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Hooda asserts himself
Haste over Singur |
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Venerable, also vulnerable
Lesson on realpolitik
Lost horsemanship
For the first time in India, the government has gone ahead to ensure a truly cashless delivery for pregnant women accessing public health facilities. The new initiative entails zero cost, and seeks to multiply India's efforts to reduce
the high maternal and infant mortality rates, as pledged under the Millennium Development Goals
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Hooda asserts himself
After
a shaky start of his second term as Haryana Chief Minister — having won a slender majority — Bhupinder Singh Hooda is now fully in command as the latest Cabinet reshuffle shows. Capt Ajay Singh Yadav, who openly – and needlessly — criticised the state’s land acquisition policy, has lost the Finance portfolio as also Irrigation, which was crucial for water-starved southern Haryana he represents. A few days ago when a minister and a Chief Parliamentary Secretary were accused of involvement in a sarpanch’s murder, Hooda immediately dropped them. He snubbed the Independent MLA from Sirsa, who returned his official vehicle and security in protest, but later made peace with him. Changing portfolios is a chief minister’s prerogative. Ideally, performance should guide Cabinet changes. But in Haryana’s faction-ridden politics, loyalty is rewarded and defiance punished. Judged on performance, Bhupinder Singh Hooda, who is in charge of the Home portfolio, disappoints. His pro-Jat leanings are well known. He let khaps go amok. The government has been a mute spectator to frequent road and rail traffic blockades by Jats. Then he mishandled the Jat-Dalit clash at Mirchpur in April last year. The government acted only after Congress general secretary Rahul Gandhi visited the victims. On Sunday, non-Jats protesting against Jat excesses at Hisar were lathi-charged. The frequent eruption of caste clashes in Haryana points to a deeper social malaise which the Chief Minister needs to address. In development Haryana has excelled — but largely in areas close to Delhi. Even there growth is haphazard. Gurgaon is an example of urban chaos. Frequent labour strikes, fuelled by growing aspirations and income inequalities, may deter fresh investment in the state’s industrial hub. Southern Haryana is a picture of neglect. Jat farmers too feel let down and are pushing for reservations in desperation. In the Jat land, others too need space and opportunities for growth. Uneven growth has created social and political problems. Given the unrest, Chief Minister Hooda should focus on balanced development and good governance, giving key posts to people who deliver, rather than wasting talent and time on caste politics and taming rivals.
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Haste over Singur
West Bengal’s
Chief Minister in a hurry, Mamata Banerjee, has clearly not heard of the saying: “ act in haste, repent at leisure”. Or else, she would not have hurried through an Ordinance first and then, when it was pointed out that an Ordinance could not be issued when the Assembly is still in session, rushed through a Bill to restore land to ‘unwilling’ farmers at Singur. The land had been acquired by the previous Left Front government for Tata Motors to set up an automobile plant. No attempt was made, however, to have a meaningful debate on the subject before the Bill was passed by the House. Although it was one of her pre-poll promises to restore land to the ‘unwilling’ farmers at Singur, there was little urgency for such tearing hurry within less than a month of the new government assuming office. By doing so, ‘Didi’ has confirmed that she remains both impulsive and impatient. To put the issue in perspective, the Left Front government had acquired 997 acres of land at Singur and distributed compensation to 60 per cent of the land owners. The remaining ‘farmers’ , however, refused to collect compensation and invited Ms Banerjee to launch a violent agitation on their behalf. The Bill passed by the West Bengal Assembly on Tuesday seeks to return land to these ‘unwilling’ farmers. The rest of the land will be used to set up industry, says the state government. This is sure to give birth to several legal complications. Those farmers, who accepted the compensation, may well argue that they merely followed the law and that the new government is rewarding those who questioned the acquisition. Some of these farmers may also demand return of the land so that they can bargain directly with industry, as the ‘unwilling’ farmers are likely to do. Finally, Tata Motors has already asserted that it hopes to be compensated for the expenses it incurred at Singur. The company claims to have spent Rs 1,800 crore and says that it still has assets worth over Rs 441 crore at the site. But the Bill rules out any compensation to the vendors, who are also said to have spent Rs 171 crore at Singur. Ms Banerjee, it seems, will have to prepare for long and unnecessary litigation.
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Venerable, also vulnerable
We
have always been taught to look up to our elders and take care of them, and sometimes some of us fail in our duty. What is unfortunate and wrong is that the elderly are also abused at times. Although this is not a new phenomenon, increasing awareness has brought the problem into public consciousness. Indeed, studies have shown that their abuse is as widespread as it is under-reported. All elder persons are vulnerable, and abuse could be physical, or mental. Inappropriate use of medication can cause its own damage, as can emotional abuse like treating the elderly like children, neglecting them, or violating their privacy. Impinging on the dignity of any person is wrong, particularly, if the person is a dependent on the family. Chandigarh does not figure in a recent study by an NGO, HelpAge India, but Delhi fares badly. In the national Capital, 100 per cent of the respondents blamed their daughters-in-law for abusing them at some or the other time. While their unanimity strengthens a stereotype, it must also be noted that the primary care-giver for the elderly in most houses is the daughter-in-law. Thus, for any perceived transgressions, the blame comes her way, rather than that of the son who would be away from home most of the time. The issue of mismatched expectations between the two parties would also impact the interaction between them. In any case, for any relationship to work, there has to be mutual respect and understanding, a rare phenomenon in today’s society. Now, it is out in the open that the abuse of the elderly is widespread. Acknowledging this is the first step. We must focus our resources and energy on taking care of this problem. We must watch out for signs that someone has been abused. Society must intervene by taking measures that would ensure that the elderly live with dignity and that the vulnerability of these venerable ones is not exploited in any manner.
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Most people enjoy the inferiority of their best friends. — Lord Chesterfield
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Lesson on realpolitik Dr Henry Kissinger, the eminence grise of America’s foreign policy establishment, has written a seminal book on his country’s relations with China (On China) to make the argument that Washington and Beijing form a condomium of sorts in a Pacific community involving the latter’s neighbours and Australia to steer the world into a peaceful 21st century. As one would expect from the good doctor, he does not disguise his admiration for Chinese leaders, perhaps flowing from his privileged relations with them from Mao Zedong and Zhou Enlai to Deng Xiaoping. Even discarding Dr Kissinger’s bewitchment with China, taking it on its terms of Chinese history, Confucianism and historical allegories, the volume is absorbing reading retailing the breaking of ice with Communist China and how he, under President Richard Nixon, steered growing interactions with Chinese leaders to win their trust. He makes much of the psychology of the Chinese as custodians of the Middle Kingdom and the leaders at the peak were willing to reward the reverential posture the Doctor adopted, much like the Chinese kings of yore accepting tributes from an inferior princeling. No wonder, Dr Kissinger has remained Beijing’s favourite American interlocutor even after divesting office. After Mao and Zhou, he became the privileged confidant of their successors, including Deng. Dr Kissinger does not have much new to say on the 1962 Sino-Indian border war, disastrous for India, except to relate how clear-headed Mao was and how he had planned the operation in advance. What he leaves unsaid (not to bruise Indian feelings further after his infamous tilt to Pakistan) was how ad hoc Indian policy planning was. In fact, Jawaharlal Nehru was a one-man foreign policy think tank and extraordinary as his grasp of history was, spur of the moment policy-making was no substitute for a well-planned exercise. The Kissinger analysis has to be commended on several counts. His extraordinary powers to summarise his views on statecraft in short pithy sentences are evident as is his deep knowledge of European history and the pains he has taken to bone up on China’s troubled background, particularly the humiliations of a century before Mao’s irrationalities took over. Although he speaks of American values such as human rights and freedom, they are for him constraints on Washington’s freedom of manoeuvre, rather than inherently good in themselves. In Dr Kissinger’s view, America’s missionary approach to spreading democracy and a market economy — the two are inextricably linked in the American mind — is parallel to the Chinese conceit of being the Middle Kingdom, exceptional by its very nature. What better way to reconcile these very different articles of faith with undertaking joint leadership under the flag of the Pacific Community? And Dr Kissinger gives the assurance to China that he was not springing a surprise by indulging in a containment policy. He writes: “It is important to understand what one means by the term ‘containment’. Countries on China’s borders with substantial resources, such as India, Japan, Vietnam, and Russia, represent realities that are not created by American policy. China has lived with these countries throughout its history”. To an impartial observer not bewitched by China as Dr Kissinger is, his definitive pronouncements on China’s relations with the US show how keen, if not desperate, America was in moving towards a rapprochement with Beijing. American officials were very knowledgeable about 100 years of Chinese humiliations at the hands of outside powers from the West and Japan and made full allowances for their sensitivities. Judging by the account, the Chinese leaders played their part admirably deigning to nod to the Kissinger team with mild encouragement while testing the limits of Washington’s need to befriend China. The author of the volume starts from the premise: “The relationship between China and the United States has become a central element in the quest for world peace and global well-being”. He then builds the mystique of China, its singularity, and ultimately pronounces: “Domineering and overwhelming in his influence, ruthless and aloof, poet and warrior, prophet and scourge, he [Mao] unified China and launched it on a journey that nearly wrecked its civil society. By the end of this searing process, China stood as one of the world’s major powers and the only Communist country except Cuba, North Korea, and Vietnam whose political structure survived the collapse of Communism everywhere else”. Dr Kissinger suggests that the famous warning Zhou gave the Indian ambassador in Beijing of Chinese entry into the Korean war if US troops crossed the 38th parallel “was more making a record for what was already decided than a last plea for peace, as it is so often treated”. On the prelude to the Sino-Indian border conflict, the author writes about Nikita Khrushchev’s word to the Chinese that the Soviet Union would support China under the Treaty of Friendship and Alliance of 1950. “It was a decision totally out of keeping with Soviet-Chinese relations in the previous years and the neutrality heretofore practised by the Kremlin on the issue of Indian relations with China”. It was to ensure China’s support over the brewing nuclear missile crisis in Cuba. The author writes, “The Sino-US rapprochement started as a tactical aspect of the Cold War, it evolved to where it became central to the evolution of the new global order”. As proof, Dr Kissinger cites the Chinese invasion of Vietnam in 1979, “…China undertook the campaign with the moral support, diplomatic backing, and intelligence cooperation of the United States - the same ‘imperialist power’ that Beijing had helped eject from Indo-China five years earlier”. Dr Kissinger’s justification for the United States’ attitude to China by becoming its virtual ally for a time is contained in this quintessential lesson he imparts on realpolitik: “American ideals had encountered the imperatives of geopolitical reality. It was not cynicism, even less hypocrisy, that forged this attitude: the Carter administration had to choose between strategic necessities and moral conviction. They decided that for their moral convictions to be implemented ultimately they needed first to prevail in the geopolitical struggle”. Dr Kissinger has earned the epithet of being a modern Machiavelli for good
reasons.
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Lost horsemanship THERE was a time when man had very close ties with the horse as the latter was not only his loyal companion but also his dependable mode of transport, which could traverse any type of terrain. In those days, government officials, especially of the revenue department, toured their area of jurisdiction on the horseback. And in the rural areas with a few kachha roads or tracks, men, women and children travelled on the horseback from one village to another. The only other popular mode of conveyance besides a bicycle was a tonga that was pulled by a horse. The horse population in the pre-partition days kept on growing because even the Army and the police needed a large number of horses. To meet this requirement, the government had established stud farms, which were run by the Remount and Veterinary Department at various places in the country. Among them, the main promoters of horses were the new colonies, namely the districts of Lyallpur, Sargodha and Montgomery (now in Pakistan). The studs in these three districts kept thoroughbred English (TBE) and thoroughbred Australian (TBA) stallions with good race records for “breeder service”. This service was utilised by the farmers with large land holdings who kept race horses. Each of these three districts had a race course where monthly races were held during the winter season. The Remount and Veterinary Department also provided breeder service to those farmers who were allotted land by the government for the purpose of keeping mares for breeding. Their offspring were procured for the Army. The Lahore race course (in West Punjab) was one of the biggest and most famous one in the country in those days; the other two were at Bombay and Calcutta. After the partition, interest in horses and horse racing declined perceptibly in North India. So much so, that there is not a single race course in Punjab, Haryana, Himachal Pradesh and Chandigarh. The old race courses at Patiala and Simla have lost their semblance due to disuse. The late Mr Aminuddin Ahmad Khan (a former Governor of Punjab) did attempt to put Punjab on the “horse map” in 1982. As a result, the Punjab Government issued instructions to the Deputy Commissioners that the revenue officers should go around their areas on horses. But these instructions remained only on paper. The horse has galloped out of man’s life, thanks to the mechanisation that has choked metropolises with pollution. Today, India leads the world in road accidents and Chandigarh leads India in fatal road accidents. Alas! This is the fallout of our losing touch with
horsemanship.
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For the first time in India, the government has gone ahead to ensure a truly cashless delivery for pregnant women accessing public health facilities. The new initiative entails zero cost, and seeks to multiply India's efforts to reduce the high maternal and infant mortality rates, as pledged under the Millennium Development Goals
The
Janani Shishu Suraksha Karyakram, launched from Mewat district in Haryana on June 1, unmistakably signals a huge leap forward in the quest to make "health for all" a reality. It spells out that all expenses related to delivery in a public institution would be borne entirely by the government and no user charges would be levied. Under this initiative, a pregnant woman would be entitled to free transport from home to the government health facility, between facilities, in case she is referred on account of complications, and also drop-back home after delivery.
Entitlements
The good thing is — entitlements would include free drugs and consumables, free diagnostics, free blood wherever required, and free diet for the duration of a woman's stay in the facility, expected to be three days in case of a normal delivery and seven in case of a caesarean section. Similar entitlements have been put in place for all sick newborns accessing public health institutions for healthcare till 30 days after birth. They would also be entitled to free treatment besides free transport, both ways and between facilities in case of a referral. Out of the 9 lakh newborns who die within four weeks of birth, about seven lakh i.e. 75 per cent die within the first week. Most of these deaths are preventable through timely and proper healthcare. Another issue is out-of-pocket payments, which are, without doubt, a major barrier for pregnant women and children so far as access to institutional healthcare is concerned. The impoverishing effect of healthcare payments on Indian households is well established. Out-of-pocket spending in government institutions is both common and substantial, partly because of a weak supply chain management of drugs and other logistics and partly because of malpractices, which include a flourishing nexus between doctors, chemists and diagnostic labs. Prescriptions by doctors, even in government settings, can be unnecessarily expensive and may include not just medicines but consumables such as surgical gloves, syringes, IV (intravenous) sets, and canulas. It is paradoxical that some states levy user charges for deliveries at the time when efforts are being made nationally to address factors impeding institutional deliveries and to give incentives to women to approach government institutions for childbirth through schemes such as the Janani Suraksha Yojana. Hence, notwithstanding substantial investments by the Central Government to improve provisioning for maternal and child healthcare, the burden of out-of-pocket expenses for pregnant women and children has persisted in the public health system across most states. The fact that entitlements were not explicitly articulated and were vague left much scope to deny the service delivery that national programmes, including the National Rural Health Mission and its precursors, have consistently strived for.
Highest maternal deaths
It is important to recapitulate that maternal and child health have been the focus of attention in India for more than two decades now. Globally, in absolute numbers, India accounts for the highest number of maternal deaths as well as deaths of children under five years. The Bhore Committee report of 1946 estimated the maternal mortality ratio (MMR) in the country to be around 2000 deaths per 100,000 live births, which is approximately 10 times higher than the estimated MMR today. Other subsequent estimates put India's MMR at 495 deaths per 100,000 live births in 1992. The National Child Survival and Safe Motherhood Programme, which was rolled out in 1992 by the Government of India, was the first attempt at integrating maternal and child health. Though health is a state subject, the programme provided assistance to the states for the training of the traditional birth attendants (TBAs) and strengthening of facilities, particularly at the CHC (community health centre) level, for emergency obstetric care, safe motherhood and neonatal care.
the past schemes
The International Conference on Population and Development in 1994 led to a reorientation of mother and child health strategies. A new programme called the Reproductive and Child Health - I (RCH-I) was launched in 1997, which further integrated vertical schemes and substantially scaled up interventions related to maternal and child health. It sought to inter alia expand skilled attendance at birth and provided funding to states for round-the-clock maternal health services, emergency obstetric care and promotion of institutional deliveries. Besides funding the states for augmenting human resources, including specialists and staff nurses, it also provided funds to local governing bodies to provide emergency transport. Ensuring availability of drugs, consumables, safe blood, equipments and trained service providers was a key focus for which states were given financial support. Also, financial incentives were provided to the staff for attending to deliveries after working hours. Reproductive and Child Health - Phase II ( RCH-II), launched in 2005 under the umbrella of the NRHM, was committed to substantially augmenting the funding to the states with a greater willingness to factor in state-specific needs and contexts through a flexible funding pool. Subsequently, the National Rural Health Mission strengthened state endeavours to reduce both the Maternal Mortality Ratio as well as the Infant Mortality Rate by providing additional flexible and need-based funding for strengthening health systems.
Rs
75,000 crore to states
By the end of 2011-12, the NRHM would have provided over Rs 75000 crore to the states to address supply-side constraints and improve public health institutional capacities to render comprehensive quality healthcare, with an overwhelming focus on pregnant women and children. Funds have been provided to the states for ambulance networks, including transport for pregnant women, drugs, and supplies, equipment, additional human resources, including nurses, doctors and specialists, large-scale capacity building of service providers, physical infrastructure, performance-based incentives and everything else that is needed to ensure service guarantees that the NRHM Framework for Implementation seeks to put in place for pregnant women as well as children. A large number of human resources have also been added for augmenting the service delivery. These comprise 61574 ANMs, 35329 staff nurses, 11931 doctors, and 7238 specialists. Clearly, the ground is well laid for strengthening the supply side and moving towards guaranteeing service delivery in public health institutions through clearly articulated entitlements. That's where the new initiative comes in. It hinges on wide publicity, by the states, of the entitlements envisaged to enhance public awareness. States have also been urged to display prominently the entitlements in every government facility and put in place robust mechanisms for feedback and grievance redressal. Armed with information and knowledge of entitlements, people are bound to demand greater accountability on the part of both institutions and service providers who may be under pressure, more than ever before, to deliver on commitments. What is heartening is the consensus that has emerged across states, recognising the need to entitle pregnant women and newborns to truly free, no-expense healthcare in public health institutions.
The writer is Joint Secretary, Reproductive and Child Health, Ministry of Health & Family Welfare, Government of India
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It invokes a new approach to healthcare, placing, for the first time, utmost emphasis on entitlements and elimination of out-of-pocket expenses for both pregnant women and sick neonates. The initiative entitles all pregnant women delivering in public health institutions to absolutely free and no-expense delivery, including caesarean section.
The Janani Shishu Suraksha
Karyakram, it is estimated, would benefit more than 1 crore pregnant women and sick newborns at present accessing the public health system every year. It would further trigger enhanced demand for care in public health institutions on the part of over 70 lakh women, who still choose to deliver at home and make healthcare accessible to those sick newborns, who are unable to get timely and appropriate healthcare because of high out-of-pocket expenses on both transport and treatment. As a result of this enhanced demand for services created in the most vulnerable, marginalised and underserved sections of the population, India can hope to bring down the 67000 maternal deaths and 9 lakh neonatal deaths that take place in the country every year.