the govt is transferring revenue rights to private parties for a specified transaction period in return for upfront money, revenue share basis & commitment of investments in the assets.
    • Real estate Investment trust(REITS) & Infrastructure investment trusts (InvITs) are the key structures being used to monetize assets in the roads & power sectors.
    • These are also listed on stock exchanges providing investors liquidity through secondary markets as well.
    • While these are structured financing vehicles, other monetization models on PPP such as Operation Maintain Transfer (OMT) & Toll Operate Transfer (TOT) have been used in highway sectors while Operations, Maintenance & Development (OMD) is being deployed in the case of airports.
  • Monetization will create further value for infrastructure creation in the country & explore innovative ways of private participation without transfer of govt ownership.
  • Since many complete assets are either languishing or no fully monetized or are under-utilized.
    • So by bringing in private participation in this arena, govt will be able to monetize it better & ensure further investment in infrastructure building.

The Govt’s Plan:

  • Roads, railways & power sector assets will comprise over 66% of the total estimated value of the assets to be monetized.
  • In terms of annual phasing by value, 15% of assets with an indicative value of Rs 0.88 lakh crore are envisaged to be rolled out in the current financial year.
  • The NMP will run a co-terminus with the National Infrastructure pipeline of Rs 100 lakh crore.
  • The estimated amount to be raised through monetization is 14% of the proposed outlay for the Centre of Rs 43 lakh crore under NIP.

Challenges that affect NMP roadmap:

  • Lack of identifiable revenues streams in various assets,
  • Level of capacity utilization in gas and petroleum pipeline networks.
  • Dispute resolution mechanism.
  •  Regulated tariffs in power sector assets.
  • Low interest among investors in national highways below four lanes.
  • The lack of independent sectoral regulators.
  • Structuring the monetization transactions providing a balance risk profile of assets & an effective execution of the NMP will be a key challenge.

Concluding Remarks:

  • Infrastructure has huge multiplier effects. The new NMP is a step in that direction of mobilizing private capital for the development of infrastructure.
  • NMP is aimed at creating a systematic and transparent mechanism for public authorities to monitor the initiative and for investors to plan their future activities. Therefore, the NMP will be a critical step towards making India’s Infrastructure truly world-class.


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