Monthly Archives: October 2012

A sickly health mission

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The district of Gadchiroli in Maharashtra, better known for deaths from conflict between CRPF forces and the Naxalites is also home to the Madia Gond, one of India’s oldest tribes and most vulnerable to the worst manifestation of malaria – celebral malaria. The Primary Healthcare Centres (PHC) that should to serve the hamlets is not functional.

This story seems a paradox of sorts when the National Rural Health Mission and the recent Srinath Reddy report suggesting Universal Health Care target inclusion in health facilities. Is there a need to look deeper?

Image source: UNICEF

Public health in its present form can be traced back to the 1943 Bhore committee, under Joseph Bhore which recommended a framework to develop a free-access network of hospitals and health centers around the country.  This model failed due to a lack of funds.

Current public health commitments took shape in a 1978 WHO conference called Alma-Ata in Kazakhstan. It declared the prospect of ‘Health for All’ by 2000 and held that health was a basic human right. The declaration also relied on ‘political will’ to mobilize a country’s resources. However, as Dr. Binayak Sen points out “The authors of the declaration have worked out one mighty shotgun burst of social engineering and left one lonely cowboy called “political will” to pull the trigger.”

The Alma-Ata declaration was replaced by the Millennium Development Goals (MDGs) in 2000. In order to achieve uniform health care facilities by the year 2015, the United Progressive Alliance government began its National Rural Health Mission (NRHM) in 2005.

At its core, the NRHM focuses on the MDG of reducing infant and maternal mortality. It also aims at more power to the panchayati raj. Public-private partnerships (PPPs) in the rural health sector were encouraged to increase the flow of funds, along with a provision for health insurance. In 2010, the proportion of GDP spent on health was 4.1 per cent, according to the World Health Organisation – a considerable increase from the 2008 figure of 1.2 per cent.

However, the NRHM is plagued with as many problems as India’s villages. Shyam Ashtekar, in a 2008 article says “The utilisation of NRHM funds in states is both tardy and ineffective.”

Dr. Sen outlines the major health problems faced by India’s villages including chronic hunger (BMI of a third of Indian adults is below 18.5 per cent according to the National Nutrition Monitoring Bureau), anaemia, maternal mortality due to intra-uterine malnutrition and poor sanitation resulting in numerous infectious diseases.

The inability of the Indian health infrastructure to tackle such a wide range of problems may be attributed to an ailing NRHM, dysfunctional public-private partnership and excessive dependence on imported vaccines.

First, for the NRHM’s main function of reducing infant and maternal mortality, ASHAs or Accredited Social Health Activists programme was implemented, to encourage institutional births against traditional home delivery.

ASHAs escort expectant mothers to a public or private hospital for which both ASHAs and the mother are given incentives. However, as Ashtekar points out, the ASHAs have been reduced from a ‘committed worker’ to a ‘lackey of the system’.

The ASHA system also tries to edge out the Dais or traditional midwives. With most women still favoring the dai system, by not providing them support, infant and maternal mortality rates could rise.

PPP in public health has found support as a “practical solution for the dismal state of national health”, according to Ashtekar or criticism as Binayak Sen displays its exploitative nature in states like Chattisgarh where nearly two million dollars was spent to set up a private heart care centre at the Raipur Medical College.

A third aspect of the NRHM is the dependence on imported vaccines. Sen says that India’s capacity of manufacturing vaccines was one of the most advanced in the world; instead India has been reduced to importing vaccines for one-sixth of its population.

The structure of the NRHM makes it dependent on the people who staff it, people who are grossly underpaid. The number of doctors in rural centres is dismally low.  As Ashtekar states, “The annual salary given to doctors is so low (Rs 12,000-18,000 per month) that it acts as a deterrent to the commitment of the doctors.”

The NRHM was aimed for completion this year, with a considerable improvement in levels of hygiene, nutrition, sanitation and drinking water, but this promised architectural correction in the basic health care system has not been achieved. Further, in the seven years of the NRHM, the scheme has received bleak coverage in mainstream media – a horrifying trend.

 

 

 

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Barren

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The earliest memories of childhood, I recall, were a gulmohar tree in full bloom, the petals of its deep red flowers strewn on a dark tar road, the smell of freshly made ghee and a hot, sweltering summer afternoon in Madras. In the background, The Beatles, Boney M, Abba and Queen would belt out one legendary song after another, from my grandpa’s most precious LP collection. He would often say these records and the gramophone were his only possessions in life.
We would have lunch, cooked by my great grandmother and I would look forward to one of the best rewards childhood pampers you with- parippu chadam, with a generous serving of ghee. In what seemed an eternity to my great grandmother, the rice on my plate would assume the shape of a mountain, with a hole in the middle to allow a small serving of rasam. Then, the mountain would break, a portion of the food would go down my throat and I’d begin building the mountain up again.
Lunch was followed by a narration of the Ramayana (I remember never liking the Mahabharata). Uncomplainingly, character by character, my great grandmother would break it down and repeat those parts that delighted me, for instance Hanuman burning down Lanka with his tail. Bama, as I used to call her, would humour me by repeating it as many times as I liked.
Now, it was time to summon Baba, my grandfather’s attention, the highlight of my day. A big, green book with pictures of sea creatures fascinated me. Baba would meticulously read out the characteristics of each creature and then quiz me. He would point out to the blue whale, the shark and starfish, and my only answer was ‘Octhopusssss’! The drill would go on, everyday, for half an hour.
Baba introduced me to the computer, an old, basic system in those early days of technology. I’d type away violently with one finger, on a white keyboard, with faded keys, long words with no meaning. In his characteristic, typically patient manner, he would wiggle his bent little finger at me. “When will you learn to type with both hands?”
Bama and Baba were like mother and father to me, till my parents came back home from work. They taught me the essential values of life, and in seeing how they, despite their age, ran behind me made me more sensitive to the goodness in them, to how much respect I ought to give them, and to generally the goodness in people.
Baba succumbed to cancer, a night before the new millennium – an event he wanted to witness, even if it were his last. Bama passed away silently in her sleep – a testimony to the silent fighter that she, a child widow, who fought societal norms to become one of Chennai’s best physics academics – had always been.
I did learn eventually that the sea had more than just the octopus, that Hanuman wasn’t the only character in the Ramayana, that the Mahabharata exudes what life is, though through bad deeds. And I did learn to type with both hands.
Their passing however, did not elicit the slightest feeling from me. I wasn’t too young to realize the enormity of death. I was old enough to realize that their absence had created a huge vacuum in my head, an emptiness that haunts me even today. Yet, I did not cry.
I used to pride myself for crying very little all through life. I thought it to be the biggest asset in my life, as a journalist, the ability to withstand pain. However, with growing up comes maturity and with maturity, the realization of feeling.
Over a decade later, it is rather too late to weep their loss, but what gives me strength is knowing that those lessons of childhood, the values learned on a hot Madras afternoon, with mountains of parippu chadam and a big green book, will continue to guide me throughout life.

An Arab Winter

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“Every revolution evaporates and leaves behind only the slime of a new bureaucracy.”

Franz Kafka

 

Kafka’s belief has only been reinforced by the West-influenced Arab Spring. As the Arab spring enters its second winter, questions have been raised about the validity of the Arab Spring – did it even exist?

Is the game really over?

The fog surrounding the revolution has been supplemented by a tendency to fit every event into a framework. Over the last two years, analysts and academics have perceived the Arab revolution through concepts like neo-imperialism or colonialism or globalisation and have viewed it within these frameworks to add dimensions. Bessma Momani, senior fellow at the Centre for International Governance Innovation says in an article in The National, “People were not living in isms.”

A common framework of the Arab spring is that of imperialism. On March 19th last year, a multi-state coalition began military intervention in Libya on the pretext of protecting civilians and establishing a democracy, which has been pointed out by neo-imperialist experts as largely motivated by Libya’s oil reserves. Soon, the coalition of Belgium, France, UK, US, Canada, Denmark, Italy, Norway, Qatar and Spain grew to 19 countries. That oil reserves motivate the intervention seems obvious.

The National Transitional Council (NTC), formed from among those who rebelled against the Gaddafi regime in Libya only helped foster these imperial interests. The forces of rebel commander Abdelhakim Belhadj were given air-support by NATO troops to free Tripoli – the same Belhadj who in the 1980s was active in Afghanistan with the mujahideen, in the 1990s, plotted Gaddafi’s assassination and even worked with the al-Qaeda in acquiring funds for arms and in 2004 was arrested by the CIA and handed over to Gaddafi.

The West’s noble ‘transition to democracy’ intervention was completely absent in Egypt or Tunisia. An editorial in the Economic and Political Weekly asks if the lack of intervention in these countries can be attributed to their anti-imperialist, welfare-state anti-Saudi regime and pro-Palestine stance.

 A second frame is that of the idea of a democracy, according to which the Arab spring is a movement to democratize the Arab nations. It started in January 2011 when Mohammed Bouazizi, a graduate in Tunisia set himself ablaze protesting against unemployment and corruption. The graduate, who was unable to find a job, tried setting up a fruit shop when police officers forced him to pay a bribe. It was the Arab spring when the Tunisian president fled to Saudi Arabia, giving up his stake to rule. It was the Arab spring when Cairo erupted in protest against Hosni Mubarak, and when, 18 days later, Mubarak stepped down after 30 years of autocratic rule.

Is it, however, the Arab spring when the people’s power has only yielded another form of dictatorship? As Alia Allana, author of ‘Arab Spring’ puts it, “The Egyptian, Yemeni and Libyan cases have brought the sweetness of the Arab Spring into question. There has been no fundamental shift in power; people’s power has failed to replace the old system where powerful generals continue to preside over power in Egypt and thugs run Libya into the ground.”

Egyptian President Mohammed Morsi has since disempowered the Egyptian military which took away most of his presidential powers soon after he was voted president. As the Spiegel International described it, Morsi’s ordering of seven top-level officers to retire and replacing them with younger ones was a “well-timed, politically clever move.” The military did not rebel against the President’s orders, which gives rise to the question of whether Morsi’s new power, backed by the Muslim Brotherhood is a step towards an Islamist state in Egypt.

The Arab revolution can also be viewed through the crisis in Syria where Assad hopes to restore a pre-revolution situation. As Lakhdar Brahimi, the UN peace envoy to Syria revealed to the United Nations Security Council, “The situation in Syria is dire and getting worse by the day… There is a stalemate; there is no prospect today or tomorrow to move forward… I refuse to believe that reasonable people do not see that you cannot go backward, that you cannot go back to the Syria of the past.”

In a population of 22 million, out of which the youth (under 30 years) constitute 66 per cent, 16.5 per cent are unemployed. The prolonged civil war in the country has also led to severe food shortage, along with several human rights violations. A Human Rights Watch Report earlier this month revealed rampant ill-treatment of detainees by the opposition, including a dozen extra-judicial killings in Aleppo, Latakia and Idlib. Worse, there seems to be no way forward.

Finally, the fourth frame is that of the Free State. Ed Hussain, author of ‘The Islamist’ and senior fellow for Middle-eastern studies at the Council on Foreign Relations draws an interesting correlation between establishing a democracy and being one. “The fall of dictatorships does not guarantee the creation of free societies. The Arab uprisings have overthrown tyrants in Egypt and Libya, but the populations and lawmakers have yet to grasp that democracy is not only about free elections but creating free societies”, he says.

In light of recent events across the Arab nations, Hussain’s point is a strong one. An American embassy was bombed in Libya on September 11, killing Ambassador Chris Stevens and three others; women were sexually assaulted on the streets of Egypt in June this year, when they marched in protest of sexual assault of women in their ‘new Egypt”; and national heritage sites have been looted and destroyed in Syria, some of which are now used to store weapons.

A Tunis court fined a TV channel in October 2011 for airing Persepolis, an animated French film on an outspoken Iranian girl. The court fined the channel head Nabil Karoui for “spreading information which can disturb public order”. An Amnesty International describes the ruling as “a sign of the continuing erosion of free speech in Tunisia”

Earlier this month, a satirical French cartoon of the Prophet in the weekly Charlie Hebdo led to an outburst of rage among many groups in the Middle-East. Further, this chaos of rage has been effectively exploited by radical Islamists and governments for political ends.

Despite successful democratic elections in both Egypt and Tunisia following the revolution, there seems to be a resistance to the basic values of a democracy like equality in the case of Egypt’s women and free speech in the case of Tunisia. As Ed Hussain writes, “It is hard for younger Arabs not born into freedom to understand how individual liberty works in real life.”

There has, however, been significant opposition to the presented view, most of which arise from observing the revolution without a frame. In a seething article in The National, Bessma Momani, states that the “Arab Spring was about people who said enough is enough.”  According to him, these frames and structures were non-existent in the minds of the protestors. They simply wanted freedom from oppression.

 Simply put, the counter argument suggests that the Arab spring is a movement that demanded basic necessities – employment, increased standard of living, efficient utilization of the people’s education and qualification and a sense of ownership of national wealth from their oil reserves. As Momani puts it, the structures were only assigned later.

The Arab uprisings resounded with the concepts of freedom and liberty – both of society and State. The struggle of the people over two years seems to have been corrupted by seemingly trivial conflicts. Whether viewed within a frame or outside it, does the real Arab spring lie in the construction of a free, stable State that the Arab people envisioned?