Yesterday, the Ministry of Health and Family Welfare released a draft Bill to address incidences of violence against healthcare professionals and damage to the property of clinical establishments.  Public comments on the draft Bill are invited till the end of September.  In this context, we discuss key provisions of the draft Bill below.

What does the draft Bill seek to do?

The draft Bill prohibits any acts of violence committed against healthcare service personnel including doctors, nurses, para medical workers, medical students, and ambulance drivers, among others.  It also prohibits any damage caused to hospitals, clinics, and ambulances. 

Under the draft Bill, violence means any act which may cause: (i) harm, injury or danger to the life of a healthcare service personnel, while discharging their duty, (ii) obstruction or hindrance to healthcare service personnel, while discharging their duty, and (ii) loss or damage to any property or documents in a clinical establishment. 

What are the penalties for committing such acts of violence?

Currently, the Indian Penal Code, 1860 provides for penalties for any harm caused to an individual or any damage caused to property.  Further, the Code prescribes penalties for causing grievous hurt i.e., permanent damage to another individual.  The draft Bill additionally specifies penalties for similar offences caused to healthcare professionals and clinical establishments. 

Under the draft Bill, any person who commits violence, or abets such violence may be punished with imprisonment between six months to five years, along with a fine of up to five lakh rupees.  However, if any person causes grievous hurt to a healthcare service professional, he will be imprisoned for a period between three years to ten years, along with a fine between two lakh rupees and Rs 10 lakh.  Note that, currently under the Indian Penal Code, 1860, an individual who commits grievous hurt is punishable with imprisonment of up to seven years, along with a fine.

In addition to the punishment for offences committed under the draft Bill, the convicted person will also be liable to pay compensation to the affected parties.  This includes: (i) payment of twice the amount of the market value of the damaged property, (ii) one lakh rupees for causing hurt to healthcare service personnel, and (iii) five lakh rupees for causing grievous hurt to healthcare service personnel.  In case of non-payment of compensation, the amount may be recovered under the Revenue Recovery Act, 1890.  The Act provides for recovering certain public arrears by attaching the property of an individual. 

How will these cases of violence be investigated?

All offences under the draft Bill will be cognizable (i.e., a police officer can arrest without a warrant) and non-bailable.  An aggrieved healthcare service professional can write a request to the person-in-charge of the clinical establishment to inform the police of an offence committed under the draft Bill.  Further, any case registered under this Bill will be investigated by a police officer not below the rank of Deputy Superintendent of Police.

This Bill is currently in the draft stage and has been released for comments by stakeholders and experts in the field.  The draft will be revised to incorporate such suggestions.  Note that, comments can be emailed to the Ministry of Health and Family Welfare at us-ms-mohfwnic.in by the end of September.

In light of recent debates surrounding the implementation of the Mid Day Meal Scheme (MDMS) in certain states, it is useful to understand the basic features of the scheme. The MDMS is the world’s largest school meal programme and reaches an estimated 12 crore children across 12 lakh schools in India. A brief introduction follows, outlining the key objectives and provisions of the scheme; modes of financing; monitoring and evaluation mechanisms and issues with implementation of the scheme. Examples of 'best practices' and major recommendations made by the Planning Commission to improve the implementation of the scheme are also mentioned. Provisions:  The MDMS emerged out of the National Programme of Nutritional Support to Primary Education (NP – NSPE), a centrally sponsored scheme formulated in 1995 to improve enrollment, attendance and retention by providing free food grains to government run primary schools. In 2002, the Supreme Court directed the government to provide cooked mid day meals (as opposed to providing dry rations) in all government and government aided primary schools.[1] Calorie norms for the meals have been regularly revised starting from 300 calories in 2004, when the scheme was relaunched as the Mid Day Meal Scheme. At present the MDMS provides children in government aided schools and education centres a cooked meal for a minimum of 200 days.[2] Table 1 outlines the prescribed nutritional content of the meals. Table 1: Prescribed nutritional content for mid day meals 

Item Primary (grade 1-5) Upper Primary(grade 6-8)
Calories 450 700
Protein (in grams) 12 20

Source: Annual Report, 2011 – 12, Ministry of Human Resource Development, Government of India; PRS. Objectives: The key objectives of the MDMS are to address the issues of hunger and education in schools by serving hot cooked meals; improve the nutritional status of children and improve enrollment, attendance and retention rates in schools and other education centres. Finances: The cost of the MDMS is shared between the central and state governments. The central government provides free food grains to the states. The cost of cooking, infrastructure development, transportation of food grains and payment of honorarium to cooks and helpers is shared by the centre with the state governments. The central government provides a greater share of funds. The contribution of state governments differs from state to state. Table 2 outlines the key areas of expenditure incurred by the central government under the MDMS for the year 2012 – 2013. Table 2: Key areas of expenditure in the MDMS (2012 - 2013)

Area of expenditure                                      Percentage of total cost allocated
Cooking cost 53
Cook / helper 20
Cost of food grain 14
Transportation assistance 2
Management monitoring and evaluation 2
Non recurring costs 10

Source: Ministry of Human Resource Development; Fourth NSCM Committee meeting, August 24, 2012; PRS. Monitoring and Evaluation: There are some inter state variations in the monitoring and evaluation mechanisms of the MDMS.  A National Steering cum Monitoring Committee and a Programme Approval Board have been established at the national level, to monitor the programme, conduct impact assessments, coordinate between state governments and provide policy advice to central and state governments. Review Missions consisting of representatives from central and state governments and non governmental agencies have been established. In addition, independent monitoring institutions such as state universities and research institutions monitor the implementation of the scheme. At the state level, a three tier monitoring mechanism exists in the form of state, district and block level steering cum monitoring committees. Gram panchayats and municipalities are responsible for day to day supervision and may assign the supervision of the programme at the school level to the Village Education Committee, School Management and Development Committee or Parent Teacher Association. Key issues with implementation: While there is significant inter-state variation in the implementation of the MDSM, there are some common concerns with the implementation of the scheme. Some of the concerns highlighted by the Ministry for Human Resource Development based on progress reports submitted by the states in 2012 are detailed in Table 3. Table 3: Key implementation issues in the MDMS

Issue State(s) where these problems have been reported
Irregularity in serving meals Karnataka, Madhya Pradesh, Orissa, Rajasthan, Maharashtra, Arunachal Pradesh
Irregularity in supply of food grains to schools Orissa, Maharashtra, Tripura, Karnataka, Arunachal Pradesh, Meghalaya, Delhi, Andhra Pradesh
Caste based discrimination in serving of food Orissa, Rajasthan, Madhya Pradesh
Poor quality of food Rajasthan, Tamil Nadu, Delhi, Chhattisgarh
Poor coverage under School Health Programme Orissa, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh, Manipur, Arunachal Pradesh, Himachal Pradesh, Chhattisgarh
Poor infrastructure (kitchen sheds in particular) Andhra Pradesh, Tamil Nadu, Puducherry, Gujarat, Chandigarh, Himachal Pradesh, Jammu and Kashmir, Orissa
Poor hygiene Delhi, Rajasthan, Puducherry,
Poor community participation Most states – Delhi, Jharkhand, Manipur, Andhra Pradesh in particular

Source: Ministry of Human Resource Development; PRS. Best practices: Several state governments have evolved practices to improve the implementation of the MDMS in their states. These include involving mothers of students in implementation of the scheme in Uttarakhand and Jharkhand; creation of kitchen gardens, i.e., food is grown in the premises of the school, in Andhra Pradesh, Karnataka, Punjab and West Bengal; construction of dining halls in Tamil Nadu; and increased community participation in the implementation of the scheme Gujarat. More information is available here. Planning Commission evaluation of MDMS: In 2010, a Planning Commission evaluation of the MDMS made the following recommendations to improve implementation of the scheme: i. Steering cum monitoring committees at the district and block levels should be made more effective. ii. Food grains must be delivered directly to the school by the PDS dealer. iii. The key implementation authority must be made responsible for cooking, serving food and cleaning utensils, and school staff should have a supervisory role.  The authority should consist of local women’s self help groups or mothers of children studying in the schools. iv. Given the fluctuating cost of food grains, a review of the funds allocated to the key implementation authority must be done at least once in 6 months. v. Services might be delivered through private providers under a public private partnership model, as has been done in Andhra Pradesh.


[1] PUCL vs. Union of India, Writ Petition (Civil) 196 of 2001. [2] The following institutions are covered: Government and government aided schools, National Child Labour Project (NCLP) schools, Education Guarantee Scheme (EGS) and Alternative and Innovative Education (AIE) centres including Madrasas and Maqtabs supported under the SSA