Recently, the Standing Committee on Health and Family Welfare submitted its report to the Parliament on the National Commission for Human Resource for Health Bill, 2011.  The objective of the Bill is to “ensure adequate availability of human resources in the health sector in all states”.  It seeks to set up the National Commission for Human Resources for Health (NCHRH), National Board for Health Education (NBHE), and the National Evaluation and Assessment Council (NEAC) in order to determine and regulate standards of health education in the country.  It separates regulation of the education sector from that of professions such as law, medicine and nursing, and establishes professional councils at the national and state levels to regulate the professions. See here for PRS Bill Summary. The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.  It felt that concerns of the professional councils such as the Medical Council of India and the Dental Council of India were not adequately addressed.  Also, it noted that the powers and functions of the NCHRH and the National Commission on Higher Education and Research (to be established under the Higher Education and Research Bill, 2011 to regulate the higher education sector in the country) were overlapping in many areas.  Finally, it also expressed concern over the acute shortage of qualified health workers in the country as well as variations among states and rural and urban areas.  As per the 2001 Census, the estimated density of all health workers (qualified and unqualified) is about 20% less than the World Health Organisation’s norm of 2.5 health workers per 1000 population. See here for PRS Standing Committee Summary. Shortfall of health workers in rural areas Public health care in rural areas is provided through a multi-tier network.  At the lowest level, there are sub health-centres for every population of 5,000 in the plains and 3,000 in hilly areas.  The next level consists of Primary Health Centres (PHCs) for every population of 30,000 in the plains and 20,000 in the hills.  Generally, each PHC caters to a cluster of Gram Panchayats.  PHCs are required to have one medical officer and 14 other staff, including one Auxiliary Nurse Midwife (ANM).  There are Community Health Centres (CHCs) for every population of 1,20,000 in the plains and 80,000 in hilly areas.  These sub health centres, PHCs and CHCs are linked to district hospitals.  As on March 2011, there are 14,8124 sub health centres, 23,887 PHCs and 4809 CHCs in the country.[i]  Sub-Health Centres and Primary Health Centres

  • § Among the states, Chhattisgarh has the highest vacancy of doctors at 71%, followed byWest Bengal(44%),Maharashtra(37%), and Uttar Pradesh (36%). On the other hand, Rajasthan (0.4%), Andhra Pradesh (3%) and Kerala (7%) have the lowest vacancies in PHCs.
  • § Nine states do not have any doctor vacancies at all at the PHC level. These states includeBihar, Jharkhand andPunjab.
  • § Ten states have vacancy in case of ANMs.  These are: Manipur, Uttar Pradesh, Chhattisgarh,Gujarat,Goa, Himachal Pradesh, Tamil Nadu, Haryana, Kerala and Andhra Pradesh.
  • § The overall vacancy for ANMs in the country is 5% while for doctors it is 24%.

Table 1: State-wise comparison of vacancy in PHCs

 

Doctors at PHCs

ANM at PHCs and Sub-Centres

State Sanctioned post Vacancy % of vacancy Sanctioned post Vacancy % of vacancy
 Chhattisgarh 1482 1058 71 6394 964 15
 West Bengal 1807 801 44 10,356 NA 0
 Maharashtra 3618 1326 37 21,122 0 0
 Uttar Pradesh 4509 1648 36 25,190 2726 11
 Mizoram 57 20 35 388 0 0
 Madhya Pradesh 1238 424 34 11,904 0 0
 Gujarat 1123 345 31 7248 817 11
 Andaman & Nicobar Isld 40 12 30 214 0 0
 Odisha 725 200 28 7442 0 0
 Tamil Nadu 2326 622 27 9910 136 1
 Himachal Pradesh 582 131 22 2213 528 24
 Uttarakhand 299 65 22 2077 0 0
 Manipur 240 48 20 984 323 33
 Haryana 651 121 19 5420 386 7
 Sikkim 48 9 19 219 0 0
 Meghalaya 127 23 18 667 0 0
 Delhi 22 3 14 43 0 0
 Goa 46 5 11 260 20 8
 Karnataka 2310 221 10 11,180 0 0
 Kerala 1204 82 7 4232 59 1
 Andhra Pradesh 2424 76 3 24,523 2876 12
 Rajasthan 1478 6 0.4 14,348 0 0
 Arunachal Pradesh  NA  NA NA NA NA 0
 Assam  NA  NA NA NA NA 0
 Bihar 2078  0 NA NA NA 0
 Chandigarh 0 0 NA 17 0 0
 Dadra & Nagar Haveli 6 0 NA 40 0 0
 Daman & Diu 3  0 NA 26 0 0
 Jammu & Kashmir 750  0 NA 2282 0 0
 Jharkhand 330  0 NA 4288 0 0
 Lakshadweep 4  0 NA NA NA 0
 Nagaland  NA  NA NA NA NA 0
 Puducherry 37 0 NA 72 0 0
 Punjab 487 0 NA 4044 0 0
 Tripura  NA  NA NA NA NA 0
 India 30,051 7,246 24 1,77,103 8,835 5
Sources: National Rural Health Mission (available here), PRS.Note: The data for all states is as of March 2011 except for some states where data is as of 2010.  For doctors, these states are Bihar, UP, Mizoram and Delhi.  For ANMs, these states are Odisha and Uttar Pradesh.

 

Community Health Centres

  • § A CHC is required to be manned by four medical specialists (surgeon, physician, gynaecologist and paediatrician) and 21 paramedical and other staff.
  • § As of March 2011, overall there is a 39% vacancy of medical specialists in CHCs.  Out of the sanctioned posts, 56% of surgeons, 47% of gynaecologists, 59% of physicians and 49% of paediatricians were vacant.
  • States such as Chhattisgarh, Manipur and Haryana have a high rate of vacancies at the CHC level.

Table 2: Vacancies in CHCs of medical specialists

  Surgeons Gynaecologists Physicians Paediatricians
State

% of vacancy

 Andaman & NicobarIsland 100 100 100 100
 Andhra Pradesh 74 0 45 3
 Arunachal Pradesh NA NA NA NA
 Assam NA NA NA NA
 Bihar 41 44 60 38
 Chandigarh 50 40 50 100
 Chhattisgarh 85 85 90 84
 Dadra & Nagar Haveli 0 0 0 0
 Daman & Diu 0 100 0 100
 Delhi 0 0 0 0
 Goa 20 20 67 66
 Gujarat 77 73 0 91
 Haryana 71 80 94 85
 Himachal Pradesh NA NA NA NA
 Jammu & Kashmir 34 34 53 63
 Jharkhand 45 0 81 61
 Karnataka 33 NA NA NA
 Kerala NA NA NA NA
 Lakshadweep 0 0 100 0
 Madhya Pradesh 78 69 76 58
 Maharashtra 21 0 34 0
 Manipur 100 94 94 87
 Meghalaya 50 NA 100 50
 Mizoram NA NA NA NA
 Nagaland NA NA NA NA
 Odisha 44 45 62 41
 Puducherry 0 0 100 NA
 Punjab 16 36 40 48
 Rajasthan 57% 46 49 24
 Sikkim NA NA NA NA
 Tamil Nadu 0 0 0 0
 Tripura NA NA NA NA
 Uttar Pradesh NA NA NA NA
 Uttarakhand 69 63 74 40
 West Bengal 0 57 0 78
 India 56 47 59 49
Sources: National Rural Health Mission (available here), PRS.

[i].  “Rural Healthcare System in India”, National Rural Health Mission (available here).  

The Trafficking of Persons (Prevention, Protection and Rehabilitation) Bill, 2018 is listed for passage in Rajya Sabha today.  Earlier this year, the Bill was introduced and passed in Lok Sabha.  It provides for the prevention, rescue, and rehabilitation of trafficked persons.  If the Bill is not passed today, it will lapse with the dissolution of the 16th Lok Sabha.  In this post, we analyse the Bill in its current form.

What was the need for a new law?

According to the National Crime Records Bureau, 8,132 human trafficking cases were reported in India in 2016 under the Indian Penal Code, 1860.[i]  In the same year, 23,117 trafficking victims were rescued.  Of these, the highest number of persons were trafficked for forced labour (45.5%), followed by prostitution (21.5%).  Table 1 provides details of persons trafficked for various purposes (as of 2016). 

Table 1: Victims rescued by type of purpose of trafficking ​

Purpose 2016 (as a %)
Forced labour 10,509 45.5
Prostitution 4,980 21.5
Other forms of sexual exploitation 2,590 11.5
Domestic servitude 412 1.8
Forced marriage 349 1.5
Petty crimes 212 0.9
Child pornography 162 0.7
Begging 71 0.3
Drug peddling 8 0
Removal of organs 2 0
Other reasons 3,824 16.5
Total persons 23,117 100

Source: Human Trafficking, Crime in India, 2016, National Crime Records Bureau; PRS

In India, the offence of trafficking is dealt with under different laws.  Trafficking is primarily an offence under the Indian Penal Code, 1860.  It defines trafficking to include recruiting, transporting, or harboring persons by force or other means, for exploitation.  In addition, there are a range of laws presently which deal with bonded labour, exploitation of children, and commercial sexual exploitation.  Each of these laws operate independently, have their own enforcement machinery and prescribe penalties for offences related to trafficking. 

In 2015, pursuant to a Supreme Court order, the Ministry of Women and Child Development constituted a Committee to identify gaps in the current legislation on trafficking and to examine the feasibility of a comprehensive legislation on trafficking.[ii]  Consequently, the Trafficking Bill was introduced in Lok Sabha by the Minister of Women and Child Development, Ms. Maneka Gandhi in July, 2018.

What does the Bill seek to do?

The Bill provides for the investigation of trafficking cases, and rescue and rehabilitation of trafficked victims.  It includes trafficking for the purposes of sexual exploitation, slavery, or forced removal of organs.  In addition, the law also considers trafficking for certain purposes, such as for begging or for inducing early sexual maturity, to be an aggravated form of trafficking.  These forms of trafficking attract a higher punishment.  

In order to punish trafficking, the Bill provides for the setting up of investigation and rehabilitation authorities at the district, state and national level.  The primary investigation responsibility lies with anti-trafficking police officers and anti-trafficking units constituted at the district level.  The authority at the national level can take over investigation of cases referred to it by two or more states. 

The Bill also provides for the setting up of Protection Homes and Rehabilitation Homes to provide care and rehabilitation to the victims.  The Bill supplements the rehabilitation efforts through a Rehabilitation Fund, which will be used to set up the Protection and Rehabilitation Homes.  Special Courts will be designated in every district to complete trial of trafficking cases within a year. 

Additionally, the Bill specifies penalties for various offences including for promotion of trafficking and trafficking with the aid of media.  All offences are cognizable (i.e. police officer can arrest without a warrant) and non-bailable.  If a person is found guilty under the Bill and also under any other law, the punishment which is higher will apply to the offender.

How does the Bill compare with existing trafficking laws?

The current Bill does not replace but adds to the existing legal framework.  As discussed above, currently a range of laws deal with various aspects of trafficking.  For instance, the Immoral Traffic (Prevention) Act, 1986 covers trafficking for commercial sexual exploitation while the Bonded Labour System (Abolition) Act, 1976 deals with punishment for employment of bonded labour.  These laws specify their own procedures for enforcement and rehabilitation. 

One of the challenges with the Bill is that these laws will continue to be in force after the Bill.  Since each of these laws have different procedures, it is unclear as to which procedure will apply in certain cases of trafficking.  This may result in overlap in implementation of these laws.  For instance, under the ITPA, 1986, Protective Homes provide for rehabilitation of victims of sexual exploitation.  The Bill also provides for setting up of Protection Homes.  When a victim of sexual exploitation is rescued, it is not clear as to which of these Homes she will be sent to.  Further, each of these laws designate special courts to hear offences.  The question arises as to which of these courts will hear the case. 

Are the offences in the Bill reasonably tailored?

As discussed earlier, the Bill imposes penalties for various offences connected with trafficking.  One of the offences states that if trafficking is committed on a premise, it will be presumed that the owner of the premise had knowledge of the offence.  The implication of this would be that if an owner lives in a different city, say Delhi, and lets out his house in Mumbai to another person, and this person is discovered to be detaining girls for sexual exploitation on the premise, it will be presumed that the owner knew about the commission of the offence.  In such circumstances, he will have to prove that he did not know about the offence being committed on his premise.  This provision is a departure from the standard principle in criminal law where the guilt of the accused has to be proved and not presumed.   

There are other laws where the owner of a property is presumed guilty.  However, the prosecution is required to prove certain facts before presuming his guilt.  For instance, under the Narcotics and Psychotropic Substances Act, 1985 it is presumed that the owner has knowledge of an offence committed on his property.  However, the Bill clarifies that the presumption will only apply if the prosecution can prove that the accused was connected with the circumstances of the case.  For instance, an owner of a truck is not presumed to be guilty only because his truck was used for transporting drugs.[iii]  However, he may be considered guilty if he was also driving the truck in which drugs were transported.[iv]  The Bill does not contain such safeguards and this provision may therefore violate Article 21 of the Constitution which requires that laws which deprive a person of his life or personal liberty should be fair and reasonable.[v] 

Does the Bill provide any protection to trafficking victims compelled to commit crimes?

The Bill provides immunity to a victim who commits an offence punishable with death, life imprisonment or imprisonment for 10 years.  Immunity to victims is desirable to ensure that they are not prosecuted for committing crimes which are a direct consequence of them being trafficked.[vi]  However, the Bill provides immunity only for serious crimes.  For instance, a trafficked victim who commits murder under coercion of his traffickers may be able to claim immunity from being tried for murder.  However, if a trafficked victim commits petty theft (e.g. pickpocketing) under coercion of his traffickers, he will not be able to claim immunity. 

Further, the immunity is only available when the victim can show that the offence was committed under coercion, threat, intimidation or undue influence, and there was a reasonable apprehension of death or injury.  Therefore, it may be argued that the threshold to claim immunity from prosecution may be too high and may defeat the purpose for providing such immunity.  

[i]. ‘Crime in India’ 2016, National Crime Records Bureau.

[ii]. Prajwala vs. Union of India 2016 (1) SCALE 298.

[iii]. Bhola Singh vs. State of Punjab (2011) 11 SCC 653.

[iv]. Sushant Gupta vs. Union of India 2014 (308) ELT 661 (All.).

[v]  Maneka Gandhi vs. Union of India 1978 AIR 597.

[vi]. Guideline 7, ‘Recommended Principles and Guidelines on Human Rights and Human Trafficking’, OHCHR,  https://www.ohchr.org/Documents/Publications/Traffickingen.pdf.