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Reforming judicial system
New-found love |
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Killing unborn daughters
Medical education at crossroads
Out in the open
Harnessing growing population
We face years of looming austerity Delhi Durbar
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Reforming judicial system PRIME Minister Manmohan Singh has rightly called for a “war” against the pending court cases. Addressing a conference of Chief Ministers and Chief Justices of High Courts on Sunday, he said that a “holistic and multi-pronged approach” was needed in this war because there was no space for “piecemeal, patchy or sectoral responses”. Indeed, with over 52,000 cases pending in the Supreme Court, more than 40 lakh in the high courts and a whopping 2.71 crore in trial courts, the issue needs to be addressed on a war-footing. Chief Justice of India K.G. Balakrishnan has also voiced similar concern and emphasised urgent remedial measures to help the litigants. Unfortunately, though arrears have been increasing in the courts, the government and the judiciary have in the past not adequately responded to well-meaning recommendations by the Law Commission and other bodies. Justice Balakrishnan, in his address, has referred to “structural obstacles” which discouraged talented law graduates from joining judicial services. He, however, does not identify what these obstacles are and the measures required to address the problem. The conference did help in grasping the nettle over the burning issue of releasing 1.7 lakh-odd undertrials languishing in jails for petty offences. The Chief Judicial Magistrates have been directed to pursue this proposal to its logical conclusion. Clearly, their release brooks no delay because in many cases the period of detention has overshot the sentence that would have been awarded to them in case of conviction. The CJI has said that those who have served more than half the sentence likely to be awarded for their crimes could be “immediately released on personal bond.” This is a welcome statement of relief for these hapless people. As there are over 3,000 vacancies of judges, there is need to streamline the long process of recruitment through better coordination between the executive and the judiciary. Cutting down holidays, longer working hours, better infrastructure, recruiting retired judges and setting up additional courts will all help. The Centre should also implement progressive legislation such as the 2005 Plea Bargaining Act and the 2009 Gram Nyayalaya Act. What is their purpose if they are not implemented? Fast track courts and consumer courts should work faster than normal courts. It is to be hoped that the new resolve to tackle these issues would lead to more concrete results than in the past.
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New-found love IF only what Jaswant Singh has said about the sorry state of Muslims in India — “We treat them like aliens” — had constituted an authentic U-turn in the official policy of the party to which he belongs, it would have been heartening news. But since it only comes out as his personal view, it is a case of the kettle calling the pot black and may just cause additional turbulence in the BJP. Some may see in it a prelude to parting company with the BJP. Others may interpret it as the fulminations of a gentleman who is in wrong company. Either way, it is unlikely to appease either the Hindutva zealots or the Muslims. The former Foreign and Finance Minister has not confined himself to expressing his new-found love for Muslims alone. He has also discovered many merits in Mohammad Ali Jinnah who, he would have us believe, was “demonised by India”. He has thus emulated Mr L K Advani. The only difference is that while Mr Advani had showered praises on Jinnah while on a visit to Pakistan, Mr Jaswant Singh has done so in India. Not only that, he has also hidden behind Gandhi to praise the founder of Pakistan, saying that Gandhi had himself called Jinnah a great Indian. Now that there are two of them, Mr Advani and Mr Jaswant Singh should strive to guide the BJP into shedding its aggressive Hindutva plank and follow a more inclusive policy under which neither Muslims nor Christians are demonised. As a first step, they should tender an unqualified apology for what happened in Gujarat and Orissa — as also in Ayodhya. That will not only increase their own stature, but also revive the party which has seen its size and influence shrink. It may just be a coincidence that its “chintan baithak” is only a day away. If some genuine introspection is done, they can avoid a “chinta baithak” in the future.
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Killing unborn daughters IN son-crazy India, the tribe of those doing
way with unborn daughters seems to be in no mood to change its mindset that favours sons over daughters. Besides, those who stand to gain from this immoral and illegal act will continue to find ways to beat the law. The PNDT law that prevents the use of pre-conception diagnostic techniques also bans advertisements of sex determination. Yet the advertisements continue to do the rounds on the Internet. Now the Union government wants the websites offering gender-testing kits to be blocked. Earlier, the Voluntary Health Association of India (VHAI), Punjab, got a ban imposed on the websites offering at home sex-determination facility. However, barring sex determination kits on websites is only one part of the solution. The practice is too widespread and requires a multi-pronged approach. It is not as if the governments are not aware of the miserable sex ratio, particularly in Punjab and Haryana. Campaigns and positive incentive schemes are very much in place. Individual efforts, NGOs and initiatives like Nanhi Chaon have been trying to save unborn daughters. Heart-warming examples like that of Delhi, which has emerged as the second state after Kerala with a pro-female secondary sex ratio, proves that government schemes such as Ladli and NGOs can play a positive role in denting gender prejudices. The Punjab government has claimed an improvement in the sex ratio in the age group of 0-6 years, but the PNDT law continues to be violated by unscrupulous practitioners who are going unpunished. While keeping a check on registered clinics, the law-enforcing machinery has to extend its arm over unregistered abortionists who provide a killing field to unwanted daughters.
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It was, perhaps, one of those cases in which advice is good or bad only as the event decides. — Jane Austen
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Medical education at crossroads
WITH The Tribune having a wide-ranging debate on education policy reforms, medical education also needs public attention. In fact, it requires urgent reforms. The number of medical colleges has mushroomed in the last 10 years. In 1990, there were 144 medical colleges with approximately 17,000 undergraduate (UG) seats. In 2000, the number of colleges increased to 190 with around 23,000 UG seats. In 2009, there are 296 medical colleges with approximately 34,000 MBBS seats. The increase in the last 15 years has been mostly in the private sector. The standard of these colleges varies a lot keeping in view the availability of qualified teachers, infrastructural facilities and admission procedures. In a majority of the colleges, education and training programmes are grossly substandard. A serious exercise to improve their standard is urgently required. Even the contents of the training programmes/curriculum need to be changed in consonance with our changing needs. Various committees, including the National Knowledge Commission, have given recommendations to reform the medical education system. These deserve urgent attention of the policy makers for implementation. The status and respect given to doctors by society have motivated a lot of talented youngsters to take up this noble profession as a career. But over the last few decades, medical profession is witnessing a gradual decline in its reputation. Students no longer consider it as a preferred choice. Bright students now prefer engineering, commerce and management courses. Only the left-out are opting for a medical career. The quality of the students is further affected as a significant number of seats are reserved for rich students who can pay a large capitation fee despite having poor performance in Class XII and entrance tests. All this is resulting in more and more mediocre students joining this profession. The country can ill-afford this discouraging trend. Society will not like to be treated by mediocre doctors. Moreover, we need bright brains for medical research and innovation to take the lead in the world of medicine. The reformists must also look into this aspect while making policies. Adequate steps need to be taken to reverse this trend. The contributing factors for the changing trend need to be analysed and adequately addressed. The most important factor seems to be the lack of opportunities to join postgraduate (PG) courses after graduation, preventing growth in the profession. These days an MD/MS degree is the minimum requirement for professional recognition for a doctor. It has become necessary for advancement in career and gaining prestige in the profession. The UG seats have markedly increased during the last 10-15 years without a comparable rise in the availability of PG seats. There are only approximately 10,000 PG seats (MD/MS & PG seats from NBE) as compared to 34,000 UGs passing out every year and desirous of joining PG courses. Many medical graduates spend up to three years preparing for the PG entrance examination. This year more than 80,000 UGs appeared in the entrance test for about 5000 Central government PG seats. The internship period, meant for gaining experience in different branches, is invariably used by students for their preparation for the PG entrance examination. The aspirants who are aware of this serious problem are reluctant to opt for the medical profession. Thus, the number of PG seats need to be urgently increased without any addition to the UG seats. Rather in the colleges which provide substandard education the UG seats should be decreased, depending upon the available infrastructure and teaching manpower. The enhancement of the number of PG seats will greatly help reverse this trend. We also need to initiate new postgraduate disciplines — faculty of medicine, emergency medicine, etc — which will not only help create manpower development in these fields but also contribute to the expansion of the number of seats. In the US, there are more PG seats than UG seats. To go in for specialisation is a global phenomenon. Lack of opportunities at home results in the bright graduates leaving for developed countries for higher-level training. They get attracted to settle down there. This results in a loss of bright medical graduates. Creating a condition for return migration is the need of the hour. This can be achieved by developing a centre of excellence for clinical and scientific research to make the country lucrative for skilled professionals. The government’s initiatives to set up new AIIMS-like institutions is a step in the right direction. It needs to be pursued with a visionary zeal by policy-makers and experienced professionals. Another important issue is to ensure adequate emoluments which medical professionals deserve. Their remuneration should be comparable to the competitive careers, considering its long duration and rigorous training programmes. The Central Government has given good salary packages to resident doctors after the Sixth Pay Commission report. The states should also follow the same pattern. The private institutes which are also recruiting residents for PG training programmes through the NBE should grant pay packages comparable to that in the government sector as these residents are actively involved in patient-care services. At present, most of these hospitals pay only one-fourth of the salary given in the government sector. Rather they may charge some capitation fee from these residents for joining speciality and super-speciality programmes. The pay structure should also be attractive for those who join as faculty members in medical colleges/institutes or various health services. It is disheartening to see that today the pay packages of the faculty in the AIIMS/PGI are lower than that available in the IITs. It is important to ponder over these issues. These steps will help reverse the trend and bright student will again look for a career in medicine. The modern medicine, being technology-driven, has increased the cost of treatment and also resulted in the commercialisation of services. The declining moral values and the lure of money seem to slowly creeping into the profession. This has eroded the confidence of the common man in the medical profession. The public expectation is also increasing and the growing perception is that every disease should be curable. All this is leading to a growing number of litigations. It is important to appreciate that medicine is a science of uncertainty and the art of probability. Even with the best possible efforts in the available set-up, it may not be possible to treat every treatable ailment because of the unpredictability factor, side-effects of drugs and unavoidable complications of various surgical or interventional procedures. Society needs to appreciate these limitations. Of course, the professionals guilty of indulging in unethical practices must be punished. It is high time we took steps to reform the medical education
system. The writer is Director, PGI, Chandigarh.
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Out in the open THE Tribune, which has the distinction of highlighting various types of eyesores of society, has now excelled by exposing the fast-growing habit of underage drinking because of easy availability of alcohol in Chandigarh. Perhaps the keen desire of the department to generate maximum revenue out of the auctions of liquor vends and thekaas (as these are commonly called) is one of the reasons for this malady. Its easy availability in plenty without any reasonable restrictions is certainly a great temptation for this underage group. It is in the month of March every year, when liquor barons as well as vendors of the City Beautiful wait eagerly for the announcement of “liquor policies” of the government. The excise departments ensure, while formulating their excise policies, that their treasuries become richer and surpass the previous years’ revenue even overlooking important social responsibilities. This year they have succeeded in their mission. As rightly highlighted by the Press some time ago, Chandigarh has more schools and that it had sold 85 lakh proof litres of Indian made liquor in the year 2007-08. Also the consumption per person is 21.31 proof litres while in Himachal the annual per person consumption is 1.08 and for Punjab and Haryana it is 1.17 and 1.06 proof litres, respectively. Chandigarh certainly surpassed in this race. Three cheers! When I was young this drink was always consumed “in camera” and prohibited areas even in the residences. I came to know from my elders that certain important guest would only get up for a quick drink in private when the password “Sir, there is an important person who is waiting for you outside” would be announced in the party. This would be followed by a scented “Ilachi Dana” to eliminate any possible odour of the liquor! However, the question of underage drinking and that too in public was unheard then. Those days imported whisky was not readily available and was a restricted item. This was considered a precious gift and friends going abroad would be loaded with requests to bring this item. The government would provide very little foreign exchange which would be hardly enough to meet both ends. I had personally experienced this on one of my visits as I had even to impose cut on my food item to save dollars for the purchase of this drink. Only two bottles could be brought then. However, I would forget all the discomforts while presenting these to my friends, when I would see a twinkle in their eyes, and a flicker of happiness on their faces! The collection of rare brands of imported liquor had also become a hobby with a section of society who would take pride to show the collection to their near and dear ones. An incident refuses to fade out of the canvas of my memory. A dear friend of mine had a similar rich collection which was very precious to him. No one was allowed to touch it. It was “no-man’s land” even for his wife. It so happened that he had to go out for 15 days. His wife utilised the absence by getting the house whitewashed and painted. In the process, the almirah containing his rare collections too got a brush of paint. On his return, he found that the drink had a slight tinge of bad odour. When the truth was revealed, he in a fit of rage destroyed the entire rare collection. What must have happened to the innocent lady of the house is left to anybody’s imagination! The abundance and easy availability of liquor these days, along with a message to the consumers, has been presented with added sparkle in the following lines: “Ram rajya mein doodh mila
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Harnessing growing population MAYA
DEVI of Supaul district Bihar was the sole women who raised the demand for safe delivery system for young pregnant mothers in the Kosi region affected by floods year after year. Living their lives next to the river makes these communities highly vulnerable to not only the immediate flood fury but to a host of fundamental development issues. It became clear that the complete lack of healthcare or non-availability of local transport was not confined to one or two villages but endemic in the entire Kosi region. Functioning of most PHC’s in rural areas is dismal and there is a high maternal mortality rate, morbidity fuelled by lack of care during pregnancy, delivery, and safe abortion in rural areas. The Kosi scenario is reflective of the larger national picture on maternal health. Every year in our country, 77,000 maternal deaths occur which can be prevented to a large extent by providing timely access to quality maternity care. The problem is one which developing countries across the world struggle with. Reproductive health problems are the leading cause of death in women belonging to developing countries. As many as 6,00,000 women die every year due to pregnancy-related causes. Is the picture concerned only with the lives of the1 .2 million people living on the Kosi banks for whom access to basic healthcare is a far cry? Or does it speak of flawed governmental priorities to the critical issue of Family Planning program. At one time a flagship program of the Central Government, the Family Planning program suffered from excesses and high-handedness of implementation authorities during the Emergency period which made the communities first resent, then defy and ultimately reject the Family Planning program. This only leads to the understanding that if welfare programs cater less to the needs of the communities on the ground and more to achieving demographic targets, they usually collapse. In subsequent years, possibly realising this flaw, there was a move to redefine and broaden the scope of the Family Planning program. There was now in place a more holistic program termed as “Mother and Child and Reproductive Health
programme”. Health Centres across the country introduced services for safe motherhood, counselling and treatment for infertility and awareness programs covering important aspects of nutrition and sanitation. Under this Family Welfare umbrella STD, HIV/ AIDS were addressed. A variety of contraceptive products were made available in the PHC and market to choose from as per their own need and life style. This holistic approach gradually took root. On 12 April 2005, Janani Suraksha Yojana
(JSY) was launched in all states and UT’s with special focus on low performing states to reduce maternal and neonatal mortality.
ASHA, a program which trained local community based workers became acted as an effective link between the government and the poor pregnant women. The process has been not without hiccups, the challenge to deal with each individual, each user of services with sensitivity and understanding rather than foist on them an already pre-conceived option for family planning. Many a times on the field, the social worker needs to use discretion and subtlety to side-step what could be an uncomfortable situation. One such instance the field staff were finding hard to discuss the spacing methods to newly weds, keen in adopting a temporary FP methods. They were hesitant and overshadowed by their mother-in laws. Rather than push the questions further, an imaginative field worker asked the newly-wed to merely point out the service she required in a chart which has all the various FP options available. As the young woman silently and shyly pointed out the service, it was obvious that the health worker had got her answer and the visit was successful! Seeing women suffering with IUD a safe, easy-to-use, effective, long-term method of contraception insertion, complaining of bleeding, pain. During such an exercise, women raised the question “What is important, the number of IUD acceptors or satisfied users?” The truth of course is the latter and this is what our programmess need to make as their cornerstone. Seen from this perspective, the component of ‘home visits’ would be measured not by not the duration or the number of visits, rather by what information is given and how it is given. Focus on these can make the home visit strategy effective. It is important for instance, to meet with individual families at a time suitable to them rather than have a blanket time schedule. The practice of flexi hours would be an effective way of planning this. Ongoing Training and orientation programs to provide latest information about the FW programs as well as brushing up on counselling skills is a must for all field staff. There are other social dynamics which the field worker has to negotiate her way through. There is intense pressure on the young woman to bear a male child. If women do not conceive, there is that constant fear of rejection, of abandonment. It is an onerous task to speak of male infertility in such an entrenched mind-set and then give information of the various treatments available. As the world observed World Population Day last month to draw attention to population related issues and its impact on development. The theme of this year is “Young and their Reproductive Health”. Nearly half of the world’s population is below the age of 25 years, of which nearly three billion will soon be of the reproductive age. Leaders at the World Summit last year, acknowledged the critical role of reproductive health in development. Although population growth has eased world wide, 90 per cent of the current growth is largely confined to developing countries which has failed to address the huge unmet requirements for family planning services For India with its burgeoning population, it is important to recognise the gigantic potential of such a human resource as it takes its place amongst the comity of nations. The somewhat graphic and perhaps narrow term of “Sex Education” can be expanded to a more expansive “Family Life Education” encompassing all that is required young people to take control over their lives and become responsible
citizens.
— Charkha Features
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We face years of looming austerity AS economies begin to expand again, policymakers are doubtless expressing a collective sigh of relief. They can now go off to the beach, with bucket, spade, sun tan lotion and dodgy economic model in hand, happy in the knowledge that their worst fears – a return to a 1930s-style Depression – have proved unfounded. When they return to their post-holiday desks and computer screens, they will perhaps find themselves having to deal with an unexpected threat. Inflation will be on the rise. Until now, inflation has been quiescent, helped by a decline in global commodity prices, particularly for oil. Yet, over the past months, oil prices have been heading up. As the credit crunch took hold, oil prices collapsed. It seems a long time ago but, in the middle of 2008, oil prices had threatened to top $150 per barrel. They then dropped, three times bouncing below $40 per barrel. Now, they are $70 per barrel. Is this a sign that the global economy is returning to renewed health and vigour as earlier worries over depression and deflation begin to fade? Or are these renewed oil price rises a threat to lasting economic prosperity? The answer depends mostly on where you live. In the US, Europe and the UK, signs of economic stabilisation are encouraging but, at present, the level of demand in these economies remains depressed. China has given a shot in the arm to global economic activity via the stimulus package pushed through over the past few months. Its renewed strength has been a key reason behind the return to much higher oil prices. Other Asian economies are also beginning to contribute. Indeed, Asia may be retuning to the buoyant economic conditions last seen in the early parts of this decade. To understand why, it’s worth thinking about how policymakers in these countries tend to conduct monetary policy. As with many other emerging nations, countries in Asia tend to link their currencies, formally or otherwise, to the dollar. So when the Federal Reserve decides on interest rates suitable for the US economy, it is also, inadvertently, setting interest rates for many other countries. If you’re an American Congressman, this reluctance stems from the blind pursuit of mercantilist trade policies by the Chinese and others. If you’re Chinese, the tie to the dollar creates a useful external anchor for monetary policy given the lack of a properly developed domestic financial system. In these circumstances, a currency target is often preferred to a domestic inflation target. The US sets interest rates for a big chunk of the world economy. If the US has a nasty credit crunch, but other countries do not, those other countries are likely to end up with interest rates which are too low. As a result, their economies expand, their credit systems go into overdrive and their financial markets boom. Rising oil and other raw materials prices are not good news for commodity-importing nations. So-called “headline” inflation – which includes the volatile bits and pieces such as food and energy – is likely to be moving up again later in the year, seemingly putting paid to earlier worries about deflation. Stronger Asian demand will boost US and European exports to that part of the world but, despite Asia’s immense regional power, its economies have yet to replicate successfully the US consumer’s role on the world stage: Asian countries are full of savers, not borrowers. My guess is that the impact of higher commodity prices will swamp the effect of stronger Asian demand for developed-world exports, creating a new set of questions about economic recovery in the developed world. The picture I’ve painted is one in which the developed world will increasingly have to make room for the strength of demand from Asia and other parts of the emerging world. Rising oil prices are part do not threaten 1970s-style inflation, where prices and wages went up in leaps and bounds. Instead, they make people in the developed world worse off. Janet Henry’s conclusions make for uncomfortable reading. In the UK, for example, inflation will be back above 2 per cent in months. Yet, the chances are that wage growth will be, at best, desultory. Real spending power will be under tremendous downward pressure. In the good old days, we’d have borrowed our way out of these difficulties. If incomes were being squeezed, we could have relied upon credit markets to allow consumption and investment to continue rising. But the credit crunch has put paid to this. The only borrower left is the government, and few governments will be either willing or able to keep borrowing at the pace seen over the past year. The credit crunch has created a pivot in the world economy. The debt-driven attempts at continued expansion in the developed world have unravelled uncomfortably quickly. Lower interest rates will provide part of the solution, but they are working more to stimulate demand in Asia than in the developed world. Asia is a lot bigger economically than it used to be, at a resource-dependent stage of its development and is helping driving energy prices back up again. Those increases, in turn, threaten to constrain the pace of economic recovery in the west by eating away at our real disposable incomes. This is why a debate over fiscal consolidation is ultimately so important. Keynes wasn’t wrong. The fiscal pump-priming we’ve seen over the past 12 months prevented a far worse economic meltdown. But, by increasing government debts, we have increased the tax burden on future generations. That’s fine if we can look forward to strong and sustained growth. But, as the global economy pivots, that becomes less likely for the developed world. At some point, we will have to accept a string of years in which the key word will be
“austerity”. — By arrangement with The Independent
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Delhi Durbar
FOR all its loud claims of patriotism and commitment to Mother India, BJP and its leaders appear obsessed with Pakistan and its founder Mohammad Ali Jinnah. And all the admonitions and rebukes of the parent RSS seem to make no difference to the Pakistan and Jinnah admiring top leaders of the party. First it was former Prime Minister Atal Bihari who put his seal of approval on the raison d etre of Pakistan during his Lahore bus journey. Then it was L.K. Advani’s turn to go to Karachi and issue a certificate of secularism to Jinnah. Now we have Jaswant Singh writing in his latest book how it was not so much Jinnah as Jawahar Lal Nehru responsible for India’s partition. But then this argument is so similar to the one extended in the official Pakistani line justifying the creation of Pakistan on identical lines blaming a ‘Hindu’ Nehru for dividing India. Be that as it may BJP leaders’ obsession with Pakistan is to be seen to be believed. The other day Advani actually said while launching the Urdu version of his autobiography that he got it translated to Urdu to reach across to the people in Pakistan. Why? Where is the need? One wonders whether these leaders realise that they are now in the era of third post-Partition generation where that past only draws a blank and vacuous nothingness, except a mild curiosity to know what the people across the border are like. Perhaps the BJP needs an immediate generational change.
SC exercises caution Extreme caution has guided the apex court in recent cases pertaining to fields involving a great deal of expertise. While Chief Justice KG Balakrishnan was quick to stay the Bombay High Court order on Maharashtra government’s response to last year’s terror attack, another Bench made it clear that medical professionals could be prosecuted for negligence under criminal law only under exceptional circumstances. “How can courts guide the Anti-Terrorism Squad (ATS) for dealing with the menace,” wondered the CJI while staying the HC order asking the ATS chief to be present in court personally. A Bench headed by Justice SB Sinha, who retired recently, explained that doctors could be prosecuted only in cases where they did something or failed to something which no medical professional in his ordinary senses and prudence would have done or failed to do. At the same time, the court was quick in passing orders in matters of public importance that required only common sense. The court ruled that unaided private schools had no right to raise tuition fees arbitrarily.
Diplomatic shake-up Amid a massive shake-up going on in the External Affairs Ministry ever since Nirupama Rao became the Foreign Secretary, there was speculation over who will occupy the post of Joint Secretary, PAI, (Pakistan, Afghanistan, Iran), now that incumbent T C A Raghavan has been named the next High Commissioner to Singapore. The buzz is that Y K Sinha, who is returning to the headquarters at the end of his term as Ambassador to Venezuela, is being asked to look after the all important
division. (Contributed by Faraz Ahmad, R Sedhuraman, Ashok Tuteja)
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