It is estimated that in India, a woman dies every two hours because of unsafe abortions. Just 10 per cent of the estimated 70 lakh abortions that happen in India every year are said to be documented; the rest are assumed to take place in shady clinics, often run by quacks. In a landmark ruling in September, the Supreme Court of India allowed a 13-year-old rape victim in Mumbai to terminate her 31-week pregnancy. Yet the same court in July ruled that a 10-year-old raped child, should not be allowed to abort at 28 weeks. On We The People we ask: Why did the families of these children have to go to the court for a private decision? And, is it time for the 46-year-old Indian abortion law to be amended?
Narendra Modi has gone for a massive revamp of his council of ministers. Two weeks of intense speculation finally gave way to some bold and surprising decisions. While 9 new ministers were sworn in on Sunday, four were elevated to Cabinet rank.
Guests: Shailaja Chandra, Former chief secretary, Delhi Govt ; Sambit Patra, BJP ; Swapan Dasgupt, Member, Rajya Sabha ; Saba Naqvi, journalis ; Jaiveer Shergill, Congress and Bhupendra Chaubey, News Anchor
Unqualified Medical Practitioners In India – The Legal, Medical and Social Dimension of Their Practice
Main Building, India International Centre (IIC), Lodhi Estate,
on 24th July 2017
Introduction by Shailaja Chandra, Former Secretary Government of Indian and author of a recent book on the subject
Panelists: Dr. Ramanan Laxminarayan, Princeton University; Dr Amit Shovan Ray, Professor of Economics, Jawaharlal Nehru University; and Dr. Anand Krishnan Professor, Centre for Community Medicine, AIIMS New Delhi
Chair: Dr. Dipankar Gupta, former Professor of Sociology at Jawaharlal Nehru University
|HEALTH TALK “Unqualified Medical Practitioners In India – The Legal, Medical and Social Dimension of Their Practice”
Introduction by Shailaja Chandra,Former Secretary Government of Indian and author of a recent book on the Subject
|Dipankar Gupta was formerly Professor in JNU’s Centre for Social Systems and affiliated to leading Universities in the US, Canada and France. Among non-academics he is better known as a public intellectual and opinion- maker who continues to write regular opinion pieces on critical issues of contemporary significance. He has been a member of the Boards of Reserve Bank of India and of NABARD|
|Introduction: Shailaja Chandra is generally introduced as the former Chief Secretary of Delhi. But much before and after that she has had a long policy level association with public health, medical education, population stabilisation and Indian medicine.
She is the author of a Status Report on the Indian systems of medicine and a strong proponent of integrative medicine for public benefit. She was the first Executive Director of the National Population Stabilisation fund.Ms Chandra has been a fellow at the Institute of Advanced Studies at Nantes, France and more recently at the Shiv Nadar University.
|Mr C K Mishra Union Health Secretary, Ministry of Health & Family Welfare|
|Panelists: Ramanan Laxminarayan directs a Center for Disease Dynamics, Economics & Policy and also teaches at Princeton University. With experience of working in WHO, the World Bank and CDC Atlanta he brings the unique perspective of an international epidemiologist and a drug resistance economist. Notably he was a TedMed Speaker in 2014 and his talk focused on growing drug resistance an aspect which is directly related to the subject of medical treatment by unqualified practitioners.|
|Panelists: Amit Shovon Ray is a Professor of Economics at the School of International Studies at JNU and a Fellow of the Royal Society of Public Health (UK). He is a development economist and an expert in the areas of health economics, IPR and pharmaceutical industry. Of special relevance to today’s Seminar are his contributions to the Independent Commission on Health in India and in particular his critiques of the functioning of the health sector. Professor Ray has published on a range of subjects but his work on medicines, medical practice and health care in India as well as the political economy of rural health care in the country make him eminently suited to comment on today’s subject.|
|Panelists: Professor Anand Krishnan is a faculty member at the Centre for Community Medicine at AIIMS for last 23 years. He heads the WHO collaborating centre for community based control of non- communicable diseases and has worked closely with WHO in supporting many countries in the region like Bhutan, Nepal, Maldives, Myanmar, Srilanka, East Timor in strengthening their national NCD Surveillance and response. He also steers a large research grant from CDC Atlanta focused on the prevention and control of pneumonia. He has spent 20 years at the rural centre of AIIMS at Ballabagrh and has a first-hand experience of primary health care issues. Relevant for today’s event is that he guided Ms.Chandra’s work on unqualified practitioners|
|Dr Soumya Swaminathan, Director General, ICMR & Union Secretary, Department of Health Research (Ministry of Health & Family Welfare)|
The coal scam has claimed ex-coal secretary and two other former bureaucrats. Is this a watershed moment for anti-corruption? Agenda looks at why IAS officers are protesting.
Guests: Shailja Chandra, Former Chief Secretary of Delhi; Sanjay Bhoosreddy, IAS Association, Pranav Sachdeva, Advocate
Anchor- Sunetra Choudhury
The National Health Policy 2017 was notified last week. Coming 15 years after its predecessor, it presented an opportunity to do things differently. First, the recognition that strong state intervention is needed to control the surge of diabetes, heart and respiratory diseases hasn’t come a day too soon. With early screening and diagnosis becoming a public responsibility, the lives of millions of Indians could be saved from debilitating illness and premature death. This shift in emphasis is noteworthy.
Second, establishing a professionally-managed state public healthcare cadre makes eminent sense. A dedicated cadre of healthcare professionals can detect state-specific health hazards and contain them before they spread. The inclusion of professionals from sociology, economics, anthropology, nursing, hospital management and communication is a recognition of a multi-disciplinary approach and an acknowledgment that cultural attitudes must be understood if public health strategies are to gain community acceptance.
The third takeaway is the goal of pushing up male sterilisation “by 30 per cent and, if possible, much higher”. After Sanjay Gandhi’s blighted nasbandi programme, even the mention of male sterilisation made political parties, particularly in North India, squirm. Even after four decades, no politician was prepared to listen, leave alone act. Putting male sterilisation upfront also exhibits concern for the plight of women, who, after dealing with unwanted pregnancies and repeated childbirths, also undergo harrowing tubectomies. Thailand successfully made vasectomies into a routine affair more than 25 years ago. If six Indian states that account for almost half of India’s population and its annual growth, can incentivise (not coerce) men to limit family size by sterilisation, it could be a game changer.
The fourth good idea is piggy-backing medical and paramedical education on service delivery. Generations of health planners have been telling the Medical Council of India to factor in the ground realities that reduce the relevance of even the best medical curriculum. Indeed, students and patients would gain vastly if such facility-based training gets implemented.
The fifth half-positive takeaway is the recognition that AYUSH needs to be integrated into the research, teaching and therapeutic components of health systems; stressing that traditional systems need to back their claims with evidence is equally positive. But by repeating the unsuccessful strategy of appointing contractual AYUSH doctors in primary health facilities, the policy goes into reverse gear. AYUSH practitioners posted in PHCs do precious little traditional medicine and simply function as spare wheels or substitutes for allopathic doctors. That pads up manpower shortfalls but devalues the strength of AYUSH. Had the policy supported recognition of approved district specialty AYUSH centers for a host of chronic problems, lakhs of patients in search of reliable AYUSH treatment could have benefited.
The policy has neatly sidestepped some basic concerns. The Clinical Establishments Act 2010 was passed by Parliament with the aim of regulating clinical standards, both in the private and public health sector, and ending quackery. It has received scant backing from the state governments and was rejected by the Indian Medical Association. Instead of emphasising the importance of oversight of all medical establishments, the policy has soft-peddled by recommending mere “advocacy”.That leaves a hapless public at the receiving end of much care, malpractice and exorbitant treatment costs with no protection. Leaving health regulation up in the air with talk of yet another standard-setting organisation will not insulate consumers from exploitation.
The policy is also hazy about generating resources. One wonders whether the reference to medical tourism earnings and “a high degree of associated hospitality arrangements” implies a desire to tax hospitals that offer frills. This sounds egalitarian but could drive away the relative advantages that Indian medical tourism presents.
The policy places enormous reliance on the eighth standard-pass female volunteer, ASHA — the lynchpin of the National Rural Health Mission. But it does not even allude to how the poor, both in rural and urban areas, are driven by a desperation to overcome acute illnesses (that result in a loss of wages) to seek medical treatment from quacks, RMPs or self-styled doctors with no medical qualifications. Fluff about upgrading sub-centres or providing additional multipurpose workers does not confront the pervasiveness of RMPs or jhola chaap doctors who administer IV fluids, antibiotics and steroid injections with impunity. The policy shows no recognition of the magnitude of what is happening on the ground, even when a WHO report shows that unqualified medical practitioners constitute more than half the “doctors” in India. The WHO’s report is based on data provided by the Census office and the erstwhile Planning Commission. Recognising that they cannot be wished away, the West Bengal government has even embarked on training quacks “to cause less harm”. This problem is too pervasive to be ignored. The policy should have confronted it.
The policy has rightly explained why the time is not ripe to make health into a justiciable right. It is good that symbolism hasn’t held sway as it did with the impractical Right to Education Act. What is more important, however, is for the states to accept the policy and implement the law. It is time that registration, accreditation and regulation of clinical establishments and standards is put in the Constitution’s concurrent list in much the same way as drugs, food and medical education. Too much is at stake to be left to the states that often look the other way when it comes to maintaining critical health standards — this is something that ought to be non-negotiable.
The challenge now is to translate the policy’s stated noble intentions into schemes and programmes supported by the requisite financial backing. It is accountability that needs early deliverance.
The writer is former secretary, Department of AYUSH, government of India, and former chief secretary, government of Delhi
Video Posted on Updated on
Published on 1 Jan 2017
Thanking people for their support and co-operation to his demonetisation drive, Prime Minister Narendra Modi on December 31 made a series of announcements reiterating his government’s focus on the welfare of farmers and the poor.
He was making a televised address to the nation on New Year’s eve and said he was grateful for the patience that people had shown amid a cash crunch that followed the ban on Rs 500 and Rs 1000 notes that he announced on November 8.
The decision was aimed at combating tax evasion and money laundering and the Prime Minister praised the people for working shoulder to shoulder with the government to defeat corruption.