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An ugly spat in public Boosting connectivity |
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Shedding veil Face-to-face with the world What Seema Devi, sarpanch of Chausala village, did by the lifting of her veil in public may not bear much significance to the urbanite. For the women of Haryana it is no less than a historic step. The gesture signifies an assertion of women’s free will that bears monumental significance in the patriarchal set-up, the state has earned notoriety for.
Privatisation
of water
Shopping
mad
Training
guns on tuberculosis
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Boosting connectivity Connectivity
and development have a symbiotic relationship. In the modern world, it is impossible to think of one without the other. Mr Sachin Pilot, Union Minister of State for Communications and Information Technology, was quite right when he stressed on the need to boost telecom in remote areas during his recent visit to Jammu. The Centre, he pointed out, has provided 580 satellite phones to the state to give connectivity to people in remote areas. His announcement that the government would install 267 more such phones in the far-off areas of the state, including the Ladakh region, is also a positive proof that the government is addressing this pressing need of the region. There are many difficulties because of its topography and the remoteness of some of the hill regions. People at large will, of course, welcome the installation of 150 mobile towers that will provide access to ordinary users. Given the geographical complexity of the region, the government is right in providing infrastructure in areas where commercial ventures avoid doing so, largely because it is not cost effective to do so. While the Minister’s reluctance to comment on the lifting of the SMS ban from pre-paid mobile services in the state is understandable, especially since the ban came from the Union Home Ministry, the Centre also needs to look anew at the ban. The rationale behind it is curbing the misuse of SMS messages by anti-social elements to forment trouble and coordinate violent protests in the Valley is quite understandable. However, the ban seems to be a case of overkill since it is making life difficult for ordinary people of the state. Surely, a more technologically focussed approach can be used, one that would ensure that the purpose of imposing the ban is served without blocking out all SMS messages. In recent years, the people of Jammu and Kashmir have shown their eagerness to develop skills that would allow them to compete in the world beyond the Valley. Connectivity would empower them to do so and the Centre should continue in its endeavour to provide better infrastructure for both mobile and Internet connectivity.
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Shedding veil What
Seema Devi, sarpanch of Chausala village, did by the lifting of her veil in public may not bear much significance to the urbanite. For the women of Haryana it is no less than a historic step. The gesture signifies an assertion of women’s free will that bears monumental significance in the patriarchal set-up, the state has earned notoriety for. If it triggers a campaign for the eradication of the purda system from the state, it will go a long way in bringing about much-needed social reforms. Like other fetters used to shackle women’s body and mind, purda is used for women’s subjugation; things they are not allowed to see, they will never understand. On their ignorance rests the longevity of patriarchy. In a state where even the police women do not hesitate from veiling their face even while on duty, the first clarion call for ‘showing their face’ to the world came from Sushma Bhadu of Dhani Miyan Khan village. On July 22 this year she discarded the ghoonghat in the presence of women panchayat members of 25 villages, girl students and anganwadi workers. She said the veil obstructed her work as a sarpanch and robbed her of her identity. Her confidence triggered a flood of discarding of ghoonghats by the young and the old alike, who were waiting for a lead. Obviously, it did not go well with men of the community who pass snide remarks at their ‘azadi.’ But this liberated woman power proved it meant business. The unveiled sarpanch got a Rs 10 lakh grant for building a sewing centre for women and roped in Punjab National Bank to sponsor a training programme for women. It’s not too late for the community to realise that a shackled and subjugated woman will never be able to save her daughter — in birth or in life thereafter.
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If at first you don’t succeed, blame your parents. — Marcelene Cox
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Privatisation of water
India
is governed by a written Constitution and any policy decision, programme by the Central or state government must be within the constitutional parameter of the Constitution. The State under our Constitution is mandated to protect the human rights. Any government policy, which seeks to shift this responsibility from the state to the private sector, would be, without anything more, unconstitutional and hence impermissible. The United Nations, since its inception, has accepted that water is a ‘human right’. In 2010, the General Assembly adopted a resolution declaring the Right to Water and Sanitation a human right. The Supreme Court has held that Article 21 of the Constitution includes the right of a citizen to water and sanitation. In that light per se any proposal to privatise water would be unconstitutional. Is it not, therefore, a matter of concern that the Indian state should be working towards privatising water supply, which really amounts to abdicating its duty to enforce human rights? Ever since the National Water Policy 2002 was formulated, there have been attempts in India to privatise and commoditise water. The water problem and its peculiarities in supply, distributions are all misdirected against the supply to the poor. I am, however, highlighting the position in Delhi, which is enforcing privatisation of water supply policy meant to cater to the affluent at the cost of the poor — 70% of the households in Delhi with a monthly per capital of expenditure of less than Rs. 1,500, the poverty line accepted by the Planning Commission. The whole exercise by the Delhi government is to give exploitive profits to the private party. Thus, according to public information, it costs the Delhi Jal Board Rs. 15 per litre to obtain water – but it has agreed to supply water to the private company at about Rs. 1.50 per litre. There is then further benefit to the company by permitting an automatic annual increase of 10% in water billing by the private company. In the new tariff apart from water charges a sewage charge of 60% is also imposed, notwithstanding that the replacement, if any, of pipes will be by the Delhi Jal Board. But most astounding is the introduction of service charges apart from the billing for water consumption. This service charge is a shame-faced attempt to give extra money because the consumer is paying separately for consumption anyway. On a consumption charge of, say Rs. 170, per month there will be added a service charge of Rs. 320 per month There is no explanation of what and how service charge can be imposed apart from consumption charges. Another unabashed provision to favour the private company is to divide colonies into District Metered Areas (DMAs) on the pretext that water would be provided to the DMAs by private companies at all times/days (24x7). But there is an ill-conceived catch so as to benefit private companies, as the performance of the water company will be assessed not on the basis of whether water is received 24x7 water in every house or not, but on the basis of whether the water company provided 24x7 water at the input of each DMA or not. The water company can also divert water from one area to another within the same DMA. This would neither affect the performance of the company nor be treated as a violation of any of the licence conditions. The water company will try to maximise revenues by diverting water to big hotels, industries etc, which would purchase water in bulk at higher revenues. The Delhi Jal Board should be looking into more worthwhile functions. It supplies 850 million gallons of drinking water per day more than its installed capacity. Its treatment facility provides for only 5.4 million gallons a day – the rest of the untreated water is one of the major sources of pollution of the Yamuna. The Delhi government is inspired by the World Bank-supported 24x7 water supply pilot projects as, for example, in Hubli- Dharwad. But the report of the Working Group on Urban Water Supply and Sanitation for the 12th Plan has pointed out that the initial project period was 2004-08 and was then extended to 2011. Reaching 10 per cent of the twin cities’ existing connections took seven years. Water privatisation and other similar schemes to benefit big corporations are the brainchild of the World Bank. Though initially the countries succumbed to this pressure, the anger of the masses at the deprivation of life-giving water to them and instead to benefit big corporation has unleashed a world movement of “re-municipalisation” of water supply in several cities, most notably Paris (which re-commenced with public water management in January 2010) due to cost-saving potential. The “re-municipalisation” got off to a promising start – water tariffs were reduced by 8 per cent in 2011. Two countries are making water privatisation illegal: Uruguay, and the Netherlands. In both cases, the new laws prohibit not only the sale of water systems but also the delegation of the operation of water supply to private companies. As recent as October 2012 many civil society organisations have protested to the President of the European Commission to stop imposing the policy of privatisation of water. The newly formed municipal corporations in Delhi have also demanded that water supply be handed over to them. It is for the Delhi Government to ignore the global trend towards “re-municipalisation” and to invite private companies to play a larger role in so essential a public utility as the supply and distribution of water. The so-called PPPs are a barely concealed cover for the public-private sharing of risk and profit such that there would be predominantly public risk and predominantly private profit. A pervious attempt to privatize water was made in 2005; At that time August 2005 when World Bank President Paul Wolfowitz visited Delhi, he was confronted with vociferous protests against ‘the Bank’s policies and condition alities of water privatization through the back door’ – a clear message of ‘Hands Off Water.’ Why is it being revived now – is the forthcoming elections in Delhi and the urgent need for getting big donations the real secret. Any continuance of water privatization policy will remain
suspect.
The writer is a former Chief Justice of the High Court of Delhi.
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Shopping mad There
are some things in life that are well-nigh impossible to do. Some of us just cannot swim, others cannot ride a bicycle, still others can never travel in the hills without feeling queasy and uneasy. But few people find themselves challenged while trying to accomplish what should be the utterly simple task of shopping. I happen to be one of that rare breed though. I just can’t shop for nuts! If I try to buy fruit, I end up buying the wrong size, the wrong variety and sometimes even the wrong fruit! I also normally end up paying much more than I should. Vegetables, groceries, stationery and such sundry sorts of items give me just as much trouble. The problem is more acute when I have to accompany my wife for shopping. My style is quick and decisive, you see; even if I make errors galore! Hers is unhurried, unruffled and seemingly endless. What happens is that when we are out to buy some clothes, I make my decision within minutes, having liked a particular pair of trousers or a shirt. She will have nothing to do with such decisiveness though. She’ll ask around for similar stuff in neighbouring stores. She’ll discuss the merits and demerits of the garments threadbare with anyone who’s ready to listen. She seldom likes what I’ve chosen, especially if it is coloured blue. “You have so many blue shirts!” is her usual refrain. Another situation arises when I am just standing around aimlessly at a store waiting for my wife. People usually mistake me at such times for a sales attendant or manager. The ladies in particular often mistake me for someone from the establishment. They ask me nonchalantly the way to the rest room or the kids section or whatever. I am forced to inform them (without sounding rude) that I am a visiting customer myself. The resultant look on their faces is quite sheepish! They make some apologetic noises and say things like ‘Oh, you were looking so important standing there that we thought you were the store manager!’ Somehow, men never make such errors of identity. They’re probably too busy doing absolutely nothing, just as I am, wishing that their ordeal would be over soon. The mobile phone is a great friend in such trying times. One can call up long lost friends and discuss their families, their careers and their choice of ice-cream; all this while the wife goes about her shopping. Another option is to grab a coffee or even a ‘paapri-chaat’ to while away the time. The waiting husband can also ogle at the lovelies at such venues. After all there are many Kareena Kapoor look-alikes to be seen at stores these days! I also wonder at times if annual awards could be instituted for long-suffering shopping victims like me. But one look at other men and their painful expressions tells me that there would be too much competition for the top
spots!
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Training guns on tuberculosis
The rise of multidrug-resistant TB in the recent past in India is worrying. The government, and both the public and private sectors, must work together to check the spread of this new threat
TB is caused by bacteria that spread from person to person through air. We are all exposed and vulnerable to it at all times. Chronic cough (for more than two weeks) and fever are the most important symptoms of the disease. When a person with TB coughs, the bacteria get ejected into the air. These get inhaled by someone else who then becomes infected. Now, with the rise of drug-resistant TB, the disease has become more complicated to control and difficult to treat. In most cases, TB is curable. However, it requires several antibiotics simultaneously and long-term treatment for cure. Patients must take at least six months of medication without interruption. If the medicine course is not completed, the bacteria can become resistant to the first-line treatment drugs. This usually happens when patients do not complete their full course of treatment; when doctors prescribe some wrong treatment, the incorrect dose, or length of time for taking the drugs; when the supply of drugs is not continuous; or when poor quality drugs are used.
Checklist for govt
For the NSP to succeed, several things need to happen.
Multidrug-resistant TB The rise of multidrug-resistant (MDR) TB in the recent past in India is worrying. MDR-TB is resistant to isoniazid and rifampicin, two of the most important and commonly-used first-line antibiotics used to treat TB. The MDR TB requires extensive treatment (two years or longer) with multiple drugs, and outcomes are usually poor. Treatment of drug-resistant TB is also very expensive because of the high cost of second-line drugs. While the current numbers may not seem alarming, the potential of how many more TB patients can become drug resistant becomes apparent when one considers the magnitude of the burden of the disease in India. India leads the world in TB-related morbidity, mortality and drug resistance. The country has over two million new cases every year. TB kills nearly 1,000 persons every day. A 2011 Global TB Report by the World Health Organisation estimated that approximately 64,000 cases of MDR TB emerge annually from the notified cases of pulmonary TB in India. Recently, a team from Mumbai reported cases of ‘totally drug-resistant tuberculosis’ – suggesting that this form of TB was incurable because of resistance to all kind of TB drugs tested. India’s Revised National Tuberculosis Control Programme (RNTCP) is widely appreciated for having made a huge contribution as it expanded basic diagnostic and treatment services to cover 100 per cent of the Indian population. Despite these achievements, TB continues to be a huge problem in India. It is because due to the neglect of TB as a public health problem and mismanagement of TB patients in both the public and private sector. The original National Tuberculosis Programme (NTP) was grossly underfunded, and failed because of low rates of case detection and cure. The RNTCP has reversed these trends in the public sector, with expanded access to improved diagnosis, short-course drug regimens and high cure rates. The diagnosis and treatment of patients with drug-resistant TB is one area that the RNTCP needs to address through better prevention and treatment services. In the public sector, a large fraction of patients with drug-resistant TB do not get adequate drug-susceptibility testing and second-line drug treatment.
Mismanagement in private sector The private sector, which diagnoses and treats more than half of all TB patients, is a continuing source of mismanagement of TB, and is largely outside the scope of the RNTCP. TB management practices in the unregulated private sector vary widely, often deviating from established standards. For example, inaccurate, blood-based, antibody tests are widely used, along with irrational drug regimens. Indeed, since antibiotics are easy available over the counter, antibiotic resistance is a major threat for control of all infectious diseases. Also, there is virtually no reporting or notification of confirmed TB cases to the RNTCP by the Indian private sector. Recognising these problems, this year the Ministry of Health and Family Welfare has issued two orders. One order banned the use, sale and import of all TB antibody blood tests in India, and the other required all healthcare providers to notify every TB case to local health authorities (e.g. district or municipal health officers). While the government must get credit for announcing these directives, it is unclear if the government has a clear strategy, advocacy plan, and funding to implement and enforce these.
Between devil and deep sea A typical TB patient in India is caught between two suboptimal options — an under-funded public programme with limited capacity to deal with drug-resistant TB, and an unregulated private sector where mismanagement is likely. Not surprisingly, patients often move from one provider to another, and between private and public sectors. And while they do this, they continue to transmit the infection to those in their families and communities. By the time a patient is adequately diagnosed and put on correct TB treatment, he may have infected nearly 15 other individuals in their homes, communities and workplaces. Patients, healthcare providers and the government will need to do their part. To begin with, all individuals with cough for more than two weeks must get their sputum tested for TB. Indeed, this is the key message behind an ongoing media campaign called “Bulgam bhai”, which informs viewers that sputum testing is available free via thousands of designated microscopy centres run by the RNTCP. If patients seek care in the private sector, they must demand sputum testing over blood tests for TB. If TB is diagnosed, the most important thing a person can do to prevent the spread of drug-resistant TB is to take medication exactly as prescribed. No doses should be missed and treatment should not be stopped early, even if symptoms improve. Patients, who cannot afford to buy drugs in the private market, must seek treatment in the public sector where drugs are given free. Role of experts Healthcare providers can help prevent drug-resistant TB by diagnosing cases quickly, following recommended treatment guidelines, monitoring patients’ response to treatment, and making sure therapy is completed. Healthcare providers should screen all individuals with chronic cough for TB using sputum tests such as smears, culture, or polymerase chain reaction (molecular) tests. TB cannot be diagnosed by any currently available blood test. Providers should also avoid starting anti-TB drug treatment without doing any laboratory testing to confirm the disease. If TB is confirmed, they should start treatment promptly and follow WHO or RTNCP guidelines.
Treatment For drug-sensitive TB, a standard four-drug treatment must be started, and the total duration of treatment must not be less than six months. If drug-resistance is suspected, it should be confirmed using laboratory tests such as culture or molecular tests. A second-line drug treatment then must be started, and the total duration of treatment must be at least two years. In all forms of TB, providers must counsel their patients about the importance of adherence, and periodically check if patients are taking the medications as prescribed. Private practitioners must refer poor patients, unable to afford medication, to the RNTCP. Pharmacies and drug stores must not dispense TB drugs without a valid prescription. The RNTCP is beginning a new phase, the National Strategic Plan, for 2012-2017. The vision of the government is a “TB-free India” with reduction in the burden of the disease until it is no longer a major public health problem. To achieve this, the RNTCP has now adopted the new objective of aiming to achieve ‘universal access’ for quality diagnosis and treatment for all TB patients in the community. The writer is Assistant Professor, Department of Epidemiology, Biostatistics & Occupational
Health, McGill University, Montreal, Canada; co-chair, Stop TB Partnership’s New Diagnostics Working Group
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Tuberculosis
