Step out of the demand-side

Shift attention to supply-side


Government has been incentivizing pregnant women to deliver in institutions since more than a decade now. The impact is evident in reduction of maternal mortality ratio at national and district levels. My doubt is that won’t these schemes that finance the demand-side create a false sense of security?

Such schemes, called conditional cash transfers, have skyrocketed institutional load to such high levels that antenatal wards in government hospitals are unable to accommodate the admissions. So, what happened to the quality of care?

Since independence, we have been crooning over abysmally low proportions of Gross Domestic Product (GDP) spent on health. This makes me wonder where all this money for demand-side financing comes from. Let us assume that all the money from GDP is paid as incentives. Now, health is a subject of the states. Union only provides resources and supports the state plans. Can the states then find their own sources of revenue to improve the quality? I bet there are more than hundred different channels through which states can make savings. A flyover completed before the deadline earns savings of several crores.

I think it is time the government prioritizes on trainings, skills development, placing the skilled personnel where their skills are required and putting the necessary infrastructure in place.

Conditional cash transfers will remain, but it is time we shine light on the supply-side.

India Supreme Court orders closure of all sterilization camps within three years | Opinion | LifeSite

The Court further directed the India central government to take an active role to assure that the standards and guidelines concerning the proper protocol for sterilization procedures be strictly followed. In the past, state governments have been responsible for enforcing the policy standards with limited success.

The ruling also requires that all women undergoing sterilization must first have the possible risks, side effects, and consequences of the procedure read to them in their own language. This is an important proviso given that there are no fewer than 122 major languages spoken in India.

Now, the soft drink bottle is unsafe too

Heavy metals have been detected in the PET bottles of soft drinks. 

Lead and chromium are established toxins in humans. Government has to undertake initiatives to ensure safe and healthy packaging of foodstuffs. 

This could have wider ramifications. 

Japanese encephalitis has to be mandatorily notified

This will be a stepping stone towards better control of the long term crippling infection of the brain. 

Notification, as a government measure, has always reaped benefits in disease control.

Measles, tuberculosis, diphtheria and others are notifiable diseases in India.

For a killer disease like JE, that not just kills, but leaves victims permanently disabled, this must help in tightening surveillance and improving monitoring.

Public health lessons from the life of Gandhi

PC: Google Images

He wasn’t just a freedom fighter. He lived his life as a message for the nation. People become revered when they sacrifice their pleasures for a noble cause. Gandhi sought pleasure in the dream of a free India, a clean India, a land of equality and nobility. While some of his dreams have already turned into reality, some others are on the process of realization. 

His principles were of self-reliance and independence. Today, we learn that the success of a health programme for the community lies in the extent to which the members of the community engage in the programme. The vision is to make a people’s programme.

Community is composed of the individuals who live in it, understood in totality of the ecology wrapping them up. People in a community should not always be perceived as mere beneficiaries of an intervention, though this is common in the initial phases of a government programme. As the intervention expands in terms of geography of coverage and political commitment, community has to acquire a wider role outside the beneficiary compartment. They should be involved in the planning, implementation, monitoring and evaluation stages too.

Gandhiji set an example of self-reliance by wearing handwoven khadi. This reflects upon the immaculate treasure trove of resources that can be churned by an efficient health programme. The principle of appropriate technology underlining the concept of primary health care emphasizes upon how an efficient healthcare system utilizes grassroot level technology to improve health outcomes. 

Gandhian philosophy has several lessons for the health administrators. These lessons are of utmost relevance in our country where the basic tenet of economics – scarce resources and perpetual demand – applies perfectly, now more than ever. 

Time for public health focus on mental illnesses

Its a whole new perspective gained in reading chapters in public health. Its a macroscopic view of things at population level. There is a big difference in the events at tissue level and when it unfolds as a population phenomenon. 

Mental health has never received the attention it deserved from public health professionals in India. We have always been running after stamping sparks of tuberculosis and malaria. With diseases undergoing epidemiological transition and societies in demographic transition, it is high time doctors adopt a refined focus on new priorities. 

A national commitment translating in clear policies would lay the stepping stones for implementing strategies for improving mental health of the public. There is acute shortage of manpower to deliver mental health services. MCI norms for psychiatry departments are relevant in this regard. Regional centres should train and retrain sufficient number of professionals in handling mental health problems at all levels, village to apex. A strong referral system should work as the spine of mental health infrastructure in India. 

One out of ten people around us suffers from one or the other form of mental illness. The weaknesses in our health system to tackle the increasing burden of mental illnesses (thanks to urbanization and industrialization) are clear on the surface now. All we need is a multipronged strategy to bring down the burden of  psychiatric illnesses.

Roll number 24


Roll number 24 is again absent. Govind Sir was curious to know what prevented Sumati from attending school. It has been three days since she went on leave. He remembers her mother telling him on Monday that Sumati is sick after passing loose motions.

Govind Sir enquired about Sumati – “Does anyone know why Sumati hasn’t come since last three days?”

Sumit, sitting on the second bench, replied – “Sir, she fell unconscious. She is admitted in Taluk hospital.” Sumit lived in Sumati’s neighborhood. 

The school was situated in a beautiful fenced portion of the land overlooking Bhavsagar lake. In the premises of the school grew flowering plants and vegetables. Yellow and red roses, orange marigolds and white lilies made the school a pleasant area for learning lessons and playing games. Children loved being at the school because they were not only taught lessons from the textbooks, but also lessons on life with all its carefulness and gentleness.

Govind Sir was the only teacher there since the time his elderly predecessor died of an old age illness. A man in his early thirties, Govind Sir was struck by the realization that the duty of a school teacher counts among the greatest social services one can do to mankind. He found immeasurable satisfaction in making his 6-10 year old pupils play games based on life skills and teaching lessons on morality and values from the textbooks printed at government press. But, today, he was a worried man. His eyes caught the stillness of Bhavsagar lake while he wondered what has happened to Sumati. He decided to visit her at the taluk hospital in the evening.

Sumati was a seven year old girl being brought up in a joint family of at least ten members. Govind Sir has always found her unique in that she never cried on her first day at school. An year has passed and she has never displayed an emotion other than a wide bright smile that was more from her eyes than from her lips. She was once asked who her best friend was. She said everyone in her class are her best friends. When the same question was asked to others in the class, there was a unanimous reply – “Sumati.” Her mother brought her to school everyday and exchanged kisses at the gates.

Rajanna was Sumati’s grandfather. He enjoyed a rare distinction in the village. The villagers regarded him as a brave man who rescued several families when the mighty Godavari river flooded. That was more than two decades back when a young Rajanna swam across the Godavari and brought his wife, his aged mother and many children to safety. Everyone lived in gratitude towards him for saving their lives.

Beautiful water body

Rajanna lived life on his terms. In grandiose terms, he worked as a Mestri (contractor) in the Indian Railways. The truth was that he worked for several years as a daily wage laborer who crushed stones and then laid them on new railway tracks. When he felt overtly conscious of his entrepreneurial skills and leadership abilities, he started guiding small groups of workers in crushing and laying stones on the track. Today, he was a happy man because he had some twenty workers who took orders and guidance from him.

His son Ramesh took up the job of painting used furniture and selling them at cheaper prices. Rajanna and Ramesh ate breakfast together and took the road towards taluk office. Ramesh had to walk another kilometer from the railway crossing while Rajanna stopped and worked there till evening. However, there was another reason for which they had to walk out together in the mornings. They were men who loved open air. They enjoyed the privacy in the openness of the lakeshore.

The family was addicted to the pleasure in open air bowel evacuation. The activity was a significant effort undertaken on a regular basis in the wee hours of the morning. After all, in a family that dines together, defecation should also be a coordinated collective event. 

Rajanna was walking back home from the distant field on the shores of Bhavsagar. He placed the corroded aluminium bucket in the bathroom. He saw the sun shining across the horizon. He had to meet his friends at the local tea shop. The shopkeeper has an old television which entertained his customers. But today wasn’t like his other days at the tea shop. There was an unusual silence. He found that his friends’ interest was captivated by the speech of India’s Prime Minister Narendra Modi. It was not just the habitual tone of his voice that caught their attention today. Today, its the topic of his speech that interested them- sanitation. 
The Prime Minister was addressing the Indian Sanitation Conference 2016. Shortened as INDOSAN, this conference was being held in New Delhi. Shri Narendra Modi said that sanitation is of utmost importance in our lives. He gave the illustration of things at his village where villagers reared goats in the toilets built under Total Sanitation Campaign. Listening to his speech on the television, Rajanna remembered how he was utilizing the wet latrine constructed in his backyard. The Prime Minister went on to say that the action that an individual does in the open field has its repercussions back in his home. His family suffers from diseases arising from the infectious material discharged in the field. Rajanna heard the PM describe how children bear the brunt of this menacious practice of the elder members. He felt the whole world of his friends at the tea shop moving away from him. He felt like a student thirsty for knowledge listening to his revered teacher giving lessons on life’s hardcore reality. He remembered his granddaughter lying sick on the hospital bed. He remembered seeing Sumati playing with her friends in the open fields. The Prime Minister’s words started hitting him hard. He knew he had to change.

Evening came. Rajanna, Ramesh and Govind Sir reached the taluk hospital to visit little Sumati. Doctor said that she is doing well and fit for discharge. Govind Sir asked the doctor to take a minute to explain what disease was Sumati suffering from. Doctor explained to Govind Sir how bacteria and viruses enter the child’s stomach and cause disease. Rajanna quickly connected the doctor’s explanation with what he heard the PM speak in the morning. He knew deep inside his mind that somewhere he had been doing wrong. 

The next day, Rajanna again woke up in the morning. He again picked his aluminium bucket up. But this day, he took a new route. He performed the activity in the old toilet. The rusted tap in the toilet was repaired. After the family members ate their breakfast, Rajanna announced his decision to everyone present – We will use the latrine from today.

Like always, Sumati exchanged kisses with her mother at the school gates. Govind Sir started  attendance call. Roll number 24 sprang up in joy – “Present, Sir!”