The importance of inclusive healthcare

 

Discussions about healthcare need to go beyond availability, affordability. Providing equitable, high-quality care to all requires recognising — and celebrating — differences among traditionally disenfranchised populations

Everyone deserves the right to dignified healthcare, regardless of their physical, professional, and geographical circumstances. Yet, India’s health systems too often fail vulnerable and marginalised people, who face a variety of obstacles in accessing high-quality care. Think of the stigma that prevents sex workers from full access to health resources or the discrimination that LGBT individuals face. Or the dearth of geriatric care to meet the needs of the elderly, or the lack of accessible and quality care for Dalit, Bahujan, and Adivasi (DBA) communities.

The Covid-19 pandemic exposed how pervasive these inequities are — and the extent to which healthcare cannot be separated from the economic, social, and cultural circumstances in which it is provided. These inequities have existed all along, and the crisis has only deepened them.

We believe the health system in India needs to fully include everyone. To get there, discussions about healthcare need to go beyond addressing availability and affordability. Providing equitable, high-quality care to all requires recognising—and celebrating—differences among traditionally disenfranchised populations. The specific healthcare needs of these communities must be understood and addressed.

Leaders of organisations that work closely with disenfranchised groups point to several reasons why some communities are marginalised by the health system. Most prominently, vulnerable populations usually play little or no part in developing and delivering healthcare services. As a result, services may be geographically, culturally, or in other ways inaccessible, and not meet the unique needs of the community.

“Creating equitable health systems is, at its core, a design issue,” noted Dr Nirmala Nair, co-founder of the Jharkhand-based nonprofit Ekjut, which works with India’s tribal communities. “The voices of these populations are often not heard.” To combat this problem, Ekjut organises tribal community meetings at the onset of the programme to engage them from the planning stage. Ekjut also conducts outreach to ensure that the poorest among those it serves participate in these meetings.

Social stigma and discrimination also pose significant obstacles. Some patients feel judged by providers because of their socioeconomic status or profession. “This judgement deters health-seeking attitudes. There is a feeling of not being wanted,” said Priti Patkar, founder of Prerana Anti-Trafficking, which aims to end intergenerational prostitution and protect women and children from human trafficking. As a result, Patkar said, patients frequently forego care or turn to local, informal providers who lack requisite knowledge and training.

Another hurdle is that healthcare systems often take an overly narrow approach when working with marginalised communities. For example, according to Patkar, healthcare for sex workers has focused almost exclusively on the treatment and prevention of HIV and other sexually transmitted diseases, ignoring other pressing health needs.

Finally, some providers lose sight of the fact that everyone, regardless of their circumstances, has value to broader society. When they do, treatment practices suffer and patients become demoralised. “At the onset of disability, if the patient is told that there is no cure, to them, that means life is over, and it shouldn’t,” said Shanti Raghavan, founder of Enable India, an NGO that supports livelihoods for people across 14 types of disability. “Instead they need rehabilitation and solutions to regain their quality of life.”

Raghavan notes that when people with disabilities receive the timely support required to regain their functional abilities—including basic forms of assistance, such as crutches or wheelchairs—many can thrive personally and professionally, sometimes “earning four or five times the national average.”

Elevating communities’ voices can contribute to better care, and collaborative action is one way to do that. For instance, our organisations, The Bridgespan Group and Piramal Swasthya, have partnered with others like the Bill and Melinda Gates Foundation to design and implement Anamaya, a recently launched tribal health collaborative. Anamaya brings together government, philanthropy/donors, NGOs, academic research organisations, and other stakeholders to work for improved tribal health outcomes.

Investing in high-quality training and support for community healthcare is another avenue for change. “It is not difficult to map out the NGOs, the communities they are working with, and what their needs are,” said Dr Thelma Narayan, co-founder of the Society for Community Health Awareness Research. “We need to do this with a sense of urgency.”

Much is also gained by employing members of traditionally vulnerable communities within healthcare systems—and celebrating their differences. These workers draw on shared experiences to develop greater trust with patients and deliver more empathetic care. For example, the ASARA project of Piramal Swasthya in the Vishakhapatnam tribal belt has engaged auxiliary nurse midwives from tribal communities, who help transcend language and cultural barriers and incorporate their lived experiences into healthcare delivery. Where the community-led programme has been implemented, maternal deaths have fallen to zero.

Covid-19 has revealed the urgency of engaging these communities with more focus and empathy. Real action is needed to build inclusive health systems that enhance communities’ confidence to seek healthcare, and provide acceptable health services. “We don’t lack resources in India,” Narayan said. “If we don’t go ahead with this, we have only ourselves to blame.”

Pritha Venkatachalam is a partner and head of market impact, South Asia in The Bridgespan Group’s Mumbai office, and Sudeshna Mukherjee is vice president – behaviour change communication at Piramal Swasthya

Written by Pritha Venkatachalam and Sudeshna Mukherjee

Source: Indian Express, 31/10/21

There’s a mismatch between India’s graduate aspirations and job availability

 

Shobhit Mahajan writes: There is a huge pool of unemployed university graduates with unfulfilled aspirations. This group of dissatisfied, disgruntled youth can lead to disastrous consequences for our society.

Anju and Anita had come to me for advice on future career prospects. They were both students in my MSc course. During the conversation, I found out that Anju was the daughter of a vegetable seller while Anita’s father worked as a clerk in a private office. Both of them had been giving tuitions to school children right after their Class XII to fund their education. They would come back from their college at 5 and from 6 to 8 in the evening they would give tuitions to a group of children at another child’s house since their place did not have enough room.

The fact that they belonged to very modest families was not surprising. The results of a survey I did last year of our students in MSc Physics at Delhi University had already made me aware of the socio-economic background of our students — more than half of them were from villages or small mofussil towns; more than 50 per cent came from families where they were the first generation of college-goers; more than a quarter of them belonged to farming families and about 70 per cent of them reported their family income as less than 5 lakh a year.

The enhanced enrollment of students from these socio-economic backgrounds is primarily a result of the extension of reservations to OBCs and EWS. In addition, the massive increase in the number of higher education institutions has led to an enlargement of the number of available seats — there are more than 45,000 universities and colleges in the country. The Gross Enrollment Ratio for higher education, which is the percentage of the population between the ages of 18-23 who are enrolled, is now 27 per cent.

What is remarkable is that despite all these initial disadvantages, these students managed to finish their undergraduate degrees and some of them were now even looking at their prospects post their Master’s degree. They, and obviously their parents, have high aspirations for their future. And, this is where there is a huge mismatch between their aspirations and what they are likely to attain.

A majority of the students are aiming to get some kind of a government job post their degree. Unfortunately, the spectacular increase in enrollment in recent years has not been matched by a concomitant increase in jobs. Employment opportunities in the government have not increased proportionately and may, in fact, have decreased with increased contractualisation. Even in the private sector, though the jobs have increased with economic growth, most of the jobs are contractual. Worse, the highest increase in jobs is at the lowest end, especially in the services sector — delivery boys for e-commerce or fast food for instance. A student who has finished his college against all odds is not very keen to take up a job in a call centre or worse as a delivery agent for e-commerce or fast food.

Thus what we see is a huge pool of unemployed university graduates with unfulfilled aspirations. This group of dissatisfied, disgruntled youth can lead to disastrous consequences for our society, some of which we are already witnessing.

Attitudes towards work would not change overnight — the time scale for change in societal attitudes is possibly in decades. A reduction in the rate of increase of universities and colleges might not be politically feasible given the huge demand for higher education. But there are several things that the government can attempt to do. A concurrent increase in the number of high-quality vocational institutions is something that can be done.

There are upwards of 15,000 Industrial Training Institutes (ITIs) in the country currently. These institutions provide training in various trades like air conditioning mechanic, electrician, mechanic etc. The quality of these of course is very uneven. They are also, by and large, poorly maintained and lacking in resources, both physical and human. The curriculum remains outdated and has not been upgraded to include some of the newer skills like maintaining networking and telecom equipment.

And yet, there is a huge competition for admission into these institutions, and polytechnics. In some places, it is harder to get into these than to get admission to the local government college. The reasons are obvious. Manufacturing units prefer hiring them for blue-collar jobs since they at least have a modicum of training. In addition, the pass-outs from ITIs also have the option of being self-employed in the various service-related sectors.

Upgrading the existing ITIs, opening many more new ones with high-quality infrastructure and updated curriculum is something which should be done urgently. There is a scheme to upgrade some ITIs to model ITIs. However, what is required is not a selective approach but a more broad-based one that uplifts the standards of all of them besides adding many more new ones. Industry might be more than willing to pitch in with funding (via the CSR route) as well as equipment, training for the faculty and internships for students. After all, the industry czars never cease to remind us about the shortage of skilled labour in the country. And surely, if the government can spend thousands of crores on existing and hypothetical Institutes of Eminence, funds should not be an issue for this exercise which, coupled with our demographic dividend can be a boon for the economy and the society.

For Anju and Anita though the future remains uncertain. They would finish their MSc, possibly do a BEd, and keep trying to get a teaching job in a government school. If they are lucky — they would succeed though in all likelihood — they would have to settle for teaching in a private school for a pittance. And, of course, continue giving tuitions to support themselves and their families.

This column first appeared in the print edition on November 1, 2021 under the title ‘Future imperfect’. The writer is professor of physics and astrophysics, University of Delhi

Source: Indian Express, 1/11/2021

Quote of the day

 “You’re braver than you believe, and stronger than you seem, and smarter than you think.”

---

A.A. Mine

Author/Poet

October 27: World Day for Audiovisual Heritage 2021

 The World Day for Audiovisual Heritage is observed on October 27, every year.

World day for Audiovisual Heritage

• Audio-visual Heritage Day is observed with the aim of raising general awareness among people related to the need of taking urgent measures.
• The day also acknowledges the significance of audio-visual documents.
• It also brings the priceless heritage of these documents to notice, telling the stories of lives & cultures from across the world.
• The day also sensitize people across the world for conserving and safeguarding valuable audio-visual resources for future generations.

Why this day is significant?

The world, particularly the younger generation, is going digital in every significant aspect of life. Thus, this is significant as it reminds that even though we are moving forward, it is important to carry heritage so that it does not get lost. It encourages the preservation of work of professionals against the range of political, technical, social, financial, and other factors that threatens the safeguards of audio-visual heritage.

Theme of the day

The Audio-visual Heritage Day 2021 was observed under the theme “Your Window to the World”. The theme highlights that, audio-visual sources provide a window in the form of documentary heritage objects, to the world.

History of the day

This day was adopted by the 21st General Conference  of the recommendations, in the year 1980, in a bid to safeguard and preserve the moving images. The day was declared by UNESCO (United Nations Educational, Scientific, and Cultural organization) on October 27, 2005.

Current Affairs-October 28, 2021

 

INDIA

– SC constitutes an expert committee overseen by former SC judge Justice R.V. Raveendran to probe Pegasus allegations

– Defence Minister Rajnath Singh delivers keynote address at Indo-Pacific Regional Dialogue 2021

– PM Modi participates in 16th East Asia Summit hosted by Brunei through video conference

– Immunologist Rajesh Gokhale (54) appointed as Secretary, Department of Biotechnology

– Post of CEO for Development of Museums and Cultural Spaces abolished

– Gandhian Salem Nanjudaiah Subba Rao passes away at 92 in Jaipur

– Union Minister of Home Affairs and Minister of Cooperation, Amit Shah inaugurates three-day National Conference on “Delivering Democracy: Two Decades of Prime Minister Narendra Modi as Head of Government”

– Indian Army celebrates Infantry Day on Oct 27

ECONOMY & CORPORATE

– Centre appoints veteran banker Kundapur Vaman Kamath as the Chairperson of the National Bank for Financing Infrastructure and Development (NaBFID), a newly set up DFI

– RBI approves appointment of Baldev Prakash as J&K Bank MD & CEO

– Plan of retail selling of small LPG cylinders through Fair Price Shops is on anvil: Govt

– Union Civil Aviation Minister Jyotiraditya Scindia launches Krishi UDAN 2.0 scheme for to facilitating and incentivizing movement of Agri-produce by air transportation

– Union Minister for MSME Narayan Rane launches “SAMBHAV” National Level Awareness Programme, 2021

– ADB, India sign $100 million loan for agribusiness development in Maharashtra

– Govt waives charges on cargo flights to boost agro exports from North East

– DGCA to conduct on-demand license exams for pilots, aircraft engineers

WORLD

– Sri Lankan President Gotabaya Rajapaksa appoints 13-member task force for the establishment of the ‘One Country, One Law’ concept

– African Union suspends Sudan after military coup

– Japan: Campaigning Hiroshima survivor, Sunao Tsubo dies aged 96

– Indian-origin politician Anita Anand appointed new Defence Minister of Canada

– Saudi Arabia comes to cash-strapped Pakistan’s rescue with $3 bn package

– World Day for Audiovisual Heritage celebrated on Oct 27

Sachchidanand Sinha’s work is a reminder of what the Republic of India is. We must cherish it

 H

ave you heard about Sachchidanand Sinha? I bet not. If you have, I guess it’s one of his namesakes, perhaps the famous member of the Constituent Assembly, or Jayaprakash Narayan’s secretary or an academic, but not the one I am talking about. Google search won’t yield much on him except for one thoughtful profile and a bland listing of his books or their Amazon links.

You should know him. At 93, he is a bridge between two centuries, someone who brings lessons of the 20th-century ideological debates to our times. Over the last five decades, he has published more than two dozen books, about a dozen in English and more in Hindi. His oeuvre ranges from contemporary politics to aesthetics, from understanding Bihar’s underdevelopment to tracing the origins of the caste system, from critiquing the ideological foundations of the Naxalite movement to writing a manifesto for socialism for our generation. The publication of his eight-volume rachnavali (Selected Works) in Hindi last month is a good occasion to (re)read him.

If you don’t know him, it’s hardly your fault. Sachchidanand Sinha has no academic credentials, not even a bachelor’s degree. He has never worked in any academic institution. A political activist all his life — first with the Socialist Party, and then with Samata Sangathan and Samajwadi Jan Parishad — he chose reading and writing as his principal arena of political action. Just as he stayed away from big parties and ideological orthodoxies, he also stayed away from big publishers. Self-effacing to a fault, Sinha has spent the last 35 years in a modest cottage in a Bihar village. His prose is as sparse as his life: no academic jargon, no fashionable lingo, no catchphrases, no stunning one-liners, no stylised provocation. He has turned down awards. In a world where the worth of ideas is determined mainly by external markers, Sachchidanand Sinha is content to remain in oblivion.

Learning from Sachchidaji

I was plain lucky to know ‘Sachchida-ji’. I saw him around 1981 at one of the post-dinner talks at Jawaharlal Nehru University (JNU) organised by the Samata Yuvjan Sabha (SYS), a youth organisation with Gandhian Socialist leaning that I belonged to. I don’t remember the topic, but recall how I was drawn to his intellect: clear logical reasoning, backed with solid knowledge sans any rhetorical flourish. Just like my father.

Over the next decade, I attended many study circles and camps where he educated the young cadre of Samata Sangathan on wide-ranging issues, from the most recent political events to the most abstract ideological and philosophical debates. Learning from him (as well as Kishen Pattnayak and Ashok Seksaria) was a privilege that I did nothing to deserve. I remember visiting his bare one-room tenement in Saket, New Delhi that seemed too big for his worldly possessions: a cot, a table and a kerosene stove that served as his kitchen. Sachchidaji was, and has remained, an ascetic.

His single-minded pursuit of ideas, unmindful of ideological orthodoxies and academic fashions, allows him to chart through the ideological contestations that marked the 20th century. He is not a non-aligned spectator. He has been, and continues to be, a socialist. But his socialism is not a creed tied to a sacred book or a  supreme leader. It helps that he comes from an unorthodox sub-stream of Indian socialism associated with Jayaprakash Narayan, Narendra Deva and Rammanohar Lohia. At the same time, Sachchidaji is not a ‘Lohiaite’ and has nothing but contempt for what passes for socialist politics in today’s India.

Beyond political ideologies

In his first major book, Socialism and Power, Sachchidaji continued this interrogation of the received socialist orthodoxy. While he is more deferential to Karl Marx than most of his colleagues, he critiques Marx and Marxists for their blind faith in big industry, megacities and capital-intensive technology. This was not a recipe for revolution, but for a concentration of economic and political power that resulted in the collapse of the USSR and the rise of state-capitalism in China.

His book, Poonji Ka Antim Adhyay, extends Marx’s magnum opus, Das Kapital, to its unwritten fourth volume. The political activist in him cannot leave things at a critique. His Socialism: A Manifesto for Survival offers an outline of socialism for our age. In his version — decentralised democracy, appropriate technology, non-consumerist standards of living, ecological sustainability and primacy of labour over capital — socialism does not remain just one of the ideologies from the 20th century but becomes a synthesis of all that is worth learning from that century.

His unique gaze extends beyond the limited world of political ideologies. In The Caste System: Myth and Reality, he counters the orientalist reading of scripturally sanctioned, ever-unchanging caste order. One of his first books, Internal Colony, questioned the established economic wisdom to argue that the backwardness of states like Bihar (which included Jharkhand then) draws upon the logic of capitalist development that must suck resources from ‘internal colonies’. In the hay days of Congress monopoly and defying proponents of the two-party democracy, he postulated that a coalition is the most appropriate form of power-sharing in a democracy like India. Unlike most political activists, he does not view art as an instrument of propaganda. His writings on aesthetics establish art as a means to contain human impulses for violence.

The problem is with us

In a world of ideas dominated by academic experts, Sachchidanad Sinha would be seen as an interloper, an amateur generalist. The problem lies not with him, but with us. He is among the last surviving species of a great tradition of modern Indian social and political thinkers that began in the 19th century. For the next 150 years or so, this intellectual effervescence and contestation laid the foundations of the Republic of India.

Unlike Europe, social and political thinking in India was not happening in universities or academic institutions. Our thinkers were practitioners, mostly social and political activists themselves. They asked big questions and provided bold answers. Anchored in our context, they engaged with the modern world on our own terms, mostly using Indian languages.

This tradition suffered a sudden death soon after Independence. Social and political theorising was taken over by experts in social sciences and humanities who looked up to and hoped to engage with their western counterparts. Not to put too fine a point, this transition has been a disaster for India – from our perspective to policy and politics. After the death of Rammanohar Lohia, the last great thinker in that tradition, in 1967 it is hard to name many Indian thinkers outside the academia who helped us connect with the big questions of our times. I can only think of Kishen Pattanayak, Dharampal, R. P. Saraf and, of course, Sachchidaji.

Sachchidanand Sinha reminds us of what we have lost and need to regain if we wish to reclaim our republic.

The author is a member of Swaraj India and co-founder of Jai Kisan Andolan. He tweets @_YogendraYadav. 

Source: The Print, 27/10/21

US govt to give preference to student visas, appointments to be available from November 1

 The United States of America (USA) will give preference to student visas as the country forecast heavy surge in the application of the authorisation with the lifting of travel curbs for vaccinated travellers, a diplomat of the country said here on Wednesday.

The US government has already announced the lifting of the severe travel restrictions on China, India and much of Europe effective from November 8. The US travel restrictions were first imposed in early 2020 to check the spread of COVID-19.
“The appointments for visa will be made available from November 1.  Priority will be given to student visas,” US Consul General to Kolkata, Melinda Pavek said on the sidelines of an interactive session with the Indian Chamber of Commerce (ICC) here.

The US has already issued 62,000 Indian student visas in 2021, she said. She said with the US presidential proclamation coming to an end on November 8, applications for all types of visas will become eligible.

The accounting period for a US visa for various purposes like work, business and studies is between September of a year to August the next year, officials said. A consul official said except for a brief period student and emergency visas were not closed. From November 8 all types of visas will be given and a heavy surge of visa applications is expected.

Patton International senior official Preeyam Bhudhia said Indo-US trade will get a boost with the lifting of the travel restrictions. Bilateral trade between the two countries had already recovered by 50 per cent till August and is expected to reach the pre-COVID level of 2019 in the current year, ICC officials said.

Source: Indian Express, 29/10/21