"Why are we not a Developed Nation?"
here's what UN has to say about nations:
Nations are judged by the well-being of their peoples; by levels of health, nutrition and education; by the civil and political liberties enjoyed by their citizens; by the protection guaranteed to children and by provisions made for the vulnerable and the disadvantaged.
So Far, we have established that the Health of the general population is not that good.
Main Reasons :
1. Poor nutrition and health practices: The Govt. itself admitted in 80s that only 15% of all the money it spends actually reaches the end-user either directly or indirectly. some say the figure is even less. Its true even today. All the liberalisation, IT explosion, did nothing to improve this situation, in fact, in some cases it actually worsened the situation in terms of showing new ways to swindle public funds. with economic liberalisation the impetus on exports grew so much that we export millions of tonnes of food, for a country with the statistics we have discussed earlier, it is a crime to let its people starve to death (People in some districts of Bengal & Orissa actually eat ants by ripping of tree barks to keep themselves alive. Some people live only on water for fortnights together before dying of hunger) There is another important statistic worth mentioning here, most of the 70-80Million tribals don't come under the BPL families. In South India poverty usually leads to suicide. Nearly 60% of all suicides that happen in the country happen in South India, mostly AP and TN. among them almost 50% happen because of abject poverty (majority of the other 50% happen because of Hero Worship and Ideological causes - Thank you NTR, Chiru, Rajini...I remember debates on Junior NTR... :-)).).
2. Poor sanitary conditions(Water & Air Borne Diseases): Access to adequate sanitation is estimated to be about 46% in urban areas and 17%
in rural areas approximately. which comes to 28% nation wide. In many cities about 50% of the waste generated is left unattended or is being disposed in a casual manner at any available place without consideration of health norms and scientific requirement. we have to remember that 20% of urban population lives in slums. Also sanitary conditions with in the Govt. hospitals are so bad that a visit to a Govt. Hospital they say will most likely become a cause for another disease. Sanitary conditions in other public areas such as Railway Stations is far worse, Millions of people every day stay so close to human feces and filth, I don't know why none of the NGOs want to take up this issue. Situation in Bus Stands is no better (AP is supposedly the most clean & green when it comes to Bus stations). There are books written on how the British improved the Health and Sanitary conditions in India when they noticed that the population moving into the British Indian Capital of Calcutta is largely sitting on a health catastrophe. But Indians during the Harappan period used the first toilet in 2500BC (discovered so far) the people had water borne toilets in each house and which was linked with drains covered with burnt clay bricks. To facilitate operations and maintenance, it had man-hole covers. After Indus Valley Civilization, I guess we lost the knowledge of sanitary Engineering.
3. Deteriorating Environment (Water & Air borne Diseases): This will become another topic but we all know that in general the situation is pretty bad leading to a lot of respiratory diseases in both adults and children. Its the children that gets affected more . Not to mention the other effects of environmental degradation. Delhi is the only city in the country which has a ban on polluting vehicles. Autos and Buses in Delhi run on Natural Gas or Electricity.
4. Education and Awareness (all diseases including HIV etc): as per some studies India will become the AIDS Capital of the world in this century.First Case of AIDS was reported in 1985 and now we have 5.1 Million AIDS patients. That is more than all AIDS patients in Europe, Latin America & North America combined. 71% of all AIDS patients in South and SE Asia are from India. AP, TN, Karnataka, Maharastra, Manipur & Nagaland are the most hard hit states. AP is the first state to be considered High Risk state. 30% of AIDS cases in AP are through STDs but it is rapidly moving into general population signified by the number of women in antenatal (Prenatal) clinics who test positive.High Prevalence dists. in AP: Vizag, E.Godavari, Guntur, Warangal, Chittoor, Kurnool & Hyd.
5. Corruption : The Indian Health network works like this : Teaching hospitals, district hospitals (Tertiary Care), Community Health Centers (Secondary Care), Primary Health Centers and Sub-centers (Primary Care), which are distributed usually on a population norm through out the country. Services at the government facilities through qualified and unqualified practitioners are mostly free or at a very low charge . The primary care in rural areas especially the most backward areas is virtually non-existent... PHCs never see a doctor and the actual care depends on quacks calling themselves Regd. Medical Practitioners (RMPs) corruption in public health is supposedly the highest in all fields of corruption in India as per a 2002 survey. for e.g. The RMP has tie-ups with hospitals in nearby towns where there is an MRI or a CAT-Scan machine. For every small ailment such as simple headache he will refer his patients to a CAT or an MRI in a particular hospital in a nearby town. In the villages in Andhra/ TN these RMPs get (from the hospital) anywhere from Rs1000 to 2000 per MRI or a Scan that is done. These unnecessary scans or tests drain their financial health and also physical health. Several other forms of corruption happens in the hospitals we can talk about it separately.
Is the government not doing anything? Well, if you look at the annual budgets, the outlay for public health since independence is around 3.2% of total govt. expenditure. This year (2004) Rs.1800 Crores is allocated for Health and Rs.5500 crores for Family Welfare. while the Ministry of Agriculture gets around Rs.5000 crores and the Ministry of Rural Development gets Rs16,000 crores.
Where is all the money(Rs 28,300 Crores) going? If you want to believe the govt. its all ending up for preventive, promotive (I didn't know there was such a word) and curative care for all..., Rural Dev, Family Health Social Welfare etc.. etc...
But, the govt. admits only 15% of it ends up actually at the end user. so in all only Rs.4245 crores gets to the people. What is happening to the rest? We discussed this some time ago when we talked about corruption. I think at least 50% is lost in corruption (I'm assuming) rest 35% will be lost in bureaucratic setup.
Look at the rural dev ministry they get 16,000 crores per year for rural dev.... if we take this amount and send checks to all the BPL families they would get above the poverty line each year.
If we accept that we are OK with losing 85% of funds. At the very least, we should see Rs.2400 crores worth of rural development every year.....
Our leaders are so impressed with our public health system that none of them actually gets treated in any of the Public Hospitals barring AIIMS.
most of our PMs go out of the country for their treatment with exception of Vajpayee. He got a surgeon to fly-in from NYC and got his surgery done in a Pvt. 5 star Hospital in Mumbai.
Apart form the government, there are thousands and thousands of NGOs involved in public health (see links below), some of their funds come from the govt. some from outside the country and some from charities and missionaries. except for a few NGOs most of them are very dedicated and actually are major contributors to the development we see in the rural areas.
What else can we do? that is some thing we need to have a more interactive discussion about.
well, I guess I touched most of the important areas in the health, Food departments. please feel free to add if you have any inputs.
let's talk about education now.
-keshav
Books, Links and resources
Politics of Health in India - Roger Jeffrey
Everybody Loves a Good Drought - P. Sainath
Freedom at Midnight - Dominique Lapierre
It was five past Midnight in Bhopal - Dominique Lapierre
India Unbound - Gurcharan Das
India Facts & Figures - Mohan M Mathew
Slumming India - GitaDewan Verma
http://www.indianngos.com
http://www.censusindia.net
http://www.indiatogether.org/
http://india-health.info/
http://www.indianchild.com/
http://www.indiadairy.com/
http://www.indiaonestop.com/
http://www.medindia.net
http://indiaimage.nic.in/
http://www.undp.org/hdro
http://www.unicef.org
http://www.unescap.org
http://www.prb.org/
http://www.foodfirst.org/
http://apps.fao.org
http://www.usaid.gov
http://www.neoncarrot.co.uk/h_aboutindia/india_statistics_1.html
http://www.hsph.harvard.edu/Organizations/healthnet/SAsia/suchana/0416/mavalankar_reddy.html
http://www.who..int/whr/2004/annex/country/ind/en/
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