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Yuko Willian
The planning commission ex official indicated that the political representatives often do not seek resources for health care. Other sectors such as industry, agriculture, trade, and infrastructure take up the priority on the demands list. The sporadic demand in health sector is mostly limited to the tertiary care hospitals for the respective political constituencies.
It appears that as a fall out of this situation the policy making for health care has minimal political accountability as well as least alignment to the needs of the people. As a matter of fact, India is going through a massive restructuring in health care in the present times. Universal health coverage is being brought to the reality. However, there is no public debate on this issue. Issues such as women safety and corruption consume a significant space of public discourse in lay media. Except for the scattered trivial media coverage, there is hardly anything above the table. This leaves space for back channeling, negotiations, and politicking by the lobbying groups. International funding agencies, pharmaceutical companies, tertiary care industry, and their representatives are predominant force in these negotiations.[1,2]
There is talk about strengthening of traditional systems of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) but the focus appears to be at developing legal framework for expansion of prescriptions for allopathic pharmaceutical products by nonqualified practitioners. Shortage and regional imbalance of physicians is a widely publicized issue. However, in spite of the public outrage, policy makers are politically refraining from bringing medical education under rightful regulation, transparency and accountability. Unregulated over the counter sale of pharmaceutical products continues. Price regulation of drugs and medical devices seems to be a distant dream. The issue of regulation of the private health care industry is being altogether declined.
Unless low cost, high quality and equitable healthcare become a political demand and an electoral issue, the situation is not likely to change. Health care is projected to be a booming industry and likely to grow many folds in the near future. Should the public health policies be synchronized with the growth of health care industry?
While representative structures were introduced by the colonial state only bit by bit, the Indian constitution adopted in November of 1949 established the framework for a constitutional democracy. The transition to democracy from colonial rule was marked by the presence of institutional structures of governance put in place by the colonial state and the introduction of republican citizenship, universal suffrage and the rule of law. This tradition was nurtured and expanded in independent India, interrupted only by a brief interlude of the emergency government regime, from 1975 to 1977. Electoral democracy has become the only game in town; even radical political forces abide by its rules and do not try to gain power outside parliamentary boundaries. Elections are free and fair; extra-constitutional veto powers are nonexistent; the military is under strict civilian control. Civil rights are guaranteed, even though with major exceptions in conflict-prone regions. Substantive democracy suffered since independence by limited electoral choice, by the decade-long predominance of the Indian National Congress Party at every political level and by the concomitant mobilization and recruitment of local notables into the party machine. This diminished the access of less-privileged sectors of society to positions of political power and obstructed structural social reforms.
However, India has undergone a dramatic (second) democratic upsurge over the last decades, with the economic empowerment of lower castes following the green revolution and their later integration into the high command of traditional parties and governmental agencies and/or the launching of new (regional) parties. The necessary byproduct of this development was unstable coalition governments at the center and in some states and a growing tendency to dispense patronage along caste lines. State governments became increasingly autonomous and other institutional veto players (the Supreme and the High Courts, the Election Commission and the president of India) grew to fill political voids.
The Indian constitution stipulates that the state is secular. Formally, neither the legal order nor the political institutions are defined by or derived from religious dogmas. A notable exception is family law, which includes Hindu, Muslim and Christian law. However, the review period saw further intensification of a Hindu majoritarian culture under the leadership of Narendra Modi of the Hindu-nationalist BJP. After the landslide victory of the BJP in the 2019 elections, the secular foundations of the Indian state were further weakened as Hindu-nationalist groups have become emboldened.
Elections in India have been free and fair for nearly seven decades since independence, with only a temporary interruption in the 1970s. Universal suffrage by secret ballot is ensured, a large number of political parties are able to run and political posts are filled according to the outcomes of elections. Parliamentary elections in India are a huge exercise. The general election of 2019 was the largest democratic exercise in the world, with over 900 million people eligible to vote and voter turnout surpassing 67% (including the highest participation of female voters in Indian history).
While polling procedures are generally considered to be transparent and impartial, the electoral process is vitiated by the role of money and the numbers of candidates with criminal records. According to the election watchdog Association for Democratic Reforms, about 19% of the contestants declared criminal charges against them in election affidavits. While money continues to play a significant role in influencing voter choices, the introduction of electoral bonds by the central government in 2018 to enable anonymous donations to political parties facilitated the influence of prohibiting corporate capital on the electoral process and consequently on policymaking. The ruling BJP secured 61% of its total electoral funding through electoral bonds.
The Indian constitution guarantees the freedom to assemble peacefully, even though the state can impose restrictions in the interest of public order or to preserve the sovereignty and integrity of India. In practice, the right to demonstrate is mostly guaranteed. Given the low degree of internal democracy in political parties, demonstrations are frequently used by civil society as a tool to forward demands to the government. Yet, Hindu-nationalist groups further expanded the general climate of intimidation over the country.
As far as the vertical separation of powers is concerned, the autonomy of state governments in the federal system is guaranteed in the fields envisaged by the constitution. The system of fiscal federalism strengthens the autonomy of the union states by providing for transfers from the central government to state governments. However, the federal states have been weakened during the pandemic due to limited financial transfers from the central government. Representative bodies at the local level have a certain degree of administrative autonomy and allow for political representation down to the village level.
The rule of law in India has been massively undermined by political corruption. Officeholders who engage in corruption often slip through political, legal or procedural loopholes and are not effectively persecuted. Corruption continues to be prevalent particularly in sectors such as the police, the judiciary, in public services and in public procurement. Corruption is prevalent at all levels and continues to affect citizens in many of their interactions with institutions.
In 2015, there were more than three million NGOs in India, according to reports based on data collected by the Central Bureau of Investigation. Many of these NGOs, however, have come under increasing pressure, particularly those that receive foreign funding. In September 2020, Amnesty International closed its operations in India due to pressure from the government, which had harassed the organizations since 2018 and frozen all of its bank accounts. The Ministry of Home Affairs quite openly argued that India prohibits interference in domestic political debates by foreign-funded entities.
The Right to Education Act, which has been effective since 2010, made education a right for the first time and started to address the goal of providing better-quality education. As far as tertiary education is concerned, there are a number of high-class colleges and universities, especially in the natural sciences. However, in the academic field, India suffers from a massive brain drain. With expenditure on education amounting to 3.8% of GDP in 2013 (no more recent data is available), and expenditure on research and development further declining to 0.6% of GDP in 2018 (2017: 0.7%; 2008: 0.9%), India still ranks low in international comparisons. During the review period, the number of politically motivated, clearly not merit-based, appointments to leading positions in universities and research institutions further increased. This was paralleled by a growing tendency toward self-censorship in Indian academia out of fear of persecution by the government. These trends are harmful to the further development of high-quality academic research.
The main and most dangerous conflict line has been the one between Hindus and Muslims. The increased room to maneuver for Hindu-nationalist groups under the Modi government has led to an increase in violence and intimidation vis-à-vis the Muslim minority, and to the establishment of a majoritarian Hindu discourse. Things have worsened following the landslide election victory of the BJP in 2019, which has led to the further polarization of the population along religious cleavages. The COVID-19 pandemic is expected to exacerbate such conflicts. For example, following a rise in infections related to a Muslim gathering, the hashtag #CoronaJihad trended on social media. The anti-COVID-19 measures to limit freedom of assembly and speech, which were implemented in an already extremely polarized political situation, have the potential to further weaken Indian democracy and undermine safeguards for minority groups.
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