Some Book Reviews

BOOK REVIEW – Unqualified Medical Practitioners in India

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Unqualified Medical Practitionersin India – The Legal, Medical and Social Dimensions of their Practice

e-Report by Shailaja Chandra, Shiv Nadar University, New Delhi

Existence of Unqualified Medical Practitioners (UMP), commonly referred as quacks is known to most of Indians: It took a person like Shailaja Chandra a distinguished administrator from the Indian Administrative Services to embark on a detailed study on UMPs in India. It is so difficult to publish and distribute books in today’s digital India and hence this publication has been simply put out on the digital platform as an e-book.

The contents of the book is in fact a report by the author on an extensive analysis covering the legal, medical and social dimensions of the unrecognized and illegal healthcare delivery undertaken by the UMPs in the nation.

The report spanning over 11 chapters cover a wide ground. The magnitude of unqualified practice forms chapter 2 after an exhaustive but crisp introductory chapter on the perspectives of the area. The author perhaps for the first time has conducted a limited market survey and documents the finding of the survey in chapter 3. The origin of quacks, where from they come, how they get qualified to do what they are doing, occupation and earnings as a doctor, how they update their knowledge on diseases and medicines and the whole gamut of their operations. The sinister linkages of UMPs with qualified and registered doctors in the vicinity including the financial dealings are well captured in this chapter 4. The nexus between pharmaceutical firms and UMPs and doctors are also covered in this chapter. The contents of this chapter is really damning and would have made real “breaking news” if any media takes it up. However in the later chapters the changing scenario and a limited but positive role played by UMPs in providing healthcare and treatment to the poor and needy is captured.

The emergence of an approach to train such UMPs to limited aspects of the diagnosis and treatment thereby providing some legitimacy to their positive contribution and reducing the risk of their medical practice is discussed by the author. Any sensitive reader aware of the problems of effective healthcare delivery in a vast country like ours would be emotionally moved to read the overall apathy, non-application of policies, and a recognition of the existence of UMPs by the parliamentarians, administrators, healthcare professional groups and even the courts. The description of responses received from The Delhi Medical Council,The Indian Medical Association, Health Policy Administrators is so disappointing and clearly defines the territory protection and turf war only and not any honest attempt being made towards either completely banning and eliminating quackery and UMPs from the system or finding practical implementable solutions to combat the problem of practice by quacks.

A good analysis of the regulatory provisions applicable to UMPs are dealt in the chapter 9 on law on UMPs. One silver lining of West Bengal example where experiments are ongoing to provide limited professional training to UMPs in specific disease areas post which they are being used to provide primary support in healthcare is documented in chapter 10. The author provides possible approaches for way ahead to tackle this area, which are still solutions in the fringe but does not provide a bite the bullet solutions. The book/report does not provide existence of quackery and their impacts in other parts of the globe nor strongly recommends implementable practical solutions. Perhaps this is not part of the project and study undertaken under the Center for Public Affairs and Critical Theory – C-Pact of Shiv Nadar University.

The report is an eye opener providing exhaustive coverage of all aspects of UMPs, and it would be worthwhile to follow-up by a nationwide market research to quantify the existence and extent of UMPs across the country.

A non-conventional disruptive change initiative is needed in this area. Society will force changes even if regulations or professions do not do so as consumers perhaps will push the boundaries. A similar study on the existence and extent of unqualified paramedical professionals including pharmacists, diagnostic lab personnel is the need of today. Students of Pharmacy Practice, Presidents & Secretaries of Pharmacy Councils new emerging courses in healthcare delivery related subjects, management graduates can take leaf out of the report for their knowledge and research in healthcare practice deliveries.

Long years of administrative expertise of the author/ investigator is truly reflected in this study and so well written report.

Dr D B Anantha Narayana, Bengaluru


Book Review – Female Foeticide – Myth and Reality

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Book review- Female Foeticide – Myth and Reality by Anurag Agarwal

Female Foeticide – Myth and Reality
Anurag Agarwal
Pages – 104
Price – Rs.300/-

Smt Shailaja Chandra
Former Secretary, Department of AYUSH, Government of India and Chief Secretary, Delhi

The book is an analysis of interviews of 374 women who underwent sex determination tests leading to female foeticide. A questionnaire was prepared and administered by volunteers belonging to an NGO. The main objective of the study was to understand the psyche of women who have undergone female foeticide. The survey covered 17 districts Punjab and it was conducted over a three-month period from November 2001 to January 2002. The interviewers were given a one-day orientation program and the training was imparted under the supervision of the concerned ANM/multipurpose health workers (female).

The questionnaire had 40 questions and the respondents were classified according to economic status. The analysis was undertaken by a computer engineer and doctors of the Punjab Health Systems Corporation who developed their own software. Some of the more important and qualitative questions put to the women respondents relate to:

· Whether belonging to the joint family structure,

· Whether they already had living children,

· Whether they already had a male child/female child,

· Awareness about prenatal testing and the source of this knowledge,

· Perceptions on whether the mother should know about the sex of the unborn child,

· Reasons why preference is given to the boy child.

· Perception about the status of women who had a son,

· Whether maltreatment was meted out for not having a male child

· Mode of maltreatment,

· Number of induced abortions,

· Feelings experienced before the ultrasonography,

· Reasons for undergoing sex determination and who suggested going in for female foeticide,

· Whether the respondent would repeat female foeticide and the number of attempts made to have a male child.

The findings show that women belonging to the upper strata of society tend to opt for sex determination and female foeticide more than the lower strata of society. There are different reasons for this but on the whole the findings show that caste, education, religion and financial status do not affect the data on gender bias and the son preference is prevalent all through but significantly higher among the more affluent and educated.

An important finding was that in 75% of the cases the respondents were pressurised by the husband and in-laws as well as parents to have the procedure done.

From all this, the author concludes that religious advocacy is not going to work and needs to be modified by reducing the monopoly of males in the religious ceremonies. He also advocates that the belief that only sons carry the family name forward and those daughters are somebody else’s wealth needs to be corrected through specific strategies.

The study also brings out that more than 60% of the women respondents stated that they would try up to 3 times for a male child and some even four times which shows the level of desperation to have a male child.

It is not clear whether the statistical methodology is robust enough to withstand technical review but even if the book is used to understand trends as well as factors that influence families in opting for sex determination, it is an extremely useful study. This book was published in 2003 and therefore much of what is written there is now very well-known and borne out by up-to-date research studies and publications. Nonetheless, the book teaches young civil servants and particularly officers who are posted in critical positions as Deputy Commissioners/District Magistrates or those entering the health sector at a senior level the issues connected with son preference and gender bias as seen from the point of view of the would-be mothers. This approach is useful because instead of castigating the role of gynaecologists, radiologists and the systemic failure of the state apparatus, the book focuses almost entirely upon the knowledge, attitudes, beliefs and practices of families belonging to different economic strata.

Book Review – The Honest Always Stand Alone

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Book review- The Honest Always Stand Alone by C. G. Somiah
Niyogi Books ,New Delhi ,2010

Honest Always Stand AloneThe Honest Always Stand Alone
C. G. Somiah
Niyogi Books ,New Delhi ,2010
Pages – 276
Price – Rs.395/-
Shailaja Chandra
Former Secretary, Department of AYUSH, Government of India and Chief Secretary, Delhi

This book published in 2010 should be read by civil servants and particularly IAS officers because the autobiography represents a career that is no longer replicable. It is a reflection on what the service once stood for and also a time when civil servants were respected for their competence, integrity and forthrightness.

Somiah’s book reads like an uninterrupted journey of one notable achievement after another and to that extent the title is misleading. Far from “standing alone”, Somiah benefited hugely by the high standards and respect for the civil service that prevailed in his time, albeit not without some aberrations.

Much has been made of his refusal to acquiesce in granting relief to tendu leaf contractors in Orissa which earned him an average entry in his ACR only to be annulled when a commission of enquiry vindicated his stand. The story is not compelling in the present context when officers are confronted with similar situations very frequently and have perforce to reconcile themselves to the fact that they have to perform a duty even when the system may not stand by them. Outsiders to the civil service will nonetheless look upon the tendu leaf story as evidence of Somiah’s toughness.

Somiah’s career cannot be compared with that of present day serving and recently retired officers. He remained with the Government of India continuously from the early eighties, all through functioning at the level of Secretary to Government until he was appointed as union Home Secretary, followed by Central Vigilance Commissioner and finally the Comptroller and Auditor General of India – a position he held until 1995. It only shows that the career profile of those recruited in the 1950s was very different from those who had joined several decades later, when the window of opportunity to serve at the topmost levels, has shrunk enormously.

The book is replete with examples of his interactions with Rajiv Gandhi, Narasimha Rao, Buta Singh, Arun Nehru, Dr Manmohan Singh and many others. The anecdotes bring out their individual personality traits and style of functioning and display the immaturity, peremptoriness, pique, procrastination and obsequiousness of different players at different moments. Told in an unaffected and casual manner there is no shade of malice and yet each episode captures the moment, supported by sufficient detail to make the accounts interesting and credible.

More important than the episodes are the descriptions of the decision-making process at the highest levels – at times rule-bound and structured and at others, informal and dependent on personal trust and understanding. This is particularly evident when Somiah describes his role as the union Home Secretary when the stand-off between Buta Singh and Arun Nehru was taking place, the attempt at the Prime Minister’s assassination at Rajghat, the unprecedented rise of terrorism, his negation of the Governor’s plan to enter the Golden Temple, including embargoing any unilateral action without consulting the Centre and his successful batting for the deployment of the National Security Guards (NSG) to surround the Golden Temple. These incidents and many more are described along with the attendant pulls and pressures that perforce form the backdrop of any high-level decision making process. Each anecdote brings out the pivotal position that the Home Secretary played and how important and convincing Somiah’s own role was.

Another story which comes out in a first person relates to the Shah Bano case and the role played by Arif Mahmood Khan and the eventual enactment of the Muslim woman (protection of rights of divorce) act – widely seen as an act of appeasement to win the Muslim vote.

Similarly his account of personally reading Satanic verses by Salman Rushdie and concluding that the book needed to be banned in the interest of mainstreaming law and order in the country comes as something of a surprise. How many people know that one individual could take such a decision?

An incident of labour unrest in the Indian Express and the manner in which he refused to acquiesce to the demands of the editor Arun Shourie and told him “ he could do his worst” shows that Somiah was a man with a backbone and capable of rare plain speaking.

The book is replete with anecdotes involving many officers who are no longer alive or are well into their 80s. They were considered stalwarts in their days and the sense of esprit de corps that existed comes out very well.

There are also numerous accounts of Somiah’s visits abroad and within the country and his love for nature, greenery; wildlife and the simple joys a close family life. These interludes are diversions from the main story which remains focused on his own career graph which went from strength to strength and never saw a U-turn. The descriptions of numerous official and personal visits and vacations however lack the spice and imagery which could have made them memorable. They only serve to show that Somiah had a happy family and enjoyed his forays into the countryside immensely, thereby driving home the point that it is possible to hold a powerful office – in fact several powerful offices including that of the CVC and the CAG and not allow official regalia to usurp the space that should stay devoted to family life.

This book delves into a past that has unfortunately left us forever. Still it remains a fairly accurate historical account of how things were managed within the government and to that extent it is certainly worth reading by younger civil servants who want to read about “the good old days.”


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Book review- THE ACROBATICS OF CHANGE by Moid Siddiqui and R.H.Khwaja

Acrobatics of Change
Moid Siddiqui and R.H.Khwaja
Sage Publishers ,2008
Pages – 304
Price – Rs.450/-
Shailaja Chandra
Former Secretary, Department of AYUSH, Government of India and Chief Secretary, Delhi


The first part of the book is written by Moid Siddiqui, a senior corporate professional possessing considerable experience in the public sector.

Siddiqui’s portion of the book has two sections and 12 chapters, each chapter introduced by a quotation which moralises about the lessons to follow. The book is full of fables, parables and stories from mythology. His analogy of change management being akin to a trapeze act is persuasive. The criticality of understanding the need for change and boldly exchanging the swing to land on the opposite platform of the trapeze is used to depict the difference between “statusquoists” and those who seize opportunity. The lesson held out is that there will always be hindrances and limitations and an unwillingness to shrug oneself from the “comfort zone,” but unless that is overcome, there can be no new beginnings. He however cautions that the change process needs to be punctuated at the right intervals.

In the section on change techniques, Siddiqui describes the five hats that change-makers must don; or the five associates one must find to play five different roles. These are the role of the discoverer – Columbus, the artist who presents a new way of looking at things, the judge who is both critical and constructive, the Sufi who plays the role of the conscience- keeper and finally the warrior who doubles up as general and soldier. Not only does Siddiqui formulate a sequence for each such persona but follows it up with a portfolio management and strategic analysis for each player. Inevitably all this leads to subchapters, boxes, numerals and bullet points – making the book sound like a heavy version of the usual management books.

Siddiqui’s tips and techniques, some ascribed to Japanese examples ultimately percolate down to questioning the ‘why’ of a problem and the ‘how’ of solving it. This is followed by dwelling on the benefits of brainstorming, trigger sessions, wild idea sessions, SWOT analysis and suggestion schemes – all well-known techniques-but not necessarily practical for those who have to grapple with priorities that change each day.

Later, Siddiqui recounts three stories of success that is of Hindustan Machine Tools (HMT), Bharat Earth Movers Ltd (BEML) and the Nagarjuna Group’s achievements, all examples of great leadership which had sometimes to be sacrificed at the altar of misplaced policies, squandering away the glory of past accomplishments.

The first part of the book is then a good read for middle level public sector managers who need stories and parables to relate to situations. However it is not of much practical value to top executives and managers or for that matter senior officers working in the government, simply because the urgency and criticality of what they confront cannot be addressed through management homilies.


The second part of the book is written by R.H.Khwaja IAS officer who was the Chairman and Managing Director of Singareni Collieries Company (SCCL).The enormity of what was achieved at Singareni has been captured very effectively in the author’s Annexures at the end of the book which depict a spectacular turnaround for SCCL: the accumulated losses in 1997 were more than RS.1200 crores. In nine years the company wiped out all its debts and became profitable. Coal production and dispatches improved by nearly 25% when the workforce was decreased by 25%. The number of strikes reduced from 310 witnessed in the pre-reform period to just 11, nine years later. The welfare expenditure per employee went up from around Rs 14,000 to Rs. 54,000. Nonetheless it remains a sincere effort at acknowledging and saluting the good work of all those who helped Khwaja achieve what he did.

One strong message that come out extremely well and should be something which Indian Chief Ministers should be reminded about, is the tremendous political will and support that was extended to him by the then Chief Minister of Andhra Pradesh. It is very easy to appreciate how a supportive Chief Minister can make or break organisations as well as their Chief Executives.

Khwaja tells of two stories when Singareni collieries (SCCL) had to confront twin disasters in the year 2003 which had a vastly sobering influence on the management. In one disaster, 17 workers perished due to water inundation and in another a roof collapse led to the death of 10 miners. Both these disasters could have completely demoralised senior managers besides leading to terrible labour unrest and the immediate transfer (and humiliation) of the CMD. But Khwaja recounts how they overcame adversity and even after he offered to leave, the Chief Minister stood by him and he continued. In these days of intolerance for the role of the civil servant and the leadership role he plays, the SCCL story reinforces faith in the system and reinforces a belief that trust begets trust.

Taken as a whole, it is a story of what can come about when relations between the PSU and the government are good; the loyalty that a kind, considerate and sympathetic CMD can command; and most important of all – what a level-headed Chief Minister can do to support good officers and good organisations. Equally it is a story of how small but thoughtful investments in people, and in this case the coal miners could reap huge dividends for the company. It also shows how a little generosity from the top can go a long way in winning the trust and loyalty of labour.

Book Review – Missing Girls

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Book review- Missing Girls by Dr Manohar Agnani

Missing Girls

Missing Girls
Dr Manohar Agnani
Books for Change ,2006
Pages – 153
Price – Rs.180/-

Smt Shailaja Chandra
Former Secretary, Department of AYUSH, Government of India and Chief Secretary, Delhi

This book though small in size seeks to cover a vast gamut of issues connected with female foeticide. It has chapters devoted to what the Census 2001 brought out in terms of states and districts with low sex ratio. For a person looking for comparisons it gives a good foundation to compare the data now available in the Census 2011.

The author has criticised the National Population Policy (2000) for sending out a strong message about the small family norm while completely ignoring that that norm should have been linked to freedom from sex bias. He goes on to analyse the Millennium Development Goals; the National Development Goals and other policy documents pointing out that none of the programs address the problem of gender imbalance although the subject is of such critical importance.

In a subsequent chapter Agnani has tabled a few examples of ambiguous messages which not only confuse the public but are patriarchal and patronising in their own way.

In a chapter titled “Catching the Culprits”, he has shown that it is possible to nab the main players by scrutinising and verifying the data supplied in various returns which have to be filed under the schedules attached to the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 (as amended). He has however repeated what various experts he has alluded to in ‘the author’s note’ have propounded but has not commented upon whether the failure to follow up on these prescriptions has been on account of connivance on the part of the district authority (Chief Medical and Health Officer CMHO) or it is due to inadequate technical capacity or any other reason. The author is in favour of implementing the existing law without seeking amendments and feels that it has sufficient wherewithal to address the menace of female foeticide. That begs the question as to why things have failed to fall into place.

The answer seems to lie in the chapter on the “Morena Experience” but the author has not said so in so many words.

On the whole the book is a sincere account of what the author observed and experienced and is based upon a sound public health grounding as well as experience of government functioning. Although one can differ with the author’s opinions at many places, he must be credited with bringing to the table a very useful and provocative account of the subject of female foeticide.

The book is by no means an academic piece of work because it does not reference portions where the author has relied upon the work of other experts and opinion makers. Although there is a bibliography at the end, it is not possible to make out which assumptions and conclusions have been made on the basis of the published work of various people and how much it is the product of the author’s own perception.

From the point of view of civil servants, particularly those working in the health sector, the chapter on Morena district presents a case study which is an eye-opener and should be taken forward for further analysis and discussion at the appropriate forum. In the chapter on “The Way out”, several suggestions have been given as to how a change in attitudes can be brought about. Some of these constitute simple prescriptions which can be implemented without any great change of policy at the national or state level and could form the basis for discussion along with the Morena case study, particularly during in-service training programs for civil servants.

Book Review-Squatting with Dignity – Lessons from India

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Squatting with Dignity – Lessons from India


Kumar Alok
SAGE Publications Pvt. Ltd ,2010
Pages – 412
Price – Rs.495/- (Paperback)
Smt Shailaja Chandra
Former Secretary, Department of AYUSH, Government of India and Chief Secretary, Delhi

Squatting with Dignity is a book on rural sanitation in India written by a professional but for the most part presented like a compendium of information on the history, implementation strategies, systems, geographical spread, achievements and challenges of this sector. The book provides many useful insights, particularly the success of the Midnapore example which stimulated an interest in and support for rural sanitation, a subject which hitherto had been a comparatively neglected sector. The growth of the Total Sanitation Campaign (TSC) of the Government of India, the institution of the Nirmal Gram Puraskar Awards, and the enthusiastic response from the Panchayats would be of direct interest to officers working in the area of rural sanitation in the Central and state Governments as well as subject specialists, NGOs and researchers.

The book is replete with descriptions of dealing with a range of stakeholders many of whom had different world-views. The insistence by specific stakeholders on acceptance of a particular point of view, the compromises and U-turns that had to be made at times provide material for a case study on departmental pulls and pressures which exist almost in all areas of development.

The book makes impressive reading in its presentation of the exponential growth of the sanitation sector and the policy and financial backing that the sector received in the decade post 2000 evinced by a doubling of outlay during the 10th plan period. This is heartening in two ways: first as the author puts it, sometimes impossible looking goals do become possible. Second, the country was able to manage the program through its own resources and to sever dependency on external partners showing also how the Government systems can be sympathetic, even supportive, once convinced. The history of the Nirmal Gram Puraskar (NGP) and the enthusiasm with which the panchayats responded to the challenge has been brought out very well and gives the hope that relatively simple ideas can indeed lead to big transformation.

An interesting story relates to how the whole business of deciding whether to use the Sholay movie as the theme for developing a communication strategy for sanitation witnessed its own internal drama within the Department. In another episode the author recounts how the monitoring division of the Department distributed funds to small players, eventually leading to an exercise in futility as often happens. But this eventually led to the concept of Report Cards being later introduced for the TSC which became a powerful tool for data analysis.

The chapter dealing with ‘Geographical Spread’ would be of interest to State Government officials working in the rural sanitation sector as it brings out the difference in levels of leadership and enthusiasm between the states.

The last chapter titled ‘The Way Forward’ gives many ideas on future partnerships and collaborations in areas like management, recycling, vermiculture and methane gas production.

This however is not a book for a general or rather casual reader as it is full of acronyms and somewhat tedious explanations of processes which, only those who have worked in the sector would relate to. While there are some interesting accounts of working with specific bureaucrats, particularly Secretaries of the Department who brought with them an individualism which influenced and often changed policy-making and strategising, the large number of references to such officers (who get transferred or retire within a couple of years and are soon forgotten), detracts from the focus, somewhat.

Also missing is a commentary on why we still see so much open defecation and whether the building of toilets has actually led to behaviour change and improved health outcomes in terms of the big picture.

The book also makes several references to ancient texts, quotations in Sanskrit, references to Mahatma Gandhi which have been treated as highly controversial by a reviewer Ravi Batharan writing for the Economic and Political Weekly in December 2011. It is possible that some people may agree with Batharan’s view that the title of the book ‘Squatting with Dignity’ does not address the question of “whose dignity?” Indeed while the terrible problems faced by women and the near absence of privacy and dignity have been brought out well, issues like scavenging, caste-based societal functions have been passed over. Some of these questions may not come under the purview of the rural sanitation programme but since they are fundamental to understanding the social justice aspects of the sector, it does leave a gap in the mind of the reader.