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Shailaja Chandra writes: Where there is no inequality

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I dream of an India more open-minded and egalitarian, where the walls of caste and class have broken down, writes Shailaja Chandra.

Indian Express

Written by Shailaja Chandra
Updated: November 23, 2022 8:47:25 am

My first vision is to secure freedom from casteism — something that has not happened in 75 years.

When India celebrates one hundred years since Independence, I may not be around. But no one can stop me from dreaming about an India that, by then, should become more egalitarian and more open-minded. It is that vision that permeates my thoughts today. While there will always be a need for improved health and education, better infrastructure and connectivity, growth in global competitiveness, and improvement in the quality of life, these are, in their very nature incremental. The way we are going, all these things will improve sooner than later. I would like instead to use this opportunity to dream and strike where it hurts. To me, four things stand out as most important.

First, to have a country free of caste — where being a Brahmin, a Kshatriya, a Bania, an OBC, a Dalit or a tribal does not matter. Second, to see those responsible for governing and protecting citizens made much more accountable — not so much by the law and the courts, as much as by citizens. By voters being able to distinguish between good governance and pretence. Third, to bridge the class divide in a country where paymasters and workers, no matter how skilled or how loyal, are underpaid, kept at arm’s length, and notoriously underpaid. I share my thoughts on making it happen.

My first vision is to secure freedom from casteism — something that has not happened in 75 years. The Scheduled Castes and Tribes listed in the Constitution have over 1,000 castes identified as once having faced deprivation, oppression, and social isolation. Over 740 tribes, who have distinct cultures and live in geographical isolation, are similarly protected. These groups constitute around 22 per cent of the population and have been receiving the benefit of laws, reservation, and a slew of social and economic benefits to overcome past and ongoing discrimination. Notwithstanding their finding political voice and reservation in government services, these efforts have been effective only in small proportions — those who were better placed initially, through access to education or their own initiative, continue to benefit. Affirmative action has not addressed the root causes of the continuing predicament of these groups.

So, while not even suggesting changing the Constitution, has the time come to identify deprivation differently? I would like to see an India where we identify deprivation not just by the caste name being included in the state lists by nativity, but by identifying families among these very groups where not even one woman in the family has studied beyond Class 8 or is a wage earner in the labour force. These signs of deprivation have many longer-term effects on the wellbeing of the family and on children’s health and education. We need to have a census of such women among the Scheduled Castes and Tribes and work towards educating and equipping them with one test of success — have they passed a minimum of a Class 10 examination and joined the labour market? Lower caste women bear discrimination of caste and gender. Empirical evidence suggests that money in the hands of mothers (as opposed to their husbands) benefits children. With fertility declining, the goalposts should be changed because India is the only country where women’s labour force participation seems to be declining.

Second, among the middle classes, I would like to see a breakdown of the walls that separate community and caste. Let more inter-caste marriages bloom and let the diversity of cultures create a band of young Indians who do not need to go to caste-based sites to select a partner. Young people’s education should equip them to understand and welcome multi-culturist attitudes to eating, dressing, speech and social mixing. Only then will the social cohesion that India receives high marks for internationally, percolate into the aspirant middle classes by choice.

Third, I would like to see young Indians participating in a thinking way in the way elections are fought and votes cast. The middle class is not small. A third of India can by most accounts be considered middle class. These people are educated, mobile and have opinions. But they do not care to vote. They do not know who their local councillor or MLA or MP is. Where then is the question of holding these “public representatives “accountable? If every adult middle-class man or woman decided to find out more about their political candidates, demanded to know what candidates and elected representatives have been doing or will do for them and force them to debate on issues that matter, it would shame those who simply ride the wave of a party. I would like the media to be assertive, not choosing their targets. In the UK, ministers are forced to resign over unethical conduct or immoral behaviour. By the time, the Indian Republic is 100, our citizens must gather voice to question, debate, discuss and kick out those who only sit as cheerleaders for their political party.

Finally, I would like to see a classless society which exists in India but which we have never taken note of. On a posting to Manipur in 1971, I was unaccustomed to seeing the baby minder (ayah) sleeping on my bed, the baby alongside. Likewise, my office peon came straight into our drawing room and occupied the sofa. The Manipuris, whether they are Meities from the Imphal Valley or tribals from the hills, live in a classless society. In Mizoram, those cooking and serving the food for a party, eat at the same table — not in some corner at the back of the house! We see our children living outside India coughing up hundreds of dollars for a plumber’s visit and offering tea while we do not even offer cold water!

My thoughts are big and small. Twenty-five years is a long time to make this happen!

The writer is a former secretary in the Ministry of Health. This article is part of an ongoing series, which began on August 15, by women who have made a mark, across sectors

This entry was posted in Critiques on Governance, News articles.

Budget disappoints on healthcare

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Shailaja Chandra writes: Many expectations for the health sector remain unfulfilled

Written by Shailaja Chandra | Updated: February 5, 2022 9:39:12 am

A hospital staff waits beside the body of a person suspected to have died after Covid-related complications at Civil Hospital, Asarwa. (Express Photo: Nirmal Harindran)

There were many expectations of the Union budget for the health sector. The big-ticket items — the digitally managed health ecosystem and provisions for mental health — veer away from the prevalent systems. They rely on the power of technology to bypass the need to undertake physical visits to doctors, carry prescriptions and wait in queues. The digital experience could be a game-changer, but only if the facility, doctors, patients, and systems work in tandem.

When it comes to Covid vaccinations, the digital platform has been a runaway success, primarily because the COWIN platform was simple and slick, and the citizen could choose between public and private facilities. Online medical consultations have started in metros and people are setting up appointments with doctors easily. But the management of hospital beds across the country is a different story. Of the 19 lakh beds in India, 62 per cent are in the private sector. Nearly 95 per cent of them are operated by small hospitals or nursing homes — the first port of call for most citizens seeking medical care. The setting up of a National Digital Ecosystem which “will maintain digital registries of health providers and health facilities,” is welcome, but one must be clear whether it will encompass both the public and private health sector and include smaller hospitals and nursing homes. And, what about consent, compliance and cost?

The other big-ticket announcement relates to the mental health sector. It serves one purpose straightaway- making society aware that such conditions can afflict anyone, but the disease can be treated, and patients should not be stigmatized. With IIT Bangalore and the National institute of Mental Health and Neurosciences (NIMHANS) in the driver’s seat, we can expect professionalism and results

The other big-ticket announcement relates to the mental health sector. It serves one purpose straightaway — making society aware that such conditions can afflict anyone, but the disease can be treated, and patients should not be stigmatised. With IIT Bangalore and the National Institute of Mental Health and Neurosciences (NIMHANS) in the driver’s seat, we can expect professionalism and results. But the budget speech did not mention if the mental health strategy will focus on all psychological problems or only those that have arisen in the wake of Covid. Many mental health conditions encompass disorders that are not amenable to teleconsultation.

While the budget has provided some financial leg up to the National Health Mission and more to the Pradhan Mantri Swasthya Suraksha Yojana (under which AIIMS-type of hospitals and government medical colleges are being established or upgraded) these are programmes that have been in progress since 2005. Four announcements were expected but did not come.

First, the need to substantially raise the overall budgetary contribution to the health sector. It is currently pegged at 1.8 per cent of the GDP and the push in the budget appears very small.

Second, during the pandemic the unorganised middle class was caught without adequate (or even any) health insurance. After excluding insurance coverage for the organised sector (both government and private), and those covered by Ayushman Bharat and state-level health security schemes, a whopping 26 crore people had no health insurance when the pandemic started. They found hospitalisation costs staggering. One of the biggest expectations from the budget was that the lower end of the “missing middle” would get some handholding.

Third, there was an expectation that Ayushman Bharat would be expanded to cover the outpatient costs faced by the poor. The Economic Survey has recognised that such expenditure is huge.

Fourth, there was a need to address the crisis of non-communicable diseases — hypertension, diabetes, and cardiovascular diseases largely caused by unhealthy lifestyles. During Covid, people with comorbidities constituted the largest segment that succumbed. Fiscal measures, incentives, and disincentives have reduced the incidences related to lethal consequences of smoking. A repetition of the prevention of smoking story was called for.

The health sector outlay leaves many expectations unfulfilled. People I spoke to said “not everything needs to be announced in the budget.” We live in hope.

This column first appeared in the print edition on February 5, 2022 under the title ‘Not so healthy’. The writer is a former secretary in the Ministry of Health.

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India’s healthcare policies need to prescribe bitter medicine

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ET_logoBy Shailaja Chandra, ET CONTRIBUTORS Last Updated: Jan 31, 2022, 06:54 AM IST

Delhi tops the obesity list with 41% of women and 38% of men being found overweight in the latest survey.

Comorbidities have been the leading cause of hospitalisation and deaths during the three waves of the pandemic. Doctors around the world are reported to have found 48% of the patients who passed away after treatment, to have had underlying comorbidities. Out of the 48%, more than 30% were diagnosed with hypertension, 19% with diabetes and close to 8% with cardiovascular conditions. In India, all doctors are agreed that hypertension, diabetes, and cardiovascular diseases have been the three leading comorbidities that delayed, even hampered recovery.

While the forthcoming budget will hopefully address gaps to ramp up hospitals, train healthcare workers and detect new mutants, much more is called for at the level of the general population. Unless people help themselves, the best hospital care will never suffice. As more and more Indians exhibit the major underlying factors that accelerate serious medical conditions, policies must aim to reverse this trend.

The State of The Nation’s Health, a joint publication of the Indian Council of Medical Research, the Public Health Foundation of India and the Institute for Health Metrics and Evaluation, USA, had in 2016 shown state by state how hypertension, diabetes and cardio-vascular diseases had been growing from 1990 to 2016. The burden of noncommunicable diseases (NCDs), far from plateauing or decreasing, had spiralled from 30% of the total disease burden in 1990 to 55% in 2016. Unhealthy diet, high blood pressure, high blood sugar, high cholesterol and being overweight were found to be the main contributors to ischemic heart disease, stroke, and diabetes.

We now have the benefit of the survey results from the National Family Health Survey -5 released in December 2021 and are able to compare the changes that have taken place since NFHS-4 released in 2015-16. Both surveys show the extent to which the growth of NCDs have soared across the country; save for a few exceptions, obesity levels have grown across the board.

Delhi tops the obesity list with 41% of women and 38% of men being found overweight in the latest survey.

Among women, the states of Punjab, Tamil Nadu, Kerala, Andhra Pradesh, Haryana, Himachal Pradesh, Telangana, Karnataka, Uttarakhand 30- 40 % are obese. In the next group fall states with an obesity percentage between 20- 30 % which include Maharashtra, Odisha, West Bengal, Gujarat, and Uttar Pradesh.

Among men, curiously in all the South Indian states of Tamil Nadu, Kerala, Telengana, Andhra Pradesh and Karnataka, along with Punjab and Himachal Pradesh display between 30-40 % obesity. In the next group which includes Haryana, Uttarakhand, Maharashtra, Odisha, and Gujarat 20-30% of the men were found obese.

Synopsis

While the forthcoming budget will hopefully address gaps to ramp up hospitals, train healthcare workers and detect new mutants, much more is called for at the level of the general population. Unless people help themselves, the best hospital care will never suffice.

Obesity significantly increases the risk of diabetes, high blood pressure, and heart disease. An obese person’s risk of a heart attack is three times greater than that of a person with a healthy weight. Research has suggested that people who are obese are up to 80 times more likely to develop type II diabetes. These data call for major efforts to control the impact of lifestyle -related diseases before the situation becomes irretrievable. In the last 22 months patients with these comorbidities required high end hospitalisation which was neither universally accessible nor inexpensive.

Over the years fiscal measures and public policies have successfully weaned lakhs of Indians away from smoking – the leading cause of cancer. It is time to announce comparable policy measures to counter the two main drivers of life -style diseases- wrong eating and sedentary routines. In the interest of citizen’s health, the budget is the right time to make some far-reaching announcements.

What can be done? The first strategy must focus on reducing the volume and improving the quality of fats and oils. Second, the marketing of unhealthy processed foods must be controlled by increasing taxes, mandating colour coding for highly calorific items, and removing agricultural subsidies given to producers of oils having high saturated fatty acids. Third, farmers need to be incentivised to grow more millets. Manufacturers must be given time limits to progressively reduce saturated fat, salt, and sugar in processed foods. Moving towards the elimination of trans fats (hydrogenated oils) used in fast food joints and by street vendors need standards, oversight, and enforcement.

When cities like Toronto mandate that every slice of pizza display the calorie content, and New York restaurants carry the calorific content along with the price of a single portion, we must build public awareness even at the cost of unpopularity. The states should also be directed to introduce healthy policies and provide dietary counselling in schools. Obesity in children has already increased.

A responsible government must heed what its own agencies have repeatedly demonstrated. If public health really matters!

(The writer is a former Secretary in the Health Ministry and Chief Secretary, Delhi)

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आबादी डेमोग्राफिक डिविडेंड तब, जब मिले शिक्षा, स्वास्थ्य और रोजगार

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जनसंख्या स्थिरता कोष की पहली कार्यकारी निदेशक रही शैलजा चंद्रा का मत

Published Patrika 2 Sep. 2019 पत्रिका सक्षात्कार

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Can IAS become an agent of change?

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For better roll-out of policies, administrative capacity at the state level needs to be fortified
HT logoShailaja Chandra | Updated: Jun 11, 2019 17:27 IST

Will a risk-averse, status-quoist bureaucracy rise to the occasion? (Getty Images/iStockphoto)

With Independent India’s diamond jubilee three years from now, new laws, reforms and announcements can be expected. Will a risk-averse, status-quoist bureaucracy rise to the occasion? Will the Indian Administrative Service (IAS) bureaucrats mostly posted in the states become agents of transformation or find ways to stonewall change? Last December, the Niti Aayog released Agenda 2022 with a foreword by Prime Minister Narendra Modi. I critique the bureaucracy’s capability to implement its aspirations.

Agriculture: The document suggests converting farmers into “agripreneurs” by expanding the e-National Agriculture Markets and replacing the existing Agricultural Produce Marketing Committee Act. A model Bill proposed in 2017 has not made much headway possibly because it extinguishes middlemen and commission agents. The state bureaucracy’s uninspiring performance in replacing water-intensive crops, containing wasteful irrigation practices and the alarming depletion of groundwater does not bode well for effecting radical change.

Sanitation: Agenda 2022 gives primacy to gargantuan problems such as landfills, plastic waste and sustainable revenue generation from municipal waste. It seeks to subsume these neglected areas under the Swachh Bharat Mission. But unless the municipal commissioners compel waste segregation and deter non-compliance with fines and penalties available under the solid waste, plastic and water pollution rules, cleanliness cannot come. Municipal commissioners and district magistrates rarely act. Unless municipal offences are fined heavily on-the-spot like traffic violations, the goals cannot be realised.

Power: Agenda 2022 seeks to rationalise power tariff to promote the use of renewable energy. But without privatising the DISCOMs, good intentions will not change the ethos underlying distribution. To reap the benefits of renewable energy fully, only privatising the DISCOMs can rationalise power purchase and tariff. No chief minister is however willing to privatise power distribution and bureaucracy by itself cannot usher in privatisation. Delhi remains the solitary exception.

Employment: The codification of labour laws and expanding apprenticeships will boost employment but unless industry has the flexibility to make a transition from micro-to-small to medium-to-large manufacturing, apprentices will have few places to learn on the job. The flexibility to reduce the workforce within the law must be ensured and the backlash met firmly. This will present the biggest challenge for bureaucracy.

Procurement: Modernising public procurement systems to international competitive bidding (ICB) standards is another important reform. Unless there is willingness to outsource this to professional bodies, ICB will stay on paper. The move will meet with stiff resistance from state politicians, contractors and lobbies. No bureaucracy can pursue this proposal without solid political backing.

Governance: The commitment to implement the recommendations of the second Administrative Reforms Commission (2008) is welcome, including two reviews nearing 14 and 20 years of service. India’s first deputy Prime Minister, Vallabhai Patel, wanted IAS officers to be men of integrity and capable of “brashness” possibly meaning bold, audacious and self-assertive. But today brashness is unacceptable to bosses within the political executive and the bureaucracy. Notwithstanding much criticism on several fronts, the IAS remains indispensable primarily because the officers provide an interface with the political executive and handle complex federal issues, Centre-State relations and municipal and panchayat governance functions. They coordinate and interact meaningfully through a nationwide network which remains matchless. No chief minister can run his government without them. However, only 4,000 officers administer populations the size of countries. This is done despite a shortage of nearly 1,500 IAS officers. Bihar, Uttar Pradesh and West Bengal, for example, have a shortage of over 100-130 officers each.

If Agenda 2022 is to become a reality state-level capacity needs to be fortified. Both at the Centre and more so in the states, there should be sizeable induction of professionals but only by following rigorous and transparent processes for selection.

Finally, unless lethal issues like air and water pollution, medical malpractice, the destruction of the environment and over-commercialisation of education are responded to through policy, oversight and enforcement, the rewards sought through Agenda 2022 cannot be attained.

I suggest two strategies:

First, subdivide the 41 identified goals into those which require the approval of Parliament or state legislatures. Set up empowered councils headed by a central minister with state ministers as members to reach consensus within six months on the lines of the VAT and GST councils. The central and state bureaucracies function best under this edifice.

Second, in areas which fall in the state domain, only if working models are seen as cost-effective and beneficial, will the state bureaucracy respond. Goals like establishing a Unified Metropolitan Transport Authority in a million-plus cities, establishing public health cadres, introducing user charges for garbage collection and toilet maintenance, using treated waste water for non-potable purposes need just one working model of each in a single State, city or district to emulate. This could be inspirational.

Agenda 2022 looks good. The spirit may be willing but now the flesh too must be strong.

Shailaja Chandra is former chief secretary, Delhi

(The writer is former secretary to the Government of India, and former chief secretary, Delhi.)

This entry was posted in Critiques on Governance, News articles.

One man’s meat …

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Antibiotics in poultry harm non-meat eaters as well. India should follow the example of EU, US and China in regulating the industry.
indian expressWritten by Shailaja Chandra | Updated: May 17, 2018 12:08:18 am

Indian chicken producers claim that antibiotics are used only for treating sick birds.

India risks becoming a global health hazard. In February the British daily, The Guardian, published a story describing the extent to which “chickens raised in India have been dosed with some of the strongest antibiotics known to medicine”. The article relied on a report of the Bureau for Investigative Journalism that claims to be an independent not-for-profit media organisation. It singled out India, even though the Bureau’s findings had also referred to similar antibiotics use in Vietnam, Russia, Mexico, Columbia and Bolivia. The issue raised in the story has serious implications for the health of all citizens, not only chicken-eaters.

Indian chicken producers claim that antibiotics are used only for treating sick birds. But an advertisement they had issued to this effect was met with sharp counter publicity. Chandra Bhushan, deputy director general, Centre for Science and Environment (CSE), published an open letter to Sania Mirza, telling her as a national icon, she should not have associated herself with a “misleading, false and libelous advertorial”. According to Bhushan, antibiotics are being “used routinely as a growth promoter”. CSE papers have established how across different districts in the country, chicken litter has been found to be multi-drug resistant. The litter had also made its way to the surrounding agricultural land. This means it carries risks for vegetarians as well.

Plucked, The Truth About Chicken , a 2017 book by Maryn McKenna unravels how chemical fertilisers, pesticides, antibiotics and hormones made chicken the conduit for not only profit-driven politics in the US but antibiotic resistance as well. It was only after a massive outbreak of food poisoning that the US regulators and consumers have become more vigilant. Now Walmart, the book says, along with some of the world’s biggest fast food chains, have started to move away from chicken loaded with antibiotics. The USFDA now expects adherence to standards adopted by the European Union 12 years ago.

Why is all this important to us? Because resistance blunts the effectiveness of drugs designed to cure or prevent infection. The bacteria survive and continue to multiply rendering ineffectual treatment for serious illnesses like pneumonia and tuberculosis, even prophylaxis in, say, caesarian deliveries. It hampers recovery in post-operative surgery. Once the bacteria becomes drug resistant, it affects anyone who gets afflicted by it. The resistance snowballs and defies even the strongest drug-based treatment exposing vulnerable populations — infants, children, farm workers and seniors — to incurable sickness.

Colistin is one of the last antibiotic weapons against serious human diseases and but is reportedly being used covertly to increase chicken weight. The Chinese have been using massive quantities of Colistin. This gave rise to a strain called mcr-1, which spread so widely that the Chinese government had to ban Colistin use. But not before people in 30 countries in five continents had eaten those chickens. After being banned in China, Colistin has found a ready market in India and has made its way into the country’s poultry farms.

Andhra Pradesh and Telangana account for over 80 per cent of the poultry meat production and half the egg production in the country, followed by Tamil Nadu, Maharashtra, Karnataka and West Bengal, Punjab and Haryana. A 2017 study (the largest so far), published in the journal, Environmental Health Perspectives, covered 18 poultry farms in Punjab and found very high levels of antibiotic resistance in the birds.

Chicken was once a part of food habits of the people in north-western, southern and coastal parts of the country. Today, it has become the favourite of the country’s fast growing urban middle-class. A new culture of eating out has been matched by innumerable quick service restaurants offering mouth-watering chicken dishes. Such restaurants are ubiquitous even in the Tier 2 and Tier 3 cities. Most consumers are oblivious to and undeterred by the health hazards of ingesting antibiotics. Meanwhile the industry is growing by some 20 per cent each year — broilers, layers and egg production taken together.

The Chairman of Food Safety and Standards Authority of India (FSSAI), Ashish Bahuguna, whose writ runs over the food-end (but not the farm-end), informed me about the organisation’s new draft regulations for chicken. These prohibit the use of 19 antibiotics in poultry and also prescribe tolerance limits for 92 other antibiotics and drugs. Currently, the public comments to the draft rules are being examined. In April 2017, the Health Ministry published the National Action Plan to combat microbial resistance. Although it signifies a political commitment to ban the use of antibiotics as growth promoters, there has been little activity on the issue, and it has not attracted commensurate funding. Unless that changes quickly, the report will remain confined to the shelf.

Should India take the path of incremental improvement or should it draw a lesson from the EU, and now the US and China, and stop such use of antibiotics? Other countries are importing herbal animal feeds from India. The effectiveness of these herbal feeds should be studied for Indian conditions. And if these feeds pass the test, Indian farmers should be advised to use them. It is time that the ministries of heath and AYUSH, and the Department of Animal Husbandry show interest in the matter.

As an immediate measure, the government must issue advisories asking poultry farmers to stop the use of Colistin and maintain records of the overall use of all drugs given to poultry. This should become a strict requirement for the poultry industry. FSSAI should publish the new regulations and ensure that enforcement is visible, punishment is a deterrent and public awareness programmes are imaginative.

The poultry businesses’ meat should not be allowed to become the Indian consumer’s poison.

The writer is former chief secretary, Delhi.

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Quotes from Shailaja Chandra in Article on Surrogacy

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Quotes from Shailaja Chandra in Article on Surrogacy

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Shailaja Chandra, former Secretary in the Ministry of Health and Family Welfare and the Chairman of the Public Grievances Commission and Appellate Authority under the Delhi Right to Information Act, says: “A poor woman can earn anything between Rs1-3 lakh from surrogacy, and with debts and growing expenditures hanging over her head, she agrees or is forced to agree. In most cases, it’s actually the women’s relatives and middlemen who compel them to go through it.”

She adds that the myths around being childless and the reluctance to consider adoption need to be addressed through proper awareness campaigns, and adoption promoted as a first choice. “Not only is that humane, but is also less exploitative on the surrogate, who has to be bolstered with hormones to prepare her to accept the embryo.”

Chandra also believes that IVF centres need to be registered. “The process should be open only to Indians or if one partner is of Indian origin. We must not permit foreigners to enter into surrogacy arrangements because it is akin to using Indian women to make a takeaway baby for them. While foreigners are generous in looking after the woman’s health and nutrition, problems of citizenship, and fulfilling the responsibilities attached to accepting the infant, even if it suffers from physical or mental deficiencies, can arise.”

About how it can be checked if the ban is being upheld once the Bill is passed, Chandra says, “Such a law, if made, will remain like so many other laws — unimplementable. There is no machinery to police what happens between two or three people by mutual consent; desperate couples and future surrogates’ families will find a way of doing it secretly. Can a woman who leaves for her native village for nine months be taken to task? It’s tough to push such laws. Do you think kidney transplant rackets have stopped and all such transplants are altruistic?”

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Cultural diplomacy as instrument of soft power is underestimated

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ht-logoShailaja Chandra | Updated: Oct 21, 2016 23:21 IST

The Namaste India festival was launched I was in Paris in a French museum — at the Musee Guimet devoted to Asian culture (REUTERS)
The Namaste India festival was launched I was in Paris in a French museum — at the Musee Guimet devoted to Asian culture (REUTERS)

Last month when the Namaste India festival was launched I was in Paris in a French museum — at the Musee Guimet devoted to Asian culture. I joined a queue of people into the auditorium to find an intense discussion on new wave Indian cinema. The panellists and audience, all French, exhibited an deep interest in Indian cinema, an advantage we ought to have exploited long ago by creating a pool of film commentators to discuss the socio-political environment on which parallel Indian cinema is based.

Cultural diplomacy is accepted as a powerful instrument of soft power whose outreach is often underestimated. It has been found to be the most effective way of influencing foreign audiences. Other countries reach out to the youth, non-elite and other audiences outside the traditional embassy circuit because this form of diplomacy derives its credibility when it is seen as being independent of government institutions. Instead, our official cultural institutions are directly marketing culture in a way that is often hackneyed, stale and superficial — cardboard cut-outs of the real thing.

People are tired of the same old stuff and all the Indian stereotypes that have been done to death. Instead of a fresh approach to contemporary realities there is a bureaucratisation of culture and far from seeking inputs from artistes, intellectuals and professionals, government organisations and officials decide what to showcase and how. Sadly patronage often has its role in all this, resulting in the resurrection of individuals who have been around for decades. Repackaged content, which we have showcased for decades, no longer attracts audiences who can easily access the best productions at the touch of a button.

Professor Alain Supiot of the College de France and the founder of the Institute of Advanced Studies at Nantes in France feels that “there is a need for the intellectual horizons of culture to go beyond western ways of thinking to establish a dialogue between cultures. The focus of cultural exchange should embrace culture in its broadest sense of the term, by being attentive to the diversity of civilisations.”

For this to happen, there must be an understanding of what French people want. Discussions with Indian authors are big attractions but not two years after a book is released. Textiles are another. “French people are enthralled by Indian textiles and the art of embroidery, weaving and block printing from so many regions” commented an avid admirer of India and who has long been a leading light of the Parisian couture industry. Another comment I heard was “why do you not introduce veg/ non-veg express thalis as a diversion from those “sempiternelle” (French for eternal) pizzas? Or run a shopping arcade of Indian groceries next to Gare du Nord railway terminus?”

And that brings one to ask whatever happened to the Indian cultural centre in Paris? What is the story behind why premises purchased years ago are still lying unused even as Namaste India is launched with so much fanfare? The property bought by the embassy is beautifully located within walking distance of the Eiffel Tower, the Qui de Bramley, and a host of cultural centres representing foreign countries. Possibly a critical CAG paragraph, lack of funds or simple apathy prevents the Centre from starting to function.

What is needed is an effort to refurbish our efforts at cultural diplomacy to demonstrate to a foreign audience that we have the ability to collect and interpret ourselves in a way that responds imaginatively to what people want. We need at the helm of affairs persons who have an understanding of local attitudes that transient embassy employees cannot possess. We also need some way of ensuring that the people who decide how to represent India abroad have the necessary gravitas and the intellectual bandwidth to do so.

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Political grandstanding, official disengagement have made MCD mess ugly: Former Delhi Chief Secy

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firstpost by Tarique Anwar Feb 5, 2016 18:35 IST

Amid the blame game and confrontation between the Aam Aadmi Party-led Delhi government and the Bharatiya Janata Party-led municipal corporations, the indefinite strike of the civic body employees entered its tenth day on Friday. Despite the Delhi High Court’s intervention and a stern warning by commissioners of North and East MCDs to employees to call off the strike and resume duties with “immediate effect or face action”, the striking doctors, paramedical staff, engineers, teachers and sanitation workers are not ready to bow down. They are demanding a “permanent solution” to their salary problem.

Firstpost spoke to former Delhi Chief Secretary Shailaja Chandra and sought to know from her the origin of the present crisis. She said every year the commissioners of the corporation – during her time it was a single entity – would plead for a grant or a soft loan to clear the salaries of the employees, citing reasons why the corporation had run short of funds. Invariably, the lament from the corporation even then was that the finance and urban development departments had not taken important factors into account and omitted making provisions for supporting MCD.

MCD-strike_PTI2

“It was a regular feature and had happened during my tenure as chief secretary as well. But it used to be resolved with some give and take on both sides. The effort being to harmonise the points of view of the finance department and the municipal corporation. Politics never came into the picture. If the impasse continued, the discussions were raised at the level of the chief minister and there would invariably get resolved.

“In no case did the differences reach the media and certainly not the streets by allowing mounds of garbage to accumulate everywhere. The bottom line was very simple: a solution had to be found and citizens should not be harassed, come what may. It was an unwritten understanding and the political executive and officers from the government and the MCD understood this,” she said.

“This dispute is an annual feature and is something that can be resolved. If there are anomalies caused by trifurcation, these have to be addressed and solutions found. The answer does not lie in blaming each other and stopping salaries,” she said.

Asked how the issues used to be resolved earlier, she explained, “There was always disagreement. Either the finance secretary or the chief secretary would take a call. Or if that did not work, the corporation commissioner would raise the level by meeting the chief minister (CM) or the lieutenant governor (LG) and seek their intervention because the matter was not receiving due attention at the official level. Despite the NCT government and the central government being from different and opposing political parties, the CM or the LG always used to give a hearing and take an administrative decision.”

Why is the same not happening now?

Because unfortunately, according to the former bureaucrat, it has become a subject for political grandstanding in full public view. Also worrying is the fact that officers do not seem to be exerting themselves perhaps because their advice is not heeded. “Officers find solutions when they are asked to do it. But if they are told to stay away, why will they give any suggestion and how will anything ever get done? After all, you may have any number of advisers but if you don’t rely on precedents and the institutional memory available confusion will take over,” she added.

Moreover no one, said Chandra, is exerting themselves to raise revenue. “If some drastic improvement is promised through taxation, public will go along but first they must see a tangible benefit which will come in a time-bound manner. If such an approach is adopted, the government may also not mind doing some temporary hand-holding. But one does not find that vision in the corporations,” she said.

The former chief secretary is not convinced that funds of the order claimed have been denied by the Delhi government “because from the figures put out in the press, which have not been contradicted by anybody, it is apparent that the government has been incrementally raising the amount of money given every year. And in no way has it gone down this year”.

It means, according to Chandra, the corporations – particularly the North and the East – have failed to raise property taxes, which is very irresponsible.

When the unit area method of tax calculation was introduced, the understanding was that a Municipal Valuation Committee would be set up every two years which would recommend raising house tax proportionately. There are A to F category colonies and the number of dwelling units is known.

“In such a legislation, one can tax the colonies having more facilities at a higher rate and reduce it as one moves downwards to less affluent areas. But you cannot maintain status quo for more than 12 years, which is what they have done from 2003 (when the Act came into effect). Definitely if the scope of revenue collection is skewed in favour of South MCD (which is considered rich), it has to be set right through discussion and if that fails through legislation. But first the anomalies and the reasons for it have to be pinpointed leaving no room for claims and counter-claims as is happening now,” she said.

Of course, she said, South MCD is the newer part of the city with large organised residential colonies, expensive properties. But always saying that they are rich and we are poor is not a “tenable argument” because it is just a statement.

“Nobody so far has actually given the exact number of properties within the tax net in all the three corporations and the numbers that have been ignored either because of apathy or connivance. For any financial decision, one must have a figure on the number of dwelling units falling in categories A to H and how many dwellers are actually paying you taxes. Whole of the Walled City in North Delhi is also very congested and raising taxes there may not be easy or practical,” she said.

“Another argument is that East DMC has less income because it has too many unauthorised colonies but what proportion of their populace resides in these colonies? Are the regularised ones paying taxes? East DMC must declare the number of the taxable properties lying in its jurisdiction which are not being taxed. If they are in so much in the red, they should think of innovative measures to raise money,” she said and suggested few measures:

Why are people being permitted to park their vehicles on the roads at night? All the three civic bodies can independently or collectively frame policies to charge people heavily for using public space for private use. The same goes for cars and sentry boxes parked on pavements. As for those who display merchandise on the market pavements, they should be liable to be fined heavily or rent taken if they are being permitted to display or sell goods from public spaces.

It needs regulation and enforcement – but neither is being done. In all markets in the city, the pavements have completely been encroached upon. The fine is too low. Why? What steps are the Delhi government and the MCDs taking to increase income?

“I think that there may be a little truth in the fact that when it was a unified MCD, it was easier to take money from one pocket and put it into another and have some sort of equity. But it cannot become a lifetime excuse,” she added.

Asked why the Fourth Finance Commission, as demanded by the BJP, was not implemented and how legal is the Delhi government’s response that it would accept it only if the panel’s recommendation for handing over the DDA is accepted by the Centre, she replied “The recommendations of the Finance Commission could have been considered and implemented during President’s rule but perhaps being a complex and contentious matter, it was left for an elected government to take a view.”

She added: “When the government took over, it took the approach that the Finance Commission’s recommendations should be implemented fully. Along with the devolution of a percentage of the Delhi government’s resources on the MCDs, it has been stated by AAP spokesmen on TV channels that there were recommendations relating to handing over DDA to the Delhi government. But so far, no one has belled the cat. On a broader plane, if the report has indeed made recommendations relating to the DDA (I have not read the report ) but if it is correct, it is totally outside the purview of the Finance Commission. DDA deals with land, which is not constitutionally under the Delhi government. So, in a way, the AAP government is asking for a constitutional amendment while highlighting the narrow recommendation relating to the DDA. Therefore, it is not implementable and the whole matter has remained up in the clouds.”

Speaking from Bengaluru, where he is undergoing naturopathy treatment, Chief Minister Kejriwal on Wednesday announced a bailout package of Rs 693 crore in a bid to woo the agitating workers of the municipal corporations. He also said, “You cannot tell us to give the money and not give us DDA which is our due and integral to the Finance Commission’s recommendation.”

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Fighting dengue: Too many questions, very few answers

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HT logoShailaja Chandra | Updated: Sep 21, 2015 01:23 IST

A view of Hindu Rao Hospital's dengue ward. Dengue continues to be rampant in New Delhi. (Saumya Khandelwal/ HT Photo)
A view of Hindu Rao Hospital’s dengue ward. Dengue continues to be rampant in New Delhi. (Saumya Khandelwal/ HT Photo)

The dengue deaths in Delhi have brought to the fore the apathy and ineptitude of the city’s hospitals. They have also exposed the acute absence of coordination between those responsible for health care services and the people.

The dengue epidemic in Delhi is still to peak: It is only by mid-November that the visitation from Aedes Aegypti mosquitoes that spread dengue will end. So unless and until there is clarity about response and responsibility, the number of cases and deaths will spiral, not just in Delhi but in other states too. In fact, of late, there has been an increase in the number of dengue cases across Southeast Asia. The World Health Organization has put out several preventive strategies that are being used by other countries, underscoring the point that dengue epidemics are an indication of the failure of a country’s public health system.

The preventive measures undertaken by the three municipal corporations of Delhi this year have been abysmal and we must seek answers to several questions: How many sanitary inspectors are available for each of the city’s 272 wards? How many institutions and individuals have been fined for ignoring mosquito breeding on their premises? What is the amount of fines levied on them each month? How many places with stagnant water have been covered or treated? What is the ward-wise result of anti-larval measures undertaken in July, August and September? Did the city’s health department provide resources on a normative basis for insecticides, wages and test monitors? Did the officials take notice when the preparation for the dengue season was found unsatisfactory? No one seems to have hard data or credible answers to these questions.

Instead, all we hear are persistent laments about the non-cooperation of private hospitals and implausible claims of increasing beds (sans commensurate medical manpower). This quest for adding more beds is diverting attention from the important referral and case management issues. Delhi’s health department had the responsibility (starting June 2015) to identify tertiary and secondary care hospitals (both in the government and private sectors) and link them for managing dengue-related medical emergencies.

Denouncing private hospitals without notifying the system to be followed by them is the best way of losing allies. The city has some 22 public sector hospitals and more than 30 hospitals in the private sector that have blood banks. At least, a third of all these hospitals could have been designated as nodal centres for providing blood components to attached satellite hospitals.

Undoubtedly public sector hospitals have to bear the brunt of epidemics, despite being over stretched even in normal times. But certainly more than 60 private hospitals in Delhi, which run emergency departments 24X7, can support them. Private hospitals cannot deny competence and refuse dengue patients. Most often, all that is required is to observe and interpret the vital parameters of a patient and provide immediate intervention. Checking blood pressure, administering intravenous fluids, assessing laboratory test results and getting fresh tests done are among the basics that any hospital claiming to run an emergency department has to provide. Hospitals which claim inability to perform these services should be directed to close down their emergency departments.

A canard is being spread that the government has no powers to enlist private hospitals. This is untrue. All private hospitals require a plethora of approvals from the government and they have to comply with a host of laws. As such they respect government authority and respond to reasonable appeals for short-term support during emergencies. No private hospital would wilfully risk losing goodwill by getting publicly shamed for callousness.

Every doctor wants to heal and emergencies often bring out their best. But for this to happen everyone in the hierarchy and in the wider network of health facilities must understand roles and responsibilities. Once they do that, written instructions need to be issued in simple, consistent and implementable language. Those links are missing today. Central monitoring of availability of beds and dengue admissions in designated hospitals would further promote quick response and accountability and the Union health ministry and the Delhi government need to jointly operationalise this. Most important, the network of emergency and tertiary facilities must be notified locality–wise, using all forms of communication.

Dengue management is comparatively routine work, but it can suddenly become complex and daunting. Unlike many other medical emergencies, dengue has the added disadvantage of becoming life-threatening just when signs of recovery show. So if a hospital (government or private) lacks the capacity to deal with a patient, there has to be a common protocol for transferring a case to another designated hospital. Otherwise the tendency to first refuse admission and then push less educated and poorer patients out will not abate.

This phenomenon was studied by the Law Commission, which gave a report in 2006 based on The Emergency Medical Treatment and Labour Act of the United States, also called the ‘Patient Dumping Law’. Once US hospitals too refused to accept poor or uninsured patients brought in an emergency medical condition. The Commission not only gave a comprehensive report on emergency medical care but also provided a model law for the use of state governments, including a protocol for transferring patients. The Delhi government would do well to adopt portions of the Bill. The Centre is unlikely to stand in the way.

Most importantly, without 24×7 political will to confront these challenges, prospects of overcoming dengue appear doomed, and mid-November is still a long way off.

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