Monday, June 6, 2011

History repeats in Congress - Mrs. Sonia Gandhi & Dr. Manmohan Singh , you must go now !

Mrs. Gandhi , Rahul & Dr. Singh,

Today, this great country is ashamed & aghast due to your cowardly & cold-blooded attacks at Ram Lila Maidan on 4th June 2011. India has reached a new low under your regime !

Every now and then, the supreme court has to intervene and direct the PM & his government to discharge routine duties towards the nation & its citizens. When the constitution of India was written , the constituent assembly laid the foundation of an independent judiciary , legislative & the executive , but due to gross misuse of constitutional powers bestowed upon the Prime Minister through his remote control boss ( Sonia Gandhi ) , you all have forced the Supreme court to run the government on important issues like corruption and high handedness , and this has never happened in the history of India .

Politics & governance under congress has reached the lowest level , and today, everyone realizes that the supreme court is running the nation on a day-to-day basis ( directly or under its fear of intervention ! ). After 4th June , Supreme court will have to make bureaucrats discharge their duties . Jai ho Supreme court and shame -shame for congress !

Congress created hue and cry when Rahul was arrested by Mayawati & now that you have mercilessly beaten up the sleeping protestors ! This clearly indicates a few things :

1. If one makes black money and does wrong , Congress will not kick you out ! ( means that Congress patronizes people who do wrong things and make money ). I believe, that you could not buy Ramdev through your so-called negotiations , and so you tried to assault him to kill him in cold blood ! I am sure that your government must be now planning to invoke your cronies in CBI , IT , ED & FDA etc to raid Ramdev’s establishments and take him to task. Same you have done to those who decided not to toe your line like Amitabh Bacchan and Narendra Modi

2. If people peacefully fast and demand the black money back , Congress will go and kick out people in mid night ?

This act on 4th June was not short of what is happening in the Arab World !! Mrs. Gandhi , since Congress party is running the government, and you have been the President of AICC & the Chairman of NAC , you have proven to be the most incompetent person in Congress as its leader. All your top functionaries are economists ( Chidambaram , Manmohan , Pranab, Montek ) , still you have failed to bring down the inflation , which was to be done in the first 100 days of coming to office !! , Common man has been left behind in all that your party is doing !

Congress has been reduced to the party of scams in the name of social schemes ! Corruption has become the order of the day & currency in this nation . Foreign media has tagged India to be more corrupt than developing ! A. Raja has become amongst the top most corrupt person in the recent international list released by a leading magazine . You are bringing down the country before the global forums . We cannot tolerate this as Indians , and I request you as a common man to resign and go immediately !!

I request the opposition parties to declare a “Corruption , mehagaye aur tanashaye ke virudh Bharat Bandh” ( preferably on a Sunday , to cause least inconvenience to people ) as a show of resentment against your dictatorial and corrupt rule . Congress has always played the politics in the name of Poor , Gandhi family and Religion and cheated the innocent poor for decades , it is time to end this rule . All national leaders marked in this email must come forward so that we do not repeat what happened on 4th June .

I must put these facts before you

The Indian Emergency of 25 June 1975 – 21 March 1977 was a blot in the name of democracy by Indira Gandhi

4th June 1989 , Tiananmen Square happened, and Sonia Gandhi’s Congress did it again on 4th June 2011

3– 6 June 1984, Congress stormed the Golden Temple and killed Sikhs in Operation Blue star Congress leaders led to mass killing of Sikhs post the death of Indira Gandhi

4th June 2011, Congress brutally attacked peaceful protestors in cold blood with an aim to assault Baba Ramdev, repeating the history of Gandhi’s & Congress , and the party has the audacity to call itself as United Progressive Alliance (UPA ) ? Shameful acts . This is what happens when you are afraid of being exposed and your black money is under threat ; Go out and kill innocent in cold blood , and , finally, the Supreme court has to take suo moto action for this cowardly act.

If you have to show courage , go to Pakistan and do an act like America did to capture Dawood Ibrahim !

Though this email , I request our national leaders in the opposition to promise that they will honor our Supreme court judges with at a least Padma Vibhushan ( if not Bharat Ratna ), who woke up our highly educated but ignorant PM to act against Raja, and the judges who took suo-moto action for the cold-blooded attacks on peaceful protestors on 4th June .

Our Tiananmen Square has happened, and now our Egypt like protest must happen . Time for India for a ‘Doosri Azadi’ from this inefficient , corrupt , bankrupt & dictatorial government . Sonia and Rahul are failed politicians and bankrupt with ideas , and a liability on the congress . I am hoping congress will stop idol worship of these two leaders; who brought down the congress in the eyes of a common man, and India in the eyes of the world & hopefully opposition will rise up to restore the faith of the common man

A Common Man

Rajendra Pratap Gupta

www.rajendragupta.wordpress.com

Wednesday, April 13, 2011

Nehru Gene , Congress & Faulty Policies - Let's move on or else suffer more !!

March – April meant a lot of travel and meetings for myself , but the most interesting part were a few conversations that I will never forget !!

Whenever I am travelling to places within India and abroad , I make sure that I interact with people and ask them how much they know of our great country and what they feel about it . I am always proud to be born in this great country . May be , this drives me to find some answers to questions that need not be stated here !!

One conversation I had was with a senior columnist in Kashmir during my visit last month . While we were talking , the issue of partition came up ( this topic is close to my heart as my mother was born and brought up in Lahore , now in Pakistan ) .

This columnist had an interesting point : He mentioned that due to the insatiable lust for power in Nehru , India got divided . His belief was that, Jinnah was at his fag-end due to cancer , if only Nehru would have waited for one more year ( It is not good to have a wish that one dies of cancer but...) , we could have saved ourselves from partition . The columnist went on to add , how could India leave Khyber pass and partition India and give away the pass to Pakistan ;The only way to reach Europe ?? I do not know geography so much , but he had an interesting point !

Other discussion I had was with my cab driver on the way from Washington DCA airport to the hotel . I figured out that the driver seemed to be from our part of the world , So I asked him where he belonged to ? I was right , he was from Pakistan but settled in the US for over 28 years !! While we kept talking about our countries before Partition and the sad story of strained relations now . He shared some very interesting information of why India got partitioned ?

According to this cabbie . India had the maximum number of Muslims , and Nehru & Congress party knew very well that, if India remained united , the vote of Muslims would swing to Indian Muslim League and not come to congress , so Nehru used his proximity with Edwina Mountbatten and planted the thought of partition in Jinnah. Well, I never thought of this angle !! Further this cabbie informed that, if you see the history of Jinnah a few years before freedom , he was never in favor of a partition . It was a congress and Nehru’s game plan and they never wanted to share a few states with IML ( Indian Muslim League ), which would have garnered power in some states, as some states had Muslims in majority , and Hindu’s & Muslims lived in complete harmony .

I completely empathise with this cabbie . I can only state that my mother’s family stayed in Lahore and Karachi , and I have seen my grandfather writing letters in Urdu , it never was an issue . It was planted by congress and today both nations are paying a price for the naked & insatiable lust of Nehru & his congress for grabbing power in 1947 .

The amount of money both these nations have spent on armed forces and conflict would have made this region developed in just 25 -30 years after freedom . But what we got was freedom for Nehru family to rule this nation and not for India !! Now we can well understand why Gandhi ji was in Calcutta during Independence and not with Nehru !! Gandhi ji died at the right time. Had he been alive , he would have revolted against Nehru .

AICC should have been dissolved after independence : Gandhi ji was never in favor of AICC continuing after freedom , In fact , he made a suggestion that since the objective of the congress were achieved by getting freedom from the British , it must be dissolved . But we know that Nehru had a different plan and India continues to ruin under this party !!

One of the interesting viewpoints I can share is from LKY ( Lew Kuan Yew , Father of Modern Singapore ). He has openly criticized Nehru for aping the central planning of the Soviet Union . LKY went on add that Nehru was a good writer & poet but not a great leader for India . Nehru kept promoting the non-aligned movement for the developing world but strongly sided with the soviet Union ( that is , he said one thing and did just the opposite , this is what I call the ‘Nehru Gene’ , which by the way is a legacy of the Gandhi family and its congress ) , and in the end, Nehru caused more harm to India than any other leader ! Nehru had a great opportunity to change the course of the nation immediately after freedom as he had a free hand and people believed in him , but he missed the opportunity .

Indians know that Nehru was the one who took Kashmir to United Nations , he was the one who promoted industries and not SME’s & agriculture ! Nehru guided India towards a disaster with his short-sighted policies ‘Nehru gene’ still rules the Gandhi family and the congress, and it is time to let this party be out of power for at least two terms so that the country can be brought back on track

Rajendra Pratap Gupta

www.rajendragupta.wordpress.com

Wednesday, March 30, 2011

Mental Healthcare Act 2010 - Needs Revisions




Registered Speed Post / E-Mail

Dated: March 24th 2011

Shri. Ghulam Nabi Azad

Hon’ble Health Minister

Government of India

Nirman Bhavan,

New Delhi -110108



Reference: Revision of Mental Health Act 1987 & Mental Health Care Act 2010 ( draft )

Dear Shri Azad ji,

This needs your esteem, kind and personal attention.

I am writing this note on behalf of the Disease Management Association of India – ( DMAI)- The Population Health Improvement Alliance . DMAI works with all the stake holders in the entire continuum of care, for improving the population health of the nation . Over the last few years, we have worked with different stake holders to help define the right priorities in healthcare for the policy makers & the care providers .

Through this note , I am drawing your attention to the revision of the mental health act of 1987 and the proposed Mental Health Care act 2010 (Draft). The process of revision of the Mental Health Act 1987 was initiated about a year back, to make it compliant to the United Nations Convention on the ‘Rights of Persons with Disability’. Disability includes persons with long term mental illness. This convention advocates equal rights for all disabled persons.

Dr Saumitra Pathare ( a private psychiatrist) and Dr. Jaya Sagade (a lawyer) of Pune were in charge of conducting the regional consultations on behalf of the Ministry. Over the last one year, there have been 5 regional consultations with various stakeholders. The major stakeholders consulted have been users, care providers, professional bodies in mental health, mental health institutions and state government representatives. However, it is to be noted that, the Medical Council of India, other specialties of modern medicine, and professional organizations of general health field, have not been consulted. This is important, as the changes which are evident in the draft bill have far reaching consequences in terms of the way the modern medicine is taught and practiced currently.

DMAI- The Population Health Improvement Alliance, is surprised with the outcome of the consultations , and that there was hardly any discussion on the final outcome to patients due to the significant changes which are being brought in terms of the 'mental health’ field of practice of medicine by way of promulgating this act. Proposed changes are likely to cost human lives , as persons who have not been trained to be physician (Clinical Psychologist, Psychiatric Social Worker, Psychiatric Nurse), will be entrusted with the role of independent examination, diagnosis and admission of patients in mental health facilities. Currently, this role rests with a Psychiatrist who is a medical doctor (MBBS) trained in Psychological Medicine. In modern system of medicine ,only a physician (M.B.B.S )can diagnose a patient, as only he has received training in all the specialties such as Medicine, Surgery, Eye, ENT, Obstetrics & Gynecology, Pediatrics, Orthopedics, Radiology, Dentistry, Dermatology, Anesthesiology, Pharmacology, Preventive and Social Medicine, Pathology, Microbiology, Physiology, Biochemistry, Anatomy etc. , which essentially means, covering all the systems of the body. Unfortunately, Human body cannot be compartmentalized and however we may wish, but we cannot have an Eye specialist who has studied only ‘Eye’ and not done MBBS ( as a basic general qualification and set of skills covering the entire human body system) to examine each and every system of human body. Similarly, we cannot have a Psychologist who has no training of the subjects studied at MBBS level, to diagnose mental disorders by only doing psychological examination!!!!

Only an MBBS trained doctor with the proper understanding of the entire human body system and its functioning, can do a detailed psychological evaluation and come to a diagnosis of whether the patient has a psychological illness or it is some physical illness, which is presenting itself as a psychological illness. In cases of latter, appropriate referral is required and any delay may even be fatal. S/he can also order various tests and imaging and interpret them for aiding in his diagnosis. After a diagnosis is arrived at, s/he can plan and provide physical treatment (ECT), pharmacological treatment or psychological treatment. The role of psychiatric nurse, clinical psychologist or a psychiatric social worker is to assist him by nursing the patient, helping him in psychological interventions, helping him in psycho-social interventions respectively. But the patient is under the overall care of a psychiatrist who is the leader of the mental health team. All the three categories of personnel work under the supervision of a psychiatrist .

A clinical psychologist, PSW ( Psychiatric Social Worker ) or a psychiatric nurse is not trained to be a physician. They have not studied the human body as an MBBS doctor and cannot do detailed physical or systemic examination, investigations and imaging like a psychiatrist. They are in no position to independently examine, diagnose and advise admission of patient. A PSW and Clinical psychologist have not general training in other subjects of modern medicine. Just by talking to patient, how can a Clinical Psychologist or PSW diagnose a mental disorder? They will be severely restricted by their inability to do general and systemic examination and order and interpret investigations and imaging. A Psychiatry examinee will fail in his examination if he did not touch the patient for examination ; however bright drug treatment he may formulate for the patient ; as without a general and systemic examination, a person cannot make a diagnosis of mental disorder. In many cases special investigations and imaging also has to be ordered and interpreted. As per the diagnostic criteria for mental illness, a mental disorder can only be diagnosed after ruling out that the signs and symptoms are not better accounted for by a medical illness or use/abuse of a substance. In this scenario, without proper validation of the reason for the particular condition , what is the validity of diagnosis of mental disorder by a Clinical Psychologist, PSW or a Nurse ? Even the quacks believe that they can diagnose and treat independently. Each such claim needs to be examined objectively in line of their competence and current practice related to their vocation.

In modern system of medicine, which is regulated by MCI, there is no specialization known as Clinical Psychology, PSW or Psychiatric Nursing. The mandate of ‘Rehabilitation Council’ is limited to rehabilitation of persons with disability and practice of modern medicine under Rehabilitation Council is neither required nor allowed. If at all, new independent specialties such as Clinical Psychology, PSW and Mental Health Nursing without any supervisory role of a Psychiatrist is being planned for modern medicine system, then the whole modern medical system (MCI, Indian Medical Association, Other Medical Specialties) must be consulted .

If we go as per the draft, it means that Clinical Psychology, PSW and Mental Health Nursing personnel are as much a specialist as a psychiatrist and can independently examine , diagnose, admit and treat patients with mental disorders.

It is not understandable why a psychiatrist has to do MBBS (study the whole human body) and then specialize in Psychiatry while for the other persons they need to study only psychology or social work and yet be assumed to be qualified to examine the whole body, diagnose, admit and treat patients (albeit without medicines) . The demand to prescribe medicines by non psychiatrist is also going around (and may be later on this will be also be made possible.) There is no institution in the country where a Clinical Psychologist, PSW, Mental Health Nurse examines patients independently, diagnoses a mental disorders, admits patients and treats them. This amounts to practice of Psychiatry under the modern system of medicine and would invite penal provisions of MCI. The sole aim of drafters is to get the bill through and take credit for drafting the bill rather than have a healthy development of the sector. Nowhere in the country there is a Clinical Psychology ward, PSW ward or Psychiatric Nursing ward. The decision to admit is taken by the leader of the mental health team who is a Psychiatrist and it is the Psychiatrist who is overall responsible for treatment of a patient with mental disorder.

One of the reasons given by the people behind the draft of the Mental Healthcare Act 2010, for giving the role of independent examination, diagnosis and admission in bill, is the shortage of psychiatrist in the country. But if we go by the definition of psychiatrist in the bill which is the same as that in the previous Act, ‘an MBBS qualified person with experience and training in Psychiatry can be designated a psychiatrist’ for the purpose of the Act.

At present , there are about 8 lac medical practitioners in the country and these can potentially be designated as psychiatrist. So where is the shortage for the purpose of the Act ? The only purpose which could be served by giving an independent examination, diagnosis and admission to Clinical Psychologist, PSW, Mental Health Nurse in the bill is to later on claim that if they are capable of doing these jobs, then this means that they can practice their trades independently under the modern system of Medicine. This would mean they will be physicians of mental disorders just like a psychiatrist.

The inclusion of Clinical Psychologist, PSW, Mental Health Nurse for purpose of independent assessment, diagnosis, admission to a mental health facility should be deleted and replaced by ‘psychiatrist’ (an MBBS qualified doctor with some training/experience in psychiatry). After this, there will not be a need for defining mental health professional in the Act. If at all it has to be defined, then Clinical Psychologist and PSW shall be designated as Assistant Mental Health Professional as in the present legislation (Section 22 of State Mental Health Rule 1990) and their role clearly specified as being- to assist a psychiatrist.

Further, the supervision and review of the decision of a psychiatrist by a Clinical Psychologist, PSW, Mental Health Nurse in the mental health review commission is not feasible as review is to be done by practitioner of the same specialty i.e. Psychiatrist. Thus, the provision of Psychiatrist in the review commission should be made mandatory.

In a multidisciplinary team such as a mental health team, each team member has a specific role. If everyone will do the same role, which is to independently examine, diagnose and admit, then there could be no team functioning. Rather the role of each mental health person should be clarified in the Guidelines /Rules clearly, so that there is good team functioning and the public is well informed and is not misguided by manipulative persons. Can we imagine a similar provision for a Nurse specializing in Medical, Surgical, OBG, Cardio-thoracic nursing to independently examine, diagnose and admit patients in Medical, Surgical or OBG, Cardio-Thoracic ward respectively? Then why should we consider similar provision for Clinical Psychologist posted with Neurology department?

Psychiatry is a medical discipline as any other discipline. If Clinical Psychologist, PSW and Psychiatric Nurse want to independently examine , diagnose, admit and treat patients without even having the training and skills for the same and government wants to allow the same, then they should be allowed to start their own wards to do so and be responsible for their decisions. If we allow such changes to be brought, this would mean that a Psychiatrist too does not need to do MBBS. Then all the specialties of modern medicine should have direct specialization rather than first spend 5.5 years to be a General doctor. Human body cannot be divided in a compartments. All organs and systems are interrelated. A stroke can present itself as a depression in a mental health facility. What skill a psychologist or a PSW has to diagnose it without doing a full neurological examination or relevant investigations. They will treat for depression while the patient will die. In my view , compartmentalised knowledge is dangerous for the medical profession and defeats the basis of evidence based medicine

We are trying to make Clinical Psychologist, PSW and Mental Health Nurse into Physicians in mental health by giving the role of a Physician to them under the new draft bill on the pretext of shortage of Psychiatrist. However, there are less than a 1000 Clinical Psychologist and PSW both combined in the country. Further, there is no dearth of Psychiatrist under Mental Health Act, as Govt. can very well designate MBBS doctors with some experience in Psychiatry as Psychiatrist (as per the definition and provision in current legislation and the draft Bill). So even the assumptions for the shortage of psychiatrists is not a right justification for this act

The role given to Clinical Psychologist, PSW and Psychiatric Nurse in the draft bill is ; independent examination of patients, diagnosis , admission and then review of decisions taken by a Psychiatrist. Instead of this, in the draft bill, the role of a Clinical Psychologist and PSW- as a rehabilitation professional , and Psychiatric nurse - as a specialized nurse, should have been clarified and focused.

The position of a Psychiatrist as a mental health team leader should be reiterated and the decision of a psychiatrist should only be reviewed by a board having a psychiatrist. These rules could further be clarified In the draft bill psychiatric social worker and clinical psychologist has been mentioned as mental health professional just like a psychiatrist. However, In section 22 of the State Mental Health Rules’1990 (the existing legislation) the PSW and Clinical Psychologist are referred to as Assistant mental health professional. The change in the draft bill under consideration has been done with a view to make their role fit for independent examination, diagnosis, admission to a mental health facility by the drafters, without any regard to the impact of this on the patient care and safety. If they are full-fledged professionals (as they claim) who can diagnose, admit and treat patients, why do they need to be defined as such in the Act. At no place in the draft bill their role has been mentioned separately. At all places they are bunched as mental health professional with no individual roles. At no place it is mentioned that they will function under the supervision of a psychiatrist. If they independently examine, diagnose and admit patients they are then deemed to have an independent role. This will increase the role conflict which is already very high in the mental health team. So much so that at some places there is no team work. In Kerala High Court, there is a case going on, to allow clinical psychologist to independently practice in community to treat patients of mental disorders.

This is a serious issue and needs to be taken up strongly so that untrained people are not given the role of a physician i.e. to practice independently to treat patients.

DMAI insists that the Medical Council of India, Indian Medical Association & patient groups & DMAI needs to be taken in confidence and consulted, as independent examination, diagnosis and admission and also treatment by psychological or psycho-social means is practice of psychiatry under modern medicine and could not be allowed to be done by persons who do not even have a MBBS degree, in view of patient safety and care.

All health personnel shall work within the limits of their competence. In section 43 and 45 of the draft bill related to admission in a mental health facility: a mental health professional (i.e. Clinical Psychologist, PSW, Psychiatric nurse) has a role to examine a person suspected to be mentally ill independently, assess mental illness and its severity and advise admission. This is a role which goes beyond their competence. There are already instances of Clinical Psychologist practicing treatment of mental disorders independently as isolated examples. There is growing demand from clinical psychologist to allow them to practice independently the treatment of mental disorders. This change in the draft bill will allow them to be recognized as persons who can independently examine, diagnose, and admit patients, which will substantiate their claim to practice independently in community rather than under the supervision of a psychiatrist. It’s altogether different matter that they are not trained to examine and diagnose mental disorders as it requires ruling out other physical disorders as well and it requires a person to be a physician to do that. In section 22 of the draft bill : Constitution of district panels of mental health review commission , two members could be mental health professionals (i.e. Clinical Psychologist, PSW, Psychiatric nurse) which may not include a psychiatrist if he is not available, but then how the commission can judge the decision of a psychiatrist if no psychiatrist is in the commission? One needs to have knowledge of psychiatry to assess the correctness of the decision of a psychiatrist in a particular case. Provision of a psychiatrist in the review commission should be mandatory rather than being replaced by non-psychiatrist personnel Mental disorders are medical disorders and should not be treated by non-medicos .

I am quite sure that you will intervene and ensure that the corrective measures are taken to address the lacunae in the bill Also,

DMAI- The Population Health Improvement Alliance has initiated a ‘NCD Policy of India’ initiative, and would be glad to have the views of the ‘Ministry of Health’ involvement on the initiative

I am quite convinced that committed leadership will take cognizance of this note and take measures to implement the suggestions after a debate with all the stake holders in the continuum of care.

Should you need any assistance at my end, do let me know.

With best regards

Rajendra Pratap Gupta

CC. Dr.Manmohan Singh, Sonia Gandhi ,Rahul Gandhi , Dr.Syeda Hameed, Dr.Murli Mahohar Joshi , Montek Singh Ahluwalia ,Shri Dinesh Trivedi , Sitaram Yechury, Members of Parliament , Sam Pitroda , Secy-Health & Family Welfare , GOI, Dr.K.Srinath Reddy, Debasish Panda , Secretary (ME) Governors , MCI DGHS,MOHFW, Dr.Sudhir Gupta , CMO, NCD-MOHFW ,Dr. Suman Sinha, Psychiatrist, IMA , Chief Minister’s of States

Tuesday, March 29, 2011

Include Homeopathy in National Health Schemes

DMAI wants the govt to give due weightage to homoeopathy in NRHM

Suja Nair Shirodkar, Mumbai Wednesday, March 30, 2011, 08:00 Hrs [IST]

The Disease Management Association of India (DMAI) has recommended the Public Accounts Committee (PAC) of the central government to increase the role of homoeopathy in the National Rural Health Mission (NRHM), especially for acute illness.

At present homoeopathy is not being leveraged properly under NRHM in spite of it being the cheapest way of treatment in the country. Rajendra Pratap Gupta, president and director DMAI pointed out that the homoeopathic medicines are cheaper and much more accessible to patients thus it is only natural that its potential should be utilised properly under NRHM.

Though the treatment used in homoeopathy is superficially similar to the medicines prescribed by a conventional doctor it differs in their source, preparation and dosage. He observed that in spite of having enough qualified homoeopathic physicians in the country the government is not giving them enough chance to play any role in the national health program. “Today there are hospitals and colleges that cater to homoeopathy and encourage its use then why isn't the government utilising these resources to increase the demand for homoeopathic medicines among the rural population.

The government should take step to ensure that the people in the rural India can also benefit from this system,” he pointed out. He said that the demand for homoeopathy has increased over the years as more and more people are adopting homoeopathic treatment due to its effectiveness compared to other available methods. Thus it should be put to use more effectively. He added, “Homoeopathic medicines are very cheap, in almost two rupees a patient can get a weeks worth of medicines which will be a great support to the rural population, it would provide them with cheapest alternative that assures best treatment.”

Homoeopathy is a system for the treatment of illness that is based both on the recognition of patterns within the symptoms of the illness and a wider consideration of how the individual is as a person. Although conventional medical assessment also takes these issues in to account, the homoeopathic approach integrates personality type, previous experiences, emotional state, the influence of the environment and other social factors to a greater degree than is usual with standard medical practice.

http://www.pharmabiz.com/NewsDetails.aspx?aid=62119&sid=1

Rajendra Pratap Gupta

Tuesday, March 22, 2011

DMAI wants the government to extend the NRHM till 2017 with radical operational changes




The Disease Management Association of India (DMAI), a non-profit organisation propagating disease management concept and tools in the country, has urged the Public Accounts Committee (PAC) of the central government to reconsider its recommendations for scrapping of National Rural Health Mission (NRHM) as the NRHM has made an impact on the lives of the rural population in the country.

The DMAI suggestion in this regard was put forth by the DMAI president and director Rajendra Pratap Gupta in a letter addressed to PAC chairman Dr Murli Manohar Joshi recently.

The NRHM was launched in the country on April 12, 2005 for a period of seven years i.e. from 2005 to 2012 for providing integrated comprehensive primary health care services, specially to the poor and vulnerable sections of the society. It means that NRHM will get expired by 2012. However, seeing its impact on the rural population, the government is thinking of a possible extension for another five years. In this regard the government had asked PAC to review the NRHM. However, in its reports the PAC has recommended on scrapping the NRHM scheme.

However Gupta suggested, “NRHM is a very useful programme and has been successful in having its presence felt even in the remote parts of the country. However, there are many radical administrative and operational changes needed to be made in the present format of NRHM.”

He suggested that with proper administrative and operational tactic, this programme certainly will have the power to create desired impact in the rural health scene. In his recommendations to the planning commission on the changes needed in NRHM for the 12th five year plan, Gupta suggested that technology must be leveraged in NRHM for accountability, transparency and telehealth and that 12th five year plan must consider opportunities to digitise NRHM in all spheres of its implementation.

He said, “There are many important changes that needs to be undertaken in the NRHM, but of all changes the first and foremost change should be to improve the quality of medicines that is being supplied at the NRHM centres. Secondly, minor surgeries are not allowed in Primary Health Centres (PHCs) as of now. This should be changed and the government must allow minor surgeries in the PHCs as it would help reduce a lot for hassles for the villagers and bring revenue for the government as well.”

Other issue that he had highlighted in the letter was on the inadequate fund flow on time which could lead to corruption among the people working at the lowest level in PHC and sub centres.

“I have met people who were not paid salary for months, and also discovered the fact that the funds that were supposed to be sent for 2010 were received by the centres in mid January 2011. Such delays must be stopped with immediate effect as this clearly will encourage and lead to corruption as people drawing a monthly salary of Rs.5000-8000 won’t be able to sustain their family without salary for months. Either they will resort to bribing, selling the government supplies or starts absconding and working for employers in parallel. Thus I suggest that the fund meant for a sub centre or PHC must be transferred in advance for the quarter if not half yearly,” Gupta points out.

He put special stress on telehealth adoption goals for NRHM and other healthcare projects, as setting up and manning the physical infrastructure with qualified professionals at remote places is nonviable. To stress the importance of telehealth adoption in the country the Telemedicine Society of India (TSI) is organising a three-day conference Telemedicon’ 11 in Mumbai from November 11 to 13. TSI is completely dedicated to the promotion of telehealth in India and is being organised at a time when there is a big push from the government and private players in the field of telehealth in India.

Rajendra Pratap Gupta

http://www.pharmabiz.com/NewsDetails.aspx?aid=61977&sid=1

www.telemedicon11.com

Thursday, March 17, 2011

Nuclear deal , FDI , Inflation & Black money - You did not change India , but changed India's image Dr. Singh !

Dear Dr.Singh,

I read the top story in the current issue of the International Magazine ‘The Economist’ , and felt sad . Whenever , people like us visit outside of India , we are questioned or pointed towards corruption in India , and believe you me , it is painful to accept such criticism for our great country ! You put us to shame !

Nuclear deal & Jaitapur Plant : Recently , Wikileaks have exposed that Nuclear deal was not even acceptable to congress MP’s but money was paid to get votes !! It calls for a review and legal action against people making mockery of the most sacred institution of our country – Parliament ! Dr. Singh , please step down , we cannot bear more international assault due to your misdeeds ! Also, that India must immediately have a rethink on the location of all the nuclear installations from a public safety point of view . Jaitaput plant in Maharashtra is in Seismic risk zone and had 92 quakes in the past 20 years . The earth quake in 1992 was measuring 6.2 on Richter scale !! It calls for a fresh consideration of the approval granted in light of the developments in Japan post the Tsunami

FDI : Last week , I read that the government is considering granting FDI in retail for metros . Please desist from implementing your flawed policies again . Do not create hype and investment around metros , it leads to lopsided development and migration . If at all you want to grant FDI , please allow it in class 3 & 4 towns first , so that the local people get employment and we can see some reverse migration of populations and the burden on metros can reduce . Frame policies where foreign retailers cannot own more than 26 % in Indian companies across board . We do not want to lose our freedom Dr. Singh ! Also , as I have always mentioned change the definition of FDI from Foreign direct investment to Finance from domestic institutions ! Encourage retailer friendly policies for locals. Britishers financially exploited India , and took our wealth . Today MNC’s ( Multinational corporations ) are acquiring flourishing Indian companies and will take the profits away ! Are not getting back to pre-1947 days ? We will be exploited financially again and forever ! We are losing freedom with every investment & acquisition ! What is the use of such independence when the financial exploitation is similar to that under the British rule ? Please come up with rules that, in any sector , investments more than 26 -40 % cannot happen . Significant majority has to be with Indians ( Resident Indians). This is in the interest of national security & maintaining independence

Inflation : I have been watching your statements for the cause of inflation . Earlier , you attributed it to recession in 2008, poor rainfall in 2009 , and now you are attributing it to money from NAREGA !! Please do not blame the poor for every thing !! When you blamed poor rainfall as a cause of inflation , people were skeptical about it . When rainfall was good in 2010 , inflation still did not go down , now you had to find another reason , and quite cleverly , yourself & Pranab have been saying that because people are getting NAREGA money so they are buying more , thereby , leading to inflation . Please do not make lame excuses Mr. Prime Minister ! You & Montek have said that we must start to live with inflation as growth and inflation are intertwined . Sorry Dr. Singh , you need to study Economics again . History has shown that high growth and low inflation is possible and has happened in Germany & China and other parts of the world. So please do not give lame excuses . The real issue with inflation is that , because of your flawed policies for rural India , the migration has become perennial , and there is a tremendous loss in productivity ( multi-dimensional loss ) and that has caused inflation . Raising interest rates would not help ever , and time will tell us this hard fact . It is difficult to find a farmer less than 30 years in age .

NAREGA In its present form is causing irreparable damage to rural India , and I do hope that the educated economists in your team and the planning commission will attend to it as top most priority

I am scared that, if God forbid , India had a famine , how are we prepared ? We know such things can happen & without any notice like the recession ,and are not prepared for any such eventuality . Please let your cricket minister work on the worst case scenario’s as well.

Black Money : Last point is about the black money . We have seen all the estimates so far , and every number is an eye popping trillion dollar amount . Please challenge my number if you can !! India spends close to 30 % of its GDP in running the government and bureaucracy every year . it is a hard fact that, every employee who takes bribe gets almost double his salary in bribes ! Now another reality is, that senior bureaucrats and politicians get disproportionately high money in bribes when it comes to comparing bribes with their salaries . So clearly , the average B-GDP ( Black GDP ) is certainly 1.5 times the 30 % of GDP that the government spends on administrative costs of running the government . So If I average out the last five years GDP at half trillion dollars a year . India would have lost One trillion dollars in black money in just last five years , and trust me , these are the most pessimistic numbers ,and so are on the lower side . Your government & Mr.Khursheed talks about corporate governance ? When political governance of the nation is a sham and people have to take out thousands of cores off the balance sheet as bribes to your cabinet ministers , how can transparency and corporate governance work in this nation ? Take the case of telecom licenses ; every telecom company paid money other than the license fee . Where did the money come from , and where did it get accounted ? Not certainly in the legitimate account books , and so the corporate governance was severely compromised . Dr. Singh , The change should start at the top . if the political governance is good , corporate governance is good , if the political governance is shady , the corporate governance can never be imagined .

Dr.Singh , the nation recalls your letter to appear before the parliamentary accounts committee . I think that is not enough . You must be interrogated by CBI and charge sheeted for leading the most corrupt government in history of India ,and perhaps the world !

Read the article below from the Economist !

A Common Man

Rajendra Pratap Gupta

www.rajendragupta.wordpress.com

Article from the latest issue of The Economist

Corruption in India

A rotten state

Graft is becoming a bigger problem—and the government should tackle it

Mar 10th 2011 | from the print edition

INDIANS’ anger over rising corruption has reached feverish levels. What people are calling a “season of scams” includes the alleged theft of billions by officials behind last year’s Commonwealth games in Delhi; $40 billion in revenues lost from the crooked sale of 2G telecoms licenses; and over $40 billion stolen in Uttar Pradesh alone from schemes subsidising food and fuel for the poor. Foreign businessmen, who have slashed investment over the past year, rank graft as their biggest headache behind appalling infrastructure. Now India’s anti-corruption chief has been forced out over, well, corruption (see article).

Graft is hardly new in India: the Bofors scandal brought down the government in 1989. But there seems to be more of it about than ever, if only because India is getting richer fast, and the faster the economy grows, the more chances arise for mind-boggling theft. The government says that in the next five-year plan period, which starts next year, $1 trillion will be spent on roads, railways, ports and so on, with billions more on re-equipping the armed forces and welfare. Add in an insatiable appetite for scarce land, water and minerals and a monsoon of bribes is forecast.

Some are inclined to shrug their shoulders. After all, corruption does not seem to be stopping India from growing. Yet imagine how much better the country would be doing without it. Corruption raises costs not just to Indians, but also to the foreigners whose capital India needs. Thanks in part to those scandals, India’s stockmarket was the worst-performing outside the Muslim world over the past year.

To its credit, the government has begun to take action against powerful individuals. Maharashtra state’s chief minister was forced out over a property scandal. Police have quizzed Suresh Kalmadi, the politician who ran the Commonwealth games. Most strikingly, Andimuthu Raja, the cabinet minister who oversaw the 2G telecom licences, was arrested.

A 2005 act giving the right to information is welcome, as are auctions for public goods, such as last year’s lucrative sale of the 3G telecom spectrum. Technology is helping. In some states, bids for state contracts are being run online, allowing anti-corruption bodies to monitor them. Gujarat does this for all contracts over 500,000 rupees ($11,000). It also puts land records and death certificates online, cutting down on one form of petty graft. Websites, led by ipaidabribe.com, reveal the cost of graft by publicising the sums demanded for everything from registering a baby to fixing a broken water supply.

The central government should now implement a plan for a universal, computerised ID scheme. It would allow welfare payments to be paid into individuals’ bank accounts, hindering theft by state workers.

The licence Raj lives on Most of all, India must redouble its efforts to liberalise. The state could outsource official tasks, cut red tape and sell wasteful and corrupt state-owned firms (why does the government make watches?). For all that the “licence Raj” was supposedly scrapped two decades ago, it can still take nearly 200 days to get a construction permit and seven years to close a business. Regulations are not, by and large, deterrents to corruption, but a source of it.

Wednesday, March 16, 2011

Inaugural Speech delivered by Rajendra Pratap Gupta on March 14th 2011, at ‘Spardha’ - A national level event organized by VAMNICOM , Pune, for students of Management & Agricultural institutes across India

Good Morning friends !

I feel honoured to be here and am thankful to my friend, Dr.Yash Patil and the Director, Dr.Reddy, for giving me an opportunity to be a part of your National event, ‘Spardha’ .

Whenever I address students - the young , energetic and vibrant crowd , I am quite convinced that India will change . You are all full of great energy and ideas, but sadly , at present , India does not offer you a readymade & attractive platform due to our inefficient leaders at the helm of affairs and corrupt bureaucracy who are eating away the money and opportunities meant for the common man . But I see that the winds of change are on the horizon , and I believe that each one of you will push India ahead ; to set a new bench mark for the world in all spheres.

Today , India stands at a very critical juncture , and institutes like VAMNICOM hold the key for either India’s meteoric rise or a gradual fall !!

I was going through your chairman, Dr.Chandra Pal Singh Yadav’s message , and I was impressed with his views that we need to support farmers ,workers and weaker sections of the society for the development of this country. I believe that the education imparted via VAMINICOM aims to deliver that goal . This is exactly what India needs today .

It is an ironical fact that IIM’s and IIT’s have lost direction and failed to deliver the mission with which they had started with. Today, IIT’s & IIM’s are about fat packages from MNC’s . In fact , they have become subservient to MNC’s packages and are doing little for this country’s betterment . In these times , we want you all to pass out of VAMNICON and set goals that will re-define the future of this great nation.

Let me put things in a little perspective so that you do not have illusions in future when you move out of the campus. I believe that you will pass out this year or next year, depending if you are in 1st year or the final year. Some of you will get back to their family business , some will seek jobs and some will become entrepreneurs . No matter which path you take , the formula for success would remain the same . So let’s understand the realities of professional life :

Each one of you needs to have two goals in mind – Urgent ( short term ) & Important (Long term )goals . ‘Urgent’ is about the present i.e. your studies, to clear the exams with good marks . ‘Important’ is about future . What are you going to do after passing out from VAMNICON ? Don’t ever commit the mistake that President Obama did ! When President Obama started his election campaign, he talked about healthcare reforms & the Wall Street reforms. By the time he became the President , things had changed, but he still focused all his energies on the ‘Urgent’ & forgot the ‘Important’; that the market conditions had changed and there was a deep recession . People were losing the jobs every hour . President Obama still kept working on his ‘Urgent’ agenda,not realizing that the conditions had changed . He accomplished Healthcare reforms & Wall Street reforms !! Mid-term elections came in for the congress . President Obama had missed out addressing the Important , and so he lost to the Republicans in 2010, and finally , he is fighting to save the essence of the bills that he had passed on healthcare & Wall Street . The point is, never loose sight of the changed circumstances and keep focusing on both the urgent & the important . Else , you will have to compromise to survive . We are living in a very dynamic and an ultra -volatile world .

We live in a material world :. Don’t try to kill your desires. Reality in life is that people worship knowledge, position, influence & money. So you need to have each of them if you want to be successful. You must aim to be debt free by the age of 40 and, have a house , vehicle and savings good enough to last you without working for a year or two. It is extremely important to draw a line as to how much is much ? If you do not have those boundaries, you are bound to get into the mad rush for making money without realizing where to stop ! This is what our current politicians are doing . They lack moral boundaries, and they go for more and more and do not stop before nature pulls the carpet under their feet !!

Getting settled in life : How many of you want to get settled in life soon? Well let me quote you an interaction with one of my dear friends – Shiv Khera . He is the biggest motivational Guru in India . Sometime in 2009, we were coming out of The Grand Hyatt hotel , and he was discussing with me about the new path he had undertaken that required tough decisions . So I asked him ‘Shiv , can you leave your book writing and speeches and join politics full time ? To which , he immediately replied ‘ I am not yet settled’ . Imagine , if a person who is the highest paid speaker and the best motivational writer, is not settled , how will people like you and me be settled ? So it is wrong to assume that we ever get settled in life . Life is about facing constant challenges. Have you ever seen an ECG ? If ECG comes out as a straight line , the patient is dead !

You cannot have a long ride without a puncture : While all of you will do well in life , but you can never drive a vehicle always in the fifth gear . Long rides cannot be without a puncture . Some time , you will feel that you weren’t wrong but still you were punished . Never mind , even Gods were punished without fault ! Lord Ram & Lord Christ were punished for no fault of theirs . But do fight back for what is right !!

Keep reading books and newspapers to update yourself on the global and national scene & across sectors . If five friends came together , you could buy one book each and read five books . Form a habit to read at least two news papers a day . But learn to appreciate the difference between education , knowledge and wisdom . A highly educated person might not necessarily be a wise person .

Stay Fit : As you move up the corporate ladder , you will need to be mentally fit and physically active . Devote 5 % of your daily time for yoga , mediation and gym Working is important but so is networking . How many of you are on facebook , Orkut or twitter ? How many of you are on a professional networking group ? Professional networking groups are a powerful professional tool for career progression . Please do not ignore them .

Always look for new ideas & not become copy cats : I was heading a large retail chain as a COO, and every time in the review meetings , I would solve the operational problems with a new approach . Once , my team member asked me , ‘Sir, every time you come out with something new , but one day you will run out of ideas , then what will you do ? I asked him “Since how many years river Ganges is coming out from Gangotri ? . He replied ‘ Since ages’. I asked him again ‘has it stopped ?’ . He replied ‘never’. He got the answer . That there is no limit to new ideas . While you are working in an organization , ensure that your work & experience profile changes every 2-3 years . Else , you would be like a truck driver with 20 years of experience. Remember that a truck driver faces the same road conditions every year . So his actual experience is just one year !!

You are amongst the five % Indians that are graduates . So you are also responsible for the remaining 95 %......... Let me ask you a question ? I know of a family where 56 % of the income goes in paying loans , 30 % of the income goes in running the household and another 10 % is miscellaneous expenditure , and only 4 % is invested to increase the income or to create assets . How would you rate such a family? Well to do, not good not bad or in a serious financial crisis ? So here are the facts about Indian economy : 55.9 % of the GDP goes into servicing the debt, approximately 30 % is the cost of running the government and bureaucracy, 2.5 % goes to subsidies , 2.6 % goes to defense . One fact is clear that only about 4 % of the GDP is going towards asset creation or wealth creation in this country . This is a very serious issue facing the nation.

How will the country be prosperous which spends about 96 % of its income with no wealth creation strategies & adds 17 million people to its population every year !!

If our country borrows Rs.80 lac a minute how will its citizens be prosperous ? Similarly, If the 99 % of the system is corrupt , you & your family members and even your next generation will certainly be harassed unless the system gets changed ?

Let me ask you another question. If you were earning handsomely after working hard, how many of you would share your monthly income with you neighbours or servants after paying your taxes ? We keep hearing that the fruits of growth has not reached the masses.

Common man will not reap the fruits of India’s prosperity unless he is the one driving it !! Why should someone share the earnings of his hard work with someone who hasn’t ? This is where each one of you can make a real difference . Agriculture continues to employ 65 % of its population and contributes just 17.2 % of the GDP. There is so much to be done but none at the policy maker level knows what to do ?

A few weeks back I was with the policy advisor of Rahul Gandhi , and we were discussing about how we could transform rural India . He informed me that he was advising Rahul to create 600 new districts at a cost of USD 1 billion each to transform India, but he could not convince me as to how 600 new districts transform the population’s standard of living ? After an hour of discussion , he admitted that the future of the villages was doomed ? Should we let this to happen ? We know the problem , lets take the challenge to change the fate of these ‘doomed’ villages . Each one of you can contribute effectively . We know that the government might not have the right answers but we must not just find solutions but also go ahead and implement them.

Rural India can transform if we understand that the basic requirement for such a transformation is having ‘transactions’ in rural India . The good thing about money is that whenever it changes hands , the hand becomes heavier ! I request you to think of creating business models that can utilize the local inputs and create products and services that leads to more transactions for rural India . Co-operatives & SHG’s ( Self Help Groups) are central to rural India’s transformation. Think about the 1.55 lac post offices , 2.38 lac gram panchayats and millions of kirana stores . Can we not create rural millionaires out of 700 million rural Indians ? We need micro-preneurs & agri-preneurs, if we want to change the rural landscape . Due to uncertainty of variable factors and no clear political vision for the prosperity for rural India , people do not want to remain in agriculture any more . If they get a job they keep moving and are selling their land. Because of the haphazard developmental policies , land and employment under agriculture is decreasing . In the western world, people are migrating to rural areas for better quality of life and in India , it is just the opposite, as Indians are migrating to urban areas. God forbid, if India ever faced a famine or severe draught , what will happen to a billion people ? Have we planned for it ? Can we guarantee it will never happen ?? We have not been able to tackle inflation even ??

A day before yesterday , I read that government wants to open the FDI in retail for metros and we have heard in the past that ‘Mumbai is being made Shanghai’ . So if we are creating hype and investing in metros , why should people not migrate ? We must create more ‘Mumbai’s in India rather than trying to create ‘Shanghai’ in Mumbai . Government has always said that opening up the FDI in retail will improve the supply chain. But we know that FDI in supply chain is already permitted . So we know that this is a wrong reason to justify FDI in retail.

Most of our growth is inspired due to the growth in China. India woke up for growth when China started growing at 10 + % per year with a much larger population . The current growth in India is about GDP and sensex . India’s growth is only applicable & benefits people who read The Economic Times . Such a growth has no strong fundamentals .

The government has allocated Rs,500 crore for skills development programme, and Rs. 40000.00 crore in NAREGA . This is, when we are facing acute shortage of trained man power in every sector at every level ! If a few thousand crore was invested in skills development for rural India , it would create a lasting value for the rural people and the economy

Wastage of agriculture produce due to lack of proper infrastructure is to the tune of Rs.30000.00 per year . Can we address this issue ? Some of you go and start a daily transportation service that carries the farm produce to the nearest town for sale . Imagine the value addition it would bring to the farmers ? You charge them a fixed percentage of sale ?? All will make money in the process and Agriculture will be lucrative for farmers – something that is missing today .

Can some of you go and set up low cost rural cold chain facilities for rural India Can some of you set up international technical collaborations for enhancing the quality and quantity of farm produce India has the largest number of cattle but not milk products . Can some of you create more Amul’s & Warna’s in India ?

India is the largest producer of milk in the world but not the top most exporter !! India is endowed with livestock resources of vast genetic diversity and accounts for about 11 percent of the world livestock population. The country boasts of 55 per cent of the world buffalo population, 20 per cent of the goat population and 16 per cent of the cattle population in the world. India has the largest cattle and buffalo population in the world and holds the second rank with respect to goat and sheep world population. Some of you could take food processing techniques to rural India

Kiwi fruit is sold at Rs. 25 a piece and it is given to pigs in Manipur as the road infrastructure is so bad that the fruits are unfit for consumption by the time they reach the markets . Some of you develop technologies to save such a wastage

Healthcare reaches only 24 % of rural India . Some of you could create a viable rural healthcare delivery model .Some of you should go and set up telemedicine centres across rural India

Some of you could maybe set up veterinary care centres ?

Kirana stores in rural India are still lagging behind . Some of you can start a rural Kirana store chain

Can some of you go and set up SHG’s in different states in India and empower them to form a national level marketing channel for rural India Opportunities are countless , just go and execute .

Let me tell you that Indian system is very good but manned by wrong people , and so public has lost trust .

Despite all the odds , everywhere in India, I see so much opportunities to work on , and it is a great boon to be born in India . It is how you take it . I believe that each one of you will have a lot to accomplish in life , and am sure that this institution will equip you with the right tools to handle the opportunities that will come your way

I wish you all the best and hope to see you again

Rajendra

Thursday, March 10, 2011

Elections in Tamil Nadu- DMK Vs AIIDMK

Yesterday I was in Chennai and discussed with some people about the scenario in the April elections for the state assembly

I was informed that the 2 G money is already showing up , and last week only DMK distributed sarees and stainless steel jar to all the residents of kovilambakkam. Each vote is likely to cost Rs.2000 to 3000 only !!

When I asked a few people ( professionals who work in different companies that , ‘ Why you all do not oppose such things ? I was told that DMK has hooligans in their cadres, and opposing DMK means inviting the wrath of these cadres and creating problems for our families !! So it is better we take the freebies & cash and vote them back

Further , these people said that DMK needs congress desperately , as if Congress is unhappy , DMK will invite action from congress for its illegal activities and black money. If congress is with DMK , State is already under its control and now centre will be blind to all the wrongs that DMK does – It is a win-win for both DMK –Congress . We know the kind of people congress works with and the thing congress supports !! DMK is widely referred as Daily Making Money for Karunanidhi – DMK

Also, a few weeks ago, I was speaking with a grass root worker from Tamil Nadu , and he informed that DMK has approached a lot of AIIDMK leaders and offered them cash as high as 50 cores and got them to work in AIIDMK and transfer their votes to DMK !! Shrewd & crafty congress allies !!

So , finally , we know what is going to be used in the state elections in Tamil Nadu & what will be the outcome on April 13. Only Almighty can intervene & swing things differently !!

Rajendra Pratap Gupta
www.rajendragupta.wordpress.com

Monday, February 21, 2011

Unhealthy Promotions- Banning toys with food products meant for Children

February 21, 2011.

Shri Ghulam Nabi Azad

Minister of Health & Family Welfare

Nirmal Bhawan, New Delhi – 110108

Subject: For Immediate action-banning of toys given as free gifts with food products & drinks, & framing guidelines on Child Health & Preventive care

Hon’ble Minister,

I am writing this important petition on behalf of the Disease Management Association of India – DMAI; The Population Health Improvement Alliance. DMAI is founded by global healthcare leaders to help improve the population health in India by focusing on the entire continuum of care.

In November 2010, during my visit to the US , I was with Senator Tom Daschle ( Senator Tom was nominated as Health & Human Services Secretary by President Obama , which he declined, and is often referred to as a senior Advisor & Mentor to President Obama). During the discussion, he asked me; how is India a better bet than China? I told him that, in the next three decades, while India will have majority of working age population, China will have one working person and three retired persons. This should put China in serious productivity issue!! India is the youngest nation today, with an average age of approximately 25.9 years, and this is often referred as a ‘demographic dividend’.

While statistically, India is having a tremendous demographic dividend , if we do not attend to the ‘ Child Health’ as a top priority , our demographic dividend will become a ‘Demographic Disaster’, as our working population would be ‘Unhealthy’ and thus drastically impact the productivity of the nation . This is the biggest hurdle for India to attend, if we need to overtake China in the long-term for being a developed & a vibrant economy

For Immediate action: Media has proliferated & children have dedicated channels on TV.They watch T.V. , which is flooded with animated cartoons & other Sci-fi serials, and children get fancied with such shows. The companies have started giving the characters associated with these shows as free gifts to entice the children to buy their food products and drinks. So children force their parents to buy the foods stuff or drinks just for the sake of these ‘Freebies’ , and they also consume these products, so that the parents do not scold them for spending so much on these food items !! Due to this, our children are fast becoming obese & unhealthy!! Just for the sake of an example , I am quoting my son who buys Mc Donald’s ‘Happy Meal’ just for the sake of getting the toy that comes free with it & I can see that he is least interested in the meal , but then he consumes the ‘Burger’ , and ‘Cold Drinks’ that comes with the ‘Happy Meals’ to ensure that next time he gets a chance to buy the Happy Meal from Mc Donald again and most importantly , get the free toy . He already weighs 40 KG at the age of 7 years. Luckily, he has joined the Gym with me. But imagine, the severely ‘Obese’ children that are a result of such ‘Unhealthy’ Promotions with food products meant for children. I have just quoted Mc Donald for the sake of example, but we have most of the companies selling ‘Unhealthy foods’ with promotions aimed at enticing children, playing for their ignorance and their intense desire for playing with toys!

Through this note, I call upon the policy makers to ban such toys and also the advertisements related to such promotions in national media with immediate effect. I also call upon the ‘responsible’ companies to sell & market their products for ‘nutritional value’ and not on ‘Unhealthy promotions’ or ‘Freebies’.

Also, the MOHFW should come up with “hand book on Preventive Healthcare for Children” below 12 years If we fail to take immediate and strict action now, our future generations will grow up to curse this generation for inaction, and the nation will be burdened by poor productivity and high healthcare costs with no signs of health ! It is a call to action . I do look forward to prompt action on the same from all the concerned.

If the policy makers fail to take action, DMAI will initiate a nation-wide campaign for such ‘unhealthy promotions’.

With best regards

Rajendra Pratap Gupta

CC.

Sonia Gandhi ,Rahul Gandhi , Dr.Manmohan Singh , Dr.Murli Mahohar Joshi , Shri Ghulam Nabi Azad Min, for information & Broad Casting, Montek Singh Ahluwalia, Dr.Syeda Hameed, Shri L.K.Advani , Smt. Sushma Swaraj, Shri Dinesh Trivedi , Sitaram Yechury , Members of Parliament , Sam Pitroda , Secy, Health & Family Welfare, GOI , Dr. K. Srinath Reddy , Chief Minister’s of States, Media

Friday, February 18, 2011

Corruption mera Karma aur Coalition mera Dharma

Dear Manmohan ji,

The common man is really frustrated with your ‘blame game’ approach in the recent press conference . When you became the PM, we had hoped that an economics Professor who had been educated in the best of institutions in India and abroad , could impress upon the people in his party and change the governance of the nation without compromise. But , by staying silent on all the unethical activities in the congress , not only you denigrated the national institutions , you lowered the stature of the Prime Minster’s post & eroded the trust of the common man .

In the press conference , you said that, ‘let’s not just focus on scams as that lowers the image of the nation’. I wish to point Dr.Singh that, not just the image but also the financial health of the nation has been affected due to your being a patron of corruption !!

You have clearly conveyed that ‘ Corruption is your Karma & Coalition is your Dharma’. While it is known that you had some good qualities like knowledge , honesty etc , but you did not exercise those qualities , so in a sense , you became a greedy professor wanting to just stick to the Chair of the PM .

I am wondering how come Pranab Mukherjee was not questioned in this scam when he is the finance minister ? Is he just responsible for collecting taxes and not about the financial loss to the nation ? He must also follow Raja in Tihar . No one is above law ! Also, If you have the guts , please question Mukesh Ambani . He is the one who routed international calls as local calls and committed a criminal offence. What has your government done ? The Telecom co’s CEO going to CBI office and having coffee & lunch does not impress the common man. We know that these visits might be a ‘eyewash’ for the common man at the behest of congress party, and the common man is made to believe that your government is acting on corruption . Do not put off the JPC demand quoting these arrests .Suresh Kalmadi is still enjoying the dollars made in CWG !! Why he is he not in Tihar ?

Dr.Singh , every one in India is talking about the black money in Swiss banks , Dr.Singh , India has more black money than all the Swiss banks combined ! Why Pranab Dada does not start taxing expenditure rather than taxing income !! Every government officer is directly or indirectly involved in bribery , every business is into tax evasion , every builder takes a portion of the cost as black money , every minister fights election on black money . Still you think that only Swiss banks have India’s black money ? Swiss banks , I believe would only have 10-15 % of the black money , rest is still in India , and may be, some money might be in middle eastern countries .

Please change your tax system. If you tax one’s income , he might not disclose it , but at the end, the money is used to purchase something , so go and tax expenditure , the government will collect more taxes , and we would be happy paying taxes on expenditure !!

Now back to my question of your moral flexibility to run the government .

Why have you tied up with DMK in a poll bound Tamilnadu ??

Why has the CBI let off Mulayam in the disproportionate assets case ?

Is this a part of Sonia’s five pronged approach to fight corruption ???

Rahul : Where is your clean up of the party going ? Are you cleaning up the honest people by such tie ups ? What about your call to go alone in polls ? While I was at 10 Janpath with you a few months ago , a first generation leader whom you inducted in your party had met up with myself , and he told me that you are just getting educated people in the party . So all new congress leaders have started enrolling in MBA !!. Finally , this call for educated leaders is leading to elite with money bags joining youth congress. You are totally disconnected from the reality on ground !! By the way , Gandhi’s are always disconnected with reality . Nothing new !!

Dr.Singh , by asking Supreme court to directly monitor the probe, you have shown that you have no interest to act on your own or you do not trust that you will do a good job in the case ! We all know why retired supreme court judges get plum posting !! So if nothing comes out of these so called ‘Blame Free investigations’ ( Which we know will happen ) , you will shed off your load saying that you had asked the top most court to direct the probe and that you are like ‘Ceaser’s Wife’ etc etc………………….. and you cannot be blamed for the culprits being acquitted !!

When you constitute the JPC , please also mandate it to come out with an action plan that can

a) Investigate the wealth creation formula of the ex Chief Justice of India K.G.Balakrishnan .

b) Bring back the black money and put the people behind the black money in Jail

c) Recover the loot of public money by people like Lalu , Maya & other leaders like Sharad Pawar etc.

d) Take action for CWG loot

e) Investigate on all massive loot cases happening in the nation

f) Frame up laws and set up a system say a CIA ( Central Corruption Investigating agency ), which can take suo moto action against any one ( Even the President of India ) , should the need arise without going through any approval , and this institution must report to the supreme body – Legislature every six months . This body should be adequately equipped with resources ( legal, financial and human resources ) to decisively act against corruption , and all top level appointments must be made by a body consisting of the P.M. , CJI , CVC & Opposition leader .

I also want you to ask CBI to investigate if Apollo Hospitals Group paid money to A.Raja. I was told by none other than the brother-in-law of A.Raja that Apollo had paid Rs.700.00 crore to Raja

I am also quite surprised that you have quoted that you will not quit the post of PM. It is the height of being shameless

Dr.Singh,history will paint you as Mohammaed-Bin-Tuglaq-A knowledgeable and wise king who caused lot of misery and pain to his people

If you do not shape up, wait for 2014, and the common man will throw the congress government and return results like Bihar

Rajendra Pratap Gupta

A Common Man

www.rajendragupta.wordpress.com

Sunday, February 13, 2011

NRHM & Jan Aushadhi Scheme review by Parliamentary Accounts Committee ( PAC)



February 14th 2011.

Dr.Murli Manohar Joshi
M.P.( Lok Sabha )
Chairman ,
Public Accounts Committee
Government of India
6, Raisena Road
New Delhi 110001

Reference : National Rural Health Mission ( Ministry of Health & Family Welfare ) & Jan Aushadhi Stores ( Ministry of Chemicals & Fertilizers )


Dear Dr.Joshi,

Namaskaar,

This has reference to our meeting on 9th February 2011 at your residence in Delhi , and our discussions regarding NRHM & its review by the PAC . I have gone through the entire NRHM set up and even visited various centres and sub centres operated under NRHM in different parts of the country . I believe that, you must reconsider your views on recommending the scrapping of NRHM, as NRHM has definitely made an impact on the lives of the rural population . Though, NRHM needs some radical operational changes , but as a program , it is impactful. Please find my recommendations to the Planning Commission on the changes needed in NRHM for the 12th five year plan . Planning commission had asked me for inputs on the same , and I am sure that the MOHFW might be working on the changes as well . Rest we will discuss when you invite me to dispose before the PAC as an healthcare expert for NRHM & other schemes of MOHFW.

Jan Aushadhi Stores ( under ministry of chemicals & fertilizers ) : In fact , this scheme is poorly planned and badly executed . You must recommend scrapping of the Jan Aushadi stores scheme with immediate effect . This is a blatant misuse of public money . Whereas , the idea of generic stores is great , but this scheme has been a failure so far , and I do not foresee this scheme taking off . In the current form , Jan Ausahdi is a scam in the making !!

If you are still to review the Jan Aushadhi stores under the PAC , I would be happy to despose based on my hands on experience with pharmacy chains and the ground reality with Jan Aushadi stores

I am sure that you will certainly consider these inputs and revert in case you need more information . Also , Dr.Joshi , I am travelling to your constituency in March 1st week to deliver a lecture at the Institute of Medical Sciences , BHU on NRHM , and If you are in Varanasi , would be glad to meet up.

With best regards

Rajendra

Rajendra Pratap Gupta
President & Director
DMAI
www.dmai.org.in

Thursday, February 10, 2011

Worst Prime Minister India has ever had & the worst President Congress ever had

A few days ago , the Prime Minister defended that, during the appointment of the Chief Vigilance Commissioner (CVC ), he was not aware of any charge-sheet against him , this is despite the fact that, Sushma Swaraj clearly raised an objection to the appointment of Mr.Thomas as CVC based on the charge-sheet.

Now ISRO says, that it had kept the cabinet in dark on the deal with Devas. This office is with the Prime Minister . I am sure that all of us realize by now that , this Prime Minister is no more than a rubber stamp of Sonia , who has no inclination to go into facts and take action . In fact, this is the worst Prime Minister India has ever had , and Sonia is the worst President Congress had ever had .

Sonia is Queen of Corruption and mother of all scams & Manmohan is a lame duck PM

Both must resign and go

Rajendra Pratap Gupta
www.rajendragupta.wordpress.com

Tuesday, February 8, 2011

What's Happening ??

Dear National Leaders,

For the last couple of months , we are seeing a ‘high octane’ battle being fought between the parties for two issues ‘ Corruption in congress and unchecked inflation’. As a common man , I am worried that this great nation is going to dogs because of the lack of governance in the ruling party , and lack of outcome based action in the opposition ( which needs to unite for a national cause ) . The current government is a serious threat to the national security

One side , Rahul Gandhi says that Congress will fight corruption , and Sonia says that she has a five pronged strategy for fighting corruption , one the other side , we see that congress goes and co-habits with DMK for the Tamilnadu elections, and the government is shy of disclosing the names of 17 account holders in Swiss banks , so it clearly tells what kind of five pronged approach congress has to fight corruption .

Arrest of Raja by CBI is a tactic by congress , CBI is not a prosecuting agency, it is an investigative agency.If congress was serious , the system would have sent him to judicial custody – I am sure that intelligent people who understand the mechanizations of congress , get the meaning.

My biggest worry is that Indian military is getting weaker day by day , and we are waiting for an attack to happen , India could face serious losses and a major setback , if that were to happen. I do hope that BJP will take action . Scams can be handled , may be, even some lost money could be recovered. But if we are attacked by a foreign power and we fail , We would have lost it all.

Congress has to go now and so has to the Gandhi Dynasty from Indian politics . I would suggest BJP to start Egypt like movement so that our Hosni Mubarak’s ( Gandhi’s ) and Mohammad Bin Tugluk ( Manmohan ) go soon , and the country can be put back on track

We don’t want our great nation to suffer more . Please get your act together

A Common Man

Rajendra Pratap Gupta
www.rajendragupta.wordpress.com

Tuesday, February 1, 2011

Re-structuring Healthcare in India - 12th Five Year plan - NRHM , ICDS & Malnutrition

January 31, 2011.

Dr.Syeda Hameed

Member

Planning Commission

Government of India

Yojna Bhawan,

Sansad Marg, New Delhi- 110001



Reference: Inputs on the 12th Five year plan W.R.T. (1) Eradicating under-nutrition and malnutrition in India through restructuring of ICDS or other means and (2) Suggestions for improvement in the present structure of NRHM.



Dear Dr. Hameed,



I am sure that this finds you doing well. This has reference to the mail from your office on 5th January 2011, requesting me to provide inputs on the 12th five year plan w.r.t.(1) Eradicating under-nutrition and malnutrition in India through restructuring of ICDS or other means and (2) Suggestions for improvement in the present structure of NRHM.



At the outset, let me put my deep appreciation for the NRHM (National Rural Health Mission) and its positive impact on the healthcare of the rural population. I had a chance to visit many rural pockets over the past few years, and my inputs are based on the reality as seen by a commoner, and I do hope it is insightful along with being helpful.



Policy Changes:



To me, there appears to be no single prescription for addressing the diverse healthcare needs of this country, which is as big as a continent, but NRHM has made its presence felt even in the remote parts of the country. Seeing that the NRHM was launched only in April 2005, and would be around till 2012, with a possible extension for another five years , one of the key policy action items that might be worth considering to create a pro-active Rural healthcare system in another six years ( assuming that the NRHM is discontinued in its current form by 2017 ), is to be able to sensitize the population on the adoption of basic standards of personal hygiene , nutrition & lifestyle necessary for fitness ( wellness) that makes our population less dependent on hospital care . This should be one of the key goals of the NRHM for the 12th Five year plan .The current NRHM has put the onus & financial burden on the centre, as the centre and state partnership in terms of the financial outlay is 85: 15 . Second important consideration , this also must get a key policy shift for the 12th five year plan which should have one more stakeholder i.e. center : state : Beneficiary .





Funding for NRHM:



We need to see a financial participation from the beneficiaries of the NRHM, as they would have got used to the services offered via NRHM centers ( ASHA , ANM, Sub Centers , PHC , CHC & District hospitals ) , and the value of offering would have increased through NRHM centers. In addition to this, per capita income will also go up in the next five years if the country continues to grow at the current pace. So we must consider if we can increase the fees for basic services towards the 10th year of NRHM; even a token increase by one rupee can deliver a quantum leap. Besides, we must keep reducing the financial incentives gradually every year to phase it out eventually. Still, the people would enjoy the safe healthcare services which are subsidized or offered at a very low cost. Villagers are getting used to these services , and I am sure that in the 10th year of NRHM , it might be a right time to bring down some of the subsidies and incentives , as the trust would have built up considerably .



NRHM should welcome ‘tax free’ donations from individuals and corporates: This should be publicized and could become a good way to raise funds in a step towards building a financially sustainable healthcare model for rural India



With a gradual reversal in the expense funding between center and the state, the expense part needs a micro planning as, though the hard infrastructure expenses might not be as high as it is now (since we are constructing sub centers & upgrading some existing centers ), but the maintenance of the infrastructure built will become a huge financial burden, and knowing that the divestment & auctions are not routine incomes for the government, this would lead to a huge deficit in the budgets over the next six years if financial planning of NRHM is not planned and managed well.



Also, one of the key considerations for the policy makers is to look at converting NRHM into NHM ( National Health Mission ) , as the conditions remain deplorable for urban poor , and the private facilities are not going beyond tier 1 & 2 towns .



Structural changes:



It would be worth considering replacing the hierarchical designations to functional designations to have a clearly defined role and an outcome driven responsibility



Mission Steering Group (at the Centre) could consist of the following :



Director for Planning & Forecasting,

Director for Strategy

Director for Analysis & Research (One who looks into the regular reporting & review)

Director – Innovation & Program improvisation (Program will certainly improvise with regular feedback & inputs)

Director – IT

Director – Procurement

Director – Logistics

Director – Finance & Accounts

Director – Standards - Medical Protocols, GCP (Good Clinical Practices) & Quality Control

Director – IM (Infant Mortality)

Director – MM (Maternal Mortality)

Director – Nutrition

Director – Immunizations

Director – Preventive Care

Director – Mental Health

Director – TB- DOTS

Director - ART

Director – NCD

Director – Anemia & Related Disorders (This needs a special focus, as more than 50 % of women are Anemic)

Director – Oral Care

Director – De-addiction (De-addiction must also be a focus area, as the consumption of alcohol has been on constant rise, and wife beating is prevalent in most of the households)

Director – Ophthalmology

Director – Ambulatory services

Director – Pharmacy

Director – NGO & Alliances

Director – Media & Communication

Director – Human Resources & Training



More people can be added depending upon the focus areas for NRHM. In fact, I would strongly recommend that all the national health programs be merged with the NRHM one by one to ensure that health & wellness issues are addressed holistically in rural India



The reason I am recommending a dedicated resource for each action area like Director – MM, Director IM etc. is that, then we have people with specific deliverable, and outcomes would be better. Currently, at the centre, we have four Joint Secretaries and four directors with multiple responsibilities . These might leave them with delivering outstanding results in some areas, and with serious gaps in some!!



The above mentioned Central Committee (Mission Steering Group ) , should be overseen by the board or committee which has members from Public Health, doctors from modern medicine, Ayush, Nursing, Public representative, patient groups & people from different walks of life, who bring diverse capabilities to the team with proven competence in envisioning and executing projects on mass scale or of making a social impact. 1/3rd of these representatives must change every two years (rotating public participation). 50 % of the members must be from the government and 50 % from the private sector. Also, of the total members, 50 % must be practicing doctors and remaining non-medicos.





Further, a similar structure needs to be set up at the state level. At the District level, the work gets delivered via same field workers.



While the PHC’s & Sub centers are done up very well, some gaps remain, like;



There is a mismatch in the requirement & stocks of medicines. All the PHC’s get similar stocks of medicines irrespective of the load in OPD. So , whereas some PHC have more stocks , some have stock outs – More of Forecasting and logistics issue
Supplies of nutrients is insufficient & inconsistent - Once we have a focused resource ( Director – Nutrition , Director – Forecasting & Director – Logistics ), these problems would reduce drastically
Need is for three doctors instead of the two currently at the PHC, so that the load can be handled well. Currently, at times, the wait period for a patient to be seen could go beyond 4 hours at times in OPD. Also, with this, the PHC can operate 24 X 7 , since doctors can do an 8 hour shift each
It would be good to have the doctor’s residence attached to the PHC
Biomedical waste disposal has to be given priority to avoid infections in villages.


Challenge: Nutrition given during ANC / PNC is consumed by the family and not by the mother.



Solution: If ASHA can monitor this during visits or otherwise, it would be effective or the gender specific nutrition packs could be made to ensure that the females consume what is meant for them. Self Help Groups have emerged as the new power centers in the villages and every village has Self Help groups. ASHA’s must work with SHG’s to address this issue and oversee that the diet meant for the lactating mother is given to her in presence of a SHG member



Challenge: Electricity – Load shedding in villages: This leads to lack of storage conditions in PHC’s & Sub centers



Solution: India has adequate sunshine for 9-10 months in a year, for rest of the months, the load shedding is less, so it is worth considering having solar panels as an integral part at all the PHC’s & Sub Centers for generating electricity needed for storage and other requirements



Challenge: Poor Quality of Medicines: It is observed that the qualities of medicines are poor, and it is procured by the district Health committee. Poor quality of medicine is a serious issue, as the patients are given medicines for treatment, and if the medicines are not effective, it will lead to mistrust in the entire system, and the poor people will have to move towards private practitioners or quacks and suffer more



Solution: Since all the companies in pharmaceuticals have national level operations, it will be good if the national level tie up is done for procurements of medicines at the NRHM rates, and the order, supplies & payments happen locally. With this, we will be able to get the best rates and also give the best quality of medicines to the needy poor patients. Also, generic medicines should only be allowed to be used under NRHM. This will help to save enormous costs to the government. Also, all the PHC’s & sub centers must set up ROP’s (re-order points for all the requirements, factoring in the time lag for supplies based on past trends. This will ensure that there are near zero stock outs).



It was observed that the specialists (Gynecologist ) in one of the model PHC (Wardha district) comes only for two hours and that too, to direct patients to private practice. This must be avoided at all costs, as this will eventually make ASHA’s & ANM’s, agents for private clinics for all the wrong reasons & erode the trust in the NRHM



Challenge: Absenteeism in PHC: It is a common problem to see that doctors are missing or come only for a few hours or few days in a month.



Solution: It is suggested that the entire NRHM attendance moves paperless (biometric attendance be made compulsory). With this, the problem of absenteeism will come to an end



Challenge: Preparing reports and paper work takes most of the productive time of the health workers



Solution: With the advent of low cost tablet PC’s & low price 3 G enabled phones; it might be worth considering giving these devices to health workers like ASHA’s. Also, if these mobiles / tablets have a GPRS connection, it can mean live data updates, thereby, reducing the three month gap between the village data entry and the central review points at Delhi



When I visited the residence of one ASHA worker, she had more registers to maintain records then her daughter would have used in her studies! In all, she had about six registers to maintain records and spent 2-3 hours daily to just fill in her records. I believe that just one register should have been good enough , with name of the beneficiary , under which head ( disease or operation ) , visit for the purpose of , repeat visit , action taken, next steps, and next due visit etc…….The register given by NRHM was in English with words like Vulnerable men / women . I believe that the language used should be bilingual and not just in English …. This needs immediate attention. Digitizing the records through mobile phones would be great, as has been done in Wardha district for IM & MM programs. The data is updated live and the impact is significant with no chances of multiple entry and errors, and also real time actions happens due to SMS based follow up and care.



Ground reality: I visited one centre in a rural area, and I was surprised to see the PHC decked up to welcome the Health & Sanitation committee that was to visit the centre. I was told by the centre staff that they have been waiting since past one week, expecting this committee and they had bouquets etc ready to welcome them. Such visits do not reveal anything and add no value to the working of the village sub centers or the PHC but work only for photo-ops!! Only surprise visits must be under taken with no formal information given in advance, so that the right picture is presented during the visit, and the action oriented steps can be taken to fill the gaps, if any.



Pharmacies are present in every part of India .It is believed that India has about 7.5+ lac pharmacies across the country, and most of the villages have a pharmacy. All the

Pharmacists must work as ASHA support systems due to their knowledge and skills, being the trusted touch point for basic health problems. Focus through pharmacists should be on chronic diseases and paternal care, and through ASHA’s on child and maternal health



Medicine kits given to ASHA should have all the instructions in English, where as all the pharmaceutical companies are expected to carry the same bilingually (English & Hindi). For NRHM supplies, pictorial presentation along with bilingual labeling must be mandated.



Tribals & Upper caste: Despite the best efforts of the government, tribals are still called the ‘Black castes’ and live in a separate area demarcated for them. One of the biggest challenges is that ASHA from a lower caste would still find few takers amongst upper caste households, and vice versa. This is one issue that needs to be addressed. It would be wrong to create two ASHA’s and further the divide , but some really significant work can be given to ASHA , so that it appears to be compelling enough for everyone to seek ASHA’s assistance- Like the entire village birth certificates must have ASHA’s signature etc.



Changes in the delivery of services



New Opportunities:



Community Radio: This is being experimented in Baramati, and must be looked into. Similar services can be started in villages to drive healthy behaviors. I had visited a few villages in north, where a simple awareness campaign (pictorial & through songs in local dialect) have reduced the maternal mortality by 93 %. The expenses in this project were not more than Rs.5000.00 per village. Such models need to be adopted



Toll free based IVR Multilingual helpline: NRHM must initiate this to help reach the right people for the right inputs



m-Health based Jeevandaini scheme : This has been piloted in Wardha district , with good results in institutional deliveries and drastic improvement in MMR. The simple mobile based applications have lead to live data upload and follow up via SMS, leading to good compliance amongst ANM’s & ASHA’s . This health based model needs to be made an essential part of NRHM . Since 3G & WIMAX is now a reality , the rural health information flow and delivery of few basic services must be done adopting m-Health ( mobile health platform ).



Mobile Sub centers: Sub centers are built at a cost of Rs.8.5 – 13.5+ Lacs. It might be worth considering to set-up mobile sub centers( Mobile Vans ) that can go across to the remotest areas and conduct outreach programmes. So the cost of operating the sub center ( rental , electricity etc ) gets consumed in the form of fuel expenses for the mobile health center and also, these sub centers can be used as an ambulance in case of medical emergencies . Thus it would save Rs.300 that is given for transferring patients to the referral centre. The cost of mobile centre is expected to be much lower than the cost of a physical centre. Location of PHC’s & Sub Health Centers is mostly around a few Km’s from the residential areas, and this needs to be corrected or filled up with such mobile health center



Digital Training of Health workers: It might be worth considering creating a TV programme on doordarshan modeled exclusively for training ASHA, ANM & for increasing awareness amongst NRHM beneficiaries. Also the same should be made available through mobile phones as 3G is now a reality. Expecting mothers must be able to see the demo & programme clippings via their handsets or through ASHA’s handsets, which could be upgraded to a 3G enabled mobile handsets for live reporting or for delivering video content for various programmes.



Technology must be leveraged in NRHM for accountability, transparency and telehealth. 12th five year plan must consider opportunities to digitize NRHM in all spheres of its implementation



Minor surgeries in PHC: Now that that PHC’s have facilities for delivery, minor surgeries must be allowed in the PHC. So far, minor surgeries are not allowed in PHC. This is one important decision that can help save a lot for hassles for villagers and bring revenue for the government. The PHC’s can enroll patients for minor surgeries, and then get a surgeon on call for a day from a nearby town and complete the minor surgeries at the PHC to function as day care centers .



Reporting of NRHM across states should be on the same format as of KPI’s (key performance indicators) so that it leads to apples to apples comparison and this could be on these indicators



Structural : Setting up and maintenance of the facilities
Functional : Human resource management and flow of instructions and funds
Fund utilization: special focus must be paid as to why the funds could not be used, as the money is meant to be spent with an outcome allocated to every rupee spent.
Outcomes : Measurable outcomes in improvement in the village / Taluka health must be done every quarter


Reporting and review must be



Weekly for Talukas
Fortnightly for Districts
Monthly for states
Quarterly at the centre


This timely reporting will itself bring out better outcomes. It was sad to learn that during the mid-term review of the 11th five year plan in July 2009, the ministry of health & family welfare was not even aware of any targets. The reality is that, the files from the planning commission were not even looked into by the ministry of health & family welfare until the mid-term review of the plan started. One of the senior official of the MOHFW had revealed to me that rarely MOHFW looked into the files from the planning commission , and they were not even aware of any targets set by the planning commission , and that if the MOHFW did not respond to the plan targets set by the Planning Commission , the planning commission assumed the targets as accepted by the Ministry of Health & family welfare .This is a structural and procedural lacunae and needs to be addressed from the planning stage for the 12th five year plan , so that the ministry does not question in the meeting who set the targets for them ??



Administrative changes:



Financial planning and flow of funds: The fund flow on time is the biggest problem. I have met people working at the lowest level in PHC & Sub centers, where the salary has not been paid for months, and the funds for 2010 were received in mid – Jan 2011. This clearly will encourage corruption. People drawing a monthly salary of Rs.5000-8000 cannot sustain their family without salary for months. Either they will resort to bribing; selling the government supplies or starts absconding and working for employers in parallel. The fund meant for a sub Center or PHC must be transferred in advance for the quarter if not half yearly. This is one single biggest action item to make a sub center or PHC Staff working 6 days a week



Referral centre: It has been found that the referral centre in Panvel (district Raigad) does not even accept patients & turns them away from the door itself ( this is a reality ), and the patients are routed to the Alibag referral centre. Such centers must be a common occurrence across India. Government is paying for them, but they are operational only on paper. Such center must be tracked down, and either made fully operational or closed down. As not only they cause a loss of money to the exchequer, but also diminish the trust of the common man in government’s flagship schemes like NRHM



Why programmes succeed or why they fail- Lessons to learn: Let’s take a look at the successful programmes like NACO for Aids, National TB control programme & the Pulse Polio programmes. All these programmes have worked well because of the fact that they have proper structure and resources allocated. In the ministry of health & family welfare, the programmes are fantastic announcements, but the human resources required are not properly allocated in the ministry to handle such programmes; only the funds are transferred in the bank for the programme. So the department handling the programme is under resource crunch , they do not even have people to handle the communication , and most of their time goes in reporting ; Result – the funds remain un-utilized and are returned back in case of calamity announcement from the PM’s fund or for other reasons and thus programmes fail to leave an impact . Planners must study the success of National TB control programme & NACO and implement the learning’s in all the programmes for Health & family welfare



Incentive to health workers ASHA’s ANM’s & other Sub center & PHC staff: It is expected that since ASHA’s and ANM’s are incentivized for institutional deliveries, referral etc. The incentive might also make them turn to private practitioners over a period of time, as the lure of money will drive them to recommend private gynecologists & give less focus to home visits and counseling, and this might be happening even today as well. It is suggested that the ASHA’s & ANM’s must be incentivized for counseling, home visits, immunization & preventive checks as a routine part of their job and the incentive must be paid for each home visit ( even Rs. 2 to Rs.3 per visit is good enough ) . This will lead to a fixed remuneration to ASHA’S & ANM’s. Certain Evaluation parameters for the success of an ASHA must be established like how many households are aware of sanitation, hygiene, preventive health and healthy lifestyle. Since the NRHM has a huge outlay of funds for the national healthcare, a ‘dip–stick’ audit using random sampling must be done with the households, and this must be done every quarter across the states where NRHM is currently operational.



ASHA is not paid a salary but is paid incentive for institutional deliveries (Rs.100), DOT treatment (Rs.250), meetings for once a month (Rs.150, out of which Rs. 100 is for travel and Rs.50 for refreshments). A supervisor is above ASHA’s and she handles about 30 ASHA’s. She is paid Rs. 3000.00 per month. She is supposed to be meeting two ASHA’s a day. Since both the ASHA’s and Supervisor have to travel long distances by road , and keep in constant touch with each other , I would recommend free local roadways pass to NRHM workers , and a mobile connection with CUG ( Closed user group , that allows free calls between users ) for NRHM staff. The cost of which could be less than Rs.75 per month



NRHM Handbook : Since the NRHM programme is the biggest healthcare programme so far, it is imperative that a detailed multi lingual NRHM Handbook, manual or ready reckoner be brought out for all those involved in the programme , covering basic protocols, bio medical waste disposal , do’s & don’ts dealt with FAQ’s . Also, the digital version must be available on mobiles and internet.



1-3 months rural posting of nurses, pharmacist and doctors must be made mandatory for the courses to fill the resource crunch, and the professionals must be remunerated for these postings along with free accommodation on site at the sub center and PHC.



Awareness & sensitization: Since NRHM is addressing the key areas when it comes to health and hygiene, it is imperative that a chapter on NRHM is added in secondary education (class 6th onwards). This will lead to awareness and sensitization amongst children to adapt to healthy habits



Role model & Case studies approach: People believe in facts, and the case studies & success stories of ASHA & ANM’s must be shared nationally to make the acceptance more impactful for behavioral change. I must share with you something interesting that I witnessed in north India. I was visiting rural belt in north India, and came across an ancient custom called ‘Shourey pratha’. Under this , when the lady delivers a child , she is confined to a room for 40 days , and cow dung is plastered on the walls ,and baked cow dung cakes are burnt non-stop to fumigate the room, automatically the mother and child suffocate to death . Now we can well imagine why the IM &MM (Infant Mortality & Maternal Mortality) was very high in the rural belt in north India. With simple explanations and scientific explanations with the help of the Self Help Groups (SHG’s), this tradition is on its way out. SHG’s is the most powerful change agent in rural India and the NRHM must use this channel to drive a behavioral change in rural India.






Eradicating under-nutrition and malnutrition



The issue of under-nutrition and malnutrition is not just an issue associated with poverty . If I were to say that malnutrition is also prevalent due to the lack of sanitation facilities, people would not believe it, leave alone talking about linking the two.



Here is an interesting linkage : Females in the village have to defecate in the open , and for that , they either go out in early mornings or late evening when it gets dark . To avoid going in between , the women not only eat little , but also feed children just good enough so they do not go out and defecate too often , and this has been a cause of malnutrition and under-nutrition . There is a common habit amongst girls studying in schools with no proper toilets that , they seldom drink water during school hours to avoid going to toilet !! Strange but true . Similarly , mal-nutrition and under-nutrition has become a sanitation issue . This calls for the involvement of the ministry of rural development to address the sanitation issue in rural India to completely address the issue of malnutrition & undernutrition . Also, the ministry of food processing to work with the players for producing locally fortified foods to reduce the cost of ready-to-use therapeutic foods (RUTF).



Nutrition is often overshadowed by other medical conditions, like malaria or diarrhea, despite the fact that malnutrition, combined with these conditions, can more often be fatal." A "severe acute malnourished child" is more than nine times more likely to die than a well-nourished one, & malnutrition from any means retards normal growth .



Besides sanitation , societal traditions that female child is a burden still plagues the nation ,and there is a bias towards the male child who is treated as an inheritor and an insurance in the old age for parents . Government needs to step its machinery on all fronts . It is a known fact that, a weak female will never bear a healthy male child , and this should form the basis of the Healthy India campaign as the discrimination against the female child is rampant in every part of the nation . The issue needs to be attacked multi-fold ;when the mother is expectant , post child birth , adolescent years, post puberty age in girls . Special focus has to be given to the female child , who bears a male child in future .



One of the key pillars of NRHM must be eradication of anemia amongst women with the focus on the girl child. Special fortified biscuits or snacks with calcium, iron and zinc need to be made available for the girl child ( developed specially for females, so that male child is not given those products ! ) and separate packing for boys to be given as mid day meal or as packaged snacks made especially for children fortified with nutrients ; ready-to-use therapeutic foods (RUTF). For boys, the nutritional support must continue till the age of 6 years but for females , this support must continue till 16 years in age



The deficiencies varies with the region , like Vidharbha region has a severe issue of sickle cell anemia , and this is becoming a serious genetic health issue . Similarly, deficiencies in every region needs to be addressed region-wise.



Diet charts are as important as immunization charts and needs to be given together during child birth based on the physique of the newly born



RDDA’s ( Recommended Daily Dietary Allowance ) should be worked out specific to each child . The role of the nutritionist gains significance in NRHM and is central to the issue . The diet plan must be made for each new born and followed under the directions of ASHA locally . So far, I have not seen a prominent role of a dietician in either the sub center or the PHC



I would recommend national health planners to tie up with WFP ( World Food Programme ) to provide daily nutrition for as low as Rs.5 per day . Even companies like Unilever are working on creating BOP Healthcare ( Bottom of Pyramid Healthcare ) models focusing on healthcare basics for the rural masses. It might be worth exploring PPP ( Public Private Partnerships ) to address this issue & come out with ready-to-use therapeutic foods (RUTF)

Indian Pediatrics has brought out a Special Issue (August 2010) on Severe Acute Malnutrition, which deliberates in detail on the global and national evidence relating to pertinent issues on this subject.

Severe acute malnutrition (SAM) in children is recognized as a major underlying cause of death amongst under-five children. These deaths are preventable provided timely and appropriate actions are taken.

According to National Family Health Survey-III, conducted during 2005-2006 in India, 6.4% of children below 60 months of age were suffering from this malady . With the current estimated total population of India as 1100 million, it is expected that there would be about 132 million under-five children and amongst these about 6.4% or 8.1 million are likely to be suffering from SAM.

With the emergence of home based management approach for SAM children, which includes the use of Therapeutic Nutrition (TN) as part of Medical Nutrition Therapy (MNT), it is possible to address this issue in a cost-effective manner. More than 85 % of total SAM cases are without medical complications and can be identified through active case finding in community to be successfully managed at the home level. Global evidence suggests that with integrated management of SAM children, case fatality rates can be reduced to less than 5 percent. Short-term therapeutic nutrition for 6-8 weeks is an integral component of home-based management of SAM. There is an urgent need to develop an indigenous preparation of therapeutic nutrition in the country and operationalize the community management of SAM. Exploring a tie up with WFP / Unilever might be a good start. Also NRHM can start a mission GYM ( Grow Your Medicines) at the PHC , Sub centers and in every households ,as most of the green vegetables and fruits can be grown locally , and can be used for fighting mal nutrition and under nutrition . On one side , fortified snacks could be given , and also the NRHM can distribute seeds for growing vegetables and fruits that can mean much cheaper source of right nutrition .

Height weight charts must be distributed in all households to keep them aware of age- weight –height ratio and the relation to malnutrition . Automated SMS based service could help in ensuring compliance as seen in the case of Wardha pilot for MM /IM.

Awareness and sensitization must happen through short films and pictorial comics about the deficiency of Iron & Calcium in females

ICDS : Policy makers must consider merging ICDS with the NRHM , as it might be worthwhile to double the number of ASHA’s and allocating more high priority job to ASHA’s.

Health Fairs must be organized locally to create awareness on the issue of malnutrition . Those parents who have the healthiest girl child must be made ‘Role Model’s’ for others to follow . A ‘healthy girl child award’ must be instituted in each village ( Say Rani Laxmi Bai Award ,Sarojini Naidu or Indira Gandhi award etc) , and the government must recognize the mother and father ( Good Parenting ) for healthy upbringing of the female child ,along with a cash award of say Rs.1000.00 , or other incentives like 2 KG extra ration at the PDS shops, free bus travel for parents for one year in ST ( state transport ) bus , 50 % fee reduction in graduation of the child ,if studying in government college etc, could also be considered depending upon the consensus of the relevant stake holders. This can be a good competition to start with, which will drive home the message that bringing up a healthy girl child is beneficial in the short run and in the long run & the responsibility of the parents , with the Government acting as an enabler for this . To start with, if each of the 6 lac + villages gives this award to one girl ( parents ) , and each encourages 10 people to take care of their girl child , we would have got 6 crore healthy females in the next 10 years !! If we want faster results , we can fix the criteria for a healthy girl child for the age group 1- 16 years , all those who qualify can get incentives for the healthy upbringing of the girl child like free travel on ST bus etc . Ministry of women and child development might like to take this up in the 12th five year plan.

NRHM must insist with the ministry of education to include in the curriculum few chapters on micro nutrients and their role in healthy living , and this should start from class eight onwards.

I do hope that these inputs are of some help .I remain at your disposal should you need more inputs on other aspects of healthcare & rural economy

With best regards

Rajendra Pratap Gupta

Office@rajendragupta.in