संघवाद और स्वास्थ्य सेवा (केंद्र-राज्य संबंध) क्या है?
ऐतिहासिक पृष्ठभूमि
मुख्य प्रावधान
12 points- 1.
प्वाइंट 1: संविधान की सातवीं अनुसूची केंद्र और राज्यों के बीच विधायी शक्तियों को बांटती है। लोगों का स्वास्थ्य और सफाई राज्य सूची में आता है, जिससे राज्यों को मुख्य जिम्मेदारी मिलती है।
- 2.
प्वाइंट 2: समवर्ती सूची केंद्र और राज्यों दोनों को कुछ स्वास्थ्य संबंधी मामलों, जैसे मेडिकल की पढ़ाई और पेशे पर कानून बनाने की इजाजत देती है। इससे अधिकार क्षेत्र में ओवरलैपिंग हो सकती है।
- 3.
प्वाइंट 3: केंद्र सरकार केंद्र द्वारा प्रायोजित योजनाओं के जरिए स्वास्थ्य सेवा को प्रभावित करती है, जैसे आयुष्मान भारत जैसी खास योजनाओं के लिए राज्यों को पैसा देना। राज्यों को अक्सर इन योजनाओं को लागू करने में छूट मिलती है।
- 4.
प्वाइंट 4: वित्त आयोग केंद्र और राज्यों के बीच टैक्स के पैसे के बंटवारे की सिफारिश करता है, जिससे राज्य स्तर पर स्वास्थ्य सेवा पर खर्च करने के लिए उपलब्ध पैसे पर असर पड़ता है।
- 5.
प्वाइंट 5: राष्ट्रीय स्वास्थ्य नीति स्वास्थ्य सेवा के विकास के लिए एक ढांचा देती है, जो केंद्र और राज्यों दोनों को उनकी भूमिकाओं में मार्गदर्शन करती है। आखिरी नीति 2017 में जारी की गई थी।
- 6.
प्वाइंट 6: आपदा प्रबंधन अधिनियम, 2005 केंद्र सरकार को राष्ट्रीय आपातकाल के दौरान स्वास्थ्य सेवा संसाधनों पर नियंत्रण रखने की इजाजत देता है, जिससे राज्य का अधिकार खत्म हो सकता है।
- 7.
प्वाइंट 7: संविधान का अनुच्छेद 256 राज्यों को संसद द्वारा बनाए गए कानूनों और संघ की कार्यकारी शक्तियों का पालन करने के लिए बाध्य करता है। इससे राज्य की स्वास्थ्य नीतियों पर असर पड़ सकता है।
- 8.
प्वाइंट 8: केंद्र सरकार स्वास्थ्य सेवा के कुछ पहलुओं को नियंत्रित करती है, जैसे कि दवाओं की मंजूरी और मेडिकल डिवाइस के मानक, केंद्रीय औषधि मानक नियंत्रण संगठन (CDSCO) जैसी एजेंसियों के माध्यम से।
- 9.
प्वाइंट 9: राज्यों के पास अपनी सार्वजनिक स्वास्थ्य कानून और नियम बनाने की शक्ति है, जो स्थानीय स्वास्थ्य जरूरतों और प्राथमिकताओं को पूरा करते हैं। उदाहरण के लिए, कुछ राज्यों में तंबाकू नियंत्रण या संक्रामक रोगों से संबंधित खास कानून हैं।
- 10.
प्वाइंट 10: वस्तु एवं सेवा कर (GST) स्वास्थ्य सेवाओं और चिकित्सा आपूर्ति की लागत को प्रभावित करता है, जिससे केंद्र और राज्यों दोनों के राजस्व पर असर पड़ता है। GST परिषद स्वास्थ्य सेवा से संबंधित वस्तुओं पर कर की दरें तय करने में भूमिका निभाती है।
- 11.
प्वाइंट 11: अनुच्छेद 263 के तहत स्थापित अंतर-राज्य परिषद स्वास्थ्य सेवा के मुद्दों पर राज्यों के बीच तालमेल और सहयोग को आसान बना सकती है, विवादों को सुलझा सकती है और सर्वोत्तम प्रथाओं को बढ़ावा दे सकती है।
- 12.
प्वाइंट 12: केंद्र सरकार अनुच्छेद 256 और 257 के तहत राज्यों को केंद्रीय कानूनों और नीतियों का पालन सुनिश्चित करने के लिए निर्देश जारी कर सकती है, जिसमें स्वास्थ्य सेवा से संबंधित कानून और नीतियां भी शामिल हैं।
दृश्य सामग्री
Centre-State Roles in Healthcare
Comparison of the roles and responsibilities of the Central and State governments in healthcare, highlighting the constitutional provisions and key areas of cooperation and conflict.
| Aspect | Central Government | State Government |
|---|---|---|
| Constitutional Basis | Union List, Concurrent List | State List, Concurrent List |
| Key Responsibilities | National Health Programs, Policy Formulation, Funding | Implementation, Service Delivery, Public Health |
| Funding Mechanisms | Centrally Sponsored Schemes, Finance Commission | State Budget, Revenue Generation |
| Regulatory Powers | Drug Approvals, Medical Education Standards | Public Health Laws, Regulations |
हालिया विकास
8 विकासThe COVID-19 pandemic (2020-2023) highlighted the importance of Centre-State coordination in managing public health emergencies. The central government invoked the Disaster Management Act to issue guidelines and allocate resources.
Increased focus on digital health through the Ayushman Bharat Digital Mission (ABDM), aiming to create a national digital health ecosystem. This involves both central and state-level implementation.
Ongoing debates about the allocation of resources for healthcare under the Fifteenth Finance Commission recommendations. States are seeking greater financial autonomy.
The central government's push for universal health coverage through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), with states having the option to integrate or implement their own health insurance schemes.
The establishment of the National Medical Commission (NMC) to regulate medical education and profession, replacing the Medical Council of India. This has implications for state-level medical colleges and institutions.
The Union Government has launched the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) to strengthen health infrastructure across the country in 2021.
Many states have launched their own health schemes to supplement or complement the Ayushman Bharat scheme. For example, the Bhamashah Swasthya Bima Yojana in Rajasthan.
The National Health Mission (NHM) continues to be a major source of funding for state health programs, with the Centre and States sharing the costs in a specified ratio.
विभिन्न समाचारों में यह अवधारणा
1 विषयसामान्य प्रश्न
121. What is Federalism in the context of Healthcare in India, and what is its constitutional basis?
Federalism in healthcare refers to the division of powers between the central and state governments, as defined in the Constitution. Healthcare is primarily a state subject, but the central government also plays a crucial role through national programs and funding. The Seventh Schedule of the Constitution divides legislative powers, with public health and sanitation under the State List.
परीक्षा युक्ति
Remember that the Seventh Schedule is key to understanding the division of powers in healthcare.
2. What are the key provisions related to Federalism and Healthcare as outlined in the Constitution?
The key provisions include: * The Seventh Schedule, which places public health and sanitation under the State List. * The Concurrent List, allowing both Centre and States to legislate on health-related matters like medical education. * Centrally sponsored schemes, where the central government provides funding to states for specific programs. * The Finance Commission's recommendations on tax revenue distribution, impacting healthcare spending.
- •The Seventh Schedule places public health under the State List.
- •The Concurrent List allows both Centre and States to legislate on certain health matters.
- •Centrally sponsored schemes provide funding from the Centre to the States.
परीक्षा युक्ति
Focus on understanding the different lists under the Seventh Schedule and their implications for healthcare.
3. How has the relationship between the Centre and States in healthcare evolved over time?
Initially, healthcare was primarily managed by provinces. Post-independence, the Constitution formalized state control over public health. However, the central government gradually increased its involvement through national programs like the National Malaria Eradication Programme and the National Family Welfare Programme. The COVID-19 pandemic further highlighted the need for Centre-State coordination.
परीक्षा युक्ति
Note the shift from state-dominated healthcare to increased central involvement over the decades.
4. What is the significance of Federalism in ensuring effective healthcare delivery in India?
Federalism allows for decentralized healthcare planning and implementation, catering to the specific needs of different states. It also fosters competition and innovation among states. However, it can also lead to disparities in healthcare access and quality if not properly coordinated.
परीक्षा युक्ति
Consider the advantages and disadvantages of federalism in the context of healthcare equity and efficiency.
5. How does Federalism in healthcare work in practice in India?
In practice, states are responsible for delivering healthcare services through their public health systems. The central government provides financial and technical assistance through centrally sponsored schemes. Coordination is achieved through forums like the Central Council of Health and Family Welfare and through regular consultations.
परीक्षा युक्ति
Understand the roles and responsibilities of both the Centre and the States in healthcare delivery.
6. What are the limitations of the current Federal structure in addressing healthcare challenges in India?
Limitations include: * Uneven distribution of resources across states. * Lack of uniform standards of care. * Challenges in Centre-State coordination, especially during emergencies. * Potential for political interference in healthcare decisions.
- •Uneven resource distribution among states.
- •Lack of uniform healthcare standards.
- •Coordination challenges between Centre and States.
परीक्षा युक्ति
Be aware of the challenges posed by the federal structure to equitable healthcare access.
7. What are the challenges in the implementation of Federalism in the context of healthcare?
Challenges include: * Conflicting priorities between the Centre and States. * Lack of trust and coordination. * Inadequate capacity at the state level. * Delays in fund disbursement. * Political differences impacting health policies.
- •Conflicting priorities between Centre and States.
- •Lack of trust and coordination.
- •Inadequate state-level capacity.
परीक्षा युक्ति
Consider the practical difficulties in achieving effective Centre-State cooperation in healthcare.
8. What reforms have been suggested to improve Centre-State relations in healthcare?
Suggested reforms include: * Increasing financial autonomy for states. * Strengthening inter-state coordination mechanisms. * Developing national standards for healthcare delivery. * Investing in capacity building at the state and local levels. * Promoting greater transparency and accountability.
- •Increase financial autonomy for states.
- •Strengthen inter-state coordination.
- •Develop national healthcare standards.
परीक्षा युक्ति
Focus on reforms that address the existing challenges in Centre-State coordination.
9. What is the role of the National Health Policy in guiding Centre-State relations in healthcare?
The National Health Policy provides a framework for healthcare development, guiding both the Centre and the States in their respective roles. It outlines national goals and priorities, promoting a collaborative approach to achieve them. The latest policy was released in 2017.
परीक्षा युक्ति
Understand that the National Health Policy provides a common vision for healthcare development across the country.
10. How did the COVID-19 pandemic highlight the importance of Centre-State coordination in healthcare?
The pandemic underscored the need for effective Centre-State coordination in managing public health emergencies. The central government invoked the Disaster Management Act to issue guidelines and allocate resources, while states were responsible for implementing containment measures and providing treatment. This required constant communication and cooperation.
परीक्षा युक्ति
Use the COVID-19 pandemic as a case study to illustrate the challenges and importance of Centre-State coordination.
11. What is the role of the Finance Commission in shaping healthcare resources available to states?
The Finance Commission recommends the distribution of tax revenue between the Centre and the States. This significantly impacts the resources available for healthcare spending at the state level. States often seek greater financial autonomy to address their specific healthcare needs.
परीक्षा युक्ति
Understand that the Finance Commission's recommendations have a direct impact on state healthcare budgets.
12. What are frequently asked aspects related to Federalism and Healthcare in UPSC exams?
Frequently asked aspects include: * The division of powers between the Centre and States in healthcare. * Challenges of Centre-State coordination in healthcare delivery. * The impact of centrally sponsored schemes on state healthcare systems. * The role of the Finance Commission in healthcare funding. * The impact of recent developments like the COVID-19 pandemic.
- •Division of powers in healthcare.
- •Challenges of Centre-State coordination.
- •Impact of centrally sponsored schemes.
परीक्षा युक्ति
Prepare well on the constitutional provisions, challenges, and recent developments related to Centre-State relations in healthcare.