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ON RECORD Public health system is sick — needs urgent help |
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PROFILE Comments Unkempt Diversities — Delhi Letter
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Public health system is sick — needs urgent help NOTWITHSTANDING India’s international ranking in human development index for year 2003 which fell from 124th to 127th, the intelligentsia would agree that what we have achieved in the areas of universal elementary education, health, gender equity and poverty reduction is totally unacceptable. Millions still lack clean drinking water. In the recent past, our economic performance picked up. And we began noticing with some pride that people from other countries were visiting India for higher education and high tech medical care. However, “the cruelest form of inequity in the present knowledge era” is how Prof. M.S. Swaminathan concludes. (The Tribune Special Supplement, Jan 3, 2004 under the heading, “With Science and Confidence”) in his description of how, in spite of the country having become self-sufficient in food production, every third child born is characterised by low birth weight caused by maternal and foetal under nutrition. And a large proportion of such children would never realise their genetic potential, physical and mental. Not that we do not have national or state plans to narrow the gap of inequalities in our populations. But the impact of implementation of such programmes on the ground has been inadequate and not for lack of evaluation reports, both internal and external. I agree that the Framework for Implementation of Sarva Shiksha Abhiyan (a programme for universal elementary education) is one of the best written documents. The writer, while managing a non-governmental not-for-profit Regional Institute of Public Health in Chandigarh has had very useful field experience over the last five years interacting with the Punjab government, at the state, district (Amritsar) and block levels in ensuring that no 6 — 14-year-olds — in particular girls — are denied the benefits of elementary education. This association will be continued in implementation of the State SSA programme. The going will be tough, unless higher educational and research institutions join the public sector agencies in evaluation and implementation of interventions. The commonly stated reasons for doing so poorly in promoting, protecting and restoring the health of the millions — in particular lower-middle and poorer sections — are : (1) dwindling government expenditure on health from 1.3 per cent of GDP in the mid-Nineties to 0.9 per cent (WHO recommends 5 per cent, (2) Health Ministries at the Centre and in the States not attracting political leaders of high calibre, (3) though health is a state subject too many health programmes are of vertical nature, sponsored and funded by the Centre, (4) frequent transfers of administrative secretaries with national average period of stay on one post for only seven months, and (5) not enough adequately trained public health professionals at the Centre, states and district levels. The health systems organisation with public health professionals playing a pivotal role therein, are more in evidence in western and southern states of the country. Those in the North West region are not progressing well in this direction. One stumbling block with our policymakers and planners has been their failure to appreciate that the determinants of health also includes education, adequate income and nutrition, adequate housing, water, sanitation, empowerment of women, etc. Thus, it would need cross-sectoral approaches and quality communitybased planning. For this reason, even WHO’s country level technical and advisory assistance is not restricted only to the Ministry of Health. However, a landmark event of 1987, is worth mentioning. A justification note was submitted to the then Prime Minister P.V. Narasimha Rao on how a university-based Post-Graduate Institute of Public Health, by also engaging in multidisciplinary, participative, action-oriented health systems research, can turn around the health status of millions in the country. A positive response followed vide his letter of June 29, 1987, to the Chancellor, Panjab University, Chandigarh, which is transcribed below: “This is in response to your letter enclosing therewith a letter received from the Vice-Chancellor of Panjab University proposing to establish an Institute of Public Health affiliated to the Panjab University. I have had the proposal examined by experts and they have opined that there is a need to establish institutes of public health in the country on regional basis. The Vice-Chancellor of Panjab University may be advised to send a comprehensive proposal including capital, recurring and non-recurring expenditure during the remaining period of Seventh Five Year Plan and Eighth Plan so that the proposal could be further examined in the Ministry”. On why the Panjab University failed to respond then, the writer is not able to comment upon. To this day, unfortunately, the Central Government’s priority is to open six more institutions like AIIMS in the backward areas of the country. Highly cost-effective would be public funding of university-based Institutes of Public Health which could provide high calibre training to sufficient number of qualified personnel — epidemiologists, biostatisticians, public health physicians, health administrators, environmental health personnel, public health nurses, nutritionists and health educators. These are badly needed to strengthen the health systems in the country. The basic sciences of public health include also economics, political science, sociology, psychology, law, public administration and a wide spectrum of the natural sciences. These are available in a university setting and all of these feed into the major areas of public health practice: disease prevention, environmental health and health care organisation. Panjab University, under the leadership of Vice-Chancellor Dr K.N. Pathak, took a bold decision in October 2002 and established a Centre of Public Health. This is attracting professionals with distinguished service record. It has established linkages with institutions within the country and in the US. It has begun assisting North-Western states in evaluating and strengthening some of their public health programmes. The university is hopeful that its long awaited request made to the Union Ministry of Health for funds to establish a regular Department of Public Health would be met in not too distant a future. And such departments by also promoting health systems research as a management tool could save huge unproductive expenditure by the governments. In the Tenth Plan period, the UGC is providing Rs 30 crore to a few select universities with potential for tailoring their academic and research programmes to mitigate the social economic problems of the nation. To promote globalisation with social justice, school of Public Health in such universities could act as a hub, networking with other departments, for promoting quality governance in their respective catchment areas. Such policy initiatives — requiring social accountability of higher educational and research institutions — on the part of the Centre needs further boost. Only such sustained partnerships with government agencies can produce impact by influencing policy, improving services and leading ultimately to better quality of life for all. The writer is Honorary Adviser, Centre of Public Health, Panjab University, Chandigarh |
PROFILE Prime Minister Manmohan Singh has called him “Yogi”. Indeed, Union Minister and Telangana Rashtra Samiti leader K. Chandrashekhar Rao has acted like a Yogi by abdicating the portfolio of Shipping Ministry for the sake of stability of the United Progressive Alliance (UPA) government. “I am not for power and position”, he says as a small step by him proved a big leap forward in defusing the crisis precipitated by the DMK. The Dravadian party’s A.R. Baalu has settled down in the Shipping Ministry as his colleagues also took charge of their respective ministries. Few in the weird world of politics give up a ministerial berth and, that too, within 24 hours of getting it; rare are persons like Rao. The TRS leader may have shown a spirit of renunciation but he is committed to another cause, much bigger to him than a ministerial post at the Centre. The sole objective of his life appears to be the creation of a separate Telangana state and he may go to any extent to achieve that objective. This was not the first time that Rao did not care for the ministerial office, that too, at the Centre. A few years back, he had not only quit the Deputy Speaker’s post in the Andhra Pradesh Assembly but went a step further. He quit the membership of the Assembly and also snapped ties with N. Chandrababu Naidu’s Telugu Desam Party. His election four times from his home constituency — Siddipet in Medak district — shows his popularity. The sole mission of the 47-year-old leader appears to be the revival of the Telangana movement. He seems to be succeeding in his mission. Rao began his political career with the Congress party as a student leader. Subsequently, he came under the spell of the late N.T. Rama Rao and joined the Telugu Desam Party. NTR saw the spark in him, was impressed by his dedication and commitment and pitch-forked him to the post of Minister. Rao also enjoyed the confidence of Chandrababu Naidu, who too inducted him in his ministry. However, nothing deterred him from his mission — the creation of separate Telangana state. Rao was well aware of the factors that prevented carving out of the new state in 1969-71. Consequently, he was determined not to repeat the same mistake 33 years later. The issue of backwardness of Telangana had been uppermost in his mind since he joined the NTR government. He had also pleaded time and again with Chandrababu Naidu not to ignore the aspirations of the people of Telangana. Later, he remarked in disgust: “Chandrababu has done more harm to Telangana than any other Chief Minister and he will face the consequences” . Rao’s warning proved to be prophetic. Naidu was routed in the elections. Rao was able to revive the Telangana movement in 2001. His plea that though the region, comprising 30 million people, is rich in resources, it remains backward and constantly neglected, caught up like wild fire. The fury of the agitation was seen at a meeting organised by the TRS shortly before elections. Nicknamed “Simha Garjana” (Roar of the Lion), the meeting was manifestation of the mass support for a separate state. Doubtless, Rao has built up the TRS from the grassroot level and mobilised support of the people throughout the region. Chandrababu Naidu realised, belatedly though, the magnitude of the movement revived under the banner of TRS. He sent emissaries to Rao, offered him a Cabinet post and a portfolio of his chose, but it was too late. The TRS leader told him rather bluntly “I do not crave for anything except separate Telangana. As Chief Minister, you have done more harm to Telangana than any other CM”. Rao has now taken his fight to the national level and succeeded in eliciting an assurance by the ruling United Progressive Alliance government that the demand for formation of a separate Telangana state would be considered at an appropriate time. Congress Parliamentary Party Chairperson and UPA Coordinator Sonia Gandhi has reportedly asked her Political Secretary Ahmed Patel and AICC Secretary Jairam Ramesh to work out a time-table for creation of the new state. Even though NTR was Rao’s mentor, he was sore with him because the founder of the TDP brought “coastal culture, language and social mores to the Telangana region and even facilitated its economic domination by settlers”. On his part, says the TRS leader, Chandrababu Naidu marginalised the people of Telangana in their own region. The antipathy of the people of the region was reflected in the results of both the Assembly and Lok Sabha elections. Chandrashekhar Rao, by voluntarily relinquishing the portfolio of Shipping, has created a good impression on both Sonia Gandhi and Dr Manmohan Singh. At the moment, he is Minister without portfolio. He is certain to get an important portfolio in the near
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Comments Unkempt In one thing at least Sonia Gandhi has succeeded: she has persuaded people who willingly never write on political matters to write about the juddering shake she has given to India’s political tree. As a consequence, Arun Jaitley has taken the field to warn Rahul Gandhi not to shoot off half-cock statements when his knowledge of history is feeble. Rahul Gandhi can look after himself if he wants and my own knowledge of history can be written on the back of a postage stamp. In history, law, public affairs etc., Mr Jaitley, of course, is streets ahead of me. Still and all I wonder if he has overread an essay “The Course of Indian History” by Rabindranath Tagore, or the poem Bharat Tirtha where are the lines (my translation) “No one knows at whose bidding so many streams of people came and lost themselves in our sea. They gave and they took, they stirred and they mixed but they didn’t ever go back from the vast Indian beachhead of human beings”. Again and again Tagore has talked about the marvellous composite civilisation that is India. He also wrote of the “true prayer of Mother India: He who is one, who is above all colour distinctions, who dispenses the inherent needs of men of all colours, who comprehends all things from their beginning to the end, let him unite us to one another with wisdom, which is the wisdom of goodness”. This is not the language that we have heard from Mr Jaitley’s party except perhaps in the last few weeks when a certain package of votes became necessary. This is surely not Sushma Swaraj’s impression of a “foreign born” woman, whose knowledge of Indian history, art, nationalism and religion were most probably not less than Mrs Swaraj’s: Sister Nivedita born Margaret Noble of Irish parents. Nor perhaps do Ms Swaraj and Ms Uma Bharati love or serve India as much as another woman born in Albania did: Mother Teresa then why the ungainly threat about a “national shame” and dire observances about a naturalised citizen? In his first rath yatra, Mr Advani carried on his rath a likeness of Swami Vivekananda. This was misleading and an injustice to Swamiji because he would never have approved of the image of Hinduism as propagated by the BJP and by its “soul” the RSS. Vivekananda described himself as “the servant of the servant of the Buddha”. Buddhism is another religion from India which travelled to many countries in Asia. If Mr Jaitley reads Sister Nivedita’s “The Master as I knew him” and follows her description of Swami Vivekananda’s excitement as his ship coursed near the shore of Morocco and the Swami recalled the robust spread of Islam throughout the region, or trace in the lectures of the Swami his innumerable references to Christ and Christianity. I am sure Mr Jaitly will not have the time to read the works of Swami Vivekananda but if he did (maybe he already has) and if he reads the poetry of Subramanya Bharati, and if he reads of the closeness of Sister Nivedita to the nationalists and revolutionaries of India he would, perhaps (I cannot go further than perhaps) have a different notion of “History”. In a BBC discussion the other day, a participant said that the educated Indian “elite” were indifferent to the election. Maybe we, many of us, thought that Sonia Gandhi’s oxygen was ambition but she gave our ears a sharp tweak. She pushed the NDA-BJP, Humpty and Dumpty, from the wall. There was a great fall and all of us fell down, too, and may be some of us are somewhat ashamed. But is that true of those in her party and its allies who have been in and out of the revolving doors of various parties? How many of them see the past, present and future of India through the perception of Tagore, Vivekananda, Gandhi or Aurobindo? How long, I wonder, will the bitter medicine of Sonia Gandhi’s wisdom work before the Congress, the Left and the NDA settle down to their time-encrusted rhythms of catch as catch can? As for the NDA, their acceptance of defeat has been singularly graceless. But even after knowing that it is fruitless I would ask Arun Jaitley, Sushma Swaraj and Uma Bharati to read Tagore’s greatest novel “Gora”, named after the hero Gourmohan or Gora, the fair and well-built young man who loved India more than life, was “foreign born” the son of slain Irish officer’s wife who took shelter in an Indian home during the Mutiny and died giving birth to a son. Gora was brought up as an Indian. He glorified all the caste and rituals of Hinduism, and never knowing his parentage till the last. When he was told immediately Hinduism all the narrownesses of rigid Hinduism, and the pettiness of institutionalised Brah-moism dropped off like bad dreams and Gora was reborn as a true Indian who still loved India more than life itself. The “history” I am shamelessly stuffing down the throats of Arun Jaitley, Sushma Swaraj, Uma Bharati and their like is, for me, difficult to describe except through quotations — other men’s flowers. Here goes: “India represents a remarkable diversity out of which a unity has developed. Some would prefer to describe it the other way, as the expression of a basic and original Unity in its various manifestations. This other way of looking at the matter has something attractive in it for those who believe in a progressive degeneration from a Golden Age of their imagination, rather than in a sequential evolution through the ages. But, in the face of observed facts, it is a case of a unity gradually becoming established out of diverse, and often contending, elements.” ...“Out of a welter of race-movements and of ideological exchanges, ferments, and equillibria, we can only see dimly the gradual establishment of a way of thought and a way of life that became associated with India as a distinct entity among geographical units and human enoses. The various races follow each other as a phased sequence, or sometimes they tumble upon each other’s heels throughout the centuries and millennia, making ultimately for that richness of life and experience and thought and spiritual perspective that are in the civilisation of India.” |
Diversities — Delhi Letter There is a lull in political activity here till June 2 when Parliament session starts. A majority of MPs have gone back to their constituencies, to be back in the Capital just a day before the new session starts. Last week, I had met Mehbooba Mufti at the J&K House here. (It looks a completely different place after last year’s renovations). She was leaving for Srinagar. When I tried to get in touch with Sunil Dutt, one was told he’d just left Mumbai, to be back on June 2 morning. I don't want this to sound like a roll-call, but there's going to be a temporary “absent” against most names. Come next week and activity would just about begin. In between those parties and receptions in their honour (to be nearer truth, public relations exercises), they'd uttering quotable quotes and getting fitted into government homes, bungalows and flats. Drive down the main roads of Lutyen’s Delhi and you’d see jeeps parked outside some of the sprawling bungalows, men moving around and activity taking place. With the new emphasis on “Vastu shastra”, there could be renovations as per the new requirements in some of these bungalows. In fact, a new book, “Golden Rules Of Vastu Shastra” (UBS) has just about landed at my door step. Written by Suman Pandit, it has such elaborate do’s and don'ts, with chapters on ‘Vastu and marital harmony’, ‘Vastu and childbirth’. If only following such do’s and don’ts can help save marriages, then it could be almost magical for wrecked marriages. Before I move on, let me add that amongst the who's who here, the one home which practices these ‘home’ rules is Kuchipudi dancer Raja Reddy’s. Right from the boundary wall to the gates leading to the little garden to the positing of a this and that in their home, everything seems in accordance with the Vastu Shastra. As a footnote, let me add he is saddled with not just one but with two wives — Radha and Kaushalya. The threesome manage under one roof, in the two-bedroom Kaka Nagar home. Summer break Even now when summer is at its actual peak, there’s much activity here. True, many are taking off for the much-needed summer break. But then, many more seem to be touching. To be honest, you don’t really need to be doing much legwork. Most can be spotted at the IIC, or as cynics simply state, “they visit the IIC simply to be spotted”. Well, in one of those ogling moods the other day, I spotted Shekhar Kapur. Looking younger and far more attractive than he looks in those photographs, he was talking rather passionately about his new film, “Paani”. Talking about it from the Indian perspective. Yes, it’s time we begin to view our basics from our viewpoint and not in accordance with western perceptions.
Ten stories On the occasion of World Press Freedom Day, United Nations Under Secretary-General Shashi Tharoor sent this elaborate note, centering around “Ten stories the world should hear more about”. These are not stories that have never been reported but they are often second rung issues that need more thorough, balanced and regular attention”. That brings me to ask what role has the UN been playing on the already reported stories of torture and abuse in Iraq and in some other war-ravaged
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When a man gives up completely all the desires of the mind, and himself delights in his Atman alone, then he is said to be a man of steady wisdom. — Sri Krishna The only true duty is to be unattached and to work as free beings, to give up all work unto God. — Swami Vivekananda That alone is good which pleases God. — Guru Nanak Charity is a duty unto every Muslim. He who has not the means thereto, let him do a good act or abstain from an evil one. That is his charity. — Prophet Muhammad No violent extremes endure; a sober moderation stands secure. — Aleyn |
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