Category: Government Policy Update

Neuro and Spine

11 reasons why the current Indian caste based reservation system is out rightly illogical and should have no place in the modern Indian society

Recently the ruling Congress-NCP government in Maharashtra decided to accord 16% reservation for Marathas and 5% for Muslims in government jobs and educational institutions in a last-ditch attempt to woo these two categories of people following the parties’ pathetic performance in Lok Sabha elections. This again raises the same question which we have been choosing to ignore until now, when will this spiraling trend of increasing proportion of caste based reservations end?

Coming from a very moderate background, I have managed to achieve a lot in the prevailing adversity of the Indian caste based reservation system. Until now I have not complained but there has to be a point where you have to say ‘enough is enough’.These type of politically motivated actions are really demotivating and it makes me feel that our coming generation will really have to struggle hard to get quality education and rightful opportunities, if such actions don’t face a strong opposition right now. I am sure that majority of people reading this blog will also resonate with my concerns.

The whole logic of caste based reservations is wrong at so many levels. Below I discuss a few reasons why a caste based reservation system is out rightly illogical and should be discarded.

1. The term ‘backward classes’has not been clearly defined anywhere in the constitution.
What actually constitutes a backward class? What are the determinants of a backward class?  Since a clear definition is lacking, it is being utilized by politicians to lure vote banks.

2. Caste of a person is just a confounding proxy factor to ascertain the backwardness of an individual. 
Instead of a correct identification of actual backward classes, castes system has been conveniently adopted as a proxy without considerations of proper checks to insure the validity of elementary factors like poverty, literacy, occupation and place of habitation. 
3. The Indian caste based reservation system assumes the rest of the population belonging ‘General Category’have normal social indicators and no person is backward if he belongs to the so called‘General Category’!
There many economically worse off children belonging to the general category, many of them may be even living below poverty line; even then they cannot get the fruits of such reservation merely by virtue of belonging to the ‘general’ category. 
4. Currently there are no timelines for this social intervention! 
Once a caste is tagged as backward, for how many years it will continue receiving the preferential status? The roots of the current structure of caste based reservation system can be traced back to the report by the Mandal commission which was established in 1979 by the central government to identify the socially or educationally backward in India and suggest measures for their upliftment. Today, after more than 30 years of the Mandal commission and 60 years of republic India; how many castes have been revoked of their reserved status?
5. These policies have been in India since more than 30 years and they have failed to meet any objectives other than giving edge to some political parties.
The government should go into the reasons of the failure. Many students despite of their reserved status of their caste don’t make it to the institutes, so the real question is, is it actually their caste which is the variable for backwardness even after 50 years of the operational caste based reservation system.
6. There are no monitoring mechanisms to the caste reservation system of India. 
Once a caste is tagged as backward, what are the criteria to ascertain that backwardness is being alleviated by reservations? What are the indicators that are being monitored that the true beneficiaries are actually getting the benefits and false beneficiaries are not getting the benefits? 
7. No disclosure of influence on social indicators by the government. 
Since the caste based reservation system is a preferential distribution of opportunities that the nation is generating, the rest of the public has a right to know the influence on quarterly and annual basis. But there are no such mechanisms for reporting and monitoring of caste based reservation system.

8. Instead of genuinely alleviating the social inequalities, reservations programmes have a very clear electoral objectives.
Even a kid who has taken his first lesson in Social Sciences at school can understand the real motive behind the whole caste based reservation system in India. That is why almost always we hear the new castes being included in the reservation pool just before the elections, how coincidental is that? Currently 49.5% of the seats in premier institutions are reserved for backward categories. This is more than 60 % in some states like Tamil Nadu and now Maharashtra is heading towards 73% after the decision by the ruling Congress-NCP government to give 16% reservation to Marathas (Not a minority, Not backward) and 5% reservations for Muslims (Religion based reservation, Unconstitutional)!

9. There is a complete skewing of the distribution of seats and opportunities in the population towards a few preferential reserved castes.
A reserved candidate can opt for both an open seat and a reserved seat. In a case if both seats are available to the reserved candidate, open seat is allotted first. On the other hand an unreserved candidate can only opt for an open seat. But since many of these have already been allotted to meritorious reserved candidates, they are not available for open category candidates. In some states which are providing up to 70% reservations, the proportion of candidates from reserved castes in the opportunity pool reaches up to 95% (including the meritorious students in the reserved castes), completely neglecting  the representation of rest of the population creating a sort of caste based oligopoly. 
10. By current policies it is even justified for the creamy layers to take the benefits meant to alleviate the backwardness!
This ‘creamy layer’ policy excluded the creamy layer (people with income above a certain range) only among the OBCs, not among the SCs and STs. This creamy layer policy has only been implemented in some states.
11. Some individuals consider this as the reversal of the oppression their ancestors have faced. 
There are two flaws in this logic. Firstly, the current social system has changed drastically as compared to its state decades ago, the hypothesis that certain classes are still facing oppression in terms of opportunities to grow is false in my view and should be retested. Secondly, there are many classes and sects which were not a part of the Indian caste system who have migrated to India due to partition or otherwise; are not they facing a sort of reverse oppression in the current scenario? They were neither a part of this so called historical oppression nor were they given any preferential opportunities but have managed to sustain, rising from scratch after partition.
The stance I have adopted is very clear, equality and equity is right of every individual in this country. By their very definition, the promotion of equality and equity are virtues which cannot be retrospectively applied but have to be strongly rooted in the present. In the current form the caste based reservation system may benefit a few individuals but there would be a great number of individuals who will enjoy the benefits without needing them. While there will be a set of individuals who are actually in need but are not  from the reserved categories who would fail to receive any benefit.  Instead of eliminating the caste based divisions, this mechanism is actually strengthening the existence of caste delineation in our society.
It will be very difficult to do away with this spiraling increase in the reservations term after term, since no party would out rightly deny the support to such a decision or oppose it in the fear of losing the vote bank. The ruling parties in many instances have even defied the Supreme Court judgement capping quotas at 50% by making amendments to the state laws. . Only solution I can think of is challenging such illogical decisions in Supreme Court or speak the language what the political outfits understand- the language of Votes! We should all take a note of parties and entities promoting and giving off reservations and take an informed decision while at the ballot to vote them out of power!

References
  • http://timesofindia.indiatimes.com/home/opinion/edit-page/Reservation-for-Marathas-and-Muslims-in-Maharashtra-might-backfire-on-Congress-NCP/articleshow/37268930.cms
  • http://www.youthkiawaaz.com/2010/02/our-fate-in-the-hands-of-reservations/
  • http://www.youthkiawaaz.com/2011/02/educational-reservations-india-solutions/
  • http://en.wikipedia.org/wiki/Creamy_layer
  • http://en.wikipedia.org/wiki/Reservation_in_India
The Arogyada
www.arogyada.in
June 27, 2014 / by drsandeep.net

What are the problems with the Indian healthcare system which the Modi government will have to tackle?

After a strong mandate the Modi government has received in general elections, everybody is having a lot

of hopes from the government.  They are hoping and waiting for transformatory changes and  strong steps to be taken in direction of revival of the Indian economy. Very soon we will be having a draft of intention of the Modi government in our hands in the form of the union budget. What kind of changes are we going to expect for the healthcare sector?

We have a Prime Minister who seems to be pro reforms and above all we have a new Health Minister, who is a doctor himself. Will this combination add up to some bold steps translating into results or are we going to have the same run of the mill actions which would lead to no substantial changes in the long run?

There are a lot of issues which have been left unattended in the past ten years which directly impact the current status and the future of healthcare in India. The time will tell which of these issues are attended by the Modi government and which are left to hang in the continuing limbo:

  • Still the India’s government spends only about 1% of GDP on healthcare (rest comes from the private)
  • India is one amongst the countries having highest out of pocket expenditures (ranked 17th, WHO 2011), resulting from lack of trust in government facilities & hospitals and lack of any universal coverage schemes 
  • The last health policy we have dates back to 2002, we should be hoping that the new government will come up with a new policy which will reset the current direction
  • Government health administrative machinery as a whole is a hyper-divided structure with overlapping actions and schemes 
  • For instance, health ministry is responsible for quality and public health, but pricing and manufacturing of pharmaceuticals is with Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers. Ministry of Consumer Affairs and Food regulates some of the aspects. The commerce ministry deals with various trade related issues, whereas Department of Industrial Policy and Promotion (DIPP) looks after patents.
  • There are also various regulators such as National Pharmaceutical Pricing Authority (NPPA), Food Safety and Standards Authority of India (FSSAI), Drugs Controller General of India (DCGI) and Patent Controller General of India monitoring different issues in the sector under different ministries.
  • There are no streamlined processes or guidance for approvals or dealing with these departments. The beneficiary party has to run pillar to post paying “cuts” at every step in all these departments for necessary approvals for healthcare & pharma businesses
  • NRHM, a flagship scheme started by central government also has had its own set of problems which range from problems with timely procurement of medicines & supplies to lack of staffing in rural areas.
  • The lead professional body MCI itself has been a source of corruption when it comes to approval of private medical colleges
We as medical professionals have seen the quality of medical education & quality of life of young doctors go from bad to worse in past ten years. This can be attributed to one or more of the following unending list of problems which medical professionals are facing these days.
  • Vote bank politics increasing reservations without substantial logic
  • Dwindling meritocracy
  • Archaic medical education system failing to promote skill development
  • Uncountable number of scams in the selection process & open sale of medical seats
  • Lack of any coordination between the centre & states over critical selection processes continuing from many years without any improvement 
  • Disparity in standards of medical education across various states and centre sponsored colleges
  • Medical colleges getting approvals without facilities & requisite staff; government colleges failing to maintain their quality standards
  • Over exploitation of junior doctors by both government & private employers in terms of overtime, low pay scales, lack of facilities & mammoth contract bonds making a viable living from hard to virtually impossible
  • The pay scales in specific, in many states have not seen any raise to cover inflation leading to declining quality of life of Government doctors 
  • Dwindling levels of academic activities and increasing  use of young doctors as bonded labourers to cover up shortage of nursing and paramedical staff in government hospitals (especially in states like Tamil Nadu)
  • Doctors on rural services face problems with their families like no arrangements for proper education, transport and residence along with workplace issues including poorly equipped, under staffed and poorly supplied healthcare facilities
Many young doctors discouraged by a sky high heap of unattended problems either choose to migrate to foreign soils or many of them are not choosing to practice at all and looking for profession change. 
This is very much apparent with the rising number of Indian applicants to countries like USA, Canada, Germany, Australia and Ireland.  
In addition to this, the medical professional profiles you happen to see these days are swaying in the direction of non-practice corporate jobs which offer a descent lifestyle to young doctors. For instance this blog alone gets 200-300 search queries each day from google inquiring alternative career options after MBBS. The majority of these corporate jobs are for pharma majors or service industry working for the US and other countries. 
Till the date, I have read that the new government is planning to formulate a new Health Policy, a program on sanitation and start National Health Assurance Mission (I guess it must be the brand name they would use to promote after making a few tweaks to the NRHM). They will also do the usual – promoting yoga in AYUSH. They plan to continue to establish AIIMS like institutions in all the states. 
Let’s have hope that the new government will also be looking into some of the issues discussed above and plan for some incremental steps in the right direction. 
References
  • http://www.business-standard.com/article/economy-policy/health-high-on-modi-s-agenda-114051900925_1.html
  • http://www.business-standard.com/article/politics/govt-to-bring-in-experts-to-implement-health-schemes-effectively-114053001429_1.html
  • http://timesofindia.indiatimes.com/india/Presidents-speech-highlights-12-key-points-of-the-Modi-government/articleshow/36309560.cms
  • http://presidentofindia.nic.in/sp090614.html
  • http://content.healthaffairs.org/content/25/2/380.full
The Arogyada
www.arogyada.in
June 16, 2014 / by drsandeep.net

The story of 10,000 new MBBS seats and the diminishing skills of budding Indian doctors

Recently the Union Cabinet approved a proposal for increasing nearly 10,000 MBBS seats at government medical colleges across the country. The financial allocation required for the additional MBBS seats was also cleared. The proposal is aimed at increasing the number of doctors to help bring down the doctor-patient ratio from the current 1:2000 to 1:1000.
From theoretical perspective this should be considered as a welcome move. But just increasing MBBS seats without increasing PG seats (Medical Specialty) is definitely gonna have big implications on the future of doctors who will be occupying these seats. 
A fresh MBBS graduate typically has limited skills and even if they are skillful they are usually not confident enough to practice independently. They usually have to work in hospitals to practice these skills and gain confidence. 
Low salaries are a big blocking factor to even think of settling down just after MBBS. And these fresh graduates find very limited usage in today’s modern hospital where their work is mostly limited to patient monitoring, ward rounds and night duties. Almost all of the decision making lies in the consultants’ hand. Owing to these factors, majority of fresh MBBS doctors actually do not start practicing after completing MBBS but they take a drop, join a coaching and prepare for PG entrance examinations. 

The system of PG entrance exam in itself is a immensely broken system with uncountable number of exams with each having its own pattern. Owing to the high number of graduates and less number of PG seats the competition is intense with approximately 10-15 MBBS graduates fighting for 1 PG seat! 
The preparation for PG entrance for most doctors lasts for 1-2 years (usually without practicing) which breaks the continuum and dilutes the clinical skills of our budding physicians.
Most of the Indian MBBS doctors can be seen in hospitals cramming, more interested in MCQ guides than taking care of patient on the bed side. And why is that?? Because none of the Indian PG entrance exam puts any stress on clinical skills, patient interactions or professional aspects of the practice.   
So in this mess, what do we need to do in the coming future?
-PG seats to be increased in the same proportion
-Pattern of entrance examination should be changed such that it favors practicing MBBS graduates who are actually doing the real clinical practice. As William Osler said – “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all”
-There should be knowledge and technical support initiatives from MCI, State Governments and the Central Government  to help the MBBS graduates to establish their own clinics. This will have lasting impacts on both equitable distribution and easy access to healthcare  
The Arogyada
www.arogyada.in
January 24, 2014 / by drsandeep.net

Cancer death rates: US vs India

Cancer is a rampant public health problem globally. There is an interesting emerging global trend in Cancer incidences  and death rates. While the rates are decreasing in the United States and many other western countries, they are increasing in less developed and economically transitioning countries[1]. Taking in perspective US and India, this trend is apparent from recent National cancer projections.

A recent report by American Cancer Society (ACS) published on January 17th 2013, revealed that overall cancer deaths in US have declined by 20% since their peak in 1991. The report notes that cancer deaths rates have fallen from 1991 (their peak) to 2009 (the most recent figures available), decreasing from 215.1 to 173.1 per 100,000 [2].

However looking at the current trends in India, it has been projected that the total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020 [3].
The latest available figure of cancer death rate is from national representative study conducted by Tata Memorial Hospital in 2001—03 [4]. The Age-standardised cancer mortality rates per 100 000 were: Rural- M=95·6  F=96·6 and Urban- M=102·4 F=91·2.

Taking cancer seriously and taking public health measures for prevention and early detection has started paying dividends for US. While in India we are walking the same path already travelled by the developed nations;  by failing to stop the adoption of unhealthy western lifestyles such as smoking and physical inactivity and consumption of calorie-dense food.  Measures in the form of awareness creation, prevention and early detection are required to cut this trend.

[1]  Ahmedin Jemal, Melissa M. Center, Carol DeSantis and Elizabeth M. Ward : Global Patterns of Cancer Incidence and Mortality Rates and Trends
[2] Rebecca Siegel MPH; Deepa Naishadham MA, MS; Ahmedin Jemal DVM, PhD : Cancer Statistics 2013 (CA: A cancer journal for clinicians)
[3] Ramnath Takiar,Deenu Nadayil,A Nandakumar : Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups
[4] Rajesh Dikshit, Prakash C Gupta et al. : Cancer mortality in India- a nationally representative survey

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The Arogyada
www.arogyada.in
January 21, 2013 / by drsandeep.net

TB Control on Indian Government’s Radar

While, the country’s annual health budget is set to increase by a meagre 13% this year, the Planning Commission has decided to raise allocation for the TB control programme to about Rs 710 crore for 2012-13. This amounts a whopping Eighty percent increase in the RNTCP budget.

In 2011-12, the programme had received Rs 400 crore. The Revised National TB control programme (RNTCP) had demanded around Rs 936 crore for 2012-13. But it will get around Rs 710 crore.

According to the 12th Plan document for TB control, for the period 2012-2017 – Anti-TB drugs alone are projected to cost Rs 1,797 crore, of which 62% is for costly second-line MDR TB drugs that such patients are otherwise unable to afford themselves.

Some TB stats

India accounts for about one fifth (21%) of TB’s global incidence, or an estimated 2 million cases of which around 0.87 million are infectious cases..

The Annual Risk of TB Infection (ARTI) is
1.1% and prevalence is around 266 per lakh population in 2010.

The four countries that had the largest number of estimated cases of MDR-TB in absolute terms in 2008 were China (100,000), India (99,000), Russia (38,000) and South Africa (13,000).

Tuberculosis trails behind only HIV as the world’s leading cause of death from infectious disease. (But its an irony that in spite of its impact on human health and economic growth, it has not ranked among the pharmaceutical industry’s priorities.)

About RNTCP

The revised strategy was pilot-tested in 1993 and launched as a national programme in 1997. By March 2006, the programme was implemented nationwide in 633 districts, covering 1114 million (100%) population.

Phase II of the RNTCP started from October 2005, which is a step towards achieving the TB-related targets of the Millennium Development Goals. Since 2006, RNTCP is implementing the WHO recommended “Stop TB Strategy”, which in addition to DOTS, addresses all the newer issues and challenges in TB control.

The objectives of RNTCP are:
  • To achieve and maintain at least 85% cure rate amongst New Smear Positive (NSP) pulmonary TB cases.
  • To achieve and maintain at least 70% detection of such cases.
References:

WHO India
Nature News

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The Arogyada
www.arogyada.in
March 6, 2012 / by drsandeep.net

A smart approach to public health (Courtesy : The Hindu)

The health insurance scheme for unorganised workers launched by the Government of India holds the potential to effect a socio-economic change of far reaching significance. The Rashtriya Swasthya Bima Yojana (RSBY), launched formally last year, will provide coverage for the families of the unorganised sector workers below the poverty line. What distinguishes this from other social schemes is the application of user-friendly information technology. The scheme provides cashle ss health insurance cover up to Rs.30,000 for all the eligible families. The smart card, which provides for the cashless transactions, and can be used anywhere in the country, has the potential to open the doors of healthcare facilities to millions of the poor. It also offers a choice between public and private healthcare. The RSBY aims to cover an estimated six crore BPL families, at one lakh per district, over the next five years. The programme, which covers costs of hospitalisation for a range of illnesses, is bound to change the lives of poor workers who are outside the ambit of even minimal social protection by bridging gaps in access to healthcare facilities. Seen in the larger context of high out-of-pocket expenses for healthcare in India and the low incomes of the unorganised sector workers, the use of technology presages major changes in how India addresses social security.

Reaching the benefits of welfare schemes to the deserving people is one of the most problematic areas of development. The introduction of the smart card technology, together with other efforts to improve medical infrastructure, could be an effective way of addressing inequities in access to healthcare. There are caveats, however. For the successful implementation of the RSBY, built-in safeguards are as crucial as the manner in which state and private healthcare providers attune themselves to the new technology. For instance, measures are needed to curb the temptation of hospitals to resort to an overuse of medical tests, taking undue advantage of the insurance cover. In the long term, as the scheme takes root and the States share experiences, policy-makers could explore the possibility of extending the range of such welfare measures. As implementing welfare schemes gets easier with technological applications, it is equally important to check abuses and leakages that short-change the poor. Smart card technology, if used imaginatively, can help in the move towards meaningful social security, a goal that has so far proved elusive.

The Arogyada
www.arogyada.in
December 7, 2008 / by drsandeep.net