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Background: Many legislatures allow for written or in-person questions to be directed to members of the administration, which is a common feature of legislatures. The parliamentary probes usually generate a lot of media attention and public interest. The types of questions that are asked in parliament and the outcomes are still unknown, despite their significance and interest.
Aim and Objectives: The study aimed to assess the interest of Indian parliamentarians (Lok Sabha) in health issues by screening the questions raised in the Lok Sabha related to health.
Methodology: A cross-sectional study using records from the 17th Lok Sabha from 2014 to 2022 was done to identify “health-related” inquiries made by parliamentarians between 2014 and 2022.
Results: The Ministry of Health and Family Welfare explicitly responded to questions in the Lok Sabha from 2014 to 2022, making up 5.41% of all questions (starred and unstarred) raised during that time. Of the total 117,967 questions raised in the Lok Sabha from 2014 to 2022, these 6389 questions were related to “health.”
Conclusion: In India, the COVID-19 pandemic has sparked worries about several issues, including the quality of health care, institutional and governmental responses, and challenges with law and order. The constitutional and statutory framework ought to be useful in answering these problems.
Keywords: COVID-19, cross-sectional studies, humans, India, pandemic
How to cite this URL:
Kanwar D, Sharma N, Singh M, Aggarwal P. Eliciting “health” as a priority among policymakers in India: A paradigm shift in focus postpandemic. MRIMS J Health Sci [Epub ahead of print] [cited 2023 Mar 30]. Available from: http://www.mrimsjournal.com/preprintarticle.asp?id=370649 |
| Introduction | |  |
A characteristic of many legislatures is that members of the legislature have the option to question members of the executive in writing or in person. Parliamentary inquiries frequently attract a lot of media coverage and public interest. Despite the importance and interest, it is still unclear that what types of questions are asked in parliament and what the results will be. Parliamentarians use questions to gather information about each member and the institution of the parliament as a whole.[1]
India's representative government not only ranks among the largest but is also the best-functioning democracy in the world for a legitimate reason. It is not just due to its size, it is also due to the variety of its nature and the trials it has endured over time. As a part of India's civilizational heritage, democratic traditions and norms have evolved and become deeply ingrained in our political psyche. These qualities include tolerance, respect for others' political beliefs, peaceful coexistence, and the resolution of a variety of disputes using democratic principles.[2]
Effective legislatures largely depend on healthy parliamentary customs and conventions, written and unwritten, for them to function effectively. The Indian democratic system functions in tandem with our constitution's provisions, rules, established customs, and procedures, with parliament serving as its supreme body or “temple of democracy.”[2]
Once voted into power by the parliament, the people's political representatives are expected to embark on enacting laws in the interest of the people and country.[2]
The “Lok Sabha” and the “Rajya Sabha,” which make up India's highest legislative body, convene to address issues of national importance. The COVID-19 pandemic has made the role of parliament in bringing up issues that affect people and giving executive guidance even more important.[3]
Representatives of the people who have been elected directly using adult suffrage make up the Lok Sabha. Typically, questions take up the first hour of a Lok Sabha meeting, which is known as the “Question Hour,” and is particularly important to the proceedings of the parliament.[4]
Members of the house have an inherent, unrestricted right to ask questions. During question hour, members can inquire about any facet of the executive branch or governmental activities.[3]
Members are entitled to ask questions to get information on issues of public concern that fall under the ministers' specific purview. The questions are of four types:
- Starred questions – A member is required to mark a question with an asterisk as a “Starred Question” if they want the minister to respond orally in the house. Members may ask additional questions after the answer to such a question
- Unstarred questions – An unstarred question, which the minister is presumed to have set on the house's table, may be asked for a written response by a member. As a result, there is no need for an oral response in the house, and no follow-up questions may be raised
- Short notice questions – A member may request a written response to an unstarred question, which is one that the minister is presumed to have laid on the table of the house. As a result, there is no need for an oral response in the house, and no follow-up questions may be raised
- Questions to private members – It may also be directed to a private member if the inquiry is about a bill, resolution, or another issue involving the business of the house for which that member is accountable (”under Rule 40 of the Rules of Procedure and Conduct of Business in Lok Sabha”). The procedure is the same for such questions as it is for questions addressed to a minister, with any amendments the speaker may see necessary.[4]
The Lok Sabha, or lower house, and the Rajya Sabha, or upper house, make up the Indian Parliament, which has the role of the nation's highest legislative body. An hour is set aside in both chambers of the Indian Parliament for asking questions of various ministries. This is essentially a way to hold the government responsible for its actions. These inquiries offer an opportunity to follow, assess, and evaluate the policies and activities of the government and are freely available through the websites of the Rajya Sabha and Lok Sabha.[5]
Democratic accountability, or the ability to answer those in front of them, is the main objective of parliamentary questions (PQs).[6]
Given the Nation's present state of health, it would be interesting to learn about the democratic accountability of the members of parliament (MPs). To demonstrate the elected parliamentarians' interest in health-care concerns in India, we consequently created this study to investigate the parliamentary health-related topics.[7]
The study aimed to assess the interest of Indian parliamentarians (Lok Sabha) in health issues by screening the questions raised in the Lok Sabha related to health with the following objectives:
- The frequency of questions raised related to health in the Lok Sabha during different regimens, (pre-/postpandemic), i.e., from 2014 to 2022 (July 25, 2022)
- Questions segregated by their type (starred or unstarred)
- The international scenario: Role of PQs in Health policymaking.
| Methodology | | |
To find “health-related” queries raised by MPs between 2014 and 2022 in the Lok Sabha, a cross-sectional analysis using data from the 17th Lok Sabha from 2014 to 2022 was conducted. The data were obtained from the website of https://loksabhaph.nic.in/Questions/qsearch15.aspx, which were openly available under public domain with free access. All questions raised by the M/o HFW between 2014 and 2022 were mapped using the select by ministry filter of the Lok Sabha's advanced search engine for questions on health. A data set comprising the question and the MPs who raised it was created on MS Excel after the questions submitted to the Ministry of Health and Family Welfare (M/o HFW) were screened. The total frequency of question related to health by the M/o HFW was mapped out year wise to find out what percentage of questions were related to health of the total questions raised in the Lok Sabha from 2014 to 2022.
| Results | | |
During the screening of the questions, it was found that of the total of 117,967 questions raised in the Lok Sabha from 2014 to 2022, these 6389 questions were related to “health,” i.e., from 2014 to 2022; the M/o HFW explicitly responded to questions in the Lok Sabha, making up 5.41% of all questions (starred and unstarred) raised during that time which is summarized in [Table 1]. | Table 1: Total questions to the Ministry of Health and Family Welfare in the Lok Sabha distributed over different regimens (prepandemic and postpandemic)
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As the study proceeded, it was discovered that the questions that lawmakers in the Lok Sabha were asking the M/o HFW during the “pandemic years” and the years that followed had changed.
During the time of the pandemic regimen (2020–2022), it can be seen that of the total questions being raised on the floor of the Lok Sabha, 5.9% were “health-related.”
Whereas in the years preceding the pandemic (2014–2019), the “health-related” questions were just 5.2% of the total questions raised on the Lok Sabha floor by the elected representatives. This depicts that in the span of 2 years, the decision-makers drastically shifted their focus on health, due to the crippling impact of the pandemic. [Table 2] shows the distribution of questions related to “health” in the Lok Sabha from 2014 to 2022. | Table 2: Distribution of questions related to “health” in the Lok Sabha (2014-2022)
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We see that there is heterogeneity in the number of questions being asked to the M/o HFW throughout the years in different Lok Sabha sessions. One cannot help but notice that the year 2016 saw the maximum number of questions being raised. This can perhaps be attributed to the fact that the majority of questions were raised to accelerate the passing of the “Mental Healthcare Bill, 2016,” and the “Indian Medical Council (Amendment) Bill, 2016.”
For example, Question No. 2504 (unstarred) asked on March 11, 2016, related to the mental health-care policy was: “Will the M/o HFW be pleased to state:
- The salient features of the mental health policy
- Whether the Government proposes to increase funding and budgetary allocation towards mental health in India, and if so, the details thereof
- Whether the Government proposes to make mental health facilities and services more accessible to vulnerable groups, and if so the details thereof
- The steps taken/being taken by the Government to provide affordable care to mental illness?”[4]
Question No. 3435: “Will the M/o HFW be pleased to state:
- Whether the Government is aware that mental health problems increase due to changes in lifestyle and if so, the details thereof
- Whether the Government proposes to introduce a holistic health care system to address mental health problems and if so, the details thereof and the action taken thereon
- The number of patients admitted into the mental hospitals during the last 3 years, State/union territories (UT)-wise
- Whether the Government has taken note of doctors administering tranquilizers and pain killers to patients for depression therapy aggravating their problems and if so, the details thereof along with the action taken and outcome thereon?”[4]
The years following the 2020 pandemic mainly saw questions related to the COVID-19 vaccine (production, distribution, and logistics), vaccination (massive drives and campaigns, vaccine hesitancy, and wastage), and majorly coming up with government schemes and policies that focused on strengthening and upgradation of health-care infrastructure and incentivizing the health-care workforce.
For example, Question No. 1617 (unstarred) question:
- The details of outreach strategy by the Government to promote awareness concerning COVID-19 vaccination
- The expenditure incurred for the media outreach programs to date, State/UT-wise?”[8]
[Figure 1] shows the distribution of questions raised in the Lok Sabha related to health. | Figure 1: Distribution of questions raised in the Lok Sabha related to health
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[Table 3] depicts the distribution of unstarred (written) and starred (orally answered on the floor of the Lok Sabha) questions to the M/o HFW on the Lok Sabha floor. It was also seen that during 2014–2019, 7.86% were starred questions, and in the 2020–2022 period, 10.8% of questions raised related to health were starred questions, perhaps due to the ongoing impact of COVID-19 which demanded increased accountability and transparency in the functioning of the legislative and executive body of the government. | Table 3: Distribution of unstarred (written) and starred (orally answered on the floor of the Lok Sabha) questions to the Ministry of Health and Family Welfare on the Lok Sabha floor
Click here to view |
The international scenario
PQs analysis offers exceptional possibilities to precisely identify the behavior of certain lawmakers as well as the purpose of contemporary legislatures. PQs, as a documented behavior, offer a special and comprehensive perspective into the issues that interest legislators. One can argue that questions are a crucial tool for evaluating a legislator's role perspective and legislative duties. PQs can give data for empirical research, permitting reasonable inferences, as opposed to much unreported or unseen parliamentary activity or documented activities that may be subjected to considerable behavioral restraints imposed by the party leadership.[1]
United Kingdom
According to the findings of a content analysis of more than 16,000 PQs submitted by 50 British backbencher MPs during the 2005–2010 legislative session, lawmakers from districts with a sizable ethnic minority are more likely to raise issues affecting minorities in their questions. In addition, parliamentarians representing visible minorities inquire about topics related to the racial diversity and equality far more frequently. By examining legislative questions, Saalfeld may thus show that Black and ethnic minorities have a meaningful representation in the British legislature.[9]
Italy
Many Italian lawmakers play the part of “constituency servants” despite the closed-list voting process, demonstrating the error of presuming that voting systems explain legislators' conduct. The study finds that Italian lawmakers with no prior national positions, along with representatives of the Lega Nord and Alleanza Nazionale parties, are just more likely to concentrate on constituency-oriented queries to explain the noticeable difference in the patterns of local versus nonlocal inquiry.[10]
Australian parliament
The study by Russell et al. aimed to understand how Australian legislators view, discuss, and interpret the problem of unhealthy food marketing to kids. The results reveal major framing discrepancies between the parties, especially between the Liberal Party of Australia (LPA) and the Greens.
When the Australian Labor Party (ALP) held political power, it backed a variety of ideas that were not governed by the government, such as emphasizing individualism in the explanation of problems' causes, perpetrators, and solutions. They were more inclined to support laws that forbade the marketing of unhealthy food while they were in opposition.
The LPA suggested industry self-regulation, healthier lifestyles for individuals, parental control over children's dietary habits, and education as solutions. The Green Party's single recommendation was to enact laws that would prohibit the marketing of unhealthy food to minors.[11]
| Discussion | | |
This study is an attempt to establish whether or not health is a priority among the elected representatives when it comes down to raising the concerns of the public through screening questions asked in the parliament. Similar studies have been conducted by Gauthamana J (2019), Aurlene et al. (2021), and Varma et al. (2021) in India that have analyzed the PQs to understand the diverse and competing concerns of politician around a health-related issue.[15],[16],[17]
In the study, while screening through the Lok Sabha questions posed to the M/o HFW over the years, it was observed that before the pandemic, i.e., in the 16th Lok Sabha (2014–2019): 3990 questions were raised by the MPs to the M/o HFW, of a total of 79,149 questions raised on the floor of Lok Sabha, which makes up for the fact that 5.04% of total questions were “health” related, whereas during the pandemic years, i.e., in the 17th Lok Sabha, an obvious shift in interest toward “health-”related issues was seen. During the 17th Lok Sabha, 6.2% of questions were raised to the M/o HFW, by the Lok Sabha members. In the years following the COVID-19 crisis, 2395 questions of 38,478 total questions raised in the Lok Sabha (6.22%) were to the Health Ministry.
It can also be observed that 22.4% of these 2395 questions were raised about the ongoing pandemic.
Therefore, this study was an attempt made in the direction to study and screen PQs to get an insight into and elicit the importance of “health” as an issue, especially during the time of the pandemic, by focusing attention on the questions raised in the context to COVID-19 pandemic in the 17th Lok Sabha.
| Conclusion | | |
In this paper, it was observed that during the time of pandemic regimen (2020–2022), it can be seen that of the total questions being raised on the floor of the Lok Sabha, 5.9% were “health-related.” Questions addressed to the M/o HFW in the Lok Sabha that is “health-related” have risen.
Given that the country was experiencing a public health emergency – the COVID-19 pandemic – and that the Lok Sabha was not holding full sessions as a result, the elected officials' change in focus to health-related issues was expected.
In India, the COVID-19 pandemic has sparked worries about several issues, including the quality of health care, institutional and governmental responses, and challenges with law and order. Even though the lockdown was successfully enforced by the Indian government and the number of cases fell, some legislators and legal experts questioned the lockdown's constitutional legitimacy and political reaction. The Central Government passed the The epidemic diseases act, 1897, and the Disaster Management Act, 2005; however, due to the disease's dynamic character, these laws are unable to effectively handle the health emergency. Thus, the constitutional and statutory framework ought to be useful in answering these problems.[12],[13],[14]
According to this study, lawmakers seek basic health policies and information on the floor of the legislature rather than pleading with the government to act, showing care for their constituents, or drawing attention to the shortcomings of the government's health policies. Therefore, questioning should aim to improve the performance and accountability of health parliamentarians.
Limitations
- The study only included the questions raised to the M/o HFW in regard to “health;” other sections of relevant questions may perhaps have been left out which were answered by various ministries in relation to health and its related aspects
- The PQs screened for this study have been accessed through a government website with open access to the public domain, one which relies on the updates done by the website for its accuracy and authenticity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Correspondence Address:
Pradeep Aggarwal,
Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjhs.mjhs_130_22
[Figure 1]
[Table 1], [Table 2], [Table 3] |
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