I have been seeing that there is a lot of Hype & Hoopla around the fact that UID will weed out corruption , and that the poor will get their share of monthly grain & Kerosene quota
Let’s examine some hard facts :
PDS system runs on corruption , systemic loot and injustice to the needy card holders. Else, why will a person take a ration shop and run it for distributing sub-standard grains to the poor with so low a margin!!
The margins are barely anything to even recover the rents & other incidental costs !! It is like the fuel stations around the country, the margin of Rs.1.22 per litre of petrol and .64 Rupee on a litre of diesel is barely anything to cover the bribes to inspection authorities , rents and salaries ( few fuel pumps could be an exemption !! ). But most of the fuel stations run on ‘Adulteration’ & ‘Lesser quantities’ dispensed per every litre of fuel.
So UID has a value proposition which will make the business of PDS ( Ration shops ) business unviable for its licensees. So while the poor will have UID card , but no shops to dispense the ration !! I am not mentioning about electricity in rural India etc.etc...for reading the UID card and other related issues w.r.t implementation
Also , UID on paper is very good. Believe me, that about 300 million people in India still think that Indira Gandhi is the Prime Minister of the country !! The reason i write this is, because , parts of our country still live in 1847 ( grossly neglected ), parts live in 1947 ( plans on paper ) and about 300 Million live in 2000 ( have had an impact of ‘time bound’ growth ).
For people who don’t have shelter to sleep , clothes to wear , where will they keep the UID Card ? What will they understand of UID when they cannot even read and write , & when they know that ‘Government establishment’ is meant for either the people in government service or the corrupt !! One must study the ‘High tech’ ideas before taking it to the people who barely have 5-6 meals per week !! Remember , 7000 children die every day due to malnutrition in India
We must also understand that corruption never started because of lack of technology , but because of wrong leadership at the top, absence of a feedback mechanism & corrupt machinery at all levels, that has never taken action . So i believe that, the powerful people in the rural India will mislead the poor and keep their UID cards or the poor will spoil them due to mishandling of the cards . Also , UID does not have the techniques to turn stock hoarders and swindlers into honest PDS contractors !! Either the rot will continue after the UID or will wipe out the PDS shops by making them non-lucrative businesses .
Time to address the real issues. UID is a good idea , whose time is yet to come !!
Rajendra Pratap Gupta
Email : office@rajendragupta.in
Wednesday, July 21, 2010
Wrong Economic priorities ,lop sided growth & flawed statistics
This is the follow up blog on my views dated 15th June 2010 & 27th June 2010 on the topic of “High GDP but low GDP per capita”.
Focussing on statistics , in April-May 2010, IIP witnessed a decent growth of 14 % but this did not cover some vital sectors . Only one sector , machinery and equipment , alone contributed 37 % to this high growth. Transport equipment , metal products and mining contributed another 32 % to IIP growth. This implies that around 70 % growth of IIP was a result of high growth in just 4 out of a total of 19 sectors . Also , that these growth rates have an important factor ‘Low base effect’ . Like manufacturing sector achieved one of the highest growth rates of 19.4 % in April 2010 over a low base of 0.4 % in 2009. Similarly, Capital goods sector’s high growth of 72.8% in April 2010 was over a negative base of 6 % in 2009.
Time to balance out. Else , we will blame Greece, Italy , Europe , China , poor rainfall etc. Etc. for all our ills, forgetting that we never looked at "REAL India" for growth
Get the priorities right and actions STRAIGHT
BJP must be focussed more on right issues than routine struggles !!
Rajendra Pratap Gupta
Email : office@rajendragupta.in
Focussing on statistics , in April-May 2010, IIP witnessed a decent growth of 14 % but this did not cover some vital sectors . Only one sector , machinery and equipment , alone contributed 37 % to this high growth. Transport equipment , metal products and mining contributed another 32 % to IIP growth. This implies that around 70 % growth of IIP was a result of high growth in just 4 out of a total of 19 sectors . Also , that these growth rates have an important factor ‘Low base effect’ . Like manufacturing sector achieved one of the highest growth rates of 19.4 % in April 2010 over a low base of 0.4 % in 2009. Similarly, Capital goods sector’s high growth of 72.8% in April 2010 was over a negative base of 6 % in 2009.
Time to balance out. Else , we will blame Greece, Italy , Europe , China , poor rainfall etc. Etc. for all our ills, forgetting that we never looked at "REAL India" for growth
Get the priorities right and actions STRAIGHT
BJP must be focussed more on right issues than routine struggles !!
Rajendra Pratap Gupta
Email : office@rajendragupta.in
Thursday, July 15, 2010
Indian Pharmaceutical Industry is already controlled by US / Europe, and now it is Retail Sector's turn - FDI round the corner
Dear Dr.Joshi,
Namaskaar,
I am sure that this finds you doing good.
Last year i had detailed discussions with you on FDI and i sent you a note on not opening the retail sector to FDI. Till last year , you were the Chairman, Parliamentary Standing committee on commerce .
This year the issue is out again . It is shocking that UPA is even considering to open the Retail sector for FDI. Just consider ;
Total retail market is Rs. 1.2 Lac crore. Isn’t that too tempting for recession hit economies like US/ Europe and U.K. to fight recession through markets abroad ? They cleverly call us as an emerging / developing economy
To foreigners , this is a market but for us (Indians) it is 40 % of our GDP. You can expect that in the next few years , a good percentage of 40 % of our GDP will be in the hands of foreigners !! . We have 15 million retailers , thereby directly employing at least 30 million people and indirectly 6 times more i.e. 90 million .
Only 4 % of our retailers have an area of 500 Sq. Ft.
Food constitute 70 % of our retail trade
The UPA’s discussion paper is a wrong start as it has by-passed the parliamentary standing committee’s report tabled in both houses in June 2009. Consisting of more than 40 Member of parliaments . The committee had taken into account the report submitted by ICRIER
British MP David Amess recently said that the Indian Government to tread"very carefully" if it opened up the multi-brand retail sector to FDI because the entry of companies like UK-based retailer Tesco would"literally change the fabric of life in India" by endangering small shops. Amess chairs the British All Party Parliamentary Group on Small Shops (APPGoSS).
The government is currently holding consultations on allowing companies such as US-based Wal-Mart, France's Carrefour and Tesco to come in. Critics have urged the government to insert safety clauses following protests from small independent retailers that potentially face closure."Britain was a nation of small shopkeepers," Amess."All of that has changed and this is because of the supermarkets, led by Tesco. It is impossible for small shop keepers, who have so much to offer, to compete with the prices of the supermarkets".
APPGoSS Secretary Bob Russell MP, added "the expansion of supermarkets in Britain has been to the serious detriment of small shops, there is no question about this".
One in six small stores in Britain have gone out of business in the last decade, the group said.
Atul Patel, an Indian origin Briton who runs Pelican News, a small store in North West London. said his family-run business was now struggling to survive, with sales of meat, groceries and fresh fruit having dropped by at least a fifth after Tesco opened a store hear his.
Largest Indian pharmaceutical companies like Ranbaxy and Nicholas Piramal have already changed hands and are no more with Indians . With the recent acquisition of Piramal with Abbott , MNC’s control more than 50 % of the Indian Pharmaceutical industry , and more acquisitions are likely to follow soon.
My personal belief is that, the when the large foreign retailers come in , the fight will not just be between large and small retailers but between large and medium retailers . Small retailers will die for sure . Needless to mention , when the elephants fight , the grass ( small retailers ) gets trampled !!
Dr. Joshi , please take it up at the appropriate levels .
Recently , it was reported that acute poverty prevails in 8 Indian states ( 421 million people in Bihar , Chhattisgarh , Jharkhand , Madhya Pradesh, Orissa , Rajasthan , Uttar Pradesh and West Bengal which together account for more poor people than in the 26 poorest African nations combined ( 410 Million ), a new ‘multi dimensional’ measure of the global poverty said According to the MPI- Multidimensional Poverty Index , developed and applied by the Oxford Poverty and Human Development Initiative with UNDP support
Also, i hear that Economy is growing at approximately 8 %. I need to tell our Dr. Manmohan Singh, the economist that the literal meaning of Economy is “Community’s system of wealth creation” and not just growth of a few sectors, as is in the case of India and we call it Indian Economy ? So Indian "economy" is not growing , but a few sectors that are in a 'few hands' are growing !!
Dr.Joshi , you have profound knowledge of each and every aspect of history , culture and wealth creation and distribution , that is even acknowledged by Congress leaders in power.
Let’s work to change all this . I am hoping to meet you soon.
Thanks with best regards
Rajendra Pratap Gupta
Email : office@rajendragupta.in
Namaskaar,
I am sure that this finds you doing good.
Last year i had detailed discussions with you on FDI and i sent you a note on not opening the retail sector to FDI. Till last year , you were the Chairman, Parliamentary Standing committee on commerce .
This year the issue is out again . It is shocking that UPA is even considering to open the Retail sector for FDI. Just consider ;
Total retail market is Rs. 1.2 Lac crore. Isn’t that too tempting for recession hit economies like US/ Europe and U.K. to fight recession through markets abroad ? They cleverly call us as an emerging / developing economy
To foreigners , this is a market but for us (Indians) it is 40 % of our GDP. You can expect that in the next few years , a good percentage of 40 % of our GDP will be in the hands of foreigners !! . We have 15 million retailers , thereby directly employing at least 30 million people and indirectly 6 times more i.e. 90 million .
Only 4 % of our retailers have an area of 500 Sq. Ft.
Food constitute 70 % of our retail trade
The UPA’s discussion paper is a wrong start as it has by-passed the parliamentary standing committee’s report tabled in both houses in June 2009. Consisting of more than 40 Member of parliaments . The committee had taken into account the report submitted by ICRIER
British MP David Amess recently said that the Indian Government to tread"very carefully" if it opened up the multi-brand retail sector to FDI because the entry of companies like UK-based retailer Tesco would"literally change the fabric of life in India" by endangering small shops. Amess chairs the British All Party Parliamentary Group on Small Shops (APPGoSS).
The government is currently holding consultations on allowing companies such as US-based Wal-Mart, France's Carrefour and Tesco to come in. Critics have urged the government to insert safety clauses following protests from small independent retailers that potentially face closure."Britain was a nation of small shopkeepers," Amess."All of that has changed and this is because of the supermarkets, led by Tesco. It is impossible for small shop keepers, who have so much to offer, to compete with the prices of the supermarkets".
APPGoSS Secretary Bob Russell MP, added "the expansion of supermarkets in Britain has been to the serious detriment of small shops, there is no question about this".
One in six small stores in Britain have gone out of business in the last decade, the group said.
Atul Patel, an Indian origin Briton who runs Pelican News, a small store in North West London. said his family-run business was now struggling to survive, with sales of meat, groceries and fresh fruit having dropped by at least a fifth after Tesco opened a store hear his.
Largest Indian pharmaceutical companies like Ranbaxy and Nicholas Piramal have already changed hands and are no more with Indians . With the recent acquisition of Piramal with Abbott , MNC’s control more than 50 % of the Indian Pharmaceutical industry , and more acquisitions are likely to follow soon.
My personal belief is that, the when the large foreign retailers come in , the fight will not just be between large and small retailers but between large and medium retailers . Small retailers will die for sure . Needless to mention , when the elephants fight , the grass ( small retailers ) gets trampled !!
Dr. Joshi , please take it up at the appropriate levels .
Recently , it was reported that acute poverty prevails in 8 Indian states ( 421 million people in Bihar , Chhattisgarh , Jharkhand , Madhya Pradesh, Orissa , Rajasthan , Uttar Pradesh and West Bengal which together account for more poor people than in the 26 poorest African nations combined ( 410 Million ), a new ‘multi dimensional’ measure of the global poverty said According to the MPI- Multidimensional Poverty Index , developed and applied by the Oxford Poverty and Human Development Initiative with UNDP support
Also, i hear that Economy is growing at approximately 8 %. I need to tell our Dr. Manmohan Singh, the economist that the literal meaning of Economy is “Community’s system of wealth creation” and not just growth of a few sectors, as is in the case of India and we call it Indian Economy ? So Indian "economy" is not growing , but a few sectors that are in a 'few hands' are growing !!
Dr.Joshi , you have profound knowledge of each and every aspect of history , culture and wealth creation and distribution , that is even acknowledged by Congress leaders in power.
Let’s work to change all this . I am hoping to meet you soon.
Thanks with best regards
Rajendra Pratap Gupta
Email : office@rajendragupta.in
Wednesday, July 14, 2010
Business , Politics and reforms - Coincidence or well planned ??
A few months back the RIL had withdrawn the EOU status ( Export Oriented Unit ) for Jamnagar and the petrol got deregulated !! So that Mukesh bhai can sell oil in domestic market
Mukesh hired the head of Tesco Lotus and the retail FDI paper is out from DIPP !!
What a coincidence ? No guesses i suppose !
Rajendra
Mukesh hired the head of Tesco Lotus and the retail FDI paper is out from DIPP !!
What a coincidence ? No guesses i suppose !
Rajendra
Sunday, July 4, 2010
National Council for Human Resources in Health - NCHRH
Date : June 30th , 2010.
Mr. Debasish Panda
Joint Secretary
Ministry of Health & Family Welfare
Government of India
Nirman Bhawan , New Delhi 110108
Ref: D.O. V.11025/10/2009-ME(P-1) dated 8th June 2010
Dear Mr.Panda,
Thanks for the invite for the regional consultation on NCHRH . Unfortunately, I could not attend the meeting at Mumbai on 18th June due to a prior commitment at Bangalore for the India Innovation Summit on the same date.
I had sent you an email on the NCHRH with two recommendations. Since then, I have dwelled on the issue at length and wish to submit some recommendations for your kind consideration
Before I start on the specific recommendations, let us consider a few important points that need to be kept in mind for the National Council for Human Resources for Health - NCHRH
• India has 1.2 Billion population out of which about 1/3rd is illiterate population
• In the next 10 years, India will add 120 million people in the working age category
• Currently, India has about 2/3rd of the population below 35 years in age
• Currently , 2/3rd of India lives in rural India and probably, in that category, healthcare does not figure in the list of priorities
• 2/3rd of India does not have adequate access to healthcare
• Awareness and sensitization about healthcare is missing . People will go and splurge money on dining outside , but will not spend a fraction in wellness .
• India believes more on religion , spirituality and charity than wellness
• Healthcare professionals available are not willing to work in the so called rural India . At max, they are willing to work in semi urban India
• The incidence of diseases is not vastly different in rural India from that of urban India for most of the ailments
• Status of urban poor is deplorable when it comes to healthcare
• PPP’s in healthcare are not going to work in rural India
• Those who study for healthcare in urban areas, majority of them are not willing to adjust to the rural lifestyle for professional or family reasons . Gives us a reason to think to start medical colleges in rural settings !!
• The entire healthcare system is focused on medicine , doctors, clinics and hospitals etc. This has created a fear & suspicion amongst the healthcare users that healthcare means pills, surgery and hospitalization
• New models of care are evolving for addressing the changing disease patterns and Indian healthcare system is ill prepared to handle the same
• Time has come to take health ( not medical ! ) education from medical school to primary school. Basic healthcare education should be made compulsory at the school level.
• 3G has now become a reality , so mHealth will not just re-define the healthcare delivery but also healthcare education
In short , I would say that , the world over , no healthcare system has answers for our problems, as all the systems are already failed or heading towards a collapse . This provides a unique challenge and an
opportunity to build a robust healthcare system for India that is low cost, agile , protocol driven, and evidence based and not eminence based system; one that avoids errors , trails and wastage . Then only we can have an outcome driven health system that cares !
Here is what I submit for your kind consideration :
NCHRH ( National Council for Human Resources for Health ) has been set up with the goals to overcome the acute shortage and uneven distribution of human resources in public health delivery system & aims at overhauling the current regulatory framework. Toward this end, it is proposed to set up a National Council
for Human Resources for Health as an overarching regulatory body to achieve the objective of enhancing the supply of skilled personnel in the health sector
What I can understand from the above stated purpose for NCHRH is that NCHRH will ;
• Regulate the current set up
• Identify the current need gap
• Project the future requirement for the next 10, 20 & 30 years
• Asses the population mix and the disease patterns and address the issues in a proactive manner
• Create a resource pool & knowledge pool ( not just impart knowledge but create it as well )
• Human resources for disaster management in healthcare is missing from the draft that I have gone through . It needs to be incorporated
Health in India has to be looked regionally and planned at the district level: It would be wrong to just limit it to five members headed by a chairman. I would suggest that you must create an “Indian Health & Wellness Service (IHWS )” for the entire nation on the lines of IAS . Today , if I have to complain against deficiency of healthcare services or standards or care at a hospital, there is no grievance redressal mechanism !! Because the system is ambiguous and there is no demarcation for people to look at health and wellness services. For erring police , I can go to SP City , DIG –Range or IGP or the DGP; for an erring postman , I can go to the Post master general etc., and the same for most of the services ; but if there is a deficiency in a hospital service provider where does a common man go ? Another hospital, I suppose !!
So when you are planning for NCHRH , You must consider having an all India service to tackle the multi headed monster called healthcare.
Have separate members in NCHRH, each having a clear role and responsibility for capacity building for the following :
1. Urban Health
2. Rural Health
3. Tribal Health
4. Health in hilly areas
5. Health in Armed forces
6. Health for retired government employees
7. Health for private sector
8. Work Place wellness
9. Healthcare amongst Minorities
10. Expatriates working in India
11. Geriatric care in urban & rural health should be handled separately by different members
12. Split ‘Mother and Child care’ under separate heads, each under a separate member . It is glaring to note that According to International Institute of Population Sciences , Mumbai , 56 % of the Indian women in the age group of 15-49 suffer from anemia
13. Diabetes
14. Hypertension
15. Arthritis
16. Cancer
17. Epilepsy
18. Mental Health
19. Telehealth should be a strong focus area for Urban & rural health. It should also be a part of the Medical curriculum and a 3 month internship should be made mandatory for telehealth
20. Medical Education
21. Home health & care technicians
22. Healthcare counselors and Physiotherapists
23. Health administrators for clinics , hospitals other wellness providers
24. Gyms & Wellness centers
25. Diet and Nutrition
26. Acute care
27. Immunization
28. Awareness & Education about wellness
29. Awareness & Education about diseases
30. NGO’s capacity building
31. Disaster management in healthcare including outbreaks & epidemics
32. Epidemiology & research on regional requirements . One example I will quote here. In north eastern part of India , in tea gardens , people take black ( known as red tea in NE ) with salt and so there is a very high incidence of Hypertension and stroke . Same applies to other belts in India which have very specific requirements that cannot be tackled with centralized planning and execution
33. Technical up-gradation & training of the workforce on latest developments in equipments and technology
34. CME for each level of workforce
35. Nurses should be renamed as Physician’s Assistant (PA’s ) or Health & Wellness Officer (HWO’s ) . There should be a plan to create enough specialized resources under this head for rural health, geriatric care , telehealth , chronic diseases etc. We need not make our healthcare system doctor & hospital centric . The number of PA’s / HWO’s should at least be double of that of the doctors in the next 10 years
36. For medical education ( all streams ), behavioral psychology should be added in the curriculum . This is one of the most important change that we need in the medical curriculum . Doctors have just been reduced to diagnosis & prescription machines . Whilst we might be imparting the best of medical knowledge, but patient care and handling is missing totally from the curriculum . Writing prescriptions does not deliver care . Patient friendly care is a must . Because of the lack of understanding of the behavioral psychology amongst doctors , the patients fear and suspect the doctors . Even the doctors do not go beyond prescriptions !! This needs an immediate change to ensure compliance and outcome from the treatment , most importantly, regain ‘Trust’ in the system by the users
37. Put a separate head for innovation in healthcare education
38. Separate head for guidelines, standards , treatment protocols , assessment & accreditation for each aspect of medical & health education and research
Further , each member should be responsible for research , planning & execution for his department. It is clear that if we do not plan for human resources , it will not just lead to deficiency in healthcare services but also increase the cost of healthcare . Limited number of healthcare professionals would be available for jobs and that will definitely lead to unrealistic inflation of salaries amongst health professionals
Since this note is about the healthcare in the country , I would also like to add that, we must look at setting up a TAB ( Technology Adoption Board ). India must not import technologies simply because GE / Siemens have
produced it and it is the latest. Technology is one of the major cost drivers for healthcare . TAB must ensure that the technologies that have demonstrated positive impact on the treatment compared to its cost and accuracy of diagnosis should only be allowed in practice . In 2007 , a 64 slice CT Scan was the most advanced , now it is 914 slide CT scan . The question is what is the difference in cost and accuracy of diagnosis compared to the earlier versions ?
Also, MOHFW should set up ICE – Insitute of Clinical Excellence to formulate and work on clinical pathways & protocol based treatment for all major illnesses , so that the doctors do not resort to expensive and arbitrary line of treatment at the cost & care of patient . A protocol based treatment would let all the stake holders in the continuum of care to work in close coordination
Also, the time has come to move to a greener healthcare system. I hope that we will learn from the MEA ( Ministry of External Affairs ). When you apply for a passport , the passport office gives you two or three receipts , one for the passport application fees, second for jumbo passport ( if you opt for ) and a third one for tatkal category ( if you fall under that category) . I fail to understand that, would it not be better to have one receipt with multiple options for ticking !! It wastes paper , ink and generates three times the heat and noise printing three receipts . MOHFW needs to ensure that we move to a Mobile Health Record system (MHR ) that does not depend on paper . Mobile phones could carry all the records, and more so , when most of the people are likely to carry mobiles. Providers could sync all the medical records with SIM cards. But the success of this depends on the will of the policy makers, honesty and efficiency of implementers ( bureaucrats ) and literacy amongst users
Lastly, it is high time to check migration of our best brains & highly skilled manpower. We can build six AIIMS like buildings, but building institutions will be an onerous task in the current scheme of things, and this could well be the first test for NCHRH.
With some good leaders at the helm of affairs in healthcare , I am quite confident of the changes in healthcare for the benefit of the common man
I do hope that the recommendations are of some help. Incase, you need some clarifications or assistance , I remain at your disposal .
With best wishes
Rajendra Pratap Gupta
Email : office@rajendragupta.in
C.C.-
Shri Ghulam Nabi Azad, Union Minister for Health Family Welfare, Govt. of India
Dr.Syeda Hameed, Member , Planning Commission , Government of India
Shri Dinesh Trivedi, Minister of State for Health , Government of India
Sam Pitroda, Advisor , Prime Minister of India & Chairman, National Knowledge Commission .
Ms.K.Sujatha Rao, Health Secretary, MOHFW, Govt. of India
Dr.K.Srinath Reddy, President , PHFI, Government of India
Dr.Murli Manohar Joshi, MP.
Mrs.Sonia Gandhi , Chairperson ,NAC , UPA.
Rahul Gandhi
Dr.Sharat Chauhan, csharat@ias.nic.in / rshankar50@hotmail.com
Dr.Gautam Sen
Dr.Devi Shetty
Encl: note on healthcare reforms sent on 23rd November 2009.
Mr. Debasish Panda
Joint Secretary
Ministry of Health & Family Welfare
Government of India
Nirman Bhawan , New Delhi 110108
Ref: D.O. V.11025/10/2009-ME(P-1) dated 8th June 2010
Dear Mr.Panda,
Thanks for the invite for the regional consultation on NCHRH . Unfortunately, I could not attend the meeting at Mumbai on 18th June due to a prior commitment at Bangalore for the India Innovation Summit on the same date.
I had sent you an email on the NCHRH with two recommendations. Since then, I have dwelled on the issue at length and wish to submit some recommendations for your kind consideration
Before I start on the specific recommendations, let us consider a few important points that need to be kept in mind for the National Council for Human Resources for Health - NCHRH
• India has 1.2 Billion population out of which about 1/3rd is illiterate population
• In the next 10 years, India will add 120 million people in the working age category
• Currently, India has about 2/3rd of the population below 35 years in age
• Currently , 2/3rd of India lives in rural India and probably, in that category, healthcare does not figure in the list of priorities
• 2/3rd of India does not have adequate access to healthcare
• Awareness and sensitization about healthcare is missing . People will go and splurge money on dining outside , but will not spend a fraction in wellness .
• India believes more on religion , spirituality and charity than wellness
• Healthcare professionals available are not willing to work in the so called rural India . At max, they are willing to work in semi urban India
• The incidence of diseases is not vastly different in rural India from that of urban India for most of the ailments
• Status of urban poor is deplorable when it comes to healthcare
• PPP’s in healthcare are not going to work in rural India
• Those who study for healthcare in urban areas, majority of them are not willing to adjust to the rural lifestyle for professional or family reasons . Gives us a reason to think to start medical colleges in rural settings !!
• The entire healthcare system is focused on medicine , doctors, clinics and hospitals etc. This has created a fear & suspicion amongst the healthcare users that healthcare means pills, surgery and hospitalization
• New models of care are evolving for addressing the changing disease patterns and Indian healthcare system is ill prepared to handle the same
• Time has come to take health ( not medical ! ) education from medical school to primary school. Basic healthcare education should be made compulsory at the school level.
• 3G has now become a reality , so mHealth will not just re-define the healthcare delivery but also healthcare education
In short , I would say that , the world over , no healthcare system has answers for our problems, as all the systems are already failed or heading towards a collapse . This provides a unique challenge and an
opportunity to build a robust healthcare system for India that is low cost, agile , protocol driven, and evidence based and not eminence based system; one that avoids errors , trails and wastage . Then only we can have an outcome driven health system that cares !
Here is what I submit for your kind consideration :
NCHRH ( National Council for Human Resources for Health ) has been set up with the goals to overcome the acute shortage and uneven distribution of human resources in public health delivery system & aims at overhauling the current regulatory framework. Toward this end, it is proposed to set up a National Council
for Human Resources for Health as an overarching regulatory body to achieve the objective of enhancing the supply of skilled personnel in the health sector
What I can understand from the above stated purpose for NCHRH is that NCHRH will ;
• Regulate the current set up
• Identify the current need gap
• Project the future requirement for the next 10, 20 & 30 years
• Asses the population mix and the disease patterns and address the issues in a proactive manner
• Create a resource pool & knowledge pool ( not just impart knowledge but create it as well )
• Human resources for disaster management in healthcare is missing from the draft that I have gone through . It needs to be incorporated
Health in India has to be looked regionally and planned at the district level: It would be wrong to just limit it to five members headed by a chairman. I would suggest that you must create an “Indian Health & Wellness Service (IHWS )” for the entire nation on the lines of IAS . Today , if I have to complain against deficiency of healthcare services or standards or care at a hospital, there is no grievance redressal mechanism !! Because the system is ambiguous and there is no demarcation for people to look at health and wellness services. For erring police , I can go to SP City , DIG –Range or IGP or the DGP; for an erring postman , I can go to the Post master general etc., and the same for most of the services ; but if there is a deficiency in a hospital service provider where does a common man go ? Another hospital, I suppose !!
So when you are planning for NCHRH , You must consider having an all India service to tackle the multi headed monster called healthcare.
Have separate members in NCHRH, each having a clear role and responsibility for capacity building for the following :
1. Urban Health
2. Rural Health
3. Tribal Health
4. Health in hilly areas
5. Health in Armed forces
6. Health for retired government employees
7. Health for private sector
8. Work Place wellness
9. Healthcare amongst Minorities
10. Expatriates working in India
11. Geriatric care in urban & rural health should be handled separately by different members
12. Split ‘Mother and Child care’ under separate heads, each under a separate member . It is glaring to note that According to International Institute of Population Sciences , Mumbai , 56 % of the Indian women in the age group of 15-49 suffer from anemia
13. Diabetes
14. Hypertension
15. Arthritis
16. Cancer
17. Epilepsy
18. Mental Health
19. Telehealth should be a strong focus area for Urban & rural health. It should also be a part of the Medical curriculum and a 3 month internship should be made mandatory for telehealth
20. Medical Education
21. Home health & care technicians
22. Healthcare counselors and Physiotherapists
23. Health administrators for clinics , hospitals other wellness providers
24. Gyms & Wellness centers
25. Diet and Nutrition
26. Acute care
27. Immunization
28. Awareness & Education about wellness
29. Awareness & Education about diseases
30. NGO’s capacity building
31. Disaster management in healthcare including outbreaks & epidemics
32. Epidemiology & research on regional requirements . One example I will quote here. In north eastern part of India , in tea gardens , people take black ( known as red tea in NE ) with salt and so there is a very high incidence of Hypertension and stroke . Same applies to other belts in India which have very specific requirements that cannot be tackled with centralized planning and execution
33. Technical up-gradation & training of the workforce on latest developments in equipments and technology
34. CME for each level of workforce
35. Nurses should be renamed as Physician’s Assistant (PA’s ) or Health & Wellness Officer (HWO’s ) . There should be a plan to create enough specialized resources under this head for rural health, geriatric care , telehealth , chronic diseases etc. We need not make our healthcare system doctor & hospital centric . The number of PA’s / HWO’s should at least be double of that of the doctors in the next 10 years
36. For medical education ( all streams ), behavioral psychology should be added in the curriculum . This is one of the most important change that we need in the medical curriculum . Doctors have just been reduced to diagnosis & prescription machines . Whilst we might be imparting the best of medical knowledge, but patient care and handling is missing totally from the curriculum . Writing prescriptions does not deliver care . Patient friendly care is a must . Because of the lack of understanding of the behavioral psychology amongst doctors , the patients fear and suspect the doctors . Even the doctors do not go beyond prescriptions !! This needs an immediate change to ensure compliance and outcome from the treatment , most importantly, regain ‘Trust’ in the system by the users
37. Put a separate head for innovation in healthcare education
38. Separate head for guidelines, standards , treatment protocols , assessment & accreditation for each aspect of medical & health education and research
Further , each member should be responsible for research , planning & execution for his department. It is clear that if we do not plan for human resources , it will not just lead to deficiency in healthcare services but also increase the cost of healthcare . Limited number of healthcare professionals would be available for jobs and that will definitely lead to unrealistic inflation of salaries amongst health professionals
Since this note is about the healthcare in the country , I would also like to add that, we must look at setting up a TAB ( Technology Adoption Board ). India must not import technologies simply because GE / Siemens have
produced it and it is the latest. Technology is one of the major cost drivers for healthcare . TAB must ensure that the technologies that have demonstrated positive impact on the treatment compared to its cost and accuracy of diagnosis should only be allowed in practice . In 2007 , a 64 slice CT Scan was the most advanced , now it is 914 slide CT scan . The question is what is the difference in cost and accuracy of diagnosis compared to the earlier versions ?
Also, MOHFW should set up ICE – Insitute of Clinical Excellence to formulate and work on clinical pathways & protocol based treatment for all major illnesses , so that the doctors do not resort to expensive and arbitrary line of treatment at the cost & care of patient . A protocol based treatment would let all the stake holders in the continuum of care to work in close coordination
Also, the time has come to move to a greener healthcare system. I hope that we will learn from the MEA ( Ministry of External Affairs ). When you apply for a passport , the passport office gives you two or three receipts , one for the passport application fees, second for jumbo passport ( if you opt for ) and a third one for tatkal category ( if you fall under that category) . I fail to understand that, would it not be better to have one receipt with multiple options for ticking !! It wastes paper , ink and generates three times the heat and noise printing three receipts . MOHFW needs to ensure that we move to a Mobile Health Record system (MHR ) that does not depend on paper . Mobile phones could carry all the records, and more so , when most of the people are likely to carry mobiles. Providers could sync all the medical records with SIM cards. But the success of this depends on the will of the policy makers, honesty and efficiency of implementers ( bureaucrats ) and literacy amongst users
Lastly, it is high time to check migration of our best brains & highly skilled manpower. We can build six AIIMS like buildings, but building institutions will be an onerous task in the current scheme of things, and this could well be the first test for NCHRH.
With some good leaders at the helm of affairs in healthcare , I am quite confident of the changes in healthcare for the benefit of the common man
I do hope that the recommendations are of some help. Incase, you need some clarifications or assistance , I remain at your disposal .
With best wishes
Rajendra Pratap Gupta
Email : office@rajendragupta.in
C.C.-
Shri Ghulam Nabi Azad, Union Minister for Health Family Welfare, Govt. of India
Dr.Syeda Hameed, Member , Planning Commission , Government of India
Shri Dinesh Trivedi, Minister of State for Health , Government of India
Sam Pitroda, Advisor , Prime Minister of India & Chairman, National Knowledge Commission .
Ms.K.Sujatha Rao, Health Secretary, MOHFW, Govt. of India
Dr.K.Srinath Reddy, President , PHFI, Government of India
Dr.Murli Manohar Joshi, MP.
Mrs.Sonia Gandhi , Chairperson ,NAC , UPA.
Rahul Gandhi
Dr.Sharat Chauhan, csharat@ias.nic.in / rshankar50@hotmail.com
Dr.Gautam Sen
Dr.Devi Shetty
Encl: note on healthcare reforms sent on 23rd November 2009.
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