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Analysis

Bit tragedy, empty rhetoric

To prevent more Gorakhpurs, shake off the apathy and fix India’s broken public healthcare

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In the wake of over 70 encephalitis-afflicted children dying after the oxygen supply at Gorakhpur’s Baba Raghav Das Hospital was cut off following a payment dispute, the stage has been set for a rigorous debate on criminal negligence and public health spending. Initiatives such as Swachh Bharat and Mission Indradhanush, though commendable, advance the notion that India’s public health landscape is positively transforming. However, it is too soon to celebrate.

Tragedies such as the mass deaths in Gorakhpur, or more recently in Farrukhabad which claimed 49 newborns, remind us of the reality of India’s abysmal public health situation and raise deeply troubling questions on India’s priorities in its run-up to becoming a superpower.

An outstanding debt of Rs 70 lakh on a prominent state-run institution served an instant death sentence to children. The government’s claims that it hadn’t known of the oxygen shortage until August 4 have been contradicted by a recent newspaper report, according to which UP ministers had been made aware of the debt and the subsequent punitive cutting off of oxygen supply in March. This continued until August 9, when chief minister Yogi Adityanath visited the hospital and was informed of the situation. However, no urgent action followed.

The same evening, the oxygen supply was cut. Thousands of children have died since 1978 when the pestilence first broke out, and the hospital management was as abysmal then as it remains today. It is time to accept that a major overhaul in India’s public health landscape will only be achieved with adequate budget allocations – a move only possible when we confront our own apathy and move beyond empty rhetoric.

Since 1978, right around monsoons when encephalitis strikes, people from in and around Gorakhpur, other neighbouring districts, and even Bihar and Nepal, teem outside the hospital as it is the only institution providing treatment for the disease. However, the hospital does not have enough trained doctors, beds, or ventilators, and it hasn’t had these for a while now. Despite the dire circumstances BRD spent Rs 426.13 crore out of its total fund of Rs 452.35 crore and was still 27% short of clinical equipment, according to a CAG report.

Since many people (mostly rural poor) have to travel miles to reach the hospital – often critical cases requiring an immediate response – many patients succumb to the disease on their way to the hospital. In 2013, on the recommendations of an independent research team, several treatment facilities were set up near villages to provide immediate care to critical patients, but were unable to function as anticipated. As a result, 40 years and numerous deaths later, BRD remains the only facility catering to patients of the deadly disease, even as it is severely under-staffed and ill-equipped to tackle one of India’s deadliest public health challenges.

According to rural health statistics for 2015, there was a 37.7% shortfall of doctors in UP. Doctors at BRD knew oxygen would ultimately run out 10 days in advance when the supply was cut off, and no steps to arrange for backup were taken. This can only be described as criminal negligence of the highest order.

The disease is commonly referred to in India as Japanese encephalitis. However, the term only represents select cases of encephalitis caused by the JE pathogen. WHO has coined the broader term acute encephalitis syndrome (AES) to refer to a cluster of illnesses with similar symptoms.

Many cases in the Gorakhpur belt have displayed symptoms common with JE albeit without the presence of the JE virus. The other pathogens could be the West Nile virus, dengue virus, Chandipura virus and chikungunya virus – all known to cause AES. However, over the years, India’s focus has been on the eradication of JE while other forms of encephalitis remain comparatively neglected.

As a result, while the number of JE cases have reduced, the havoc of undiagnosed encephalitis continues. In 2015, the Indian Council of Medical Research found that from over 10,000 cases of encephalitis, only 8.4% were of the JE strain. While several independent research teams have carried out research to understand the disease in its entirety and presented often conflicting findings, no concrete diagnosis for the “other aetiology” encephalitis has been found.

Without diagnosis, it is impossible to devise any practical preventive strategies. Forty years down the line, it is high time for a more stringent, research-driven focus on the other causes of AES.

With no significant allocation of funds towards public health, and the poor state of health infrastructure in the country, economically disenfranchised people are forced to turn to private healthcare which leaves them penniless and in debt. There is a need to spend a significantly higher proportion of our GDP on public health, make public health more accessible to the poor by investing in more facilities, improve the quality of healthcare by increasing human resource and training them well and regularly, monitor the public and private health sectors to ensure quality health services for all.

When we thump our chests and speak of development for progress of the nation, do we forget that people make the nation and not the other way round? If by development we mean skyscrapers, wealth, health and privilege for some (but certainly not all), what kind of nationalism are we buying into? So long as our medical facilities continue to languish, and our people continue to perish due to sheer negligence, our patriotism rings hollow.

(Credit: This Article is published on The Time of India Dated 05/09/2017)

The Author is former Union Minister and Member of Parliament from Rajya Sabha

DISCLAIMER : Views expressed above are the author’s own.

Analysis

2018 In Retrospect: Permanent peace eludes Jammu and Kashmir, as it has for last 30 years

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Jammu/Srinagar, Dec 17: It’s been a fairly turbulent year in the state, both security-wise and politically. It saw more violence compared to last year, even though the security forces killed many militants, including some top commanders of militant outfits.

There were 587 incidents of violence during 2018 compared to 329 last year. Official figures say 240 militants were killed during the year against 200 last year.

Casualties among civilians and the security forces have also been comparatively higher. Thirty-seven civilians and 86 security men were killed in 2018 against 36 civilians and 74 security personnel killed last year.

Permanent peace eluded the state in 2018 as it has during more than 30-years of strife.

According to senior intelligence officers, there are still around 240 militants, including foreigners, who are active in the state.

“The number keeps on varying depending upon infiltration of new militants from across the line of control (LoC) and recruitment of local youth into militant ranks”, said a senior intelligence officer.

Summing up the security scenario, Lieutenant General A.K. Bhatt, who commands the Srinagar-headquartered 15 corps of the Indian Army and is the senior-most army officer in the Valley, said: “The security forces have a limited role in controlling the ground situation in the state. The final solution has to be political.”

On the political front, there was a dramatic turn in June when the right-wing Bharatiya Janata Party (BJP) suddenly announced in New Delhi that it was withdrawing from the ruling coalition in the state, headed by the Peoples Democratic Party.

The announcement was not unexpected as the two ideologically opposed parties were ruling the state for four years through an uneasy arrangement that appeared brittle from day one since the late Mufti Muhammad Sayeed announced it in 2015.

With the withdrawal of BJP support, the Mehbooba Mufti-led coalition fell and Governor N.N.Vohra dismissed the government, even though the state assembly was kept in suspended animation for any future alliance to stake claim to power.

Vohra was subsequently replaced by Satya Pal Malik who became the first politician to be made the state governor. As compared to his predecessor, Malik chose to speak to media as often as he could to put forth his view point, sometimes to the embarrassment of both New Delhi and Malik himself.

The fist thing the new governor did was to announce local urban bodies and panchayat elections in the state. Both these democratic processes were concluded peacefully throughout the state and their conduct is considered a feather in the administration’s cap as the elected government had been shying away from conducting the elections.

With the imposition of governor’s rule, the PDP started suffering desertions as some of its dissident legislators launched an open rebellion against the party leadership. In the forefront of the dissidents was senior Shia leader and former state minister Imran Ansari who finally joined the Peoples Conference (PC) headed by Sajad Lone, himself a former minister in the PDP-BJP coalition government.

Sajad’s PC started emerging as the possible Third Front that could, in future, pose a challenge to both the PDP and the regional National Conference (NC) headed by Farooq Abdullah.

Ever since the elected government fell, rumours started doing the rounds in the state that dissidents in the PDP, the NC and even the Congress party were waiting in wings to join the Third Front. The visit of BJP general secretary Ram Madhav to the state and his meetings with Sajad Lone and dissidents kept fuelling these rumours even when Madhav said there was no immediate move to form a government in the state.

The fear of their flock being poached pushed the arch rivals, the NC and the PDP, come close to each other. In a surprise move, Altaf Bukhari, senior PDP leader and former minister emerged as the contender for the Chief Minister’s post with outside support by the NC. With the NC’s 15 and the PDP’s 29 seats, the two parties hold a simple majority in the 87-member state assembly.

The NC and the PDP said they had decided to sink their differences to protect the special status of the state as article 35-A and other constitutional provisions were being challenged to dilute this.

There were also reports that the Congress was in the loop to shoot down horse-trading in the state. The PDP president, Mehbooba Mufti, sent a fax to the Raj Bhawan seeking an appointment with the Governor to stake claim to power. The fax was never received as the Governor said later the fax operator at the Raj Bhawan was off duty due to a holiday.

Amid claims and counter-claims, Governor Malik, in a dramatic move, dissolved the state assembly on November 21, justifying this by saying that he wanted to “prevent horse-trading”.

The possibility of any dialogue between the centre and the separatist leadership remained a distant possibility during the year. In all likelihood, this will have to wait till a new government takes office at the centre after the 2019 general elections in the country.

Elections to the state assembly are also likely to be held simultaneously with the 2019 Lok Sabha elections around April-May next year.

By Sheikh Qayoom

(Sheikh Qayoom can be contacted at [email protected])

 

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Analysis

Agrarian crisis dominates, set to influence 2019 general elections – 2018 In Retrospect

At the same rally, Congress President Rahul Gandhi had said: “The voice that is reverberating now across the country is of the farmers who are in deep distress and crisis.”

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New Delhi, Dec 17 : Agrarian crisis emerged as a major political concern in 2018, fuelled mainly by a fall in crop prices and a poor procurement mechanism which will provide opposition parties a common ground to rally against the BJP ahead of the next year’s general elections.

The anger brewing against the perceived “anti-farm policies” of the government could be measured by the poor performance of the BJP in the rural parts of Hindi heartland states in the just-concluded Assembly elections, that saw the BJP ousted from power in all three states.

In past one year, the national capital alone saw at least five major rallies of farmers, despite the BJP-government coming up with a new price-fixation formula and a score of schemes to impress the tillers of the soil.

The police firing in Madhya Pradesh’s Mandsaur last year that led to the death of six farmers, sparked agitations throughout the country over rural distress, which snowballed into a major political and social issue this year. The simmering discontent among farmers gained political traction in 2018.

Various opposition parties have been raising their voices against different issues to suit their electoral needs but they showed unanimity in expressing their solidarity with the demands for better crop remuneration and farm loan waivers during the November 30 farmers’ rally in the capital.

At the same rally, Congress President Rahul Gandhi had said: “The voice that is reverberating now across the country is of the farmers who are in deep distress and crisis.”

For the first time, the 2019 Lok Sabha elections will be fought on issues revolving around rural distress, said Yogendra Yadav of Swaraj India, who is credited with bringing over 200 farmers’ outfits under one banner — the All India Kisan Sangharsh Coordination Committee (AIKSCC).

“There has always been agrarian distress in the country. However, it never got an occasion to become a principal factor in the elections. The BJP’s defeat in the Assembly polls, coupled with the newly-achieved unity among farmers, has ensured that farm distress would take a centre stage in the 2019 elections,” Yadav told IANS.

He termed the BJP regime led by Prime Minister Narendra Modi “the most anti-farmer” government in the history of the independent India because of its “unsympathetic” treatment of farmers in the past four-and-a-half years.

Many videos throughout the year went viral on the social media, featuring angry farmers throwing their harvest and milk on the roads in the absence of remunerative prices.

Amid protests, the government increased the Minimum Support Price (MSP) for certain agriculture commodities. However, the farmers found this not at par with their demands and expectations.

Also, poor procurement of commodities owing to inadequate numbers and delay in the opening of purchasing centres by the government agencies forced the farmers to make distress sales.

In the case of vegetables, while the retail prices hovered between Rs 20-30 in major cities, the prices received by farmers for semi-perishable commodities such as potatoes and onion slumped to Rs 1 per kg.

The Agriculture Ministry seemed “ineffective” to create a redressal mechanism, activists said, though it came up with three procurement plans. Notably, Union Minister and Senior BJP leader Nitin Gadkari had in June this year acknowledged that there was agrarian crisis due to surplus crop output and sought action to address the problem.

And yet, the BJP-government failed to take corrective action by analysing the demand-and-supply situation, said Swabhimani Shetkari Sanghatana leader and Lok Sabha member Raju Shetti, who quit BJP-led National Democratic Alliance (NDA) over farmers issues’ last year.

“The government has been quite aware of the farmers’ issues. However, it did not take required action to ensure remunerative prices for farmers and the procurement of their harvest was ineffective,” Shetti added.

Noted agronomist Ashok Gulati said there was “lack of understanding” and “lack of vision” in the current BJP regime. He said the government did not carry out the required market reforms but resorted to just slogans and announcements.

“Even after the Mandsaur firing episode, the government did not act,” he said.

Any government needs a smart agriculture minister for effective implementation of schemes, he added.

Interestingly, Agriculture Minister Radha Mohan Singh chose to attend a Yoga session with Baba Ramdev in Bihar two days after the Mandsaur firing.

(Saurabh Katkurwar can be contacted at [email protected])

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Analysis

Now comes the hard part for the Congress

The Congress and its president will have to realise that such generalities no longer pay political dividends. The voters, especially the youth, are interested in specifics, including the spelling out of targets.

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Winning, although narrowly in Rajasthan and Madhya Pradesh, was the easy part for the Congress.

The favourable signals were there from the party’s earlier by-election victories in the two states. But despite the Congress’s latest success, what must be worrying for the party is that it missed losing by a hair’s breadth, given how close the voting percentages were for the two contenders – 39.3 per cent for the Congress in Rajasthan against 38.8 for the Bharatiya Janata Party (BJP) and 40.9 per cent in Madhya Pradesh for the Congress against the BJP’s 41.

What this means for the Congress is that it doesn’t have a moment to lose to show that it can provide better governance than its predecessor. There is no time for the party to bask in the glory of having risen like a Phoenix from the ashes of the 2014 drubbing. It has to hit the ground running, as the phrase goes.

It will not do for the Congress to bank only on populist measure like loan waivers for farmers which are frowned upon by economists as sops which ultimately help neither the farmers nor the agricultural economy. The loan waivers are in line with Sonia Gandhi’s favourite rural employment scheme of the Manmohan Singh government which was of no help to the party in 2014.

Nor will the pursuit of a “soft” Hindutva line to project the Congress as a BJP minus the gau rakshaks be of any help. Instead, the party will have to take definitive steps to demonstrate that it means business in dealing with agrarian distress and unemployment – the two main factors which brought about the BJP’s downfall.

Neither of the two steps will be easy for a state government, especially when there is an unfriendly regime at the centre, waiting to see how it fumbles. But an emphasis on irrigation and on groundwater and surface water management can underline the state government’s serious intent.

An expansion of the formal credit facilities can also reduce the dependence of the farmers on rapacious money-lenders, as can efforts to ensure that the routine subsidies are not misappropriated by the richer farmers.

Similarly, joblessness can be partly alleviated by helping in the growth of small and medium businesses in states which haven’t yet been able to shed the damaging BIMARU tag of being “sick” where the social and economic indicators are concerned.

But, in addition to such initiatives which are within the capabilities of the state governments, it is time that the Congress at the national level outlines its broad economic vision, which has been hazy so far as was evident from Rahul Gandhi’s reluctance to specify what he means when he talks of supporting farmers, creating jobs and extending health care, as he did at the London School of Economics last summer.

The Congress and its president will have to realise that such generalities no longer pay political dividends. The voters, especially the youth, are interested in specifics, including the spelling out of targets.

Since the problem with the Congress is that it has been unable to make up its mind between populist and pro-market policies, it appears to be suspended in midair where economics is concerned with no one knowing what to expect from a Congress government – a return to Manmohan Singh’s economic reforms or to Sonia Gandhi’s focus on freebees.

So far, the Congress governments in Punjab and Karnataka have been run-of-the-mill ones with little to show them as result-oriented, especially in the matter of bolstering the economy.

But, now that three more states have come under the party’s aegis, there has to be greater focus in its policies instead of a recourse to homilies.

For Rahul Gandhi, the unambiguous projection of an economic direction in the run-up to the next general election will be a bigger test than containing the Congress’ age-old malady of internal factionalism dating to the Tilak-Gokhale split of 1907.

If Narendra Modi is perceived to be faltering, it is because he tried to tackle the country’s economic ills with patchwork repairs like opening myriad bank accounts, providing direct cash transfers for cooking gas cylinders, extending rural electrification and undertaking faster highway construction. But he failed in carrying out what are called “big bang” reforms to rejuvenate the economy, which was the expectation behind his 2014 success.

If Rahul Gandhi, too, is found to be following in the BJP’s footsteps not only in pursuing “soft” Hindutva, but also in the economic field, the unforgiving people of India, who are increasingly becoming impatient for quick results, will have no hesitation in dumping the Congress.

The Congress president’s problem is that he will have carry with him his allies in the mahagathbandhan – if and when the grand alliance is formed – and so he cannot make unilateral announcements on key issues.

But he must remember that the eagerness with which many of them court foreign investors shows that the earlier aversion of the average politician to capitalism is dying out.

Rahul Gandhi will have to state whether he shares their views or still considers himself to be a foot soldier of the Niyamgiri tribals of Odisha who ensured the eviction of investors from their sacred hills.

(Amulya Ganguli is a political analyst. The views expressed are personal. He can be reached at [email protected])

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