Global Gender Gap, promoting gender equality, gender equality
|Several recent reports put India at the bottom when it comes to gender equality. It is time for a clearly-spelt new policy on women and development. SHAILAJA CHANDRA|
“By and large the attitude of a man towards his wife is possibly worse than his attitude towards his buffalo.”
Human Rights Lawyer
The World Economic Forum, in a report titled the Global Gender Gap 2009, has quantified the magnitude of gender-based disparity in 134 countries. Appallingly, India ranks the very last on health and survival and is at the 114th position overall. Comparing Gender Equality derived from three National Family Health Surveys spanning 13 years, a report published by the International Institute of Population Studies (IIPS Mumbai 2009) also presents a miserable picture. Far from improving, the gender gap is widening.
Child Sex ratio: Punjab and Haryana continue to have the lowest sex ratios in the country but surprisingly in the smugly superior South, all states, even Kerala, have registered an adverse child sex ratio. Jharkhand followed by three northeastern states have the best female child sex ratios countrywide which suggests that tribal societies recognise the need for a balanced sex ratio and gender equity.
Education and employment: The IIPS report shows that among married women from 25 to 49, only one out of five women had completed 10 or more years of education. So, despite the hype, every time a rare woman breaks into a man’s professional preserve or cracks a cerebral examination, only 7 per cent of Indian women are employed in professional or managerial occupations; and the proportional increase has been just 1 per cent between each survey. A vast majority of women continue to be engaged in dead-end agricultural operations the proportion of which has grown in the last 13 years.
Age of marriage: Comparisons over 13 years also show that the median age at marriage for women aged 25 to 49 was 16.8; about six years lower than that for men. In a period of one and a half decades, the age at marriage within this group had not gone up by a single year. This when the legal age of marriage has been 18 for decades! The National Population Policy 2000 had advocated that marriages should take place only after 18 and preferably after 20 years of age. How can a country continue to blatantly ignore its own policy and that too when the Supreme Court of India has directed that all marriages regardless of religion, must be registered?
Unmet need for contraception: Since not even half the couples in the reproductive age group use any contraception, anaemic, adolescent girls and malnourished women continue to deliver underweight children, who either succumb or become prey to infancy and childhood diseases. The “cafeteria approach” to family planning has failed to prevent unwanted pregnancies or lower the fertility rate, substantially.
Needed change: According to Prabhat Kumar, a former Cabinet Secretary, there was a downright refusal on the part of the key Central Ministry in charge of women’s development to prepare a comprehensive gender policy even when directed to. The reason is not far to find. A policy paper would raise questions and ring uncertainty for bureaucracies and NGOs that have thrived thus long on repetitive, ineffective programmes. It is high time that drastic changes are made to scramble out of the quagmire that we have been stuck in for decades.
There is a need to jettison jaded programmes that have failed to deliver. Simply crowding women into a room to learn the three R-s has not taken them anywhere. The ICDS supplementary feeding programmes for preschoolers and lactating mothers, after running for three decades, have not made a dent on women’s anaemia levels or prevented severe malnutrition in children. Sex determination, far from being halted, has grown among the educated and affluent and quietly leeched into the hinterland also. Those in charge of enforcing the legal age of marriage have utterly failed to stop the marriage of minor girls. Even the few well-intentioned schemes to popularise the birth of girls and encourage school retention have remained symbolic, having had no impact on the enormity of inequality that persists. Something is going horribly wrong.
India would do well to learn from a country like Korea which was a pitiable agrarian economy, way behind India in the 1960s but overtook us in just 20 years. This was largely possible because Korea placed a strong emphasis on creating opportunities for girls and women to become wage earners. The quest for family planning and literacy was an automatic by-product, largely self-driven.
We need a white paper accompanied by a status report on failed outcomes of programmes related to women. Taking stock of the gender divide across states, the paper should enumerate laws that are needed to create opportunities and mainstream women into educational and employment avenues, on fast track.
What should the policy contain? First, there should be a coercive law which reserves for women at least 10 per cent of all benefits given to entrepreneurs including bank loans, seats in vocational and industrial training institutions, all scholarships and all jobs cutting across the public and private sector for at least 10 years. The identification of specific jobs where women might be considered unsuitable should be left to a Commission to determine. Second, within the existing reservations for SCs, STs and OBCs, 50 per cent should be reserved for women, a step which is equally fair to both sexes and ought not to raise a battle cry from men. Third, the 2007 timorous law on prevention of child marriage should be replaced with a Draconian law that treats marriage of minors as a cognizable offence and jails parents and relatives that marry daughters before the legal age.
Fourth, a completely new Ministry should be established to handle the subject of National Competitiveness and Gender Equality. The Ministry should be made responsible for framing and amending laws, in particular those that seek to promote reservations, grant property and land tenure rights to women, oversee female absorption in educational and employment avenues and monitor implementation of the laws and schemes introduced for bridging inequality. The Ministry should also have strong linkages with finance, education, vocational training, and small industry. Unless the Cabinet Secretary reviews the progress and reports it to a Group of Ministers, the subject will not get the attention needed.
Engaging civil society
Finally, a role has to be found to engage civil society in promoting gender equality. We already have excellent examples like the Pardada Pardadi Educational Society in Bulandshahr district of Uttar Pradesh which has nurtured a sense of self-reliance in local girls. Special programmes are needed and inducements, incentives and tax benefits offered to civil society organisations that contribute effectively to such initiatives that help instil self-confidence in rural women.
If several radical measures are not taken now, India is doomed to remaining at the rock bottom when future measurements of gender equality are made. It is no longer a matter of women’s rights. It is a question of how tall the country can stand in terms of economic growth and competitiveness. Strong corrective measures are needed because this nation’s progress is clearly at stake.
Civic authorities will have to deal with the problem of strays with the seriousness it deserves
.The stray dog controversy has dogged the municipal authorities in Delhi longer than one can remember. For years animal rights activists armed with laws, rules, court rulings, research papers and editorials have scored over tongue-tied municipal officials. Even Mahatma Gandhi has been quoted and misquoted out of context with abandon.
I too profess to be a dog lover and feel sorry for the pathetic creatures that I meet, one eyed, three-legged, eye clouded over with cataract, infested with mites, but still having the spunk to bark. Who owns them? No one. The dogs are there by rights conferred by a rule that directs them to be returned to their “normal habitat”. The rule was introduced in 2001 under the Prevention of Cruelty of Animals Act, 1960 that enjoins, “Every dog shall be released at the same place or locality from where they were captured.” This is an aberration; it runs counter to the laws governing the performance of municipal functions that emphasise the need to provide safe surroundings for residents.
Privately, the MCD and the NDMC wring their hands lamenting how difficult it is to keep track of thousands of stray dogs that roam the streets of Delhi. According to them there is no way of identifying dogs which have been inoculated. Delhi’s Director-ate of Health Services used 1,70,000 rabies injections in one year. That does not include the figures of Central Government hospitals or those run by MCD that would account for thousands more.
In the Lodhi Gardens three dogs sprawl across the stone walkway. They trouble no one. But who is their owner? Admittedly, none of the dogs are a nuisance but neither are the golden retrievers and St Bernard’s that amble by, accompanied by proud owners or their menials. Both are breaking NDMC’s rules, each powerful group secretly promoting the other. The three dogs and their invisible “owners” do so 24 hours a day as unleashed dogs are prohibited. The other group does so by ignoring rules that expressly disallow the entry of dogs at given timings. NDMC knows it is best to look the other way.
The other day I visited Jeevashram, a veterinary outfit near the international airport. Unlike many vets, I watched Vinod Sharma and his team of vets handling an assortment of dogs. They were undeterred by their snarls, growls, flea infested skin or their pariah parentage. Here were real dog lovers but even so they offered upfront advice on what should be done about stray dogs, which they differentiated from street dogs. The latter live and die on the streets they said. The former are the abandoned progeny of mating episodes that occur because owners are irresponsible. The vets at Jeevasharam quoted several international best practices to fortify the need to legislate on owner’s rights and liabilities, licensing of breeders and removal of unclaimed dogs from public roads and streets to dog pounds. And clearly these people cared for canines.
To take the stand that the dogs must be restored to where they originally came from is bizarre. It does not seem to find a place in any of the world laws on stray dogs in cities. France, Canada, Australia are all dog loving countries, but nowhere do they cart back strays dogs onto the streets.
In the US, roaming dogs are impounded. Issues of human health and safety override everything and each State has its own laws on street dogs. Some US States do not even delegate the function to municipal authorities. “In a highly urbanised society, dogs cannot be allowed to run free, human safety being most important,” says a comprehensive US website. No dog is permitted to “roam at large” unless accompanied by the custodian. In inner London both police and dog wardens are jointly responsible for catching stray dogs and are required to deposit them in a dog pound. The public can demand this service by rights.
The Commonwealth Games are round the corner. Flags flutter down Rajpath as yet another dignitary visits the capital. Roads are restored, trees are pruned and signages spruced up. Incredible India claims that it treats its guests as god. But the menace of stray dogs running amok at railway stations, bus stops, markets, monuments, streets and even hospitals, only grows. Meanwhile, in side streets of the city, dogs are regularly stoned, beaten and maimed, far from the earshot of the cruelty to animals shouting brigade. There lies the difference between ground reality and emotional rhetoric.
Breeders too need to be licensed and covered by regulation. If a pet dog produces a litter, the fine should be hefty and should be deposited in an Animal Welfare Fund that pays for maintaining special pounds for street dogs. Abandoned puppies should not be left to scrounge off the streets in the pious hope that each year they would be caught, inoculated, neutered, treated for infestation and worms and restored back.
Year after year NDMC continues to pay NGOs Rs 500 per street dog for performing this function and a few NGOs are indeed performing an admirable service. But the main roads and precincts of the capital city and a busy metropolis cannot become the permanent repository for stray dogs, while its residents are exposed to the risks of being bitten, intimidated and held liable for road accidents. If there is a conflict of law, surely human safety comes first? A dog’s life cannot become larger than life.
How fair is it that men are never targeted to accept blame for the unwanted pregnancies that occur year after year? Must women continue to suffer for policy failure?
Last month I was in Ghadchiroli district. It ranks last among Maharashtra’s 35 districts on a combination of social indices. Synonymous with remoteness, surrounded by forests and inhabited by tribal people, a health worker was to show me how neonatal care had improved survival rates of infants. I asked her how many people used contraceptives. She told me straightaway, no one did. Women went in for tubal ligation as soon as they had two children.
Visits to see newborn babies ensued. Entering a shack, I noticed an infant clinging onto his grandfather. Inside the house an emaciated woman, removed a dirty cloth from a tiny mound on the floor to reveal a shrivelled neonate underneath. As soon as she lifted the cloth, swarms of flies settled on the baby’s face. She had delivered the second baby within a year of the first. She herself was no more than 18 and a bag of bones, her eyes devoid of emotion, and her lips a straight line.
Ghadchiroli is ranked at the 345th position out of the 593 districts surveyed by the International Institute of Population Studies (IIPS). Not bad compared with hundreds of lower ranking districts in the country. At least they had access to sterilisation services.
The percentage of women having three or more children is a direct measure of fertility. The larger that percentage, the weaker the impact of the family planning programme. As can be expected, the worst hundred districts in the country according to the IIPS study done belong to Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh and some North-Eastern States where between 50 per cent and 60 per cent of women beget three, four and even more children.
India was the first country to launch a Government family planning programme in 1952. Due to mismanagement, forced sterilisations and chasing fictitious targets, the programme received an unsavoury reputation it just cannot discard although decades have gone by.
Post-1994, Cairo and ICPD, Governments the world over supported by international organisations and NGOs ushered in a new reproductive child health approach. Today, people who talk of population control and explosion are considered barbaric. In the name of giving “reproductive choices” to women and offering “a cafeteria approach”, the old targets, incentives and disincentives have been struck off the strategy list. Rightly so, if one goes back to the horrors of family planning excesses, but wrongly so if there is no cafeteria, no coffee (read condoms), IUDs or oral pills to make that choice.
The emergency contraception pill, the most needed of all, is unheard of in most of the country. The social marketing approach can deliver up to a point – no more.
So steeped is our present culture in the soft new approach that we refuse to face the fact that of the 26 million babies born each year, some 40 per cent are underweight, underdeveloped, often stunted and incapable of later imbibing even elementary education, leave alone become productive citizens. Infant and under five mortality continues to be extremely high, mainly because family planning is denied the thrust it badly needs.
While tender talk about quality issues and women’s rights is well intentioned, how can we enable severely anaemic women not to have to produce unwanted babies and face repeated pregnancies? How can one prevent men from forcing pregnancies? How can one stop adding generations of unhealthy children if there is no insistence on increasing the age of marriage, spacing and male sterilisation?
How fair is it that 98 per cent of all sterilisations performed in the country are on women? How fair is it that men are never targeted to accept blame for the unwanted pregnancies that occur year after year?
The unmet need for contraception continues to be displayed in colourful computer generated bar charts at all population conferences. But who is going to fill that unmet need and how? To provide access to contraceptives more than a modicum of sustained service delivery is essential. A large percentage of villages, particularly in the northern States, are more than 10 km away from a primary health centre (even if such outfits are functional). How do women living there protect themselves from unwanted pregnancies?
Some right thinking industries and tea estates have tried to help and ended up complaining how their efforts to sensitise men to stop child marriages, early marriages, several marriages and multiple partners and to explain how all such behaviour is self-damaging, falls on “deaf ears”. Government schemes, letters, meetings, monitoring supplies and disposal will continue, as it must. But at the end of the day if women are still forced to bear children they do not want, at the cost of their own physical health, what could be a greater denial of a human right?
It is time that spacing and male sterilisation were resolutely brought back on the front line. Lest the next generations require more hospitals than schools to attend to the abysmal levels of anaemia among women, and the resultant wasting and stunting of children, accompanied by high levels of under-five mortality. This beckons a deliberate restoration of family planning services to prevent unwanted pregnancies.
(These are the author’s personal views)
Most of us prefer to grumble in the confines of our homes, hoping and praying that some angel of mercy will transform Delhi into a world-class city. But two brothers, chartered accountants by profession, recently took the bull by its horns by demanding a response from the Municipal Corporation of Delhi and the Delhi police. These two brothers from Pandav Nagar in East Delhi questioned why when there existed very specific and stringent provisions for dealing with repeated violations of the law, rampant encroachments continue to be tolerated. That they still harboured a hope that improvement was possible was itself heartening.
This is their story. Exasperated with continuing inaction against flagrant street encroachments, the two brothers meticulously listed road side shops selling mobile phones, cosmetics, hamburgers, sweets, shoes, electronic goods, photography services, provisions, clothing, hardware and offering motor repair services, giving complete details of each shop which had annexed about 15 feet of the street on a single road. The poor pedestrian had been as usual left to play hopscotch between the wares displayed on the pavements, to say nothing of the clientele that congregated there to take their pick. These were no petty hawkers peddling moongphali or polishing shoes but proper shops which had willfully, knowingly and illegally usurped public space for purely commercial ends. Why should the public put up with such repeated violations, the brothers demanded to be told.
Dutifully the three agencies totted up figures of action taken, which in their own admission had had no deterrent effect whatsoever, despite “raids” and confiscation of merchandise. Under the Municipal Corporation Act (1957), challans were filed on eight days in the whole year, which resulted in fines ranging from Rs 200 to a maximum of Rs 2,400 per person. This did not amount to even a rap on the knuckles. In comparison, the traffic police prosecuted hundreds of violators, but each case ended in a piffling fine of Rs 100 or a maximum of Rs 300. The offences ranged from violation of Supreme Court orders, dangerous driving, ignoring ‘No Entry’ signs, to improper parking. Unimpressed by the figures, the brothers demanded to be told why auto-rickshaws from Uttar Pradesh were plying in the area, ferrying six passengers per vehicle, many driven by children? When plying without a permit is prohibited and Section 192 of the Motor Vehicles Act 1988 expressly provides that repeated violations end in “imprisonment for one year, and which shall not be less than three months with fine which may extend to Rs 10,000 but shall not be less than Rs 5,000”, why were these provisions never enforced? How could the officials whose attention was physically drawn to the goings-on, turn a blind eye?
Continuing their polite but firm inquisition, the siblings then drew attention to the provisions of Section 461(2) of the Delhi Municipal Corporation Act (1957) which expressly provides that “projections and encroachments that obstruct safe and convenient passage or any construction that overhangs, juts out or interferes with proper use of the street by way of walls, booths, structures and which causes obstruction or encroachment or occupies any portion of the street” can incur imprisonment (simple) for six months and a fine of Rs 5,000 or both. Again, when such provisions exist, why were they never been used, demanded the public spirited duo.
From the district police, they sought to know why they were filing cases under Section 283 of Indian Penal Code which only leads to a paltry fine of Rs 200, when the Penal Code specifically describes a “public nuisance” as “one which causes injury, danger or annoyance to the public or to the people in general who live or occupy property in the vicinity”. Why were such provisions of law never used, despite repeated public complaints? Under Sections 268 and 291 IPC, repeated violations could lead to six months imprisonment or fine or both. But again these provisions had not been used, even once. This, when the law expressly states that a “common nuisance” is not to be excused on the ground that it causes “some convenience” or “some advantage”. When the provisions were so explicit how could the authorities disregard the automobile workshops, illegal platforms, kiosks, windows, doors and staircases which opened on to the street and for that matter everything that stood in the public right of way?
Full marks to the two citizens who have drawn attention to this abysmal apathy and failure to enforce the law. That they did despite being pursued with threats and a visitation asking them to “lay off”, makes it all the more commendable. The good news is that the authorities have finally responded that indeed the provisions do exist and instructions are under issue to implement the identified sections of the law. Let us hope along with the two Pandav Nagar brothers that things may yet change.
A former municipal commissioner of Surat who won awards and accolades for cleaning up Surat told me how he had taken recourse to the Prevention of Damage to Public Property Act 1984 – a succinct two page legislation having All-India application. Under that law, “interfering with the production, distribution or supply of water, light, power or sewage works, etc., “constitutes mischief”. Any such offence “shall be punished with rigorous imprisonment for a term which shall not be less than six months and which may extend to five years and fine”. Why then do we mollycoddle people who steal water, break water pipelines and dig unauthorised wells in their backyards? For that matter, all those who erect illegal hoardings on electric poles, dig footpaths and pavements for personal needs can be put behind bars. Any municipal commissioner who paves the way should win national acclaim and at least a Padma Shri.
If the authorities do not act, sooner or later the public is going to do so. What has been described above is not just my personal view of how Delhi should be cleaned with a broomstick. It is what the public is demanding with perfect logic and legitimacy. If the law of the land describes offences and when much worse is going on under one’s nose, why should the law which expressly provides for imprisonment be ignored? The way citizens are doing their homework, the day is not far off when more than bijli, pani and sadak it will be (non) enforcement of law which will be the test of good governance. At least in Delhi.
The incident of organ trade is shocking but not surprising in a country where there is an annual demand for 150,000 kidneys, while the transplants remain only 3,500. It’s time authorities streamlined organ transplant law The kidney excavations at knife-point has been among the biggest stories during the last two weeks. The principal targets are three — the police for conniving with and even facilitating the macabre organ digger, the health authorities for not doing enough to stop organ trade and medicos for hoodwinking and causing the poor to bleed (sometimes to death.) The story revives memories of Robin Cook’s novel and the film Coma (1978) which unraveled a grotesque story of how young men and women visiting a particular hospital for a simple procedure, were deliberately rendered comatose; to be strung up brain dead until their livers and kidneys were harvested by ruthless auctioneers operating a bizarre global organ trade. The Gurgaon kidney scam is no less wacky. The difference is that in the novel, the victims were young, educated, independent and able-bodied. The Gurgaon outfit sounded rudimentary and the victims were poor, illiterate and defenceless. The only reason why it made so much news was because at long last at least one racketeer had been nabbed. Otherwise, accounts about South Indian fisherfolk ravaged by the tsunami selling off a kidney each for Rs 50,000 and 50 per cent of village populations in Pakistan living on one kidney have been recounted for years; as have been reports about thousands of organs purloined from Chinese prisoners fated for execution. But the expos? and the notoriety that surrounds the Gurgaon scam demand wider thinking about the issue. Kidneys are the most frequently transplanted organs (around the world). In a country where poverty is ubiquitous, life is cheap and demand outstrips the supply, strategies have to be practical. Several countries have a solution whereby the donor has to explicitly dissent to organ donation during his lifetime. In the US, the regulation of organ donation is left to individual States within the limitations of the Federal National Organ Transplant Act, 1968. Many States in the US have encouraged organ donation by allowing the donor’s consent to be entered on the driver’s licence. Thereafter, state regulations lay down the systems and processes to be followed. In the early 1990s when I was the Secretary for Medical and Public Health in Delhi, doctors and policemen made several suggestions. Pass a law, they suggested, that in case an accident victim’s body is not claimed on the spot, the organs may be harvested at a designated facility and used according to the registry of needy recipients. Looking at the number of accident cases involving young people, it will be easy to operationalise this strategy, particularly if it were coupled with the consent given on the driving licence. Efforts have been on for decades to persuade the public to donate just corneas — far less threatening than retrieving kidneys, but to little avail. Aishwarya Rai has fluttered her gorgeous lashes on countless television commercials encouraging people to pledge their eyes (like her), but the supply remains woefully short. The Economic and Political Weekly writing editorially has referred to an annual demand for 1,50,000 kidneys while the transplants remain only 3,500. The well-intentioned 1994 Organ Transplant Act has clearly failed to prevent the illegal trade of kidneys because criminals would hardly present themselves before the authorisation committee to humbly seek permission. The recent comments by the Chief Justice of the Supreme Court that the problem is with the implementation and not the law appear to address the enforcement angle. However, no less important is the fact that in a country where poverty drives people to sell their land, house, livestock, jewellery and even children, what is the value of a kidney for the love of money? Especially when it is possible to live perfectly well on its pair? There is also the whole question of the emotiveness that surrounds death. Whether Indians exhibit their feelings more or less is not the point. In the Indian context, when funeral rites are given such enormous importance, few families would be willing to face the additional trauma of waiting for organ removal in a hospital setting. It is not that the idea of harvesting organs or the establishment of organ banks should not be pursued. The point only is that it will take a long time to convince families overwrought with grief to take decisions and get embroiled with hospitals and operation theatres for one minute longer than necessary. The consent on the driving licence is perhaps a good way of giving freedom to the individual, but also to the police to whisk away deceased accident victims for organ retrieval while preserving the body for the last rites. Second, it is the fundamental duty of every local Government to build awareness among poor people that they might be compromising their lives by agreeing to donate a kidney. For starters, all construction and building contractors should be enjoined under municipal regulations to display a film about the harmful effects of kidney removal, for all hired labour. The message may yet percolate to a wider group of poor people — particularly those living in urban areas where nursing hospitals, homes and kidney seekers abound.
Matter of life and death Shailaja Chandra Hospitals need to be made legally responsible for collecting and collating data on all treatments. Only then can research unravel outcomes and let people know that ‘more’ does not necessarily mean ‘better’. Or else unnecessary check-ups on the unfailing advice of ‘life and death’ will be a routine affair It was Sunday afternoon. It was the first emergency I had faced in our new home in a private colony where we had moved after my retirement. Shorn of Government props of 40 years standing, I felt fearful as I touched my mother’s burning forehead again and again. Afternoon would soon become evening and then night. Things would get increasingly difficult as time passed. I desperately thumbed through the colony directory and located a physician. I begged him to come over and see my mother. He came soon enough, checked the BP, ran the stethoscope, looked for pain, murmurings, nausea and concluded that the lungs had some liquid. Since my mother was over 100, he advised me to take her to a hospital immediately. “But which one?” I asked helplessly. “Since she is a Government pensioner you can take her anywhere you want”, and “the nearest to you are Rockland, Max, Fortis and a little further away, Apollo. CGHS will pick up the costs. Don’t worry.” “But doctor,” I pleaded, “They will put her through a battery of needless procedures and tests. I cannot bear to see her being tormented like that.” “That is bound to happen,” he replied. “Once you get into the hospital you will have no say and I would not be surprised if they put her through a CT scan, and the full cardiac drill.” “Can’t I just get her treated without any invasion … just drugs or antibiotics or something? Don’t I have an option?” “I’m afraid you have none,” said the doctor as he wrote out a prescription, folded his stethoscope and banged his briefcase shut. At your mother’s age you should not take chances,” he added. As I saw him to the door, I suggested hesitantly, “Doctor, can I not take her to the RML hospital instead?” He turned on his heel and unexpectedly said what I longed to hear. “You would be 100 times better off in RML hospital if you know someone there,” he added for good measure. “They will have no interest in plugging her into the ICU or ordering a battery of procedures and tests. They will do the minimum and, god willing, she will be fine.” My situation was something that all of us face these days. Medical malpractice is entirely different from medical negligence. A conscious decision to force medical procedures and tests for monetary gain (all in the name of medical ethics) is malpractice, but we can’t measure its prevalence or contain its practice. We all know that in urban hospitals the caesarian rate is 80 per cent when it should not exceed 10 to 15 per cent. We also know that angioplasties invariably lead to the implantation of stents, procured or ordered to be purchased from a particular source. We also know that people who go to certain hospitals with chest pain invariably have to undergo by-pass surgery, on the unfailing advice that it was a matter of life and death. We also know that the MRIs and endoscopies that hospitals and doctors order almost routinely, were unnecessary but who can question a busy specialist or an impersonal monolithic hospital? One would not even have the vocabulary to start inquiring. The costs of health care in the US are spiralling but out there full information on procedures, tests and investigations has to be collected and published, making it possible for researchers to unravel the data and relate it to outcomes. The New Yorker recently published a piece called the ‘Cost Conundrum’ in which real-life medical care costs are juxtaposed with health outcomes, on the basis of research conducted at the Dartmouth Institute for Health. The research shows that in the US the more money Medicare spent per person in a state, the lower was that state’s ranking in quality health outcomes. Treatment records of one million elderly Americans diagnosed with colon or rectal cancer, hip fracture, or heart attacks were examined. They found that patients in higher spending regions got more frequent tests and procedures, more visits by specialists, more frequent admission to hospitals but they did no better than other patients whether measured by survival, ability to function or satisfaction with the care received. “If anything, they seemed to do worse.” That brings me to the conclusion. In India, the Supreme Court has brought medical negligence under the Consumer Protection Act (subject to some needed safeguards) but negligence does not encompass the wide range of costly procedures, tests and investigations that are ordered by hospitals and doctors, devoid of explanation, alternatives, leave alone obtaining informed consent. In the name of medical ethics, how can hospitals and doctors do what they like, regardless of a patient’s age, symptoms or prognosis? Hospitals need to be made legally responsible for collecting and collating data on all such procedures and investigations. Only then can research unravel outcomes and let people know that ‘more’ does not necessarily mean ‘better’. Hospitals with higher costs and poorer outcomes might just discontinue indiscriminate procedures to pad hospital and consultant’s fees — regardless of the quality of outcomes. At least we would know. ——————————————————————————–
A CM who performs Shailaja Chandra What makes Sheila Dikshit different from others? For starters, she doesn’t allow bureaucrats to spin circles around her. Labyrinthine explanations cut no ice, making it impossible for babus to suck her into the vortex of red tape that they whisk up in a jiffy After Ms Sheila Dikshit’s recent victory, countless people asked me what it was like to work with her. How does her style differ from others? What was so special about her? Is she efficient? How does she manage the bureaucracy? A few nuggets might help create pictures, albeit completely unrelated to the third-time coronation of somebody labelled as ‘Aunty No 1’. When I first took over as Delhi Chief Secretary in 2002, Ms Dikshit had already been Chief Minister for four years. By then she had seen two Chief Secretaries — both men. I was acutely aware of the universal belief that two women can never get along and whatever might happen, was eager to explode that myth. Unexpectedly, her first instruction was to ask me to run the Government “like a thrifty housewife”. After decades of working with political stalwarts and managing mega projects and programmes I felt punctured like a flat tyre. Over time I realised that for Ms Sheila thrift did not mean frugality. A Satish Gujral painting or exotic cuisines were easily indulged in the name of State elegance. But electricity conservation, recycled waste, running crusades against plastic bags, a partiality for ethnic weaves and an equal loathing for synthetic kitsch were her personal passions — something one has never witnessed in any Minister of Energy, Environment or Textiles, despite all the tall talk about preserving the planet. That made Ms Sheila a real person with feelings and taste-not just a marionette playing a part, mouthing predictable clichés. Ms Sheila’s second priority after I joined was to locate a professional housekeeper. She mentioned this to me thrice in my first two days and again I had misgivings about abandoning the regatta of Bharat Sarkar. But the IAS is accustomed to working with worse idiosyncrasies so I began the hunt. Luckily, I discovered a battleship, somewhat unsuitably attired in pink chiffon and pearls, but reputed to have given a facelift to UPSC’s dingy interiors. Without much ado I appointed her and sent her packing to take orders from the Chief Minister directly. Ms Dikshit did not think it infra dig to deal with housekeeping morning, afternoon and evening. Not until the brass planters in the Y-shaped Player’s building began to gleam, fresh flowers appeared in hallways, bundles of Government files disappeared from windowsills and brooms, swabs and phenyl bottles found unseen shelter, did the gasping housekeeper get time to breathe. The touch of class shone everywhere, with visiting dignitaries bowled over after each visit. Ms Dikshit’s ability to put humour and pleasantness above business is legendary.
Most Ministers are too preoccupied with their own importance to spare anything but a frozen smile. Most bureaucrats only bother about people worth bothering about, with little space for random hilarity. The Chief Minister’s morning telephone calls to me transmitted complaints but not until she had wished me a cheery good morning, and cracked a joke did she embark upon the litany of woes she had personally heard. By then she had already instructed the heads of the concerned organisations directly. But in madam’s management handbook supervision was the Chief Secretary’s business, not hers. The astonishing thing was that so many people — mostly very ordinary public — actually managed to get through to her. The pesky private secretaries adept at blocking telephone calls (ubiquitous at all levels of bureaucracy and a contagious disease with Ministers,) did not exist in Sheiladom. Her backstage management was superb, fortified by the watchful eyes of a powerful sister-daughter and in-law brigade and a hand-picked set of unpretentious back-room players. Meetings, functions, catastrophes may come and go but messages were always relayed. As she hurtled between the length and breadth of the city in her modest Ambassador, the call back would come, brief as the exchange might last. During interdepartmental conclaves she deposited the monkey squarely back on the shoulders of bureaucrats, particularly the perpetrators of blame games. Labyrinthine explanations cut no ice with her, making it impossible to suck her into the vortex of red tape that all bureaucrats whisk up in a jiffy. It made no difference to her opinion of an officer whether she saw his face once a week, once a month or never. Erudite economic theories did not hold her attention. Slow, inefficient and even lazy officers were given second and third chances but those who deliberately complicated things were replaced, even if the move looked like a reward.
They were never rehabilitated thereafter, (although the smiles and hugs continued as before.) The Secretariat lobby, the driveway of her small house (then) at Mathura Road, a staircase, a lift, alighting from the car, saying goodbye in the porch were all places where she listened to officers at all levels and gave the nod they awaited. No single officer, leave alone a coterie could prevent an officer from directly interacting with the Chief Minister. Hierarchy levels, IAS and non-IAS did not matter to her if work was getting done. These lessons went beyond the ken of her political foes, including some astute bosses that longed to clip her wings. Like her, hate her, in the end Ms Sheila Dikshit has had her day.