TOI EXCLUSIVE - `India needs to generate new health system models'

Bill Gates





There's No Magic Number For Health Spending But It's Not Possible To Maintain An Adequate System With Inadequate Financing

There are many ways to tell India's story of progress over the past generation. Prime Minister Narendra Modi will tell one version when he addresses the nation at the Red Fort.My favourite ve r s i o n i s this: In 1990, 3.3 million Indian chil dren died before they turned five. Since then, the population has gone up by 48%, so you'd expect that 4.9 million Indian children died last year. In fact, the number was 1.3 million.That's 3.5 million children who would have died last year but who lived because the Indian government prioritized health.The next task is to get from 1.3 million to as close to zero child deaths as possible, that means studying the progress of the past, learning from it, and improving upon it.
India's success in saving children's lives so far, means that it hasn't just met but surpassed the UN's ambitious Millennium Development Goal (MDG) on child mortality. In 2000, UN agreed to a sweeping plan to improve the lives of the poorest people in the world, including specific targets in eight key areas of development, with a deadline of 2015. The MDGs helped countries and development organizations set priorities, measure progress, and continually get better.
Now, the deadline for the MDGs is near. The MDGs are being replaced by a new set of goals, the Sustainable Devel opment Goals (SDG), which run from 2015 to 2030. The SDGs provide an opportunity to consolidate all the lessons you've learned in the past 15 years and chart your next course. You get to ask yourselves, “What kind of country do we want to have in 2030, and what do we need to do to get there?“ When it comes to health, the area I follow most closely, I see two big needs: More resources and using those resources as effectively as possible.
The SDGs are backed by a bold vision of the future, but to put it bluntly, that vision costs money that is not yet available. In India, public spending on health amounts to just 1.1% of GDP, compared to 2.9% and 4.1% in China and Brazil, respectively. Many countries spend even more. There is no magic number for the percentage a government needs to spend on health, but it is not possible to maintain an adequate public health system with inadequate financing.
Resources matter, but how they are used is just as important. India is immense -and immensely complex. There is no existing health system model that can simply be applied to India. You need to generate new models. How can you provide high-quality care in vast rural areas where there are very few doctors?
Given that so many Indians use private health providers, how can the government work with the private sector to improve care? How can such a sprawling health system produce and use data in real time to respond to what is happening on the ground? These are challenges India is wrestling with. You have the creativity and intellect to solve them, and I believe you also have the political commitment.
In 2014, India developed a strategy to save the lives of infants, added vaccines to the routine immunization schedule, and created the Indradhanush and Swachh Bharat missions to promote universal immunization coverage and better sanitation. That's an impressive record for just a single year.
But it's not enough for these plans and missions to exist. They must perform. If you look at the statistics about quality of life in India, the first thing that jumps out at you is how much better it has gotten.But the second thing is how uneven it still is from state to state. The child mortality rate in the worst-performing states is three times higher than it is in the best states.
More than anything else, we should make sure that primary health systems in every state reach every single person with high-quality services. It is possible because we have seen it in many places.We have also seen that it takes long-term attention and investment.
India's record on child survival is impressive. But to maximize the impact those children will have in the future, India needs to make sure that they not only survive but thrive. So, this Independence Day , in the new era of the SDGs, I hope Indians focus on an ambitious goal that is good for India and good for Indians: Creating a society where every citizen has access to healthcare, education, and nutrition they need to fulfill their potential.
Call it a new social compact. If the government can ensure that the Indian people have access to these services, the Indian people will build a strong future for the country .
Bill Gates is founder & co-chair of the Bill and Melinda Gates Foundation

Union govt. staff can expect good news

7th pay panel award will result in 15.79% rise in salary outgo, says Jaitley

Indicating good news soon for Union government employees, the Modi government said on Wednesday that the implementation of the Seventh Pay Commission award would result in a 15.79 per cent increase in the salary outgo for 2016-17.

The medium-term expenditure framework statement, tabled by Finance Minister Arun Jaitley in Parliament, said the salary expenditure would rise 9.56 per cent to Rs. 1,00,619 crore in the current financial year of 2015-16. The outgo would rise to Rs. 1,16,000 crore in 2016-17 and further to over Rs. 1,28,000 crore in 2017-18 with the implementation of the recommendations of the commission, the framework projected. The salary bill for the current year works out to 12.6 per cent of the tax receipts the Centre estimates it will collect during the year.

The commission was set up by the previous UPA government in February 2014 with the mandate to recommend revision of salaries of over 50 lakh Central government employees and remuneration of 30 lakh pensioners. It is expected to submit its recommendations — to be effective from January 2016 — by August-end. Mr. Jaitley said the impact of the commission award on the exchequer posed “a risk.” The statement projected that the pension bill would rise to Rs. 88,521 crore in the current fiscal, which is estimated to further increase to more than Rs. 1,02,000 crore in 2016-17 and over Rs. 1,12,000 crore in 2017-18. Mr. Jaitley expressed the commitment of the government to cut fiscal deficit and push subsidy reforms. “Macro-economic outcomes have improved significantly, primarily with the revival of economic growth and subsidence of inflationary tendencies,” he said.

The Centre is committed to bringing down the fiscal deficit to 3.5 per cent in 2016-17, and 3 per cent in 2017-18. For the current fiscal, it has been pegged at 3.9 per cent of the GDP. The fiscal consolidation strategy hinges on reclaiming high growth in gross tax revenues achieved in the past and gradually reducing expenditure on subsidy through reforms. This is essential for creating space for financing programmes of the government, he said.

Keywords: Modi government, Seventh Pay Commission, central government employees

'MGNREGS reduced poverty, empowered women'

The programme reduced poverty by up to 32 per cent and prevented 14 million people from falling into poverty.

The Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) reduced poverty by up to a third and gave a large number of women their first opportunity to earn cash income, a new research has found.

Officials from the Ministry of Rural Development (MoRD) and the National Council of Applied Economic Research (NCAER) released a new report Wednesday evening which used data from two rounds of the India Human Development Survey (IHDS) – 2004-5 and 2011-12. The survey was conducted by the NCAER and University of Maryland, involving over 26,000 rural households across the country.

Comparisons between the two survey rounds found that the programme reduced poverty overall by up to 32 per cent and prevented 14 million people from falling into poverty. “Economic growth contributed to overall poverty reduction during this period, but we found that the MGNREGS also played a significant role,” Sonalde Desai, principal author of the study, said.

The numbers show that the MGNREGS is likely to have had a much smaller impact on the rural job market and on rural wages than is commonly believed. At an all-India level, the average days worked under the MGNREGS is less than four, pointing to the relatively small impact of the scheme to the overall rural job market. “On the surface, MGNREGS has virtually no impact on rural employment patterns since it fails to add to the number of days that individuals work. But it seems to attract individuals who were previously employed in less productive work, thereby raising their incomes,” the report notes. Overall, while the period of 2004-5 to 2011-12 saw a sharp rise in rural wages, MGNREGS plays only a modest role in wage increases, the report notes. The United Nations Development Programme on Wednesday also released a review of recent research studies on the MGNREGS which found similarly, and found that the scheme’s uptake is far greater in the lean season that in the peak agricultural season.

The part of the rural job market that the MGNREGS did seem to have a more significant impact on was for female work. About 45% of female MGNREGS workers were either not working or worked only on a family farm in 2004–05, indicating that the MGNREGS “may well be the first opportunity many women have to earn cash income”. As a result, there was a substantial increase in women’s control over resources — including cash in hand and the likelihood of having a bank account — and improvement in women’s ability to make independent decisions about their health, the report found.

Children from MGNREGS households were likely to obtain higher levels of educational attainment than their non-MGNREGS peers, the report found, and were less likely to be working.

While financial inclusion rose in general during this period and reliance of moneylenders declined, the effect was much greater for MGNREGS households, as was the decrease in the overall interest paid by the household. Simultaneously, accessing of formal credit grew.

What holds the MGNREGS back is “work rationing” — the inability of all interested households to get 100 days of work — as a result of mismanagement or pressures, and affects the poorest the most, the report finds.

“These findings clearly show that there is a large unmet demand for MGNREGS work,” Jugal Kishore Mohapatra, secretary, Ministry of Rural Development, said, adding that a paucity of funds at the level of implementations and erratic fund flows, particularly in 2014-15 had affected both demand and supply. “For the last four months, our job has been convincing everyone that the scheme is not going away and rebooting demand,” Mr. Mohapatra said.

Keywords: MGNREGA, Mahatma Gandhi National Rural Employee Guarantee Scheme, rural job scheme, Ministry of Rural Development, National Council of Applied Economic Research, United Nations Development Programme

Source: The Hindu, 13 August, 2015

Scholarships to study in New Zealand, check it out here

Faculty of Business and Economics of University of Auckland is inviting applications for Dean’s Asia Scholarships. Scholarships are available for Asian international undergraduate students to complete a bachelor of commerce, bachelor of business information management or bachelor of property degree at the University of Auckland Business School. The scholarship is paid as a tuition/compulsory fees credit over three years in two installments per year, one in the first semester and one in the second semester.

Eligibility: The scholarships will be awarded to international undergraduate students from any country in the Asian continent.

The scholarships will be awarded by the University of Auckland Council upon the recommendation of a selection committee comprising the dean of the University of Auckland Business School (or nominee), the associate dean, academic programmes (or nominee) and one head of department from the business school (or nominee).

The scholarships will be paid as a tuition/compulsory fees credit over three years in two installments per year. The deadline is November 26, 2015.

For more information about this award contact:

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The Scholarship OfficeThe University of Auckland
Phone: (09) 373 7599 
Email: scholarships@auckland.ac.nz
Also visit The University of Auckland Scholarships webpage: http://www.auckland.ac.nz/uoa/home/for/current-students/cs-scholarships-and-awards 
Search for University of Auckland scholarships on: http://www.auckland.ac.nz/uoa/cs-search-for-scholarships-and-awards 

Naga peace treaty: Look back to move ahead

Every effort at resolving the Naga imbroglio has been embroiled in a challenging quagmire of unending and conflicting demands. While most commentaries on the recent consensual framework for a long-term agreement between the Centre and the NSCN(I-M) have focused on the here and now and sought to define the long road to peace, I will focus on the critical pre- and post-World War II years that have had a significant impact on both the Naga movement and India’s responses.

The Nagas, one of the most robust, reflective and remarkable communities in south Asia, have challenged every Indian government since Independence through a war of weapons, ideas and words. The gauntlet was laid down in 1918 with the formation of the first political association among the Nagas, the Naga Club, followed by a presentation on January 10, 1929, to the Indian Statutory Commission, commonly referred to as the Simon Commission.

The Commission was looking at future constitutional structures under a possible reforms package. Members of the Naga delegation included a range of government employees: Interpreters and teachers as well as a doctor, an overseer and a clerk. It demanded that the Nagas be placed under direct British rule and rejected the reforms plan which sought to bracket them with the rest of India.

The memorandum’s closing paragraph has been at the core of Naga political mobilisation since: “ … we pray that the British Government will continue to safeguard our rights against all encroachment from other people who are more advanced than us by withdrawing our country that we should not be thrust to the mercy of other people who could never be subjected; but to leave us alone to determine ourselves as in ancient times”.

A member of that commission from the British Parliament was the Labour Party leader Clement Attlee, who succeeded Winston Churchill as prime minister after World War II and played a key role in India’s Independence.

The impact of the visit to Kohima, then little more than a village and not the bustling town that it is today, on the MPs, especially on the future premier of Britain, has not been documented. But it was substantial enough for the Commission to propose that the Nagas, along with other hill tribes such as the Mizos, Garos, Khasis, Jaintias and parts of Lakhimpur and what is today’s Arunachal Pradesh, be placed in the Excluded Area category, which would be directly administered by British officers who were responsible to the governor and not the chief minister of the province (Assam).

“Nowhere in India is the difference between the life and outlook of the … hill-men and the totally distinct civilisation of the plains more visible,” the report said. Referring to the need for change, it prophesied: “If progress is to benefit and not to destroy these people, then it must come about gradually and the adjustment of their needs with the interests of the immigrant will provide a problem of great complexity and importance for many generations to come.”

Then came a sentence which was drowned out in the tumult of the anti-colonial sentiment sweeping the subcontinent: “It is a matter for the most serious consideration that whether the British Government which found the hill tribes independent can leave them dependent.”

The scholar Marcus Franda says that when the Commission’s report was debated in the British Parliament in 1935, its members said that they were advocating protection, not independence, for the hill groups.

Over a decade later, political conditions were dramatically different. World War II was over and the British were preparing to leave. But how were they to leave the backward and excluded areas? There was serious consideration of a Crown Colony plan, devised by Sir Robert Reid, who served as Assam governor, which would have ensured direct British rule of a large swathe of territory from parts of western Burma across the Chittagong Hill Tracts till the Tibet border. Naturally, this was unacceptable to the Congress and the plan fell through.

Attlee himself was to tell Parliament in 1947 that as far as the “hills in the Northeast Frontier are concerned, they come into the Province of Assam and will be dealt with by the constitutional assembly of which Assam forms a part”.

In between there were more complex moves and counter moves including the accord of July 1947 between the first Indian governor of Assam, Mohammed Saleh Akbar Hydari, and the Naga National Council, where the Nagas were given the option of reconsidering their relationship with India after 10 years. Hydari’s interpretation was that they had acceded to India for they had agreed in the interim to be with New Delhi.

Charles Pawsey, the knowledgeable administrator of the Nagas hills, who had been through the critical war years, foresaw trouble. (The battle for Kohima, celebrated as one of Britain’s greatest battles and a key to the outcome of World War II, was fought on the tennis courts of his official bungalow.)

In a note to a junior officer on the eve of Independence, Pawsey remarked pensively: “I don’t know what the eventual fate of the Nagas will be, there’s nothing more to help them that we haven’t already done. But it seems a pity that we couldn’t have had a few more years to get things straight.”

Sanjoy Hazarika is director, Centre for Northeast studies, Jamia Millia Islamia University. The views expressed are personal.

the speaking tree - Pledge Your Organs Today

BIMAL MOHANTY





There are several misconceptions with regard to organ donation. Firstly , do not harbour the feeling that organ donation is charity . We simply return a tool (faculty) that was a gift from the Divine for a purpose, for which we have no use any more. Entertaining the vanity of charity is ahamkara, or ego, of one kind that belittles one's sublime action of donation.Secondly , the misconception that a spiritual compatibility between the recipient and the donor is necessary , is not true.Essentially , it is the divinity inherent in all organs that is always conscious equally with everybody . The apparent inequality in consciousness is a superimposition caused by physical conditions only . There is no conclusive proof that an organ received from a criminal will make the recipient a criminal. That is the domain of individual actions and thoughts and sanskaras from past lives.
Thirdly , physical compatibility is important only to the extent that the donated organ must be compatible with matching tissues and so on to avoid a rejection. You need not worry about matching other physical parameters.
Fourthly , a donated organ must be able to perform the same function for the recipient. Simply sacrificing one's body or an organ is not organ donation. The examples of Dadhichi donating his rib bone to make a weapon or Ghatotkacha sacrificing his whole body by falling over the Kaurava army , or even a soldier sacrificing his body in fighting -noble actions as they may be -are strictly not organ donation.

Aug 13 2015 : The Economic Times (Delhi)

FOREST RIGHTS ACT - Don't Rush On Tribal Land Rights: Centre

Nidhi Sharma

New Delhi:





Taking No Chances: Chhattisgarh and Jharkhand told to follow law in letter and spirit

The Centre has sent a stern directive to Jharkhand and Chhattisgarh governments to follow proper procedure for settling land rights claims of tribal people under the Forest Rights Act.The directive has come after the state governments issued circulars to hold gram sabhas and get certificates from the tribals that their rights had been settled by a certain deadline.While Chhattisgarh had issued a circular on July 27 asking all district collectors to wrap up the process on August 15 by calling special gram sabha meetings, Jharkhand government set a deadline of October 2. The tribal affairs ministry intervened, asking the two states not to settle the land rights claims in a hurry .
“While this ministry appreciates the efforts of the government towards taking pro-active measures for implementation of the Forest Rights Act, it is also important to draw attention to the fact that the vesting and recognition of forest rights under the said Act requires careful consideration by the gram sabha,“ the ministry said in letters to chief secretaries of the two states.
The ministry has also asked Chhattisgarh not to settle the claims in the special gram sabha meetings called on August 15. Pointing out specific rules under the Forest Rights Act, the ministry said, “As these meetings have multiple agenda items, it is apprehended that the sabhas will not be able to consider the question of whether rights recognition process under Forest Rights Act is complete in the area under their jurisdiction with the requisite attention and application of mind.