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Recently, the government announced that it plans to transfer benefits under various schemes directly into the bank accounts of individual beneficiaries.  Benefits can be the Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) wages, scholarships, pensions and health benefits.  Beneficiaries shall be identified through the Aadhaar number (Aadhaar is an individual identification number linked to a person’s demographic and biometric information).  The direct cash transfer (DCT) system is going to be rolled out in 51 districts, starting January 1, 2013.  It will later be extended to 18 states by April 1, 2013 and the rest by April 1, 2014 (or earlier).  Presently, 34 schemes have been identified in 43 districts to implement the DCT programme. Currently, the government subsidises certain products (food grains, fertilizers, water, electricity) and services (education, healthcare) by providing them at a lower than market price to the beneficiaries.  This has led to problems such as high fiscal deficit, waste of scarce resources and operational inefficiencies.  The government is considering replacing this with an Aadhaar enabled DCT system.  It has claimed that the new system would ensure timely payment directly to intended beneficiaries, reduce transaction costs and leakages.  However, many experts have criticised both the concept of cash transfer as well as Aadhaar (see here, here, here and here). In this blog, we provide some background information about cash transfer, explain the concept of Aadhaar and examine the pros and cons of an Aadhaar enabled direct cash transfer system. Background on cash transfer Under the direct cash transfer (DCT) scheme, government subsidies will be given directly to the beneficiaries in the form of cash rather than goods.  DCTs can either be unconditional or conditional.  Under unconditional schemes, cash is directly transferred to eligible households with no conditions. For example, pension schemes.  Conditional cash transfers provide cash directly to poor households in response to the fulfillment of certain conditions such as minimum attendance of children in schools.  DCTs provide poor families the choice of using the cash as they wish.  Having access to cash also relieves some of their financial constraints.  Also, DCTs are simpler in design than other subsidy schemes.  Even though cash transfer schemes have a high fixed cost of administration when the programme is set up, running costs are far lower (see here, here and here). Presently, the government operates a number of DCT schemes.  For example, Janani Suraksha Yojana, Indira Awas Yojana and Dhanalaksmi scheme. In his 2011-12 Budget speech, the then Finance Minister, Pranab Mukherjee, had stated that the government plans to move towards direct transfer of cash subsidy for kerosene, Liquified Petroleum Gas (LPG), and fertilizers.  A task force headed by Nandan Nilekani was set up to work out the modalities of operationalising DCT for these items.  This task force submitted its report in February 2012. The National Food Security Bill, 2011, pending in Parliament, includes cash transfer and food coupons as possible alternative mechanisms to the Public Distribution System. Key features of Aadhaar The office of Unique Identification Authority of India (UIDAI) was set up in 2009 within the Planning Commission.  In 2010, the government later introduced the National Identification Authority of India Bill in Parliament to give statutory status to this office.

  • The Aadhaar number is a unique identification number that every resident of India (regardless of citizenship) is entitled to get after he furnishes his demographic and biometric information.  Demographic information shall include the name, age, gender and address.  Biometric information shall include some biological attributes of the individual (such as fingerprints and iris scan).  Collection of information pertaining to race, religion, caste, language, income or health is specifically prohibited.
  • The Aadhaar number shall serve as proof of identity, subject to authentication.  However, it should not be construed as proof of citizenship or domicile.
  • Process of issuing and authenticating Aadhaar number: First, information for each person shall be collected and verified after which an Aadhaar number shall be allotted.  Second, the collected information shall be stored in a database called the Central Identities Data Repository.  Finally, this repository shall be used to provide authentication services to service providers.

For a PRS analysis of the Bill, see here. Aadhaar enabled direct cash transfers Advantages Identification through Aadhaar number: Currently, the recipient has to establish his identity and eligibility many times by producing multiple documents for verification.  The verification of such documents is done by multiple authorities.  An Aadhaar enabled bank account can be used by the beneficiary to receive multiple welfare payments as opposed to the one scheme, one bank approach, followed by a number of state governments. Elimination of middlemen: The scheme reduces chances of rent-seeking by middlemen who siphon off part of the subsidy.  In the new system, the cash shall be transferred directly to individual bank accounts and the beneficiaries shall be identified through Aadhaar. Reduction in duplicate and ghost beneficiaries: The Aadhaar number is likely to help eliminate duplicate cards and cards for non-existent persons or ghost beneficiaries in schemes such as the PDS and MNREGS.     Disadvantages Lack of clarity on whether Aadhaar is mandatory:  According to UIDAI, it is not mandatory for individuals to get an Aadhaar number.  However, it does not prevent any service provider from prescribing Aadhaar as a mandatory requirement for availing services.  Therefore, beneficiaries may be denied a service if he does not have the Aadhaar number.  It is noteworthy that the new direct cash transfer policy requires beneficiaries to have an Aadhaar number and a bank account.  However, many beneficiaries do not yet have either.  (Presently, there are 229 million Aadhaar number holders and 147 million bank accounts). Targeting and identification of beneficiaries:  According to the government, one of the key reasons for changing to DCT system is to ensure better targeting of subsidies.  However, the success of Aadhaar in weeding out ‘ghost’ beneficiaries depends on mandatory enrollment.  If enrollment is not mandatory, both authentication systems (identity card based and Aadhaar based) must coexist.  In such a scenario, ‘ghost’ beneficiaries and people with multiple cards will choose to opt out of the Aadhaar system.  Furthermore, key schemes such as PDS suffer from large inclusion and exclusion errors.  However, Aadhaar cannot address errors in targeting of BPL families.  Also, it cannot address problems of MNREGS such as incorrect measurement of work and payment delays. Safeguard for maintaining privacy: Information collected when issuing Aadhaar may be misused if safeguards to maintain privacy are inadequate.  Though the Supreme Court has included privacy as part of the Right to Life, India does not have a specific law governing issues related to privacy.  Also, the authority is required to maintain details of every request for authentication and the response provided.  However, maximum duration for which such data has to be stored is not specified.  Authentication data provides insights into usage patterns of an Aadhaar number holder.  Data that has been recorded over a long duration of time may be misused for activities such as profiling an individual’s behaviour.

The Parliamentary Standing Committee on Health and Family Welfare tabled a Report in Parliament on May 8, 2012, on the functioning of the Central Drugs Standard Control Organization (CDSCO).  CDSCO is the agency mandated with the regulation of drugs and cosmetics in India.  The Report covers various aspects of drug regulation including organizational structure and strength of CDSCO, approval of new drugs, and banning of drugs, among others. Following the Report, the Minister of Health and Family Welfare has constituted a Committee to look into the procedure for drug regulation.  The Committee is expected to make its submissions within a period of two months. This post focuses on irregularities in the approval of new drugs by CDSCO.  It discusses the regulations relating to drug approval and the Standing Committee's observations on the working of CDSCO. Approval of new drugs Drugs are regulated by the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetic Rules, 1945 [Rules].  The CDSCO, under the Ministry of Health and Family Welfare, is the authority that approves new drugs for manufacture and import.  State Drug Authorities are the licensing authorities for marketing drugs. New Drugs are defined as:

  • drugs that have not been used in the country before,
  • drugs that have been approved by a Licensing Authority but are now being marketed for different purposes, and
  • fixed dose combinations of two or more drugs that have been individually approved before but are proposed to be combined in a fixed ratio that has not been approved.

The Rules require an applicant for a new drug to conduct clinical trials in India to determine the drug’s safety and efficacy.  These trials are necessary for both domestically manufactured and imported drugs.  However, the authority can exempt a drug from the requirement of local and clinical trials in the public interest based on data available in other countries. Observations and recommendations of the Committee The Committee found that a total of 31 new drugs were approved between January 2008 and October 2010 without conducting clinical trials on Indian patients.  The Report mentioned that drug manufacturers, CDSCO officials and medical experts colluded to approve drugs in violation of laws.  Following are some of the Report’s findings:

  • Under the Rules, the Drugs Controller General (India) (DCGI), the head of CDSCO, can clear sites of clinical trials after ensuring that major ethnic groups are enrolled in these trials to have a truly representative sample.  This rule was violated by the DCGI when sites for clinical trials were approved without ensuring diversity.  The Committee recommended that the DCGI approve sites for trials only if they cover patients from major ethnic backgrounds.
  •  The Report found that certain actions by experts were in violation of the Code of Ethics of the Medical Council of India.  A review of expert opinions revealed that several medical expert recommendations had been given as personal opinions rather than on the basis of scientific data.  Additionally, many expert opinions were written by what the Report calls ‘the invisible hands’ of drug manufacturers.  The Committee recommended that CDSCO formulate a clear set of written guidelines on the selection process of experts with emphasis on expertise in the area of drugs.
  •  The Rules ban the import and marketing of any drug whose use is prohibited in the country of origin.  CDSCO violated this rule by approving certain Fixed Dose Combination drugs for clinical trials without considering the drugs’ regulatory status in their respective country of origin.  Drugs such as Deanxit and Buclizine, which have been prohibited for sale and use in their countries of origin, Denmark and Belgium, respectively, were approved for clinical trials.  The Committee recommended an inquiry into the unlawful approval of these drugs.
  • The Rules require animal studies to be conducted for approval of a drug for use by women of reproductive age.  CDSCO violated this rule in approving Letrozole for treating female infertility.  Globally the drug has only been used as an anti-cancer drug for use among post-menopausal women.  The drug has not been permitted for use among women of reproductive age because of side effects.  The Committee recommended that responsibility be fixed for unlawfully approving Letrozole.
  •  Rules require Post-marketing Safety Update Reports (PSURs) on drugs to be submitted to CDSCO.  PSURs are used to collect information on adverse effects of drugs on Indian patients as a result of ethnic differences.  When asked by the Committee to furnish PSURs on 42 randomly selected new drugs, the Ministry was able to submit PSURs for only 8 drugs.  The Report contended that this action reflected a poor follow-up of side effects on Indian patients.  The Committee recommended that manufacturers of new drugs be warned about suspension of marketing approval unless they comply with mandatory rules on PSURs.