Expected Reading Comprehension for SBI Clerk | NABARD – Set – 58

Directions:(1-5) Read the following passage carefully and answer the questions.

A contentious element of the National Medical Commission (NMC) Bill 2017 — an attempt to revamp the medical education system in India to ensure an adequate supply of quality medical professionals — has been Section 49, Subsection 4 that proposes a joint sitting of the Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine. This sitting, referred to in Subsection 1, may “decide on approving specific bridge course that may be introduced for the practitioners of Homoeopathy and of Indian Systems of Medicine to enable them to prescribe such modern medicines at such level as may be prescribed.”

The debates around this issue have been ranging from writing-off the ability of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners to cross-practise to highlighting current restrictions on allopathic practitioners from practising higher levels of caregiving. However, these debates miss the reality: which is a primary health system that is struggling with a below-par national physician-patient ratio (0.76 per 1,000 population, amongst the lowest in the world) due to a paucity of MBBS-trained primary-care physicians and the unwillingness of existing MBBS-trained physicians to serve remote/rural populations. Urban-rural disparities in physician availability in the face of an increasing burden of chronic diseases make health care in India both inequitable and expensive.

Therefore, there is an urgent need for a trained cadre to provide accessible primary-care services that cover minor ailments, health promotion services, risk screening for early disease detection and appropriate referral linkages, and ensure that people receive care at a community level when they need it.

The issue of AYUSH cross-prescription has been a part of public health and policy discourse for over a decade, with the National Health Policy (NHP) 2017 calling for multi-dimensional mainstreaming of AYUSH physicians. There were 7.7 lakh registered AYUSH practitioners in 2016, according to National Health Profile 2017 data. Their current academic training also includes a conventional biomedical syllabus covering anatomy, physiology, pathology and biochemistry. Efforts to gather evidence on the capacity of licensed and bridge-trained AYUSH physicians to function as primary-care physicians have been under way in diverse field settings, and the call for a structured, capacity-building mechanism is merely the next logical step.

The 4th Common Review Mission Report 2010 of the National Health Mission reports the utilization of AYUSH physicians as medical officers in primary health centres (PHCs) in Assam, Chhattisgarh, Maharashtra, Madhya Pradesh and Uttarakhand as a human resource rationalization strategy. In some cases, it was noted that while the supply of AYUSH physicians was high, a lack of appropriate training in allopathic drug dispensation was a deterrent to their utilization in primary-care settings. Similarly, the 2013 Shailaja Chandra report on the status of Indian medicine and folk healing, commissioned by the Ministry of Health and Family Welfare, noted several instances in States where National Rural Health Mission-recruited AYUSH physicians were the sole care providers in PHCs and called for the appropriate skilling of this cadre to meet the demand for acute and emergency care at the primary level.

Our own experience at the IKP Centre for Technologies in Public Health shows that there is hope. Here, the focus has been on deploying a capacity-building strategy using AYUSH physicians upskilled through a bridge-training programme, and the use of evidence-based protocols, supported by technology, to deliver quality, standardised primary health care to rural populations. Protocols cover minor acute ailments such as fever, upper respiratory tract infections, gastrointestinal conditions (diarrhoea, acidity), urological conditions, as well as proactive risk-screening. The Maharashtra government has led the way in implementing bridge training for capacity-building of licensed homoeopathy practitioners to cross-prescribe.

Capacity-building of licensed AYUSH practitioners through bridge training to meet India’s primary care needs is only one of the multi-pronged efforts required to meet the objective of achieving universal health coverage set out in NHP 2017. Current capacity-building efforts include other non-MBBS personnel such as nurses, auxiliary nurse midwives and rural medical assistants, thereby creating a cadre of mid-level service providers as anchors for the provision of comprehensive primary-care services at the proposed health and wellness centres. Further, the existing practice of using AYUSH physicians as medical officers in guideline-based national health programmes, a location-specific availability of this cadre to ensure uninterrupted care provision in certain resource-limited settings, as well as their current academic training that has primed them for cross-disciplinary learning hold promise. These provide a sufficient basis to explore the proposal of bridging their training to “enable them to prescribe such modern medicines at such level as may be prescribed”.

Ensuing discussions will be well served to focus on substantive aspects of this solution: design and scope of the programme, implementation, monitoring and audit mechanisms, technology support, and the legal and regulatory framework. In the long run, a pluralistic and integrated medical system for India remains a solution worth exploring for both effective primary-care delivery and prevention of chronic and infectious diseases.

Directions(6-10): Read the following passage carefully and answer the questions.

Today’s so-called crisis of globalisation is nothing more than a new variable of the old battle between protectionism and free trade. On the one hand, it is the tribalists while on the other it is the globalists. On one side, there are the anti-Amazon, pro-retailers, losers of a global challenge, while on the other, there are the pro-Amazon, e-commerce winners.

Nothing more, really. The opening of trade walls has accelerated industrial evolution in such a way that workers have had to learn to adapt to almost every generation. The difference, today, is that the evolution didn’t happen within a lifetime, but a few times within that lifetime. This is why the Indian farmer, who initially moved to the city to work in a call centre, had to reinvent himself as an Uber driver and is now worried about driverless cars — all within one lifetime.

Technological innovations are what accelerate the rhythm of change. The medium is the message all over again. It is the transformation of technology that affects society, not whatever that technology delivers (news, electricity, TV series). And this is why in the United States and the United Kingdom and in some parts of Europe, so many 50-somethings, unemployed, disgruntled voters who found it hard to reinvent themselves ended up voting for someone who promised to bring back an impossible past — a greater America, a more British Britain, whatever that may mean.

Up until 20 to 30 years ago, you could reach your pension age before a new radical evolution in the job market, which created its winners and losers. Today, the challenge is that evolutionary shifts happen not just once before reaching pensionable age, but often. This is what causes globalisation’s discontent. Blue collar workers from the mid-West cannot move to Silicon Valley; it’s a totally different skill set, and only few can manage it.

U.S. President Donald Trump’s and Brexit’s victories can be seen as a sort of “revenge of the losers”. The victims of the system described above decided to vote for someone who promised to protect them. Ludicrous. And, in fact, little has been done by Mr. Trump or British Prime Minister Theresa May to help those workers. And little is being done. Their standards of living have not improved. Or have certainly not returned to previous levels. Nor is there any policy in motion indicating that the previous levels will return. There won’t be any promised return to the past. Which doesn’t mean the economy will not thrive. It just won’t bring back the same old jobs to the unskilled.

For example, the latest U.S. tax reform promises to lower corporate taxes, rehashing the ancient myth job, the “trickle down” theory, will not impact the lower middle classes who voted for Mr. Trump. At the dangerous cost of increasing the deficit and widening the hole, Mr. Trump is lowering too high corporate taxes to bring them down to European levels.

It would seem to make sense even though the impact on total taxation will be marginal. Lowering tax on capital may increase wages for those skilled workers whose productivity will be positively affected by increased demand for capital intensive work, but while engineers might see an increase in their wages, the unskilled won’t benefit directly from it.

In other words, instead of fighting the ills of globalisation, Mr. Trump has found a way to economically hit the coastal electorate who mocked and railed against him — the Hillary Clinton voters. By lowering the maximal for family deductions and real estate taxes, he has hit those middle to upper middle classes in the east and west coasts who hate him. They are the ones who will not benefit from this reform. This is what he’ll obtain with this tax reform. Brilliant from his point of view because the reform dips into the pockets of people who never have and never will vote for him.

U.S. manufacturing is down to 11.7% of U.S. GDP (2016), while farming agriculture is only 1% (2015). America produces services such as Amazon, Google and Facebook; these are the richest corporations. Their expansion is thriving globally. And so is the expansion of other multinational corporations.

Even though the discontent of globalisation is a leftover of the crisis of 2008, today we don’t see that it will really impact globalisation seriously. At least, so far, we don’t see the results of this desire to raise barriers. Globalisation is here to stay.