1) Looking ahead after the Ladakh walk back.
After making a political choice in the disengagement, the government has to now deal with the strategic consequences.
GS-2: International relations: India and its neighborhood- relations.
GS-3: Security challenges and their management in border areas – linkages of organized crime with terrorism.
- The last round of military-diplomatic talks between India and China (on January 24) was confirmed last week when China made the announcement of the start of disengagement between the two armies
- This is not the end of the 10-month-old military stand-off yet but, palpably, the beginning of the end.
- It is a welcome move because heightened tensions between the two nuclear-armed Asian powers serve no useful purpose for anyone, certainly not India’s.
The limited Disengagement:
- The current disengagement is limited to two places on the Line of Actual Control (LAC) in Ladakh: north bank of Pangong lake and Kailash range to the south of Pangong.
- There are three other sites of contention on the Ladakh border where the PLA had come in Depsang, Gogra-Hot Springs and Demchok and talks will be held to resolve when current phase of disengagement is completed.
- There have been regular clashes between the soldiers of both sides at the north bank of Pangong Lake, nearly a quarter of all the Chinese transgressions on the LAC between 2014 and 2019 have taken place in the Pangong Lake areas.
- The Pangong Lake has limited strategic importance, but is a popular tourist spot after the climax of the super hit Hindi film, 3 Idiots, was shot there.
The Political priority:
- Unlike other areas of contestation, there are habitations in the vicinity of the north bank which can observe any Chinese ingress. This means the disengagement at north bank was a political priority.
- The impact of tourists visiting the area again to signal normalcy and led to it being clubbed with the Kailash range to the south of the lake.
- The Kailash range was the only place where Indians had taken the initiative to hold hitherto unoccupied peaks in end-August.
- The heavy deployment of troops and tanks caught the Chinese by surprise who responded by their own deployment, with the two sides separated by a few yards.
A stance that is unclear:
- The Kailash range was a venerable that could spark off a much bigger crisis with a minor accident. The Chinese have been insistent that the two sides disengage from this area first.
- India had resisted taking that call until now, instead seeking a simultaneous resolution of all the flashpoints on the Ladakh border.
- The Indian government has not clarified the reasons for its change of stance which was clearly dictated by something more than the desire to remove the most dangerous flashpoint on the border.
- India even does not restore the status quo ante of April 2020 and the details about the south bank are sketchy, the disengagement deal on the two banks of Pangong is a fair deal for India when seen from the limited prism of only these areas.
- The considered from the perspective of the whole LAC in Ladakh, it raises questions about the wisdom of giving up the only leverage India had at north bank for the sake of disengagement.
The Depsang issue:
- The leadership is aware of the strategic importance of the Depsang plains in the Daulat Beg Oldi (DBO) sector, not only due to its proximity to the Darbuk-Shyok-Daulat Beg Oldie (DSDBO) road, the DBO airstrip and the Karakoram Pass, but because of the threat it poses to Indian control over the Siachen glacier.
- DSDBO remains the only area on the Indian landmass where China and Pakistan can physically collude militarily, and has been identified by former northern army commanders as tough to defend in case of a Chinese military attack.
Buffer zones and Suggestion for India’s interest:
- The excuse that the Depsang problem precedes the current crisis on the LAC and thus must be treated separately holds little water, for it would be in India’s interest to club them together and find a holistic solution.
- The current disengagement plan provides us with a window into the mindset of the Indian decision makers who prefer the creation of a ‘no patrol’ zone or buffer zone as a solution to the tensions on the LAC.
- Before the buffer zone was created at the north bank of Pangong, a similar buffer zone was created in Galwan in July 2020 around the place where India lost 20 soldiers in a deadly clash a month earlier.
- That buffer zone has held well till date, even though it denies India access to the areas up to PP14 which it patrolled earlier. There are worries that such buffer zones would lie majorly on the Indian side of the LAC, thus converting a hitherto Indian-controlled territory into a neutral zone.
- A no patrol zone has not been announced, for the Kailash range and that exposes the limitations of any plan to create such buffer zones in all the contentious border areas for the sake of peace and tranquility on the LAC.
A power differential:
- As the Indian media highlighted the rapid pace of the PLA’s withdrawal from disengagement sites, obliquely suggesting a Chinese weakness, the response from Chinese experts was in the form of a threat.
- India does not have the military capacity and the political will to evict the Chinese troops out of its territory.
- The power differential with China, India’s best-case scenario is to deploy sufficient troops to prevent any PLA ingress as was done with a massive deployment on the LAC after May 2020.
The enduring impact on India’s strategy:
- The political imperative of defending every inch of territory, while lacking the wherewithal to reverse a Chinese ingress, is likely to favour an enhanced deployment of the Indian Army all along the LAC, from Ladakh to Arunachal Pradesh.
- Not only will it stretch the Army, it would divert scarce resources towards the continental border away from the maritime domain.
- India’s attractiveness to the United States and the Quadrilateral Security Dialogue, better known as the Quad, firmly anchored in the Indian Ocean, such a move would work to China’s advantage.
- It is another matter that having struck a disengagement deal with China, New Delhi itself may no longer be as enthusiastic about the Quad as it was a couple of months ago when the Chinese threat was imminent, lead to a reset of ties with China.
- The option of undertaking a prompt quid pro quo military operation in Chinese territory, as advocated by the Non-alignment 2.0 strategy document produced by Centre for Policy Research in 2012, contains escalatory risks which an India in economic recession lacks the appetite for.
- The restoration of peace and tranquillity on the LAC instead of a reversion to the status quo ante as of April 2020, the government has made a political choice in Ladakh. It will have to bear the strategic consequences of these choices.
- The disengagement and subsequent de-escalation from Pangong Tso was achieved after quiet backchannel conversations between the two sides, and trust between the two sides, creation of ‘no patrol’ zones and buffer area can lead to peace and tranquility on the LAC.
2) In telehealth, scaling up the Indian advantage.
There are lessons from the pandemic that can be applied usefully to how health care can be delivered.
GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
- In the wake of novel corona virus pandemic and fear of transmission, health-care providers have been reassigned from other specialties to COVID-19, restricting high quality care for other conditions.
- A survey by the World Health Organization (WHO) in 105 countries (July 2020) pointed essential services were disrupted in the majority of countries, with immunization, antenatal and childcare services among the most widely affected.
- About 45% of low-income countries incurred at least partial disruption of over 75% of services, relative to only 4% of high-income countries. Almost 60% of services were at least partially disrupted in South East Asian countries.
COVID-19 impact on essential services:
- In India, detection of tuberculosis cases was down by 50% in April-December of 2020 relative to the same period in 2019, and antenatal care visits were down by 56% in the first half of 2020.
- The blood sugar control for diabetics was at risk, increasing the chances of adverse events requiring hospitalization, including worse outcomes in the case of COVID-19 infection.
- The Cancer care has been badly affected in many countries, as well as diagnosis and treatment of other non-communicable diseases.
- The pandemic has exacerbated inequalities in health care people living in rural and remote areas were further disadvantaged by not being able to travel to cities to seek specialist care.
- The pre-existing shortage of specialists in many rural areas led to care being delayed or not happening at all.
The Enhancement of technology use:
- The acceleration in the use of digital technologies has mitigated the impact of COVID-19 to some extent. Virtual consultations avoid the risk of COVID-19 transmission and are helping to bridge this socio-economic divide.
- The Indian government’s e-Sanjeevani platform offers both provider-to-patient interactions and provider-to-provider interactions, where patients visit Smartphone–equipped community health officers in rural health and wellness centers; these in turn connect to general practitioners and specialist doctors through a hub-and-spoke model.
- The Private providers and non-governmental organizations (NGO) have also expanded virtual access to undeserved populations.
The urgent need to increase the efficiency:
- The scale of unmet demand, there is an urgent need to increase the efficiency and effectiveness of every minute spent in virtual care interactions.
- There are lessons we can learn from the pandemic that can be applied usefully to how we deliver health care.
- Remote-shared medical appointments in which multiple patients with similar medical needs meet with a clinician at once and each receives individual attention can greatly increase telehealth capacity by eliminating repetition of common advice.
The Utilising shared appointments:
- Remote shared medical appointments essentially virtualise in-person shared medical appointments (SMAs) which have been offered successfully in the United States for over 20 years.
- Patients get more time with their clinician, albeit not in private. SMAs enable peer support and peer-to-peer learning.
- Providers who have offered SMAs have found them to improve both productivity and outcomes for many conditions, notably diabetes. SMAs could help tackle India’s widespread “sugar” problem.
- The eye hospital found that in shared appointments, patients spur one another to engage more and ask more questions. Such virtual peer interaction could be welcome in the current paradigm of social distancing.
The e-Sanjeevani and alternate telehealth platforms:
- The e-Sanjeevani and other telehealth platforms could consider offering virtual shared medical appointments.
- Patients in different villages, with similar conditions can be seen at once remotely by a generalist or specialist, during the pandemic.
- Once transmission risk subsides, seeing patient groups within each village centre will help build supportive bonds, enable sharing of local knowledge, and likely attract supplementary providers.
- The eSanjeevani is a telemedicine service which is implemented under Ayushman Bharat health initiative for doctor-to-doctor interaction.
- It aims to connect all 1.5 lakh health and wellness centre which has been established under Ayushman Bharat. This service is also available to Android users,
- The hospital provide e-sanjeevani opd, OPD is an online doctor consultation system that is totally free.
The importance of information access tools:
- Providers can offer virtual group information sessions accessible via smartphone in which a health-care worker explains the benefits of COVID-19 testing and vaccination and answers questions, reaching potentially quite large audiences.
- Engaging in real time with a care provider in an interactive format will likely encourage safe behaviours to a greater extent than if the same information is provided without interaction.
- In switching to radically different care delivery models requires rigorous testing combined with mentoring, training and behavior change for both patients and providers.
- The unique telehealth capacity crisis which COVID-19 has created is drawing interest to virtual SMAs.
- The Training platforms such as ECHO, which train primary-care providers in many States through an online platform can accelerate adoption and should also guide implementers on how to gather data that can be used to scientifically validate this care model.
The advantage for India:
- Relative to other nations, India is well poised to ramp up telehealth. Data plans are cheaper in India than anywhere.
- It is possible to get 1.5GB of data a day for a few hundred rupees a month, and Indians from all socioeconomic groups regularly enjoy group video chats with friends and relatives.
- Having a group interaction with a care provider on an appropriately secure platform is certainly conceivable.
- WHO’ s Global Strategy on Digital Health, adopted by the World Health Assembly, is a call to action providing a road map for nations to rapidly expand digital health services.
- With innovation in systems thinking, learning and adaptation, new digital tools bring an opportunity to leapfrog into a reality of ‘Health for All’.
- All services were affected, due to covid-19 including essential services for communicable diseases, no communicable diseases, mental health, reproductive, maternal, newborn, child and adolescent health, and nutrition services, now slowly improving through telehealth.
- The Emergency services were the least disrupted, although 16 countries reported disruptions across all emergency services. The most severely affected service delivery platforms were mobile services, often suspended by government, and campaigns, for example as used for malaria prevention or immunization.