Wednesday, May 30, 2012

Of venal & corrupt Health Administration venal & corrupt health administration

All is surely not well with the Health Administration of the country. The other day two shocking revelations were made in the press. One of them related to detection of serious irregularities by the Parliamentary Standing Committee on health and family welfare in respect of advices and letters of recommendations from some experts submitted to the Drug Controller General of India (DCGI) regarding several drugs. These recommendations, apparently, read the same, word-for-word, as those submitted by the drug companies concerned. Experts’ endorsements are crucial testimony for country’s Central Drugs Standard Control Organisation for allowing launch of drugs in the market.


The disclosure revealed a nexus between some experts and a few drug companies enabling unquestioned endorsement of the scientific recommendations of their own products for onward transmission to DGCI. These are required to be submitted by the experts after due consideration of the drugs’ content and their efficacy. Evidence, however, has been unearthed indicating that the experts merely affixed their signatures to the recommendations submitted by the companies concerned. Worse, some were submitted on the day of their receipt by the experts, obviously without according to them due consideration. More alarming was the fact that the experts are from a few iconic medical institutions of the country and some of them happen to be working as professors in these institutions.

The innocent, ignorant and unwary patients will be at the receiving end if drugs are pushed in such a manner by the drug companies in collusion with highly placed medical experts without being evaluated in regard to their therapeutic potential. Suspect efficacy of drugs will hit all classes of people across the board and with high drug prices it would be a sort of double whammy for them. Already, people are suffering under the weight of their medical bills. A recent report said that the “out-of-pocket” expenditure – the percentage of expenditure incurred by households on medicines – has increased by 75% during the past couple of years. High medical costs, along with rising prices of essentials, are biting the common man. According to 2011 World Health Organisation estimates about 70% Indians spend their entire income on healthcare and purchase of drugs. With the prices of drugs for common ailments like cardiac disease, hypertension, diabetes creeping up northwards, market watchers are asking for State intervention. Poor are simply unable to afford many drugs. Decrying the ineffectiveness of the National Pharmaceutical Pricing Policy even ruling party politicians are concerned about common man’s woes. 

Such improperly evaluated medicines can also adversely impact exports once they fail to live up to their claims. India is considered the pharmacy of the world. While the domestic retail market in 2008 was estimated to be valued at more than Rs. 55000 crores ($10 billion app.), exports were worth around Rs. 38000 crores ($6 billion app). Unless checked, corrupt practices at the stage of approving and launching a drug in the market would amount to shooting oneself in the foot. 

The health sector is somehow saturated with corruption, whether at the Centre or in the states. A former central minister of Health & Family Welfare was involved in several scandals during his tenure, including what is known as the “vaccines scam”. He ordered the public sector units to discontinue manufacture of various essential vaccines only to throw open the entire market to one of his cronies for easy pickings. Ultimately, the other day he was charged by the Central Bureau of Investigations in a Delhi court for abusing his authority and permitting a medical college to admit students without having necessary faculty and clinical facilities. Establishment of medical colleges has become a very paying proposition. Politicians, in collusion with money bags, bribe their way into acquiring prime lands for establishing such colleges, the approval and later recognition for which is easily obtained by pulling strings and money changing hands. The President of the Indian Medical Council, Dr. Ketan Desai, and two others were arrested last year for taking hefty bribes for granting recognition to a medical college. No wonder, the quality of medical education leaves much to be desired. Barring a few reputed hospitals, medical institutions and (elderly) private physicians, the general quality of medical attention to the patients is poor, more so to those belonging to the economically weaker sections.

The National Rural Health Mission (NRHM) appears to have become a goldmine for corrupt politicians, doctors and administrations. The ambitious goal of the Mission is to “improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women and children”. The second news report was about the sleaze detected NRHM in Madhya Pradesh where, one after the other, two directors of health services have been caught with huge amounts of liquid and fixed assets - all disproportionate to their respective incomes. In the earlier case even the minister in-charge was involved along with the principal secretary of the department of health, an IAS officer, who, mercifully, is being prosecuted. The minister resigned but escaped prosecution. In the recent case, the director was found to be in possession of assets worth more than Rs. 100 crores (Rs.1 billion app). Serious irregularities were detected in the process of tendering and procurement of medicines, mosquito-nets, etc. During the raid at the director’s residence his wife reportedly advised the Lokayukta (Ombudsman) officials to raid the houses of ministers to whom a crore (Rs. 10 million) of rupees was required to be delivered every month.

 One can imagine the astronomical sums that have been poured into the Mission from the fact that in Uttar Pradesh alone Rs 10000/- crores are believed to have been siphoned off. Two chief medical officers and three other officials were murdered and scores of engineers, doctors, administrators and ministers have been charge-sheeted by the CBI.

Conscious of the abysmal level of public expenditure on health (1.4% of GDP) the government has been allocating huge amounts of tax-payers’ money to the states in an effort to achieve universal health coverage, including cashless treatment. The Centre’s resolve to boost government spending can potentially make high-quality care accessible to all. It has not shied away from making necessary allocations as can be imagined by the way the system has been milked by the powers-that-be at the Centre and in the states, especially, in MP and UP. No wonder, despite the (now waning) growth story India ranks below the Sub-Saharan Africa in many international health-related indices. While the corrupt, cannibalistic predators do not allow the benefits of outlays to reach the needy, high drug prices and raging inflation prevent millions from buying essential medicines because of pervasive poverty – a significant facet of the Indian growth story.

 Clearly, the corrupt hordes in the government wouldn’t allow it to achieve its own “goal” of building a healthy and strong India.


Sunday, May 20, 2012

Of LPG, edibles & prices

A time seems to have come when people should give up cooking. A recent report said that a domestic LPG cylinder is soon going to cost Rs. 996/-, virtually a thousand rupees, for those who have an income of more than Rs.6 lakhs per annum. The Standing Committee on the matters relating to petroleum ministry has made the recommendation indicating that those who are rich should not be supplied the subsidised LPG. For all one knows, the recommendation may even get accepted regardless of the fact that identification of those who are in receipt of the specified income is going to be a tough proposition. If implemented, only the salaried class would get trapped while others, who are professionals, traders and self-employed, etc. and have to declare their own incomes (which most don’t do entirely) are likely to continue to get subsidised LPG.

The scenario that is unfolding is quite frightful. As the rupee continues to lose value vis-a-vis` the dollar one cannot really imagine where all it is going to end up. In another year or two a LPG cylinder could hit Rs. 2000/- taking it well beyond the reach of many. With the growing trade gap, rising fiscal deficit, astronomical sums poured into the social sector (mostly siphoned off) and flight of foreign investment from the country things have gone from bad to worse. Dollars have become so scarce in the foreign exchange market that the currency has been constantly appreciating against the rupee – one of the major factors which has made prices of petro-products go through the roof.

LPG has been the standard domestic fuel for the last few decades and has been instrumental in changing urban lifestyle. Modern Indian kitchens are not made for the kind of fuel that, for example, my mother used to use – soft coke, fire wood and cow-dung cakes. Besides, they have disappeared from most cities and towns. Unfortunately, for an urban household currently there is no alternative to LPG except electricity as energy source. That, too, has been becoming expensive virtually every year. With the distribution companies unable to check persistent power theft and the prevailing rampant corruption in their ranks power tariffs are hiked annually. Using electrical appliances of high-wattage is, therefore, beyond the reach of many middle-class households. One could perhaps tap solar power but not all houses get enough sunshine. In rural areas women and children forage around for fire wood, dried twigs or whatever, being unable to afford even the subsidised LPG. Only the rural rich now can afford kerosene or LPG. Soon they too may have to give them up as the government progressively loosens its hold over fuel pricing. 

Cooking food at home may soon become a thing of the past. That will be a great tragedy. Indians cannot do without food cooked at home. Besides, influenced as they have been over hundreds of years by different cultures, the recipes are such that food has to be cooked in oil and fried with colourful and aromatic spices. Every meal, from breakfast to lunch and from afternoon snacks to dinner, has to be cooked. If cooking fuel becomes unaffordable, Indians wouldn’t know what to do. Very few Indians can survive on raw vegetables or processed meats. In fact, in many regions of the south and the east none would ever have raw vegetables barring tomatoes and onions. Westerners, perhaps, can manage with their salads and mass-produced cold cuts, but not Indians. 

Then, there is another emerging problem. Even if one is able to somehow manage the fuel the question that remains is what does one cook – prices of everything edible having gone impossibly high? Prices of edible oil and vegetables, for instance, are sky high. Prices seldom come down even in the season when availability peaks. What is more, there are hardly any seasonal vegetables now which, in season, used to be cheap. Every vegetable, whether of summer or winter, is available right through the year. Hence one finds okra in winter and cauliflowers in summers – thanks to advancement in horticulture and a little more easy availability of cold-storage facilities. But prices always rule high despite the fact that India is one of the top producers of vegetables in the world. According to the figures of the Ministry of Agriculture India is at the top of the world in production of peas, second in production of aubergines, cabbages, cauliflowers and onions and third in potatoes and tomatoes. Yet, the prices rule high because of the middlemen and the evil of cartelisation. While middlemen push up the prices of all food items –vegetables, lentils and food grains – cartels don’t allow the prices to come down. Farmers and consumers are at the receiving end of their intervention.

Some farmers, however, have become smart. They have taken to injecting chemicals into vegetables to ripen them quickly to get a better turnover. That, in the process, they inject toxins which, on ingestion, could be a health hazard is of no concern to them. This aberration is of recent origin but has continued unchecked for want of effective governance. Likewise, colouring agents and sweeteners are routinely injected in fruits like papayas, watermelons, melons, pomegranates, etc. Wellness-gurus recommend steady consumption of fruits and vegetables without realising that most of them carry contaminants that could prove to be toxic. In any case, the prices have shot up to such astronomical heights that they have become unaffordable for a large section of the population. Supplies may not be matching the demand, stimulated as it is by rising incomes but, if one goes by ads, fresh vegetables and fruits are also being increasingly used in manufacturing of cosmetics – moisturisers, fairness creams, feeding the craze for a fairer complexion. No wonder, even the lowly banana, once a fruit for penniless sadhus wandering in the wildernesses for moksha, are going for Rs.40/- a dozen.
Non-vegetarian stuff, too, has not remained behind. In a decade and a half mutton prices have shot up five fold, from Rs.60/- a kilo to Rs.300/-. The same has been the case for fish and poultry. While fish could carry deadly heavy metals, poultry in many parts has been detected with heavy dosage of harmful antibiotics. Nonetheless, once again the rise of the middle classes has fuelled the demand that has further been stoked by television channels showing foodies cooking and hogging non-vegetarian stuff. The way things are going, soon non-vegetarian food may become unaffordable for a vast segment.

The country has certainly witnessed rapid GDP growth. But, so have the prices of fuel and edibles risen exponentially in tandem. Largely a poor country, with widespread hunger and malnourishment, no wonder India is scraping the bottom of several international social sector indices.

DISAPPEARING FREEDOM OF EXPRESSION Rama Chandra Guha, free-thinker, author and historian Ram Chandra Guha, a free-thinker, author and...