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22 February 2017 Editorial

 

22 FEBRUARY 2017

The Saeed test

The flurry of actions by the Pakistan government on Lashkar-e-Taiba chief Hafiz Saeed gives the impression of movement on an issue that has been a point of contention between India and Pakistan. For the past two weeks, Saeed, who is on the UN Security Council’s terror list, has been under “preventive detention” and “house arrest”, along with four other members of the Jamaat-ud-Dawa, an avatar of the LeT. All five are on the “export control list” for travel. A few days ago the authorities put Saeed on its Anti-Terrorism Act list as well, and on Tuesday followed that up by revoking weapon licences issued to Saeed and others. Although details have not been shared, Pakistani officials said they have placed restrictions on the functioning and funding of Saeed’s JuD and its ‘charity arm’, the Falah-e-Insaniyat Foundation. In addition, Pakistan’s military gave Saeed’s detention its full backing by calling it a “policy decision in the national interest”, while Pakistan’s Defence Minister Khawaja Asif told an international audience at the Munich Security Conference that Saeed was a “security threat” to Pakistan. It would seem that even the Indian government has given the action against Saeed a half thumbs-up, with the Ministry of External Affairs calling it a “logical first step”.

As observers of Pakistan know, the action against Saeed is not a new step or even the most serious measure taken against him over the past two decades. Since 2001 he has been in and out of detention at least five times, and released by the courts on a number of occasions. Besides, unlike in 2008 and 2009 when he was detained for the 26/11 Mumbai attacks case, this time there has been no First Information Report registered, or any specific reason given. If Pakistan were indeed serious about the UN list, these actions should have been carried out in 2008, when Saeed and the JuD were put on the list. It is more than likely that Pakistan’s action is actually timed for the Financial Action Task Force’s officials meeting in Paris this week where a report on Pakistan’s terror funding record is being presented. Pakistan Prime Minister Nawaz Sharif may even be attempting to show ‘good faith’ to both U.S. President Donald Trump and Prime Minister Narendra Modi by the action, even as he faces domestic pressure to act against terrorists in the wake of a slew of bombings recently in Pakistan, including at the Sehwan shrine in Sindh. It is too early to fully assess what the action against Saeed means, and what signal Pakistan may be sending to India. For New Delhi, steps towards a resumption of bilateral dialogue may be more purposeful than simply gauging which way the wind is blowing.

 

 


Necessary limit

Capping the prices of medical stents, which are used to treat coronary artery disease, by the National Pharmaceutical Pricing Authority (NPPA) is an extreme regulatory measure necessitated by the market failure that afflicts the overall delivery of health care in India. Rising costs have led to impoverishment of families and litigation demanding regulation. Given the overall dominance of private, commercial, for-profit health institutions, and the asymmetry confronting citizens, correctives to bring about a balance are inevitable. Two important pointers to the need for cost regulation are available from research published in The Lancet in December 2015: nearly two-thirds of the high out-of-pocket expenditure on health incurred by Indians went towards drugs; even the meagre research data available showed that there was irrational use of medical technologies, including cardiac stents and knee implants. Regulated prices can, therefore, be expected to make stents more accessible to patients who really need them, helping them avoid using up the weak insurance cover available, while also reducing the incentive for unethical hospitals to use them needlessly. It is worth recalling that there are over 60 million diagnosed diabetics in the country, and the average age at which the first heart attack strikes Indians is 50, a decade earlier than people in developed nations. At appropriate prices, and with a health system that pools the cost among all citizens, it would be possible to provide access to stents and other treatments for all.

Health-care providers often demand market-determined pricing of medical technologies on the ground that newer ones will not be available under a regulated regime. In the case of cardiac stents, this argument does not hold water since stakeholder consultations held by the NPPA in January revealed that there are ‘huge unethical markups’ in the supply chain. It would serve the cause of medical innovation if costing is transparent, and a system of risk pooling is introduced to help patients get expensive treatment without high out-of-pocket spending. It was estimated five years ago by the Planning Commission’s expert group on universal health coverage that raising spending on public procurement of medicines to 0.5% of GDP (from 0.1%) would provide all essential medicines to everyone. What is necessary, then, is for a two-pronged approach to improve access to medicines and technology. The Centre should monitor expenditures jointly in partnership with the community, use regulation where needed, and raise public spending on health. Several developing countries have moved ahead on this path. Well-considered price control is a positive step, but more needs to be done. The latest measure provides an opportunity to expand the availability of stents, and by extension angioplasty procedures, in the public health system. District hospitals should offer cardiac treatments uniformly. This should be a priority programme to be completed in not more than five years.

 

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