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.

Last week, the Planning Commission filed an affidavit in the Supreme Court updating the official poverty line to Rs 965 per month in urban areas and Rs 781 in rural areas. This works out to Rs 32 and and Rs 26 per day, respectively. The perceived inadequacy of these figures has led to widespread discussion and criticism in the media. In light of the controversy, it may be worth looking at where the numbers come from in the first place. Two Measures of the BPL Population The official poverty line is determined by the Planning Commission, on the basis of data provided by the National Sample Survey Organisation (NSSO). NSSO data is based on a survey of consumer expenditure which takes place every five years.  The most recent Planning Commission poverty estimates are for the year 2004-05. In addition to Planning Commission efforts to determine the poverty line, the Ministry of Rural Development has conducted a BPL Census in 1992, 1997, 2002, and 2011 to identify poor households. The BPL Census is used to target families for assistance through various schemes of the central government. The 2011 BPL Census is being conducted along with a caste census, and is dubbed the Socio-Economic & Caste Census (SECC) 2011. Details on the methodology of SECC 2011 are available in this short Ministry of Rural Development circular. Planning Commission Methodology Rural and urban poverty lines were first defined in 1973-74 in terms of Per Capita Total Expenditure (PCTE). Consumption is measured in terms of a collection of goods and services known as reference Poverty Line Baskets (PLB). These PLB were determined separately for urban and rural areas and based on a per-day calorie intake of 2400 (rural) and 2100 (urban), each containing items such as food, clothing, fuel, rent, conveyance and entertainment, among others. The official poverty line is the national average expenditure per person incurred to obtain the goods in the PLB. Since 1973-74, prices for goods in the PLB have been periodically adjusted over time and across states to deduce the official poverty line. Uniform Reference Period (URP) vs Mixed Reference Period (MRP) Until 1993-94, consumption information collected by the NSSO was based on the Uniform Reference Period (URP), which measured consumption across a 30-day recall period. That is, survey respondents were asked about their consumption  in the previous 30 days. From 1999-2000 onwards, the NSSO switched to a method known as the Mixed Reference Period (MRP). The MRP measures consumption of five low-frequency items (clothing, footwear, durables, education and institutional health expenditure) over the previous year, and all other items over the previous 30 days. That is to say, for the five items, survey respondents are asked about consumption in the previous one year. For the remaining items, they are asked about consumption in the previous 30 days. Tendulkar Committee Report In 2009, the Tendulkar Committee Report suggested several changes to the way poverty is measured.  First, it recommended a shift away from basing the PLB in caloric intake and towards target nutritional outcomes instead. Second, it recommended that a uniform PLB be used for both rural and urban areas. In addition, it recommended a change in the way prices are adjusted, and called for an explicit provision in the PLB to account for private expenditure in health and education. For these reasons, the Tendulkar estimate of poverty for the years 1993-94 and 2004-05 is higher than the official estimate, regardless of whether one looks at URP or MRP figures. For example, while the official 1993-94 All-India poverty figure is 36% (URP), applying the Tendulkar methodology yields a rate of 45.3%. Similarly, the official 2004-05 poverty rate is 21.8% (MRP) or 27.5% (URP), while applying the the Tendulkar methodology brings the number to 37.2%. A Planning Commission table of poverty rates by state comparing the two methodologies by is available here.