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GENDER ISSUES IN HEALTH IN HARYANA Dr. R.S. Dahiya Assoc.Prof, PGIMS, Rohtak. It is a well established fact the biologically women are a st...
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Friday, December 14, 2007
Health System in India-- Its weaknesses
Weakness of the Public
Health System in India
In India during British rule, state and philanthropic intervention played a significant role in healthcare, though most of these facilities were located in large towns, thus projecting a clear urban bias and neglect of the rural population. Modern medicine gradually undermined systems of Ayurveda and Unani, and those traditional practitioners who survived often concentrated in the small towns and rural areas where modern medicine had not yet penetrated. Despite the Bhore committee's recommendations at the dawn of independence towards correcting the rural-urban imbalance and suggestion of integrated planning for increasing access to health services, even postindependence the weakness of public health services in rural areas
and growth of private practice continued. Public health remained a low priority in successive five-year plans and public health efforts remained focused on specific vertical programmes, of which the Family Planning programme was the most prominent. This contributed to the slow and inadequate improvement in health of the population in the period from the 1950s to the 1970s. It may be noted that until 1983 India had no formal health policy; the planning process and various committees appointed from time to time provided most of the inputs for the formulation of health programme design.
This unsatisfactory situation was recognised in the National Health Policy of 1983, which was critical of the curative-oriented western, urban-based model of healthcare, and emphasised a primary healthcare approach. There were recommendations for preventive services and a decentralised system of healthcare, focusing on low expenditure, de-professionalisation (involvement of volunteers and paramedics) and community participation. Although, significant expansion of healthcare infrastructure did take place during the 1980s, this remained grossly underutilised because of poor facilities and low attendance by medical staff, inadequate supplies, insufficient hours, lack of community involvement and lack of proper monitoring mechanisms. The Primary Healthcare Approach was never implemented in its full form, and selective vertical programmes were pushed as a substitute for comprehensive health system development. This already unsatisfactory situation seriously worsened with the
onset of globalisation-liberalisation-privatisation from 1990s onwards. In this situation of inadequate and top-down development of public health, the impact of neo-liberal policies from the 1990s has precipitated the crisis of the public health system; there has been a retreat from even the nominal universal healthcare access objectives. Guided by prescriptions from agencies such as the World Bank, public healthcare has been further constricted to certain 'cost effective' preventive-promotive services and selective interventions, paralleled by spiraling and unregulated expansion of the private medical sector. Introduction of user fees at various levels of public health facilities has also been a feature of the phase since 1990s.
A new National Health Policy was announced in 2002, which acknowledged that the public healthcare system is grossly deficient on various fronts and resource allocations are generally insufficient. While this policy stated goals like "increase utilisation of public health facilities from current level of less than 20% to more than 75%", no corresponding large-scale measures for rejuvenating and strengthening the debilitated public health system were planned. In fact the 2002 NHP seems like a collection of unconnected statements, a dilution of the role of public health services and an unabashed promotion
of the private health sector, including 'medical tourism'. Thus the phase of privatisation-liberalisation has witnessed
staggering health inequities, resurgence of communicable diseases and an even more unregulated drug industry with drug prices shooting up, adding up to the current crisis in public health. Along with the retreat from the goal of universal access, special health needs of women, children and other sections of society with special needs have become further sidelined or are inadequately addressed. A much overdue response to this situation, with certain positive features but beset with its own contradictions, was launched in the form of NRHM in 2005, which is discussed in a separate section below.
To summarise, the objective of universal access to good quality, appropriate healthcare, envisaged over half a century ago at the dawn of Independence, today remains unrealised. Public health has effectively remained a low priority for the Indian state in terms of financing and political attention. Consequently, there has been a major and growing divergence between the policy rhetoric (such as the Alma Ata Declaration) and actual implementation. Moving in to occupy the hiatus, there has been a massive growth of the private sector, which is unaffordable for a large section of the population, and which lacks any regulation and standardisation. Closely related to this, and compounding this situation has been a Techno-managerial model of healthcare inspired by the West, with an inability to evolve effective indigenous models and appropriate technologies, or to effectively integrate modern and indigenous systems of medicine in contrast to China. The system of Health planning and
decision making has remained highly centralised and top-down with minimal accountability, little decentralised planning or scope for genuine community initiatives. A prime example of this is the various communicable disease control programmes that are discussed separately in a later section.Now, to better understand the lopsided development of the health system, we will first take a look at financingof healthcare in India.
R.S.Dahiya
Health System in India
In India during British rule, state and philanthropic intervention played a significant role in healthcare, though most of these facilities were located in large towns, thus projecting a clear urban bias and neglect of the rural population. Modern medicine gradually undermined systems of Ayurveda and Unani, and those traditional practitioners who survived often concentrated in the small towns and rural areas where modern medicine had not yet penetrated. Despite the Bhore committee's recommendations at the dawn of independence towards correcting the rural-urban imbalance and suggestion of integrated planning for increasing access to health services, even postindependence the weakness of public health services in rural areas
and growth of private practice continued. Public health remained a low priority in successive five-year plans and public health efforts remained focused on specific vertical programmes, of which the Family Planning programme was the most prominent. This contributed to the slow and inadequate improvement in health of the population in the period from the 1950s to the 1970s. It may be noted that until 1983 India had no formal health policy; the planning process and various committees appointed from time to time provided most of the inputs for the formulation of health programme design.
This unsatisfactory situation was recognised in the National Health Policy of 1983, which was critical of the curative-oriented western, urban-based model of healthcare, and emphasised a primary healthcare approach. There were recommendations for preventive services and a decentralised system of healthcare, focusing on low expenditure, de-professionalisation (involvement of volunteers and paramedics) and community participation. Although, significant expansion of healthcare infrastructure did take place during the 1980s, this remained grossly underutilised because of poor facilities and low attendance by medical staff, inadequate supplies, insufficient hours, lack of community involvement and lack of proper monitoring mechanisms. The Primary Healthcare Approach was never implemented in its full form, and selective vertical programmes were pushed as a substitute for comprehensive health system development. This already unsatisfactory situation seriously worsened with the
onset of globalisation-liberalisation-privatisation from 1990s onwards. In this situation of inadequate and top-down development of public health, the impact of neo-liberal policies from the 1990s has precipitated the crisis of the public health system; there has been a retreat from even the nominal universal healthcare access objectives. Guided by prescriptions from agencies such as the World Bank, public healthcare has been further constricted to certain 'cost effective' preventive-promotive services and selective interventions, paralleled by spiraling and unregulated expansion of the private medical sector. Introduction of user fees at various levels of public health facilities has also been a feature of the phase since 1990s.
A new National Health Policy was announced in 2002, which acknowledged that the public healthcare system is grossly deficient on various fronts and resource allocations are generally insufficient. While this policy stated goals like "increase utilisation of public health facilities from current level of less than 20% to more than 75%", no corresponding large-scale measures for rejuvenating and strengthening the debilitated public health system were planned. In fact the 2002 NHP seems like a collection of unconnected statements, a dilution of the role of public health services and an unabashed promotion
of the private health sector, including 'medical tourism'. Thus the phase of privatisation-liberalisation has witnessed
staggering health inequities, resurgence of communicable diseases and an even more unregulated drug industry with drug prices shooting up, adding up to the current crisis in public health. Along with the retreat from the goal of universal access, special health needs of women, children and other sections of society with special needs have become further sidelined or are inadequately addressed. A much overdue response to this situation, with certain positive features but beset with its own contradictions, was launched in the form of NRHM in 2005, which is discussed in a separate section below.
To summarise, the objective of universal access to good quality, appropriate healthcare, envisaged over half a century ago at the dawn of Independence, today remains unrealised. Public health has effectively remained a low priority for the Indian state in terms of financing and political attention. Consequently, there has been a major and growing divergence between the policy rhetoric (such as the Alma Ata Declaration) and actual implementation. Moving in to occupy the hiatus, there has been a massive growth of the private sector, which is unaffordable for a large section of the population, and which lacks any regulation and standardisation. Closely related to this, and compounding this situation has been a Techno-managerial model of healthcare inspired by the West, with an inability to evolve effective indigenous models and appropriate technologies, or to effectively integrate modern and indigenous systems of medicine in contrast to China. The system of Health planning and
decision making has remained highly centralised and top-down with minimal accountability, little decentralised planning or scope for genuine community initiatives. A prime example of this is the various communicable disease control programmes that are discussed separately in a later section.Now, to better understand the lopsided development of the health system, we will first take a look at financingof healthcare in India.
R.S.Dahiya
JAN SAWASTHAYA ABHIYAN
Jan Swasthya Abhiyan
In 1978 at Alma Ata, the governments of the world came together to sign the
Alma Ata Declaration that promised "Health for All by 2000". However this
promise was never taken very seriously and was subsequently marginalised in
health policy discussions.
As the year 2000 approached it appeared that "Health for All by 2000"
was quietly being forgotten by governments around the world. To remind
people of this forgotten commitment the First People's Health Assembly
was organised in Savar, Bangladesh in December 2000 . The People's Health
Assembly was a coming together of people's movements and other nongovernment
civil society organisations all over the world to reiterate the pledge
for Health for All and to make governments take this promise seriously. The
assembly also aimed to build global solidarity, and to bring together people's
movements and organisations working to advance the people's health in the
context of policies of globalisation.
The national networks and organisations that had come together to
organize the National Health Assembly, decided to continue and develop this
movement in the form of the Jan Swasthya Abhiyan (People's Health
Movement). Jan Swasthya Abhiyan forms the Indian regional circle of the
global People's Health Movement..
Despite medical advances and increasing average life expectancy, there is
disturbing evidence of rising disparities in health status among people
worldwide. Enduring poverty with all its facets and in addition, resurgence of
communicable diseases including the HIV/AIDS epidemic, and weakening
of public health systems is leading to reversal of previous health gains. This
development is associated with widening gaps in income and shrinking access
to social services, as well as persistent racial and gender imbalances. Traditional
systems of knowledge and health are under threat.
These trends are to a large extent the result of the inequitable structure
of the world economy, which has been further skewed by structural adjustment
policies, the persistent indebtedness of the South, unfair world trade
arrangements and uncontrolled financial speculation - all part of the rapid
movement towards inequitable globalisation. In many countries, these
problems are compounded by lack of coordination between governments
and international agencies, and stagnant or declining public health budgets.
Within the health sector, failure to implement primary health care policies as
originally conceived has significantly aggravated the global health crisis. These
deficiencies include:
• A retreat from the goal of comprehensive national health and drug polices as
part of overall social policy.
• A lack of insight into the inter-sectoral nature of health problems and the
failure to make health a priority in all sectors of society.
• A failure to promote participation and genuine involvement of communities
in their own health development.
• Reduced state responsibility at all levels as a consequence of widespread and
usually inequitable policies of privatisation of health services.
• A narrow, top-down, technology-oriented view of health and increasingly
viewing health care as a commodity rather than as a human right.
• It is with this perspective that the organisations constituting the Jan Swasthya
Abhiyan have come together to launch a movement, emerging from the
Peoples Health Assembly process. Some objectives that this coalition set for
itself (which are set out in detail in the Peoples Health Charter) can be listed
briefly as below:
• The Jan Swasthya Abhiyan aims to draw public attention to the adverse
impact of the policies of iniquitous globalisation on the health of Indian
people, especially on the health of the poor.
• The Jan Swasthya Abhiyan aims to focus public attention on the passing of
the year 2000 without the fulfillment of the 'Health for All by 2000 A.D.'
pledge. This historic commitment needs to be renewed and taken forward,
with the slogan 'Health for All - Now!' and in the form of the campaign to
establish the Right to Health and Health Care as basic human rights. Health
and equitable development need to be reestablished as priorities in local,
national, international policy-making, with Primary Health Care as a major
strategy for achieving these priorities.
• In India, globalisation's thrust for privatisation and retreat of the state with
poor regulatory mechanisms has exacerbated the trends to commercialise
medical care. Irrational, unethical and exploitative medical practices are flourishing
and growing. The Jan Swasthya Abhiyan expresses the need to confront
such commercialisation, while establishing minimum standards and
rational treatment guidelines for health care.
• In the Indian context, top down, bureaucratic, fragmented techno-centric
approaches to health care have created considerable wastage of scarce resources
and have failed to deliver significant health improvements. The Jan Swasthya
Abhiyan seeks to emphasize the urgent need to promote decentralisation of
health care and build up integrated, comprehensive and participatory approaches
to health care that places "Peoples Health in Peoples Hands".
The Jan Swasthya Abhiyan seeks to network with all those interested in
promoting peoples' health. It seeks to unleash a wide variety of people's
initiatives that would help the poor and the marginalised to organise and
access better health care, while contributing to building long-term and
sustainable solutions to health problems
The Jan Swasthya Abhiyan is being coordinated by National Coordination
Committee consisting of 21 major all India networks of peoples movements
and NGOs.
R.S.Dahiya
Disparities
Disparities
v Social and Economics inequalities give birth to inequalities in health Inspite of great improvement in Global health in last four decades, the difference in infant mortality rate
between 26 Richest countries and 46 most undeveloped countries is 16 times.
Ø Out of 6 Arab estimated population of the world, about 3 Arab people are surviving on less than 2 dollar per day expenditure.
v Out of these 3 Arab, 1 Arab 30 crores survive on 1 dollar per day expenditure.
Ø Daily 84 crore people are sleeping hungry.
v In the poorest 46 countries half of their people do not get Modern Health facilities
Ø 3 Arab people do not have sanitation facilities.
v The Difference of per capita income between the richest and poorest countries was 11:1 in 1870 was 38:1 in 1960 and 53:1 in 1985
Ø 3 hours expenditure of the world’s defence is equal to WHO Annual Budget.
v With 3 weeks world’s expenditure on armaments the whole population of poor countries can be provided safe drinking waterand sanitation and primary health care.
R.S.Dahiya
v Social and Economics inequalities give birth to inequalities in health Inspite of great improvement in Global health in last four decades, the difference in infant mortality rate
between 26 Richest countries and 46 most undeveloped countries is 16 times.
Ø Out of 6 Arab estimated population of the world, about 3 Arab people are surviving on less than 2 dollar per day expenditure.
v Out of these 3 Arab, 1 Arab 30 crores survive on 1 dollar per day expenditure.
Ø Daily 84 crore people are sleeping hungry.
v In the poorest 46 countries half of their people do not get Modern Health facilities
Ø 3 Arab people do not have sanitation facilities.
v The Difference of per capita income between the richest and poorest countries was 11:1 in 1870 was 38:1 in 1960 and 53:1 in 1985
Ø 3 hours expenditure of the world’s defence is equal to WHO Annual Budget.
v With 3 weeks world’s expenditure on armaments the whole population of poor countries can be provided safe drinking waterand sanitation and primary health care.
R.S.Dahiya
GENDER ISSUES IN HEALTH IN HARYANA
GENDER ISSUES IN HEALTH IN HARYANA
Dr. R.S. Dahiya
Assoc.Prof, PGIMS, Rohtak.
It is a well established fact the biologically women are a stronger sex. In societies where women and men are treated equally, women outlive men and there are more women than men in adult populations. Naturally there are106 boys for 100 girls at birth as the more boys die in infancy& ratio is balanced. The unequal status, unequal access to resources and lack of decision making power experienced by girls and women because of their gender would result in disadvantages in health. These disadvantages include a higher likelihood of exposure to health, greater susceptibility to adverse health consequences as a result of the exposure, and a lower probability of receiving timely, appropriate and adequate health care.
It is widely acknowledged on the bases of studies done in diverse settings, that inequalities in health across population groups arise largely as a consequence of differences in social and economic status and differential access to power and resources.. The heaviest burden of ill health is borne by those who are most deprived, not just economically, but also in terms of capabilities such as literacy levels and access to information. In the words of Noble Laureate Amartya Sen, India, with its present population of 1 billion has to account for some 25 million missing women.
On the top of that in a modern world of today this discrimination has not allowed a gender sensitive language to develop. There is mankind but no woman kind; there is house wife but no house husband; there is house mother but no house father; kitchen maid is there but no kitchen man. The unmarried woman crosses the threshold from bachelor girl to spinster to old maid but the unmarried man is always bachelor.
Discrimination means ‘treating one or more members of a specified group unfairly as compared with other people.’ A convention on this issue was held on the elimination of ACI forms of discrimination against woman (CEDAW) by the United Nations in 1979. The gender discrimination in that convention was defined as:
“any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their material status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field”. This gender discrimination emanates from an ideology that favours men and boys and undervalues women and girls. It is perhaps one of the most widespread and pervasive forms of discrimination. Measures of gender empowerment measure (GEM) show that there is gender discrimination worldwide. In many countries, especially from the developing world, a much larger proportion of women than men are illiterate. World wide women occupy only 14% of parliament seats. Practically in all countries, developing as well as industrialized, women’s participation in the labour market is lower than that of men, women are paid less for equal work and work many more hours doing unpaid labour as compared to men. The most blatant expression of discrimination against female is the practice of sex determination in the womb and then selective sex abortion. Modern technology has now come to the aid of perpetuating culture of discrimination This has resulted in a decline in the proportion of females as compared to males in Haryana and many other states of India. According to 2001 courses, the sex ratio in Haryana is 861 & from 0-6 years of age, this sex ration is 820. The sex ratio amongst literate people is 617 (economic survey of Haryana 2003-2004) which is very alarming. This brings the present education into debate.
The gender discrimination has got its roots in our older cultural practices and way of living also, of course it has got a material base. The cultural practices of Haryana have a gender bias. At the time of birth of a boy, it is celebrated by beating a ‘Thali’ whereas the birth of a girl is mourned (matka phorna) in one way or the other; at the time of delivery, if a child is male, the mother will be given 10Kg ghee (do dhari ghee) and if a child is female, the mother will be given 5 Kg ghee; the sixth day (chhath) of a male child will be celebrated; the namkaran sanskar will be done if the child is male; the girls are not allowed to fire the funeral of the family members some where as the can burn mounds of wood in chulha at home . As the number of woman is going down in Haryana, they are becoming more insecure in the society. The violence in home and outside has increased in Haryana and is affecting the health of women adversely. The news papers carry many news items daily in this regard. The doctors and the para medical staff also behaves as the whole society behaves on the gender issues. The number of gynecologists in govt. hospitals is very meager compounding the women’s health still further.
In one of the districts of Haryana the cases for torture of dowry were recorded to the 37 in 1999 where as they are 38 up to June 30th in 2004. Similarly the recorded rape cases under 3761PC were 16 in 1999 where as there are 15 cases in 2004 up to June30th. Molestation cases were seven in 2000 where as 8 cases have been reported by June 30th 2004. The unregistered cases are many more. This indicates that the price of women or the importance of woman has not increased by the decrease of their number as conceived by many people in Haryana. Violence affects the health of women in many ways.
The other thing which is happening in most of the villages of Haryana is that the number of unmarried males is increasing. Beyond 30 years of age, many males can be seen without marriage in each village. Unemployment is increasing amongst boys and girls both .Also there seems to be increasing trend of impotency in males because of multiple factors. The purchase of bridegrooms is becoming an accepted cultural practice in most of the villages. All these factors are adding the miseries of the women in Haryana. Side by side son preference and the under-valuation of daughter manifests itself in discriminatory practices against daughters such as well being, including, premature and preventable death of female child.
The data from the National Family Health Surgery – 2 indicate that the median duration of breast feeding for girls was slightly lower (24.6 months) than the median duration of breast feeding for boys (26.4 months). A larger proportion of female children than male children were severely underweight (19/1% of girls and 16.9% of boys) and severely stunted (24.4% of girls and 21.8% of boys). Moreover female child mortality rate (1-4 years) during the ten years preceding 1998-99 was much higher (36.7 percent 1000 than male child mortality 24.9 per 1000).
This deprivation in childhood contributes to substantial proportions of women being malnourished and stunted as adults. About 47.0 percent women in Haryana in reproductive age (15-49 years) were having anaemia and about one third were malnourished. For a significant proportion of adolescent Indian girls, an early marriage followed soon after by a pregnancy is the norm. The percentage of women age 25-49 years married before the age of 18 in Haryana is 59.9. Sixteen percent of all women aged 15-19 and nearly half of currently married Indian women age 15-19 years had already a child according to HFHS-2. They have no say on sexuality and reproduction. Child bearing in adolescence affects women adversely in many ways; socially, economically, psychologically and physically. It truncates their education, limits their income-earning opportunities and burdens them with responsibilities at an age when they aught to be exploring life. In developing countries, early childhood bearing carries a greater relative risk of dying in pregnancy and delivery as compared to woman in the 20-24 age groups from around 80% to as high as 400%. Maternal mortality ratio for all women is also very high in India – 540 per 100,000 live births for the ten year preceding 1998-99.
It is very unfortunate that our legal system has not been able to remove the existing social biases. Despite the constitutional guarantee of equality between men and women the law implementing agencies failed in their execution. That is the reason the women also often lack the authority to make their health care decisions for themselves. Though half a century has elapsed after framing of constitution, our social customs have not changed to match the spirit of the constitution. Still customary laws and traditions are given perferance over constitutional commitment in combination with patriarchal norms that deny women the right to make decisions regarding their sexuality , reproduction and health. Women are exposed to avoidable risks of morbidity and mortality in Haryana.
Dr. R.S.Dahiya
Senior Professor,
PGIMS, Rohtak.
Violence Against Women in Haryana
The violence against women has increased so much in Haryana in recent years that the state has attained the dubious distinction of being among the states with high VAW rate.
A girl's status in the state is that of an unpaid labourer, be it her parents' place or her in-laws. The whole day they are found toiling in various chores such as rearing children, tending cattle, managing the home, working as labourers in fields Despite all this, these women do not have any role in decision-making, even where it concerns them. The inferior status of women is the result of repression inflicted on her, it is the off-shoot of gender inequality of hundreds of years, female foeticide, female infanticide, dowry, lower benefits of employment, issues relating to inheritance, lack of political participation and illiteracy. Sex ratio is an important social indicator to measure the extent of prevailing inequality between males and females of this society. And some of the important reasons for Haryana being one of those states where the sex ratio is lowest are neglect of girl child resulting in higher mortality at younger age, high maternal mortality, sex selective female abortions and female infanticide. One of the Haryana folklores depicts death of female child as a stroke of luck and that of a male child as a stroke of bad luck. ''Chora mare nirbhag ka, chori mare bhagvaan ki.'' At the time of birth of a boy ‘ladoo bantey jatey hain’ and at birth of an girl ‘Mattam manaya jata hai’ When agirl is born, the mother is given 5 kg of ghee and when o boy is born the mother is given 10 kg of ghee. ''Parda'' is another form of repression responsible for the backwardness of women. This makes them more dependant on their male counterparts and is also the main hindrance in their active participation in Panchayati Raj institutions.
R.S.Dahiya
A girl's status in the state is that of an unpaid labourer, be it her parents' place or her in-laws. The whole day they are found toiling in various chores such as rearing children, tending cattle, managing the home, working as labourers in fields Despite all this, these women do not have any role in decision-making, even where it concerns them. The inferior status of women is the result of repression inflicted on her, it is the off-shoot of gender inequality of hundreds of years, female foeticide, female infanticide, dowry, lower benefits of employment, issues relating to inheritance, lack of political participation and illiteracy. Sex ratio is an important social indicator to measure the extent of prevailing inequality between males and females of this society. And some of the important reasons for Haryana being one of those states where the sex ratio is lowest are neglect of girl child resulting in higher mortality at younger age, high maternal mortality, sex selective female abortions and female infanticide. One of the Haryana folklores depicts death of female child as a stroke of luck and that of a male child as a stroke of bad luck. ''Chora mare nirbhag ka, chori mare bhagvaan ki.'' At the time of birth of a boy ‘ladoo bantey jatey hain’ and at birth of an girl ‘Mattam manaya jata hai’ When agirl is born, the mother is given 5 kg of ghee and when o boy is born the mother is given 10 kg of ghee. ''Parda'' is another form of repression responsible for the backwardness of women. This makes them more dependant on their male counterparts and is also the main hindrance in their active participation in Panchayati Raj institutions.
R.S.Dahiya
Pre-Birth Elemination of Female & new paradigm of development in Haryana.
Pre-Birth Elemination of Female & new paradigm of development in Haryana.
The issue of missing girls and women in Haryana has gone to an alarming stage and needs a serious in depth overview so that some concrete interventions can be thought of. Consumerist oriented economic development, commercialization of medical profession and sexiest biases in our society, combined together have created a sad scenario of ‘missing girls’.Instead of women empowerment, we are doing feminisation of labour. Global comparisons of sex ratios shows that sex ratios in Europe, North America, Caribbean, Central Asia, the poorest regions of Sab Saharan Africa are favaourable to woman as these countries neither kill/neglect girls nor do they use NRT’s for productions of sons. On the other hand the lowest sex ratio is found in some parts of India and Haryana is one of them. Bottom ten districts in child sex ratio (0_6) are Fatehgarh (754), Patiala (770) ,Kurukshetra (770), Gurdaspur(775), Bhatinda(779), Mansa(779), Amritsar(783), Sonepat(783),Ambala(784). There are 16 districts in India having less than 800 sex ratio and 10 of them are from Punjab ana Haryana.There are 1852 villages in Haryana where child sex ratio (0-6)is less than 750.This practice had been earlier also, but now it has taken a new turn with wide spread use of new reproductive technologies in Haryana during the period of Green revolution. These NRT’s are based on principle of selection of the desirable and rejection of the unwanted. In Haryana desirable is “baby boy” and the unwanted is the “baby girl” and the result is obvious. The census results of 2001 have revealed that with sex ratio of 927 girls for 1000 boys, India had deficit of 60 lakh girls in age group of 0-6 years, when it entered the new millennium. In Haryana we are deficit of 322436girls in the age group of 0-6 years as per 2001census. These NRT’s in the context of patriarchal control over women’s fertility and commercial interests are posing major threat to women’s dignity and bodily integrity. Two child norm policy is also posing a negetive impact .The supporters of Pre Birth Elemination of Females put forward various arguments like ‘ Pay Rs 500 now and save Rs 5,00,000 later’ and “Women’s choices” as if women’s choices are made in vaccum.Also it need to be clarified that the right to abortion must remain as an essential right of women, a right to determine their life, their body and fertility. In this context the crucial and important questions is can we allow the Haryanvi girls to become an endangered species?
Dr. Sabu George and myself conducted a study on female foeticide in rural Haryana in a rural population of about 13,000 in Rohtak district and we interviewed more than 1000 women to know the pregnancy outcomes during 1995 to 2000.We have found that the ‘Sons only’ and “Sons Must” syndrome has been perpetuated by resorting to female foeticide, using the modern technological tools, thus reinforcing patriarchal values as cultural determinants.In our another survey done in 2004 in 12 villages there were 50 cases of purchased brides from other states. In last Panchayat elections it became an election issue that if they will win they will arrange for more purchased brides. When we discussed the issue with the group of women in study villages, they had a misconception that if their number decreases, their worth will increase. Actually reduction in the number of women would enhance atrocities domestic and societal on women. As per As per the data published by the National Crimes Record Bureau, New Delhi, out of the total 1,15,723 cases related to women and registered under IPC in 1996, rape accounted for14,846 (12.8 per cent), dowry deaths 5513 (4.8 per cent) and cases of torture 35,246 (30.5 per cent). In 1994, 98, 948 cases were registered under crime against women compared to 83,954 cases in 1993 and 79,037 in 1992. The figure was 74,093 in 1991 and 68,317 in 1990. The National Commission for Women is a statutory body constituted under the National Commission for Women Act 1990 to protect and promote the interests and to safeguard the rights of women. From January to December 2000, the Commission received a total of 5,268 complaints, which included dowry deaths 527, murder 235, rape 277, molestation 11, dowryharassment 963, sexual harassment 131, bigamy 110, desertion of wives 267 and other types of harassment 2,747.
They also told that they have to have extra care from the birth of the girl child till they are married and later life as well becouse of increasing insecurity in the society. They revealed that when a girl is born, there is atmosphere of ‘Mattam’ and when boy is born this is celebrated by beating a ‘thali’ and distribution of sweets.Tradition of 6th day celebration on birth of a boy ‘Chhath’ is there. A mother who give birth to a boy is given 10 kg of ghee and the mother giving birth to a girl is given 5 kg in the villages. When asked whether they celebrate the ‘Namkaran Sanskar’ of girls, all of them answered in negative. Similarly many traditional discriminatory points came in to discussion. (list is very long) confirming again the reflex conditioning of the women psyche and society as a whole through these cultural practices for son preference at the cost of girl. Study done byMs Ruhani in 2005 in Haryana had revealing cases. In an interview with one of the Paediatric Surgeon,it was revealed that various reasons for deformities are like fluoride excess, pollution, lack of food, pesticide and insecticide residual effects. But there are many cases of deformities where they want to have male kids after many girl issues.For this they take medicine from quacks for giving birth to a son. Actually they shouldn’t take anything in the first trimester because by 3 months whole baby is formed. Neural tube defects are very common in such cases. They effect from top of spinal cord to the end. In such cases they should terminate. These were the views of one of the Paediatric surgeon of PGIMS Rohtak .
Ompati 36 years old VPO Baas Distt, Hissar had a son of 18 years who died 2 years back. She didn’t bother about not having another child after him when it didn’t happen naturally since he was a son.. She got pregnant. Had drug from a doctor in Bahadurgarh who gave her medicines to drink over three months She had to get an abortion induced of a deformed baby in the 7th month. Deformities were Placenta posterior , Occipital encephalocele and foetal ascitis.
Now the question is that how to respond to the challenging situation. This is a real challenge. Prenatal Diagnostic Technique Act was enacted in 1994 as a result of pressure created by forum against sex determination and sex preselection. But it was not implemented. After another decade of campaigning by women’s rights organizations and public interest litigation by CEHAT, MASUM and Dr. Sabu George, the prenatal diagnostic techniques (regulation and prevention of misuse) amendment act, 2002 received the assent of President of India on 17-1-2003. The act provides “for the prohibition of sex selection, before or after conception, and for regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or sex linked disorders and for the prevention of their misuse for sex determination leading to female foeticide and for matters connected there with or incidental there to”. PNDT Act amendment rules 2003 have activated the implementation machinery to curb nefarious practices contributing for missing girls.This is true but much more important ,we have a great task in front of us i.e to change the mind set of doctors, the people at large and the victim women in particular, to create a socio-cultural milieu that is conductive for girl child’s survival and monitor the activities of commercial minded techno-docs thriving on sexiest prejudices. Dr B.S.Dahiya did a serious exersise and made cases against defaulting doctors.
The policy level changes are required and also these need to be actually implemented by the state through both governmental structures and voluntary organizations.
-Registering & monitoring of all pregnancies from 6th weeks onward & not from 12th weeks.
-Increase marriage age of girls from 18 to 21
-Provide compulsory, free, quality education to all girl children up to Secondary school level
-Extend 50% representation to women in all decision making bodies of the state to introduce a feministic political culture conducive to women friendly political action.
-Eradicate child Labour and guarantee employment for adult women.
-Bring policy and legal measures to ensure that women have rights and control over productive resources, for the economic empowerment of women.
-Provide life-sustaining resources such as health, nutrition, water, education to all the children without gender bias.
-Entrust power to panchayats to maintain a register of demographic profile with the details on vital statistics.
-Frame the child policy and girl child policy to protect the interest of the girl children.
-Extend gender sensitization training to policy makers, planners, administrators and implementers at all levels.
-Promote gender perspective in to all policies and sectoral- programmes
Besides all this , different level efforts are being made to sensitise the people on the issue of gender and caste discrimination. Navjagran- a new renaisance movement though slow is going on. “Ek Nai Suruat” natak needs a mention here .This new renaisance movement i.e ‘Navjagaran’ has to be supported by all sections of the society of Haryana so that a civic society in Haryana can be created where these types of gender and caste discrimations will not be there and missing girls will also have a space to be born and survive as an human being. Last but not the least is Your Contribution to the Navjagran Campaign as---
* An enlightened student
* A enlightened citizen
* A enlightened teacher
* A enlightened mother
* A enlightened father
* A enlightened family member/ relative
* A enlightened medical professional
* A media person
* Do not publish advertisements offering sex determination facilities. Instead, make a positive contribution by publishing articles in your magazine or newspaper to generate awareness about the heinous practice of PBEF, the law prohibiting it and difficulties in the implementation of the law. Support the cause of the girl child through your writing , photographs, films, documentataries or any other medium
R.S.Dahiya
Professor of Surgery
PGIMS, Rohtak
Haryana Gyan Vigyan Samiti, Rohtak
The issue of missing girls and women in Haryana has gone to an alarming stage and needs a serious in depth overview so that some concrete interventions can be thought of. Consumerist oriented economic development, commercialization of medical profession and sexiest biases in our society, combined together have created a sad scenario of ‘missing girls’.Instead of women empowerment, we are doing feminisation of labour. Global comparisons of sex ratios shows that sex ratios in Europe, North America, Caribbean, Central Asia, the poorest regions of Sab Saharan Africa are favaourable to woman as these countries neither kill/neglect girls nor do they use NRT’s for productions of sons. On the other hand the lowest sex ratio is found in some parts of India and Haryana is one of them. Bottom ten districts in child sex ratio (0_6) are Fatehgarh (754), Patiala (770) ,Kurukshetra (770), Gurdaspur(775), Bhatinda(779), Mansa(779), Amritsar(783), Sonepat(783),Ambala(784). There are 16 districts in India having less than 800 sex ratio and 10 of them are from Punjab ana Haryana.There are 1852 villages in Haryana where child sex ratio (0-6)is less than 750.This practice had been earlier also, but now it has taken a new turn with wide spread use of new reproductive technologies in Haryana during the period of Green revolution. These NRT’s are based on principle of selection of the desirable and rejection of the unwanted. In Haryana desirable is “baby boy” and the unwanted is the “baby girl” and the result is obvious. The census results of 2001 have revealed that with sex ratio of 927 girls for 1000 boys, India had deficit of 60 lakh girls in age group of 0-6 years, when it entered the new millennium. In Haryana we are deficit of 322436girls in the age group of 0-6 years as per 2001census. These NRT’s in the context of patriarchal control over women’s fertility and commercial interests are posing major threat to women’s dignity and bodily integrity. Two child norm policy is also posing a negetive impact .The supporters of Pre Birth Elemination of Females put forward various arguments like ‘ Pay Rs 500 now and save Rs 5,00,000 later’ and “Women’s choices” as if women’s choices are made in vaccum.Also it need to be clarified that the right to abortion must remain as an essential right of women, a right to determine their life, their body and fertility. In this context the crucial and important questions is can we allow the Haryanvi girls to become an endangered species?
Dr. Sabu George and myself conducted a study on female foeticide in rural Haryana in a rural population of about 13,000 in Rohtak district and we interviewed more than 1000 women to know the pregnancy outcomes during 1995 to 2000.We have found that the ‘Sons only’ and “Sons Must” syndrome has been perpetuated by resorting to female foeticide, using the modern technological tools, thus reinforcing patriarchal values as cultural determinants.In our another survey done in 2004 in 12 villages there were 50 cases of purchased brides from other states. In last Panchayat elections it became an election issue that if they will win they will arrange for more purchased brides. When we discussed the issue with the group of women in study villages, they had a misconception that if their number decreases, their worth will increase. Actually reduction in the number of women would enhance atrocities domestic and societal on women. As per As per the data published by the National Crimes Record Bureau, New Delhi, out of the total 1,15,723 cases related to women and registered under IPC in 1996, rape accounted for14,846 (12.8 per cent), dowry deaths 5513 (4.8 per cent) and cases of torture 35,246 (30.5 per cent). In 1994, 98, 948 cases were registered under crime against women compared to 83,954 cases in 1993 and 79,037 in 1992. The figure was 74,093 in 1991 and 68,317 in 1990. The National Commission for Women is a statutory body constituted under the National Commission for Women Act 1990 to protect and promote the interests and to safeguard the rights of women. From January to December 2000, the Commission received a total of 5,268 complaints, which included dowry deaths 527, murder 235, rape 277, molestation 11, dowryharassment 963, sexual harassment 131, bigamy 110, desertion of wives 267 and other types of harassment 2,747.
They also told that they have to have extra care from the birth of the girl child till they are married and later life as well becouse of increasing insecurity in the society. They revealed that when a girl is born, there is atmosphere of ‘Mattam’ and when boy is born this is celebrated by beating a ‘thali’ and distribution of sweets.Tradition of 6th day celebration on birth of a boy ‘Chhath’ is there. A mother who give birth to a boy is given 10 kg of ghee and the mother giving birth to a girl is given 5 kg in the villages. When asked whether they celebrate the ‘Namkaran Sanskar’ of girls, all of them answered in negative. Similarly many traditional discriminatory points came in to discussion. (list is very long) confirming again the reflex conditioning of the women psyche and society as a whole through these cultural practices for son preference at the cost of girl. Study done byMs Ruhani in 2005 in Haryana had revealing cases. In an interview with one of the Paediatric Surgeon,it was revealed that various reasons for deformities are like fluoride excess, pollution, lack of food, pesticide and insecticide residual effects. But there are many cases of deformities where they want to have male kids after many girl issues.For this they take medicine from quacks for giving birth to a son. Actually they shouldn’t take anything in the first trimester because by 3 months whole baby is formed. Neural tube defects are very common in such cases. They effect from top of spinal cord to the end. In such cases they should terminate. These were the views of one of the Paediatric surgeon of PGIMS Rohtak .
Ompati 36 years old VPO Baas Distt, Hissar had a son of 18 years who died 2 years back. She didn’t bother about not having another child after him when it didn’t happen naturally since he was a son.. She got pregnant. Had drug from a doctor in Bahadurgarh who gave her medicines to drink over three months She had to get an abortion induced of a deformed baby in the 7th month. Deformities were Placenta posterior , Occipital encephalocele and foetal ascitis.
Now the question is that how to respond to the challenging situation. This is a real challenge. Prenatal Diagnostic Technique Act was enacted in 1994 as a result of pressure created by forum against sex determination and sex preselection. But it was not implemented. After another decade of campaigning by women’s rights organizations and public interest litigation by CEHAT, MASUM and Dr. Sabu George, the prenatal diagnostic techniques (regulation and prevention of misuse) amendment act, 2002 received the assent of President of India on 17-1-2003. The act provides “for the prohibition of sex selection, before or after conception, and for regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or sex linked disorders and for the prevention of their misuse for sex determination leading to female foeticide and for matters connected there with or incidental there to”. PNDT Act amendment rules 2003 have activated the implementation machinery to curb nefarious practices contributing for missing girls.This is true but much more important ,we have a great task in front of us i.e to change the mind set of doctors, the people at large and the victim women in particular, to create a socio-cultural milieu that is conductive for girl child’s survival and monitor the activities of commercial minded techno-docs thriving on sexiest prejudices. Dr B.S.Dahiya did a serious exersise and made cases against defaulting doctors.
The policy level changes are required and also these need to be actually implemented by the state through both governmental structures and voluntary organizations.
-Registering & monitoring of all pregnancies from 6th weeks onward & not from 12th weeks.
-Increase marriage age of girls from 18 to 21
-Provide compulsory, free, quality education to all girl children up to Secondary school level
-Extend 50% representation to women in all decision making bodies of the state to introduce a feministic political culture conducive to women friendly political action.
-Eradicate child Labour and guarantee employment for adult women.
-Bring policy and legal measures to ensure that women have rights and control over productive resources, for the economic empowerment of women.
-Provide life-sustaining resources such as health, nutrition, water, education to all the children without gender bias.
-Entrust power to panchayats to maintain a register of demographic profile with the details on vital statistics.
-Frame the child policy and girl child policy to protect the interest of the girl children.
-Extend gender sensitization training to policy makers, planners, administrators and implementers at all levels.
-Promote gender perspective in to all policies and sectoral- programmes
Besides all this , different level efforts are being made to sensitise the people on the issue of gender and caste discrimination. Navjagran- a new renaisance movement though slow is going on. “Ek Nai Suruat” natak needs a mention here .This new renaisance movement i.e ‘Navjagaran’ has to be supported by all sections of the society of Haryana so that a civic society in Haryana can be created where these types of gender and caste discrimations will not be there and missing girls will also have a space to be born and survive as an human being. Last but not the least is Your Contribution to the Navjagran Campaign as---
* An enlightened student
* A enlightened citizen
* A enlightened teacher
* A enlightened mother
* A enlightened father
* A enlightened family member/ relative
* A enlightened medical professional
* A media person
* Do not publish advertisements offering sex determination facilities. Instead, make a positive contribution by publishing articles in your magazine or newspaper to generate awareness about the heinous practice of PBEF, the law prohibiting it and difficulties in the implementation of the law. Support the cause of the girl child through your writing , photographs, films, documentataries or any other medium
R.S.Dahiya
Professor of Surgery
PGIMS, Rohtak
Haryana Gyan Vigyan Samiti, Rohtak
Health Alert
Should Competetion Decide the Drug Prices?
Let us first look at some of the prices of the same molecules sold under different brand names. The variation are miles apart. Some examples:
· Fexofenadine 120mg: one tablet of Alernex(Dabur) costs Rs.
5 while Allegra (Hoechest) is priced at Rs.8-the difference being 60%.
· Two brands of cetrizine are priced at Rs. 1.60 and Rs. 2.60 per
tablet : a difference being 62%.
· Gliclazide: Glidiet(Modi-Mundipharma) is priced at Rs. 31 (for
10 tablets) compared to Rs. 59 for Diamicron( Serdia) a difference of over 90% .
· Two brands of ofloxacin cost Rs. 100 for 10 tablets(Oflin by
Cadila Healthcare) and Rs. 530 for Tarivid (Aventis). The difference:530%.
· The difference in the cost of Riseperidone is beyond
imagination : Less than Rs. 18 for all manufacturers except Joh
nson& Johnson that costs Rs. 135! A difference of 750%.
· Amlodipine prices are widely different: Amlodac 10mg is
priced at Rs. 14 for 10 tabs while Amlovas of equal strength costs Rs. 35 for 10 tablets-gap of 250% .
There are scores of other examples. Since no manufacturer would be selling at loss, it is obvious that huge profits are being made.
Normally the sale of cheaper brands should not only be substantially more than costly brands but expensive brands die a natural death in due course.Let us look at the facts and figures:
v As per ORG figures, Cyclovir (Zydus) brand of acyclovir with the therapy cost of 812 rupees had a total sale of Rs. 57 lacs annually period compared to Rs. 3.17 crores for more expensive Herpex (torrent) brand( cost of therapy: Rs. 922).
v Diamicron(Serdia) brand of gliclazide at Rs. 59 for 10 tablets was worth Rs 7 crores against the cheaper brand that had a measly sale of Rs. 66 lacs(Glidiet of Modi Mundipharma). The medicine is to be taken for life.
v The most expensive brand of enalapril(Envas) sells hundreds of times more than cheaper but equally reputed brands including Cadila’s BQL! The cost difference is over 33%. It is a life long medicine.
Oblviously, doctors are oblivious of cost to patients. A more logical explanation is that doctors get easily influenced by manufacturers who have the capacity to spend large sums of money on aggressive promotion and offer huge incentives to “Right” prescribers. Some examples are :
Ø In the past eight years, a south Delhi based surgeon has been sent on vacation to Switzerland by a south Delhi base pharma company every year. In turn he prescribed only the obliging company’s products. In the case of antibiotics he went one step further. Instead of five to seven days, the patients were made to swallow the bitter pills for ten days.
Ø Johnson & Johnson that produces epoetin alfa ( life saving for kidney transplant patients ) was gracious enough to sponsor 300 kidney specialists to attend a 3 hour “scientific conference” in Singapore with stay extended to 3 days ! Needless to says spouses were also included. Result : Its brand has the highest sale.
Ø Ranbaxy sponsored the visit of about 400 prescribers to Bankok.
Ø Glaxo has given thousands of refrigerators to Chemists.
In India every doctor decides on his own which medicine to give. Not infrequently the choice is scientifically inappropriate and financially costly. Why does this happen? The matter needs to be debated. One of the solutions lies in controlling the profits on all molecules to the same class as well as other drugs used in the same therapeutic area. For instance, if the price of diazepam is fixed leaving other benzodiazepines uncontrolled, then prescriptions will shift to them.
Health Alert
Should Competetion Decide the Drug Prices?
Let us first look at some of the prices of the same molecules sold under different brand names. The variation are miles apart. Some examples:
· Fexofenadine 120mg: one tablet of Alernex(Dabur) costs Rs.
5 while Allegra (Hoechest) is priced at Rs.8-the difference being 60%.
· Two brands of cetrizine are priced at Rs. 1.60 and Rs. 2.60 per
tablet : a difference being 62%.
· Gliclazide: Glidiet(Modi-Mundipharma) is priced at Rs. 31 (for
10 tablets) compared to Rs. 59 for Diamicron( Serdia) a difference of over 90% .
· Two brands of ofloxacin cost Rs. 100 for 10 tablets(Oflin by
Cadila Healthcare) and Rs. 530 for Tarivid (Aventis). The difference:530%.
· The difference in the cost of Riseperidone is beyond
imagination : Less than Rs. 18 for all manufacturers except Joh
nson& Johnson that costs Rs. 135! A difference of 750%.
· Amlodipine prices are widely different: Amlodac 10mg is
priced at Rs. 14 for 10 tabs while Amlovas of equal strength costs Rs. 35 for 10 tablets-gap of 250% .
There are scores of other examples. Since no manufacturer would be selling at loss, it is obvious that huge profits are being made.
Normally the sale of cheaper brands should not only be substantially more than costly brands but expensive brands die a natural death in due course.Let us look at the facts and figures:
v As per ORG figures, Cyclovir (Zydus) brand of acyclovir with the therapy cost of 812 rupees had a total sale of Rs. 57 lacs annually period compared to Rs. 3.17 crores for more expensive Herpex (torrent) brand( cost of therapy: Rs. 922).
v Diamicron(Serdia) brand of gliclazide at Rs. 59 for 10 tablets was worth Rs 7 crores against the cheaper brand that had a measly sale of Rs. 66 lacs(Glidiet of Modi Mundipharma). The medicine is to be taken for life.
v The most expensive brand of enalapril(Envas) sells hundreds of times more than cheaper but equally reputed brands including Cadila’s BQL! The cost difference is over 33%. It is a life long medicine.
Oblviously, doctors are oblivious of cost to patients. A more logical explanation is that doctors get easily influenced by manufacturers who have the capacity to spend large sums of money on aggressive promotion and offer huge incentives to “Right” prescribers. Some examples are :
Ø In the past eight years, a south Delhi based surgeon has been sent on vacation to Switzerland by a south Delhi base pharma company every year. In turn he prescribed only the obliging company’s products. In the case of antibiotics he went one step further. Instead of five to seven days, the patients were made to swallow the bitter pills for ten days.
Ø Johnson & Johnson that produces epoetin alfa ( life saving for kidney transplant patients ) was gracious enough to sponsor 300 kidney specialists to attend a 3 hour “scientific conference” in Singapore with stay extended to 3 days ! Needless to says spouses were also included. Result : Its brand has the highest sale.
Ø Ranbaxy sponsored the visit of about 400 prescribers to Bankok.
Ø Glaxo has given thousands of refrigerators to Chemists.
In India every doctor decides on his own which medicine to give. Not infrequently the choice is scientifically inappropriate and financially costly. Why does this happen? The matter needs to be debated. One of the solutions lies in controlling the profits on all molecules to the same class as well as other drugs used in the same therapeutic area. For instance, if the price of diazepam is fixed leaving other benzodiazepines uncontrolled, then prescriptions will shift to them.
R.S.Dahiya
Should Competetion Decide the Drug Prices?
Let us first look at some of the prices of the same molecules sold under different brand names. The variation are miles apart. Some examples:
· Fexofenadine 120mg: one tablet of Alernex(Dabur) costs Rs.
5 while Allegra (Hoechest) is priced at Rs.8-the difference being 60%.
· Two brands of cetrizine are priced at Rs. 1.60 and Rs. 2.60 per
tablet : a difference being 62%.
· Gliclazide: Glidiet(Modi-Mundipharma) is priced at Rs. 31 (for
10 tablets) compared to Rs. 59 for Diamicron( Serdia) a difference of over 90% .
· Two brands of ofloxacin cost Rs. 100 for 10 tablets(Oflin by
Cadila Healthcare) and Rs. 530 for Tarivid (Aventis). The difference:530%.
· The difference in the cost of Riseperidone is beyond
imagination : Less than Rs. 18 for all manufacturers except Joh
nson& Johnson that costs Rs. 135! A difference of 750%.
· Amlodipine prices are widely different: Amlodac 10mg is
priced at Rs. 14 for 10 tabs while Amlovas of equal strength costs Rs. 35 for 10 tablets-gap of 250% .
There are scores of other examples. Since no manufacturer would be selling at loss, it is obvious that huge profits are being made.
Normally the sale of cheaper brands should not only be substantially more than costly brands but expensive brands die a natural death in due course.Let us look at the facts and figures:
v As per ORG figures, Cyclovir (Zydus) brand of acyclovir with the therapy cost of 812 rupees had a total sale of Rs. 57 lacs annually period compared to Rs. 3.17 crores for more expensive Herpex (torrent) brand( cost of therapy: Rs. 922).
v Diamicron(Serdia) brand of gliclazide at Rs. 59 for 10 tablets was worth Rs 7 crores against the cheaper brand that had a measly sale of Rs. 66 lacs(Glidiet of Modi Mundipharma). The medicine is to be taken for life.
v The most expensive brand of enalapril(Envas) sells hundreds of times more than cheaper but equally reputed brands including Cadila’s BQL! The cost difference is over 33%. It is a life long medicine.
Oblviously, doctors are oblivious of cost to patients. A more logical explanation is that doctors get easily influenced by manufacturers who have the capacity to spend large sums of money on aggressive promotion and offer huge incentives to “Right” prescribers. Some examples are :
Ø In the past eight years, a south Delhi based surgeon has been sent on vacation to Switzerland by a south Delhi base pharma company every year. In turn he prescribed only the obliging company’s products. In the case of antibiotics he went one step further. Instead of five to seven days, the patients were made to swallow the bitter pills for ten days.
Ø Johnson & Johnson that produces epoetin alfa ( life saving for kidney transplant patients ) was gracious enough to sponsor 300 kidney specialists to attend a 3 hour “scientific conference” in Singapore with stay extended to 3 days ! Needless to says spouses were also included. Result : Its brand has the highest sale.
Ø Ranbaxy sponsored the visit of about 400 prescribers to Bankok.
Ø Glaxo has given thousands of refrigerators to Chemists.
In India every doctor decides on his own which medicine to give. Not infrequently the choice is scientifically inappropriate and financially costly. Why does this happen? The matter needs to be debated. One of the solutions lies in controlling the profits on all molecules to the same class as well as other drugs used in the same therapeutic area. For instance, if the price of diazepam is fixed leaving other benzodiazepines uncontrolled, then prescriptions will shift to them.
Health Alert
Should Competetion Decide the Drug Prices?
Let us first look at some of the prices of the same molecules sold under different brand names. The variation are miles apart. Some examples:
· Fexofenadine 120mg: one tablet of Alernex(Dabur) costs Rs.
5 while Allegra (Hoechest) is priced at Rs.8-the difference being 60%.
· Two brands of cetrizine are priced at Rs. 1.60 and Rs. 2.60 per
tablet : a difference being 62%.
· Gliclazide: Glidiet(Modi-Mundipharma) is priced at Rs. 31 (for
10 tablets) compared to Rs. 59 for Diamicron( Serdia) a difference of over 90% .
· Two brands of ofloxacin cost Rs. 100 for 10 tablets(Oflin by
Cadila Healthcare) and Rs. 530 for Tarivid (Aventis). The difference:530%.
· The difference in the cost of Riseperidone is beyond
imagination : Less than Rs. 18 for all manufacturers except Joh
nson& Johnson that costs Rs. 135! A difference of 750%.
· Amlodipine prices are widely different: Amlodac 10mg is
priced at Rs. 14 for 10 tabs while Amlovas of equal strength costs Rs. 35 for 10 tablets-gap of 250% .
There are scores of other examples. Since no manufacturer would be selling at loss, it is obvious that huge profits are being made.
Normally the sale of cheaper brands should not only be substantially more than costly brands but expensive brands die a natural death in due course.Let us look at the facts and figures:
v As per ORG figures, Cyclovir (Zydus) brand of acyclovir with the therapy cost of 812 rupees had a total sale of Rs. 57 lacs annually period compared to Rs. 3.17 crores for more expensive Herpex (torrent) brand( cost of therapy: Rs. 922).
v Diamicron(Serdia) brand of gliclazide at Rs. 59 for 10 tablets was worth Rs 7 crores against the cheaper brand that had a measly sale of Rs. 66 lacs(Glidiet of Modi Mundipharma). The medicine is to be taken for life.
v The most expensive brand of enalapril(Envas) sells hundreds of times more than cheaper but equally reputed brands including Cadila’s BQL! The cost difference is over 33%. It is a life long medicine.
Oblviously, doctors are oblivious of cost to patients. A more logical explanation is that doctors get easily influenced by manufacturers who have the capacity to spend large sums of money on aggressive promotion and offer huge incentives to “Right” prescribers. Some examples are :
Ø In the past eight years, a south Delhi based surgeon has been sent on vacation to Switzerland by a south Delhi base pharma company every year. In turn he prescribed only the obliging company’s products. In the case of antibiotics he went one step further. Instead of five to seven days, the patients were made to swallow the bitter pills for ten days.
Ø Johnson & Johnson that produces epoetin alfa ( life saving for kidney transplant patients ) was gracious enough to sponsor 300 kidney specialists to attend a 3 hour “scientific conference” in Singapore with stay extended to 3 days ! Needless to says spouses were also included. Result : Its brand has the highest sale.
Ø Ranbaxy sponsored the visit of about 400 prescribers to Bankok.
Ø Glaxo has given thousands of refrigerators to Chemists.
In India every doctor decides on his own which medicine to give. Not infrequently the choice is scientifically inappropriate and financially costly. Why does this happen? The matter needs to be debated. One of the solutions lies in controlling the profits on all molecules to the same class as well as other drugs used in the same therapeutic area. For instance, if the price of diazepam is fixed leaving other benzodiazepines uncontrolled, then prescriptions will shift to them.
R.S.Dahiya
Role of Medical Students and Interns in Disater Management
Role of Medical Students and Interns
in
Disaster Management
Dr. R.S. Dahiya
Introduction:
Hardly a day now passes without a disturbing news about a major or complex emergency happening in some part of the world. Disasters continue to strike and cause destruction in developing countries specifically and the developed countries as well, raisin peoples concern about their vulnerability to occurrences that can gravely affect their day to day life and their future.
There is no doubt that remarkable progress has been achieved not only in the field of science and technology but in all spheres of human activity particularly during the current century. But unfortunately the same progress has been exploited to produce agent of mass destruction such as nuclear, chemical and biological weapons, capable of wiping out all the achievements made so for with in a matter of minutes. The floods and the draughts are also many times because of mismanagement. Even the science and technology has developed to a level where the houses can be made to bear with the earth quakes and cyclones.
There is a growing trend of various forms of disasters in the world. Number wise in 1998 alone, there were 74 major floods, 5 cyclones, 17 earth quakes, 18 draughts and 162 major accidents the world over. During the period of 1960 to 1989, our own country experienced a total of 191 disaster events of various types resulting into 1, 51, 179 deaths; 2,11,535 injured persons and 174,28,72,678 people were affected one way or the other.
All disasters can be broadly classified into two major categories.
A. Natural disasters such as earth quakes, floods, draughts, cyclones and volcanic eruptions etc.
B. Man made disasters which may be
· Intentional (Unconventional war fare, Civil strife, floods, droughts, etc.)
· Non intentional (industrial accidents eg. Bhopal gas Tragedy, Chernobyl Nuclear Plant disaster etc.)
The man made disasters are totally preventable provided there is will and the non intentional disasters can be prevented to a long extent .
C. Ecological disasters
v Oil Spills
v Air, water and soil pollution
v Desertification
v The green house effect
v Environmental degradation
v Refugees besides nuclear, chemical ,and biological catastrophes
These are man made and require determined, concerted efforts to prevent them.
Objectives are:
Ø To visualize preventive measures
Ø To reduce the loss of property
Ø To achieve international solidarity
Ø To achieve inter- sectoral cooperation
Ø To achieve community participation
Ø to achieve greater involvement and dedicated participation of medical and health personnel
This paper deals with the last objective.
How to really involve medical and health personnel with dedication during and after the process of disaster is over, is a serious issue. There are certain riders in the way of active and participatory involvement of these sections. Without addressing these challenges, the real involvement will be a far distant dream.
You can force a horse to go to the pond but you cannot force him to drink. The basic challenge is that they might not have been exposed to such situations earlier. Their orientation to deal with such situations may be weak. Many a times their motivation may be weak. Their working conditions may be worst etc. because of which their sensitivity towards human beings in general is eroded. Many times the interns are having a self alienation. Overall erosion of human values and domination of market values is a big rider. This cannot be inculcated overnight. Hence a selection is required. Those who volunteer for the job should be considered first.
Many times the things are expected from the private sector health personnel where has they have left this role in the market driven society.
The basics of disaster preparedness and management should be included in the under graduates syllabus. The involvement of undergraduates and interns in tackling various emergencies and in post disaster relief activities of health should be well planned and also be included in the curriculum.
While providing medical relief to disaster affected people under graduates and interns learn many things. They observe and treat cases; know about the principle of Triage while handling mass casualties; learn how to treat cases with optimal drugs and limited facilities; how to deal with the psycho-social- cultural problems and their impact on health; how the records of various activities are maintained and what is their significance in regular surveillance and monitoring of information to higher authorities.
They also learn that medical relief is integral to general disaster management. They see themselves that the disaster however imposes a sudden unexpected burden on the existing health services which prove incompetent to tackle such emergencies effectively since they are basically meant to provide the routine medical/health care to the community under their care during peace time/normal time. The communication channels are disrupted miserably and they learn how to reach the people who are under distress. They learn that outside medical assistance during disaster and in post disaster period is must. The assistance can be from within the district/state/ country and even international assistance depending upon the degree of damage caused.
Usually at a district level the Civil Surgeon and the District Health Officer along with their subordinate staff i.e. Medical Officer Incharge PHC/dispensary of affected area, implement the District Relief Plan, prepared and kept ready always in advance.
When the existing health infrastructure cannot cope with the extra workload, staff from adjoining health centers as well as state health services has to be mobilized for the medical relief work. Even this may not prove sufficient sometimes and extra help may be required from the nearby medical colleges and hospitals during different situations eg. Floods, famines, earthquakes, refuge relief work etc. The involvement of medical undergraduates, interns and P.G students including lady medical interns proves invaluable at many occasions. The floods of 1995 in Rohtak are a relevant experience where about 100 junior doctors of PGIMS Rohtak participated in medical relief work organized by Haryana Gyan Vigyan Samiti, a non governmental voluntary oraganisation.
The Medical relief work involves various activities such as :
1. Running an OPD for the patients
2. Attending indoor patients in temporary hospitals in schools/chopals/tents.
3. Rendering First Aid.
4. Treating of various kinds of emergencies.
5. Immunisation.
6. Keeping a watch on food and milk supply.
7. Ensuring supply of safe drinking water.
8. Imparting of health education.
9. Motivating people to participate in the relief work.
10. Make amendments and adjustments according to specific local needs.
11. They are exposed to experience of different preventive measures.
Hence it is strongly recommended that disaster management should become the part of undergraduate curriculum so that the under graduates and interns have a theoretical backup in this field when they are exposed to manage any disaster (during and post disaster period).
in
Disaster Management
Dr. R.S. Dahiya
Introduction:
Hardly a day now passes without a disturbing news about a major or complex emergency happening in some part of the world. Disasters continue to strike and cause destruction in developing countries specifically and the developed countries as well, raisin peoples concern about their vulnerability to occurrences that can gravely affect their day to day life and their future.
There is no doubt that remarkable progress has been achieved not only in the field of science and technology but in all spheres of human activity particularly during the current century. But unfortunately the same progress has been exploited to produce agent of mass destruction such as nuclear, chemical and biological weapons, capable of wiping out all the achievements made so for with in a matter of minutes. The floods and the draughts are also many times because of mismanagement. Even the science and technology has developed to a level where the houses can be made to bear with the earth quakes and cyclones.
There is a growing trend of various forms of disasters in the world. Number wise in 1998 alone, there were 74 major floods, 5 cyclones, 17 earth quakes, 18 draughts and 162 major accidents the world over. During the period of 1960 to 1989, our own country experienced a total of 191 disaster events of various types resulting into 1, 51, 179 deaths; 2,11,535 injured persons and 174,28,72,678 people were affected one way or the other.
All disasters can be broadly classified into two major categories.
A. Natural disasters such as earth quakes, floods, draughts, cyclones and volcanic eruptions etc.
B. Man made disasters which may be
· Intentional (Unconventional war fare, Civil strife, floods, droughts, etc.)
· Non intentional (industrial accidents eg. Bhopal gas Tragedy, Chernobyl Nuclear Plant disaster etc.)
The man made disasters are totally preventable provided there is will and the non intentional disasters can be prevented to a long extent .
C. Ecological disasters
v Oil Spills
v Air, water and soil pollution
v Desertification
v The green house effect
v Environmental degradation
v Refugees besides nuclear, chemical ,and biological catastrophes
These are man made and require determined, concerted efforts to prevent them.
Objectives are:
Ø To visualize preventive measures
Ø To reduce the loss of property
Ø To achieve international solidarity
Ø To achieve inter- sectoral cooperation
Ø To achieve community participation
Ø to achieve greater involvement and dedicated participation of medical and health personnel
This paper deals with the last objective.
How to really involve medical and health personnel with dedication during and after the process of disaster is over, is a serious issue. There are certain riders in the way of active and participatory involvement of these sections. Without addressing these challenges, the real involvement will be a far distant dream.
You can force a horse to go to the pond but you cannot force him to drink. The basic challenge is that they might not have been exposed to such situations earlier. Their orientation to deal with such situations may be weak. Many a times their motivation may be weak. Their working conditions may be worst etc. because of which their sensitivity towards human beings in general is eroded. Many times the interns are having a self alienation. Overall erosion of human values and domination of market values is a big rider. This cannot be inculcated overnight. Hence a selection is required. Those who volunteer for the job should be considered first.
Many times the things are expected from the private sector health personnel where has they have left this role in the market driven society.
The basics of disaster preparedness and management should be included in the under graduates syllabus. The involvement of undergraduates and interns in tackling various emergencies and in post disaster relief activities of health should be well planned and also be included in the curriculum.
While providing medical relief to disaster affected people under graduates and interns learn many things. They observe and treat cases; know about the principle of Triage while handling mass casualties; learn how to treat cases with optimal drugs and limited facilities; how to deal with the psycho-social- cultural problems and their impact on health; how the records of various activities are maintained and what is their significance in regular surveillance and monitoring of information to higher authorities.
They also learn that medical relief is integral to general disaster management. They see themselves that the disaster however imposes a sudden unexpected burden on the existing health services which prove incompetent to tackle such emergencies effectively since they are basically meant to provide the routine medical/health care to the community under their care during peace time/normal time. The communication channels are disrupted miserably and they learn how to reach the people who are under distress. They learn that outside medical assistance during disaster and in post disaster period is must. The assistance can be from within the district/state/ country and even international assistance depending upon the degree of damage caused.
Usually at a district level the Civil Surgeon and the District Health Officer along with their subordinate staff i.e. Medical Officer Incharge PHC/dispensary of affected area, implement the District Relief Plan, prepared and kept ready always in advance.
When the existing health infrastructure cannot cope with the extra workload, staff from adjoining health centers as well as state health services has to be mobilized for the medical relief work. Even this may not prove sufficient sometimes and extra help may be required from the nearby medical colleges and hospitals during different situations eg. Floods, famines, earthquakes, refuge relief work etc. The involvement of medical undergraduates, interns and P.G students including lady medical interns proves invaluable at many occasions. The floods of 1995 in Rohtak are a relevant experience where about 100 junior doctors of PGIMS Rohtak participated in medical relief work organized by Haryana Gyan Vigyan Samiti, a non governmental voluntary oraganisation.
The Medical relief work involves various activities such as :
1. Running an OPD for the patients
2. Attending indoor patients in temporary hospitals in schools/chopals/tents.
3. Rendering First Aid.
4. Treating of various kinds of emergencies.
5. Immunisation.
6. Keeping a watch on food and milk supply.
7. Ensuring supply of safe drinking water.
8. Imparting of health education.
9. Motivating people to participate in the relief work.
10. Make amendments and adjustments according to specific local needs.
11. They are exposed to experience of different preventive measures.
Hence it is strongly recommended that disaster management should become the part of undergraduate curriculum so that the under graduates and interns have a theoretical backup in this field when they are exposed to manage any disaster (during and post disaster period).
The Virus of Communalism: What will be our response?
INDIA 2002: DESPAIR
" Where the mind is filled with fear and the head cowers in terror,
Where knowledge is communalized and commercialized,
Where the world has been broken up into fragments by narrow domestic walls
of caste, class, religious faith, ethnicity and occupation,
Where words come out from the superficiality of untruth, contrived, misinterpreted,
Where tireless activity stretches its arms towards promoting hate, avarice and fear,
Where the clear stream of reason has lost its way in the dreary desert sands of dead habit
And the stormy winds of communalized frenzy,
Where the mind is closed and stunted by ever widening circles of hate and despair,
Into ever widening chasms of strife and destruction,
Into that hell of bondage why hast thou let my country descend?"
-With Apologies To Rabindranath Tagore
Adapted From Geetanjali)
First they came for the Dalit
And I did not speak out because I was not a Dalit,
Then they came for the Adivasi
And I did not speak out for I was not an Adivasi,
Then they came for the Muslims
And I did not speak out because I was not a Muslim,
Then they came for the Sikhs
And I did not speak out for I was not a Sikh,
Then they came for the Christians
And I did not speak out because I was not a Christian,
Then the they came for the Secular Hindu
And I did not speak out for I was not a secular Hindu,
Then the came for the Social Activist who worked for the Poor or Marginalized,
And I did not speak out because I was not poor or marginalized.
Then they came for me
And there was no one left to speak out for any one,
No Dalit, no Adivasi, No Muslim, No Sikh, No Christian, No Secular Hindu,
No Social Activist
No poor or marginalized. No me....
R.S.Dahiya
INDIA 2002: DESPAIR
" Where the mind is filled with fear and the head cowers in terror,
Where knowledge is communalized and commercialized,
Where the world has been broken up into fragments by narrow domestic walls
of caste, class, religious faith, ethnicity and occupation,
Where words come out from the superficiality of untruth, contrived, misinterpreted,
Where tireless activity stretches its arms towards promoting hate, avarice and fear,
Where the clear stream of reason has lost its way in the dreary desert sands of dead habit
And the stormy winds of communalized frenzy,
Where the mind is closed and stunted by ever widening circles of hate and despair,
Into ever widening chasms of strife and destruction,
Into that hell of bondage why hast thou let my country descend?"
-With Apologies To Rabindranath Tagore
Adapted From Geetanjali)
First they came for the Dalit
And I did not speak out because I was not a Dalit,
Then they came for the Adivasi
And I did not speak out for I was not an Adivasi,
Then they came for the Muslims
And I did not speak out because I was not a Muslim,
Then they came for the Sikhs
And I did not speak out for I was not a Sikh,
Then they came for the Christians
And I did not speak out because I was not a Christian,
Then the they came for the Secular Hindu
And I did not speak out for I was not a secular Hindu,
Then the came for the Social Activist who worked for the Poor or Marginalized,
And I did not speak out because I was not poor or marginalized.
Then they came for me
And there was no one left to speak out for any one,
No Dalit, no Adivasi, No Muslim, No Sikh, No Christian, No Secular Hindu,
No Social Activist
No poor or marginalized. No me....
R.S.Dahiya
CORRPORATE RULE AS A THREAT TO WORLD HEALTH
CORPORATE RULE AS A THREAT TO WORLD HEALTH
Dr. R.S. Dahiya
The medical fraternity and the people at large are on cross roads that what has happened to the health of people at large? The people have lost faith in the medical profession. to improve the relationship of people at large with medical profession and their health, for the last 10-15 years many prescriptions like selective Primary Health Care, Structural Adjustment Programme, World Bank’s take over of the Third World Health Policy and the McDonalization of WHO and UNICEF have been advocated. In reality all these steps are in a way assaults on Primary Health care as conceived in Alma Ata and are manifestations of the dominant “free market” paradigm of development. As undemocratic as it is unsustainable, it promotes economic growth of the rich regardless of the human and environmental cost.
The present model of economic development is dependent on ‘market system’ and is very much dangerous to health. It is quite evident when we consider the impact of its biggest industries. In economic terms, the World’s three biggest industries are :
1) Military/ arms
2) Illicit Drugs
3) Oil.
All three of these biggest Industries are posing far reaching daggers to the sustainable well being of humanity and the planet as such.
These big industries or the corporate sector puts lot of money in elections of different countries and the people, who get elected with their support to these public offices, undermine democratic process. This impedes humanity from taking decisive steps to rein in the biggest emerging global human threats to human health, such as global warming, the pending third world war, the deepening poverty of one third of humanity, the global pandemic of crime and violence and the disempowerment that leads to terrorism.
Rather than confronting the underlying causes of these globalised threats to health, the world chieftains- with their ties to the arms, drugs and oil industries use the current crises as a pretext to systematic role back of civil liberties and rights, public services and rein in on corporate greed. Ultimately, the health as a whole and especially of the last person in afar off place either in a remote village or slum area of a city is affected very adversely. The whole responsibility gets shifted to the medical professionals or paramedics who are working in that area. Today the people and the health services personnel are accusing each other for the ill health of the majority of the people. This is not true. The real culprits are these three corporate sector big industries and their greed, the govts. Of the states who succumb to the manipulations of these big industries and the people themselves who do not struggle against this misconception.
In sum, far from progressing towards health for all, humanity may currently be on a collision course towards Health for No One. It is time to collectively wake up and change course.
Dr. R.S. Dahiya
The medical fraternity and the people at large are on cross roads that what has happened to the health of people at large? The people have lost faith in the medical profession. to improve the relationship of people at large with medical profession and their health, for the last 10-15 years many prescriptions like selective Primary Health Care, Structural Adjustment Programme, World Bank’s take over of the Third World Health Policy and the McDonalization of WHO and UNICEF have been advocated. In reality all these steps are in a way assaults on Primary Health care as conceived in Alma Ata and are manifestations of the dominant “free market” paradigm of development. As undemocratic as it is unsustainable, it promotes economic growth of the rich regardless of the human and environmental cost.
The present model of economic development is dependent on ‘market system’ and is very much dangerous to health. It is quite evident when we consider the impact of its biggest industries. In economic terms, the World’s three biggest industries are :
1) Military/ arms
2) Illicit Drugs
3) Oil.
All three of these biggest Industries are posing far reaching daggers to the sustainable well being of humanity and the planet as such.
These big industries or the corporate sector puts lot of money in elections of different countries and the people, who get elected with their support to these public offices, undermine democratic process. This impedes humanity from taking decisive steps to rein in the biggest emerging global human threats to human health, such as global warming, the pending third world war, the deepening poverty of one third of humanity, the global pandemic of crime and violence and the disempowerment that leads to terrorism.
Rather than confronting the underlying causes of these globalised threats to health, the world chieftains- with their ties to the arms, drugs and oil industries use the current crises as a pretext to systematic role back of civil liberties and rights, public services and rein in on corporate greed. Ultimately, the health as a whole and especially of the last person in afar off place either in a remote village or slum area of a city is affected very adversely. The whole responsibility gets shifted to the medical professionals or paramedics who are working in that area. Today the people and the health services personnel are accusing each other for the ill health of the majority of the people. This is not true. The real culprits are these three corporate sector big industries and their greed, the govts. Of the states who succumb to the manipulations of these big industries and the people themselves who do not struggle against this misconception.
In sum, far from progressing towards health for all, humanity may currently be on a collision course towards Health for No One. It is time to collectively wake up and change course.
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