24 May 2023 : The Indian Express

Editorial 1: Health in the hinterland

Context:

• Recently, The Standard Treatment Guidelines for Sickle Cell Anemia Disease were unveiled by Ministry of Health and Family Welfare on May 8, 2023. In the 2023-24 Union Budget had announced India's aim to eradicate sickle cell anaemia by 2047. Under a new scheme, the Centre plans to screen 70 million Indians in affected tribal areas under the age of 40 years.

Status of Scheduled Tribes in India:

• The tribal population in India, though a numerically small minority (8.9 percent), represents an enormous diversity of groups. There are about 744 recognised STs in the country.
• As per Article 366 (25) of Constitution of India, the Scheduled Tribe is defined as:
• "Such tribes or tribal communities or part of or groups within such tribes or tribal communities as are deemed under Article 342 to the Scheduled Tribes (STs) for the purposes of this [Indian] Constitution".
• Certain tribes have been characterised as Particularly Vulnerable Tribal Groups (PVTGs) (earlier known as Primitive Tribal Groups) on the basis of their greater ’vulnerability’ even among the tribal groups. There are 75 such tribes in India.

According to Lokur Committee (1965), criteria for Scheduled Tribe included

• Indications of primitive traits
• Distinctive culture
• Geographical isolation
• Shyness of contact with the community at large
• Backwardness.

Health related problems of Tribes:

• As per a report by the Ministry of Tribal Affairs, the mortality rate in tribal areas is 44 per cent higher than the national average, and infant mortality is 63 per cent higher. 
  • According to the National Family Health Survey conducted in 2014, the tribal infant mortality rate was 38 per cent, more than "others" (other than ST, Schedule Castes and Other Backward Classes), it said.
  • According to Tribal Health Report 2013, Infant Mortality Rate (IMR) among tribal people is somewhere between 44 to 74 per 1,000 live births.
  • As per ‘The Lancet: ‘Indigenous and Tribal Peoples’ Health’ (2016)’: India has the second highest infant mortality rate for the tribal people, next only to Pakistan.
• They had been subjected to various forms of deprivation such as health issues, water availability, lack of infrastructure, medical professionals, connectivity, affordability, equipment, insurance, funding, etc.
  • Poor health Infrastructure: There is a 27% to 40% deficit in the number of Primary health facilities, and a 33% to 84% deficit in medical doctors in tribal areas.
• Financial outlay under the Tribal Sub-Plan (TSP), equal to the percentage of the ST population in the State, has been properly implemented by all States.
• High prevalence of disease, like malaria, cholera, tuberculosis, diarrhoea and jaundice, problems associated with malnutrition like iron deficiency and anaemia, low levels of life expectancy, etc.
  • Child malnutrition is 50% higher in tribal children: 42% compared to 28% in others
  • Malaria and tuberculosis are three to 11 times more common among the tribal people.

Steps taken by the Government:

• Swasthya: National Tribal Health Portal as a one stop solution which aims to facilitate the exchange of ideas, information and learnings among stakeholders; leading to evidence-based and data-driven decision making.
• The '1000 Springs Initiative' by the Ministry of Tribal Affairs and United Nations Development Programme demonstrated a localized innovative solution by harnessing the potential of perennial springs to meet the water needs of the remote tribal communities.
• Sickle Cell Disease (SCD) Support Corner to bridge the gap between patients and health care services in tribal areas. The Portal provides a web-based patient powered registration system which will collate all information related to SCD among tribal people in India, including proving them a platform to register themselves if they have the disease or the trait.
• Model Village (Aadarsh Gram): The Holistic Village Development Program (HVDP) under Saansad Adarsh Gram Yojana (SAGY), where each Member of Parliament adopts one village from their constituency to transform that village into a model village. The ideal village model is based on multidimensional aspects including water issues, agriculture issues, gender issues, health issues etc.
• The National Health Mission (NHM) is a Centrally Sponsored Scheme which envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. NHM encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM).
  • The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases, including in the tribal areas.
• Ayushman Bharat- Health and Wellness Centres (HWCs) are established by transforming the Sub-Health Centres (SHCs) and Primary Health Centres (PHCs), as part of the Ayushman Bharat - the flagship programme of Government of India, to deliver twelve packages of Comprehensive Primary Health Care (CPHC) that includes preventive, promotive, curative, palliative and rehabilitative services which is universal, free and close to the community.
  • In the current financial year, over 90109 HWCs have been operationalized till 06th February, 2022. Of these, 15041 are in 177 tribal districts.
• The population norms for setting up Health Facilities in vulnerable areas are relaxed. Against the population norms of 5,000, 30,000 and 1,20,000 for setting up of SHC, PHC and CHC, the norm is 3,000, 20,000 and 80,000 respectively in vulnerable areas such as remote, tribal, desert and hard to reach areas.
• Recently, NITI Aayog and United Nations Development Programme (UNDP) jointly released a compendium of best practices across 14 social sectors, highlighting initiatives that are sustainable, innovative, impactful and replicable.
  • Among them is the Mera Baccha Abhiyan, which aims to fight malnutrition through public participation in Datia district, Madhya Pradesh.
    • As a result, the malnutrition rate in the district dropped by 17.5 per cent, making it lower than the state’s average. Because of this, the district also witnessed a rise in immunisation from 53.2 per cent to 79.6 per cent, breastfeeding from 32 per cent to 56.4 per cent, and a drop in diarrhea from 12.9 per cent to 5.7 per cent.
    • This scheme perfectly demonstrates the power of public partnerships in healthcare provision.

Conclusion:

• As India moves towards its centenary, healthcare as a fundamental human right, for all our fellow citizens, lies both with private and government institutions. Through inclusive leadership and investments in healthcare infrastructure in tribal areas, we can empower our tribal communities, achieve sustainable development, and fulfil the United Nations SDG 1,2,3. Let us pledge to ensure no one is left behind as the country moves towards India@100.

Editorial 2: Questions Remain

Context:

• Since January 2023 when New York-based investor research firm Hindenburg Research accused industrialist Gautam Adani-led conglomerate of “brazen stock manipulation and accounting fraud scheme over the course of decades”, shares of Adani Group companies have nosedived. Adani, who until recently was the richest Indian in the world, has now slipped to 22nd spot in the Forbes Real-time billionaire list for 2023.

Key events in the Adani-Hindenburg saga:

• Accusations: The research firm, which has short positions in Adani companies through US-traded bonds and non-Indian-traded derivative instruments, said key listed companies in the group had “substantial debt” which has put the entire group on a “precarious financial footing”.
  • The report claimed to show evidence of various irregularities in Adani’s finances, from inflated stock valuations to sky-high debt.
  • It said the conglomerate was being run unprofessionally like “a family business”, with Adani family members “controlling the group’s finances and key decisions”.
  • The report also accused the conglomerate of operating multiple shell companies, often offshore, “to serve several functions, including stock parking/ manipulation, and laundering money through Adani’s private companies onto the listed companies’ balance sheets in order to maintain the appearance of financial health and solvency”.
• Fall in Stocks: In the wake of the report, Adani’s market losses have swelled over USD 100 billion. According to a report in Reuters, the listed Adani firms now have a combined market value of USD 108 billion, versus USD 218 billion before Hindenburg’s report.
• RBI sought Details: As the market continued to hammer its stocks, the Reserve Bank of India (RBI) has sought details from banks about their exposure to the group. Market regulator SEBI, however, has not announced any probe into the crash in Adani shares and the withdrawal of Rs 20,000-crore FPO.
  • While State Bank of India (SBI) is yet to officially disclose its exposure, sources said it could be over Rs 21,000 crore. Punjab National Bank (PNB) said its total exposure to the Adani Group of Rs 7,000 crore is backed by adequate cash flows and there is no worry on repayments at present. Bank of Baroda has an exposure of Rs 4,000 crore. 
  • Union Finance Minister Nirmala Sitharaman said Friday that both LIC and SBI were not “over-exposed” (to Adani Group shares) and that “investors’ confidence” would endure in the market.
• Judicial Intervention: On March 2, the Supreme Court issued orders on a batch of petitions — that had claimed that Adani Group company share price declined due to the Hindenburg Report of January 2023 — to form a committee headed by a retired Supreme Court judge and eminent experts to inquire into the concerns of the petitioners. It gave the committee a specific remit to, inter alia, look for breaches of securities law, failures of regulations (if any) and non-disclosures of related-party transactions.
• Report of the Committee:
  • First, the committee in its report exonerates SEBI (regulator) of any failure. At the same time, the committee leaves it for SEBI to further investigate the matter.
  • Committee suspects wrongdoing only regarding minimum public shareholding limits and 12 suspicious transactions but no evidence of stock price manipulation.
  • No pattern, of artificial trading or wash trades among the same parties multiple times, was found.
  • Enforcement Directorate (ED) and Central Board of Direct Taxes (CBDT): No breach of law was pointed out by either agency.
    • What is intriguing is that the ED puts things back in the lap of the SEBI. Just a passing mention of concerted selling by interested parties ahead of the publication of the Hindenburg Report and possible destabilisation of Indian markets, and nothing further.
    • The CBDT gives a general response and the pattern is similar, passing the buck to the Income Tax Department.
    • Adding to this pickle, SEBI in its response to the committee claims its inability to investigate the wrongdoing on account of the absence of information from foreign agencies.
  • There is also no mention of any action by the Serious Frauds Investigation Office (SFIO).

Key Takeaways for India:

• The Indian financial system is rock solid: Major international brokerages, ratings agencies, retail investors and everyone else on Dalal Street looking for any systemic risk to Indian banks but nothing significant was found.
  • The RBI asked each bank to disclose their exposure to Adani group debt. As it turns out, the exposure of public sector banks was just 0.7 percent of their loan book, and for private banks, it was a mere 0.3 percent.
  • For every single one of these banks, the debt exposure was well below the limit fixed by the RBI. And none of these loans had turned into NPAs anyway.
  • Even for LIC, the amount invested in Adani shares was under 1 percent of their total assets under management. And so far, they have returned a profit even on that.
• Short seller report used opportunistically to attack India: Major international publications pounced on this report to declare India as unworthy of investment, a den of crony capitalism, and so on. 
  • Creates Distrust in the economy: The revelation of facts, such as by the Hindenberg Report, creates distrust in the economy leading to decreased capital inflows and thus investments.
• Stock market crashes: Such a report causes economic loss to companies and individual investors as happened recently with Adani company’s stocks.

Conclusion:

• Need is for the regulators like SEBI and other entities to be swift in their action to prevent such motivated attacks on Indian stock markets through proper regulation and preventing volatility in the stocks to protect investors interests and punish such malicious attacks by short sellers, to ensure stability and credibility of Indian stock market.

About:

Short selling

• The Securities and Exchange Board of India (Sebi) defines short selling as the sale of a security or share that the seller does not own. In short selling, an investor sells borrowed shares in the market in the hope of buying them back at a cheaper price.
• In other words, short selling is exactly the opposite of usual stock market investments, where an investor has bought a stock, hoping that its price will rise in future. In short selling, an investor holds a short position after anticipating a decrease in the value of a stock.
• In short selling, an investor does not need to own a particular company’s shares to sell them. Instead, they can borrow shares/assets of the company from any broker or dealer.

Follow-On Public Offer (FPO)

• FPO is the issuance of shares to investors by a company listed on a stock exchange. A follow-on offering is an issuance of additional shares made by a company after an initial public offering (IPO). Follow-on offerings are also known as secondary offerings.
• An FPO is a process wherein a company that is already publicly listed in the stock market issues additional shares to investors.
• It is made by the company after an Initial Public Offering (IPO).
• IPO stands for ‘Initial Public Offer’. When a company raises funds by allotting shares to the general public for the first time, it is called an IPO. It is the main source of raising capital from the general public and the company allots shares to the investors in return. 

Shell Companies

• Shell companies are a main component of the underground economy, especially those based in tax havens. They may also be known as international business companies, personal investment companies, front companies, or "mailbox" companies. Shell companies can also be used for tax avoidance.