THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS, PAPERS 8 TO 11 MARCH, 1990 BANGALORE
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- THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS, PAPERS 8 TO 11 MARCH, 1990 BANGALORE
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CO Al H 3vl
RF_COM_3H_3_SUDHA
' COM*®”1”1'
pEING HEALTHY
. 5S0
(or)
HEALTH FOR ZiLL - NOW
INTRODUCTION
:
The single most important need for all of-us is good health.
It is more important to us than all the wealth in the world.
It
is true that all of us living must eventually die-but while we live
if we must be tn a position to enjoy our lives and live to the
fullest extent.
we must be healthy.
•
Ill health and disease also
leads to premature deal th for drores of our people.
While in
many countries of the world a child bom can expect to live on
an average for 75 years or more an Indian child can expect to
live for only 57 years.
While in many, countries of the world
for every 1000 children born less than 10 will die in the first
year of life,
in our country almost 100 will die within one year-
more than one in every ten.
e
Even this figure does not tell the rruth for it as an
average of the rich few and the many who are poor,
The poor
have a for worse situation and die far more easily than the rich.
Zind more importaat such figures hide the fact that while they
live, the poor suffer from repeated attacks of disease and their
grouwth and development is so stunded both physically and
mentally that they can never live fully.
WHAT IS HEALTH ?
’’Health is not the mere absence of disease.
Health is
a state of complete physical, mental and social well-being”
(Definition of Health by World Health C rgani sation).
What
is it that our beirjg healthy depends on?
Being Healthy depends essentially on our having adequate
food to- eat,
safe water to drink,
a clean environment to live
in, proper employment and proper leisure,
It is these five
components that are essential to. health.
HUNGER s
It is meaningless to talk of good health when most of
«
:2s
people who die of hunger are .seen ‘as dying of some disease or
the other.
illness.
a
body weakened by hunger is a prey to every passing
A mild diarrhoea,
an attack of measles,
a chest infection,
a fever - which in a normal healthy person would be only a few days*
inconvenience that would go away by itself, is enough to kill a
Thus it is that the
maln.ouri shed person especially children.
commonest c'ause of death of children are conditions like respiratory
(chest) infection, diarrhoeas, measles, . all of which need sever have
caused death at all but for the malnouri shment.
Malnourishment also leads to a stunting of the physical
growth of the child, so that it can never realize its potential,
(The average weight of the Indian rural male is as low as 44*Kg.
while of the female is only 40 Kg.).
The root causes of malnutrition lie in poverty - in the
inability of our people to purchase the food they need. There
is,
except on occasions, no true .scarcity of food.
Indeed our
country grows enough food - even to export if necessary.
And
if needed we have the capacity and the knowledge to produce
much, much more.
A BALANCED di ET:
Is malnutrition caused by lack of knowledge about the type
of food to be eaten? Scientists say that a proper^ diet - a
balanced diet for an average Indian must include adequate staple
grain like rice or wheat or jowar,
include about 170 gms.
nil,
and adequate pulses.
It must
about 65 ml. of fats and
of vegetables,
55 gms. of sugar and at least 250 ml. of milk or equivalent
value of meat,
fish or eggs.
If a person has all this he needs
np special health foods, no tonics to maintain his health,
is the best tonic.
Food
Grains like rice or jowar or wheat is the main food,
It is the
chief supplier of energy for the body,
The fats and oils are als*
a rich source of .energy and especially in children they are
import an t. as the stomachs of childern are small and they cannot
eat tco much of just rice or wheat.
Fish, meat,
eggs and milk
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Other than these the body also need small amounts of
substances called vitamins.
Carrots, mangoes,
leafy vegetables,
and fish, meat especially the liver are good sources of Vitamix-A
a substance essential for- our eyes & skins.
major cause of blindness in India.
.Fish,
Lack of this is a
fruits & vegetables
*are a good source of Vitamin-C, especially lemons, guavas,
amla.
Even green chilies & other fr.-sh vegetables & fruits contain this.
A lack of this leeds to painfull bleeding into the skin and joints.
Milk,
eggs & meat provide Vitamin-D.
However a good exposure
to sunlight is by itself enough to provide enough Vitamin-D &
deficiency of this substance which is essential for strong bones and
teeth is thus commoner in women who stay indoors ail the time.
Then there are minerals, like iron which is needed for the blood
clacium that is needed for bones and iodine.
obtained from good,
all of it.
Thesd
too are
Thes<3 too
and the balanced diet suggested would provide
However the average Indian finds such food far out of his reach.
His money is just enough to buy the staple grains that he needs &nd
some salt and perhaps a few chilies, and if money permits a bit
of dal.
An average Indian family of about 5 or 6 people would
require almost 3.5 Kg. of rice or lowar or wheat and about a
quarter kilo of pulse per day.
This itself would cost at least
rupees twenty per day and even this is a great struggle to obtain.
And one has to remember that on many days there is no work to be had,
or there is sickness that prevents him from earning • a wage.
It is
for these reasons basically that the poor do not have a bal anced
They krow that milk is good for children, that eggs are
good for health, that green vegetables are good, th^t meat and
fish make you strong - but they cannot but itw
diet.
. There is nothing much that a doctor can do,
as a doctor to
Were he
remove this single most important cause of ill-health.
to prescribe a
tonic or a milk powder or health food he is
actually depriving the family of much needed food.
Such health
foods and tonics are frauds promoted by drugs companies to make
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vegetables, bananas, guavas, orgnges and lemons are all healthier
and more nutritious that any tonic and far cheaper too.
CCMBATTING HUNGER:
Then what indeed can be done to tackle hunger and ensure our
health.
The single most important measure is to ensure employment that provides the minimum income necessary for a person to
live as a human being.
This would mean effective formulation and.
implementation of laws regarding land reform and of ensuring a
minimum wage for agricultural workers and indeed all other
categories of workers. Whatever the circumstances the minimum
wage cannot be less that the amount needed to provide the minimum
food, clothing and shelter needed to sustain life and this can be
determined by scientific calculations.
Ensuring employment must also in the present context mean
rural development programmes and technologies and industrial
development stratergies that are able to absorb the entire labour
force and provide gainful employment to all«NUTRITION EDUCATION:
However a proper programme of nutritional education may
be needed in addition to ensuring a minimum income, especi ally to
help parents make optimum use of the scarce resources available to
provide proper nutrition to children. Malnutrition in children
is often compounded by wrong feeding practices and ineffieicnt
use of available resources.
Breafet feeding during the first 9 months of life is one
effective guarantee of good health,
The change to bottled milk
powders and infant formula is a major cause of preventable infant
deaths and in most cases should never be done,
Even where
bottles are to be used close attention need to be given to washing
the bottle and plastic nipple in boiling water for at least 5
minutes or better still feed the infant with a clean
cl ©an spoon and
avoid the bottle altogether.
Young children also need for their body weight a higher amount
of
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cheap fruits like banana etc. should be given them as also a
greater content of fats and oils.
• FOOD SUPPLEMENTATION SCHEMES:
Food subsidies are no long term solution as they are difficult
to sustain due to, high costs and more important as they create a
culture of dependency.
However given the abyssmal poverty of some
sections of the population and the impact that it has on the food
intake of the,.sections within these sections which are most
vulnerable to the ill effects of malnutrition namely children and
preganant women,
food supplementation or subsidy schemes remain
an essential component of primary health care. It is therefore
essential that the special ^nutrition programmes, the ICES
1 Anganwadi 1 based programme and mid-day school meals programme be
strengthened and expanded along with schemes like the ’food for
work’ programme.
Efforts need also be made tb administer them
effieiently, and in a corruption free manner and to ensure that
these subsidies reach the sections that need them frost.
SAFE DRINKING WATER:
After food, the single rncst important determinant .f’health
is the availability
safe, potable drinking water.
an essentialreomponent of all lif^.
^day the eff.rts
Water is
secure
adequate water for one’s essential needs occupies the^energies
and time *f most,households,
especially of the wtmen.
There are
many districts especially in Punjab, Haryana, Andhra and Tamil
Nadu where the'water so obtained had deleterious levels of
fluorides - ’b substance "that leads ho crippling of a considerable
At other places high levels or iron
section of the population.
□ r salt makes the water difficult to drink. Indiscriminate
dumping of factory effluents especially from chemical companies
and tanneries have also rendered water hazard*us for drinking In
many areas All over the country,
Madras, N*rth*Arc«t etc.
as for example in and around
More ctmrr.anl^water.is a. carrier of dangers germs cf
diseases like diarrhoea, cholera, typhoid, poliomyelitis,
t
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drinking water are therefore the two sides of the same c"ln.
Scientists estimate that almost 80% percent .f all preventable
incidence of sickness can be eliminated by provision of safe
drinking water alcne.
'The status of health in the iountry should
be measured1 not by the number of doctors it has but by the number
of water taps’ - a very true quote indeed to whiih are may add the
number if water taps with water in them!
Provision of safe drinking water and proper sanitary facilities
is not an insurmountable pr.blem even with already available
technol>gy.
what wculd concretely need to be done for this in
your area? One may for example need a) proper construction of
wells taking all the necessary safety precautions to prevent
chlorination .f wells c) filtration plants
c.ntaim*aticn
in urban areas and larger rural habitats with a regular piped
water supply d) prevent!»n of defecation near tanks and streams
fr»m which water is used for drinking purposes e) instruction
■Jf locally appropriate, cheap and culturally acceptable latrines
□long with a proper sweage disposal system in urban and larger
rural habitats f) deflucridation techniques or identification of
safe drinking water sources in flu.ride and ir.n affected areas
g) preventing factories and sweage disposal systems from dumping
untreated or hazardoues waste into river and other water sources
mcMing the sea. If indeed this is such an important, yet in most
places a$ easy measure, why has it not been done?.
There are man^t
reasons for it but one major reascn we should n.te is because we
the people have noc demanded it - despite’'the fa^t that diarrhoea
has killed and polio has crippled more of our children than any
a"
ether Single disease.!
Eventually me we can ensure
own
—:------ 1
health and it is high time we organized
ensured safe
drinking 'water in our own axe a.
There are however many <areas in the country where availability
of any water is a great problem,. In such areas engineering works
minor ojf major will ha\e to be taken up or new technologies like
desalination of salt water adopted.
ENVIROi ^MENT s
i
Th^ third important determinant of our health is the
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to both industries and to the inefficifent smoky chulhas are a'
major cause of chronic cough and other respiratory problems.
Indiscriminate use of pesticides and unsafe unscientific disposal
wf industrial wastes/ poisons the land and water in laany areas.
BIOLOGICAL ENVIREMENT :
Man as part of the living warld, and related by evolution to
all living things/ i£ also affected by a ny serious affection of
Cutting down of trees and green plants deprive
the living world,
the air of oxygen sc essential for life. The indiscrimin-ate
killing off of so many plants and animals has altered the delicate
balance in nature on which all life depends. This as well as the
unplanned urban and rural development that leads to dirty cesspols
water in all our cities and towns have become ideal breeding
grounds for mosquitoes and flies and other carrier® ef disease.
The rhosquitoe alone is known to be a vector of 5 diseases in
India. Malaria, filaria, brainfever (viral encephalitis),
viral fever® (dengue), haemorrhagic fevers (fever with bleeding)
the- first three of which are major causes of death and disease.
Flies are the carriers of diseasd like typhoid, cholera, worms
and dysentery and many other diseases.
The sand-fly causes
Kala-azar in many parts of Bengal, Assam, Bihar and Orissa.
Similarly pests on crops are. also rapidly multiplying. Con’trol
of such pests whether affecting man or crops is possible in the
long run only by ensuring a proper ecological balance and a
healthy environment.
Measures like pesticides may be needed in
a limited and controlled manner but seldom will it by itself offer
a solution.
(The failure & programmes like the National Malaria
Control Programmes* are related to this).
SHELTER :
However by environment we need also include the social
environment. The provision of good shelter and clothing is one
major aspect of this.
A person with adequate clothing hiving
in a well ventilated house which is not over crowded within
the house or located in an over crowded area is far less likely
to be affected by disease then the millions of homeless scantily-
'J,
8 :
Of the various respiratory infections, by far the most
serious is tuberculosis. Despite various programmes the
incidence of tuberculosis continues to rice and is more than
million today. °f there despite the. fact that good drugs are
available 5,00,000 die every year. On the other hand, tuberculosis
which was a common disease in the West once is now almost
eradicated there. This is not prirarily due to drugs but to less
overcrowding, better shelter and nutrition.
Even in India,
tuberculosis is primarily a di seas, of the poor and a reflection
of their standard of living.
•
EMPLOYMENT 5
u
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Another aspect of social environment and a essential
pre-requisite for health is proper employment and leisure*
Proper employment is not only essential because an Income
purchases food
clothing and shelter but it is essential
as an end in itself for mental and social well being. Indeed
man1 s prime want is to play a productive and useful role in
society and his satisfaction is most when his employment ensure
this. And his leisure he can use for rest and for developing
all the various aspects of his self that all contribute to
being a complete human.
Indeed a social environment free of
•onfliets and tensions, meaningful employment and adequate
leisure are the basis for mental and social well-being for
a truky healthy citizen.
(The basis of many a social disease
like suicides, alcoholism, drug addictions/ crime are to be
found in the lack of satisfactry work and related social tensions).
Just as only healthy individuals can make a healthy society, it
is also t#ue that a healthy society is needed for healthy
individuals*
HEALTH EDUCATION :
Tb nearly all people much of this is common knowledge.
Medical science has only helped establish that most disease
result from a lack of, these essentiai;. requirements. Medical
science has helped us understand also how for example diarrhoea
results from contaminated water so that nq^t only can be prevent
i
I
This knowledge about how our body works and about how diseases
are caused is another essential pre-requisite of being healthy.
It is necessary that not only doctors and nurses or health
workers know about this but that every person has a 'minimum
idea of it, so that they can understand their own bodies and
keep it healthy.
Health education should also include a minimum knowledge
of diagnosis and treatment of simple diseases. Take for example
. diarrhoea. If diarrhoea is watery and not associated with blood
or mucus the best and only correct treatment is to give the
patient plenty of fluids.
The fluidt adviced can be prepared at
the home by mixing a scoop of sugar and a pinch of salt in a
glass of boiled water. Alternatively rice water with some salt
a^ded is also good treatment. The imajority of deaths due to
diarrhoea/ especially in children can be prevented by this one
measure alone. Indeed more deaths have been prevented due to
this one advance than any^other single advance in medical science
in these last few decades.
Similarly colds, simple cuts & bruises, an occasional body
ache or headache can all be treated with proper knowledge.
Health education should also be adequate for people to
identify certain serious diseases like polio, measles/
chickenpox, tetanus etc. so that they seek medical help early.
Measures to prevent diseases like tetanus & rabies, knowledge
about .Immuni zation/ knowledge about occupational health hazardsall are essential aspects of being health.
EDUCATION :
obviously a literate person has far greater access to such
knowledge than an illiterate person.
Literary is an essential
•omponent of health. But mere literacy is not enough.
The level
of general education is important* General education increases
the 'health' literacy' of the people.
It enables them to under
stand their health problems and how to identify, prevent and
control -chem. It helps them make maximum are of what is provide
to them, including nutritional supplements, vaccinations, medical
v‘.
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disseminate a lot of knowledge about health# and the’ access to
thisinformation is directly related to literacy.
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i
Women's literacy and schooling of girls needs special
emphasis for the impact of• this oh society & the family is
much more.
Indeed’ just like food# water#
shelter and work, education
must be also considered an essential component of being healthy.
maternal
health
'care
:
One area where medical science has led 'to a great benefit
There was a time when many
is about pregnancy and childbirth.
women and even more children died due to pregnancy and at
t
childbirth. Now we can in most cases detect rproblems of
pregnancy well in advance and take proper steps to save the
lives of the children, and mother.
we know that a pregnant
.\
women needs extra nourishment and should have more rest and
should be spared heavy work. We also know that if they have
many children too soon and too frequently it endangers the
lives of the child a nd the mother.
It is recommended that
the first child should be after the age of 21# the second child
should be after a gap of 4 years at least and there should be
no third child.
This is essential to safeguard her health.
Suitably trained persons - both doctors and health work-ers
can detect the pregnancy cases where natural delivery is not
possible or dangerous and in such cases the child can be safely
delivered by an operation or forceps.
When natural delivery takes
place we can ensure by simple hygienic measures that any trained
nurse knows that the delivery is safe and that there are no
complications for the mother.
CHILD % CARE :
The newborn .child fed on breast milk from a healthy mother
is likely to be healthy. Immunication protects us against a
few major killers like tetanus, diphtheria, whooping cough
measels and polio.
Proper nuttition and feeding practies are also
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>i rth,
■j
and many more (about 40/1Q00) die in this age group
due to ca uses related to childbirth* indirectly.
The. reason for this lies in the poor health of our mothers
and the‘difficulty in getting or total lack oi maternal’ and
child care in most of. our villages. .Even if they;, are available
women are not adequately aware of why> they need such'help and
the vast, difference suph help will make to their lives and that
The children* of illiterate women die far
of their children’s.
more often, than those of literate mothers.
Studies have even
estabilished relationships between numbers of yeafs of schooling
of the mother, and infant mortality.
i;
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This is not only related to the proper socio-economic
background of ...the illiterate and the knowledge about health
that literacy contributes but also to a critical awareness of
their own reality and their attitude towards it.
*
The inability of the illiterate woman to make the correct
choice - to ensure the health of tlieir children, their own health
and of their children,
their inability to plan for the future
security for the family leads her to reject the temendoua pressures
that the ^overnment exerts today for the family welfare programme
and thereby she seriously endangers her own health.
THE F/^1ILY PLANNING PROGRAMME
4*
India is one of first countries in the world to have a major
Enormous resources have been
family planning programme.
spent on it - In the last five years plan period alone - more
than 3000 crores have been spent on it. Nearly half the budgetary
allocation for^health care goes to family planning - yet the
programme has not succesded.
The crude birth rate over the
last 11 years has remained static at about 31/1000 as against
a 22/1000 that it was supposed to reach. Or in simpler words
despite 3000 crores spent there has been almost no change at
all in kirth rate.
The measage of family planning has been
literarlly taken to every corner of the country, roughly to
every village X.- every home - to meet with only a,poor response.
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is the only lung term investment or savings they can make.
•*
When
they are .Id «r sick it is only their ^children that they can fall ‘
back upon.
(in a better income gr.up in our ccuntry .r in more
developed cuntries savings is,in the form of a home, in a bank,
pension,
provident fund etc) .
N.w when 10 out of 100 children
die the need to ensure a living child and that too a male child
becomes a matter of para mount importance. The less of a child
for a mother is ia matter of great ag.ny. and guilt, f.r the being
she brought into the world and loved so intensely is lust as the
was unable to protect it.
But the millions of-m.thers are voiceless
and we do not hear them cry.
And even as they,cry they need to go
through it again - to ]*ear more children.
Only in s society where there is social security and low
infant mortality will the birth rate curne down.
And .nly- in a
cWciety where the woman is literate and liberated en.ugh to make
her own chrlses will family welfare be realized.
There are
countries like Cuba where there is nr Family Planning Programme
at all yet the birth rate is low.
There is no p«pulation problem
in any ef the developed countries .f the world.
them want more people,.
Indeed all of .
This day our women are educated,
they day
they are able to ensure the survival of their children and become
active participants of social development, that day family
planning will bec.me universal.
Till then all we can do ife to
ensure easy access f.r every m.ther to health services which
include family planning and to inf.rraation abjut family planning.
The money being wasted on many of the schemes be better spent in'
educating women, providing basic health care and .n development
pxigrammes.
PREVENTION OF ENDEMIC DISEASES :
ft
Good knowxedge ef the way diseases spread consequent to the
advancements of medical science have also helped us ompletely
eradicate some diseases like small pox which once killed millions
of people every year.
It has made i.t also possible fwr us to
eradicate .er rontrol may of others.
Take guinea women for example
with existing knowledge and\technology resources it is possible
v(
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fr.r take endemic goitre which is limited to -the Vfoothills of
the Himalayas/ the Terai area, and to north east.
This is a
.disease that causes children to b.e born mentally related due.
to lafck bf
iodine in the diet, Providion of 'iodized salt
alone.
(The- details of prevention of a few endemic diseases
specific to +-hat area must be undertaken nt this point)*.
FUNCTIONS OF HEALTH SERVICES :
When me of us as * an individual suffer fr>m many of these
diseases there is little to be c.t>ne.c but to see La 1 d^ctc r’ . But
let us never forget that is’ffcst instances, had we acted together
earlier we would have taken measures or forced the gjvernment to
take measures that weuld have ensured that none of us. ever undergo
■that disease at all.
However when we do fall sick we do need^a
trained person tr examine us and tell us what wur ailsfrent j.s? - Is
it just a common cold that will pass off by itself? • •
,1s it jaundice?
If it is jaundice is it the type which we
mus; commwniy see, which is most cases becomes alright by itself
provided we take rest and prwper diet or is it a different variety
which^we need to take treatment or very rarely even undergo an
*»perati jn?
'-/e all need to know something abwut the cwiamen diseases
bu-^ knowledge abwut diseases is nc'W so fnuch that some^po^ple be it a ^trnmunity health worker, a nurse or a doctor, are needed
whose p-rtfessien is to provide T?e al th care.
There are many diseases that we get due to eut body1 s own
mechanisms being ihddequate - either due to defects inherent in
• ur cells or due
the "body ^eing unable to cwpe with an
• verwhelming an external factor.
Good medical^ care help eur
body be rests ?ed tr its normal function or at least ameliorate the
symptoms thereby lessening the suffering caused by diseases. Often
medical science is inadequate to do either and we need to accept
the J,imitati®n3 • f this science and adjust our li'/es accordingly.
' *
Death is inevitable. Medical science can prevent a* number
*>f preventable deaths, postpone it and make it less agnozing.
The function of health services - the para medical workers, the
doctors & nurses, the primary health centres and hospitals, the
drugs and diagnosis equipment like X-rays is tr find the causes
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EQUITABLE DISTRIBUITQN s
Unfortuna.cely though there are tens of thousand-s- wf doctors,
and even some of them are unemployed, the vast majority < f our
These who are rich enough
peiple have no access to health care.
.te pay and live in cities have access to the best equipment and
drugs and dectvrs and they consume the major part of what iy
spent for health.
The p«or especially those living in aur villages '
have no access t» any medical care4 Even if tnere is a primary
health centre n.ereby it is understaffed poorly equipped and usually .
lack the basic drugs needed to provide primary health services.
r*
The general hospitals are overburdened and themselves terribly
unsanitary places, the medical staff there overworked and the
health care provided mostly inefficient.
HEALTH WORKER
Y
COMMUNITY
---v *
It has been repeatedly been stressed that proper access to
medical care must be based upon deploying adequate numbers of
r
suitability trained ahd mbtivajed
btivated ^immunity health workers. A <<
community health workers is a person of your own village, who
has studied at least upto 6th standard in school, who is trained
’
4.
te recognise common illness and treat them. He qan also recogni ze
will advice yeu te see a doctor.
more serious-illness for which
He will als< be abihe to assist at delivery, give immunization to
children and advige regarding prevention of other diseases. He
may be a peasant who works his land who only spends a few hdurs
•t
*
per day on such wcrk er a local- traditional healer er dai trained
for this purpose.
■I
The precense of such a person or person in ycurvvillage means
that yeu need not run to- a doctor cr to ia far-eff centre,, but can
have basic health services at ycur doorstep <rbm a person y<y
trust.
Does you village‘have -me such worker, who is easily
accessible toi you when you or yr,ur child has a health pi>blei^?
If not you must ensure that one of ih the* village be trained, for it.
L/RUG S s
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the district or taluk hospital.
Even here no mere than some 150
drugs are needed to take care of all the possible medical treatment
you may ever need.
Unfortunately in most places including these 25 primary health
centres these 25 drugs are not available.
Even at taluk and
district level hospitals often there 25 drugs are not available —
not to speak of the* 150,.
But at the same timeevery local drug
shk>p and even at villages there are freely available hundreds of
ether toni.cs and injections and tablets which are of -no use at all.
Because people do not know the causes of- their diseases they often
take tonics and 6ther tablets 1 f».r feeling better or stronger 1.
Then why are they there at
But thes£ medicines waste our money,
all?
Why do debtors prescribe than?
them?
Wi>'do companies make thefc?
Why do governments allow
Of all these fruestions only the last has an easy - answer.
The
companies make them because they get a let of money by selling them.
We need to ensure that our governments and doctors do not encourage
We also need to insist
such useless drugs that waste our money,
that the drugs essential in that area are cheap and easily
accessible.
OF DOC^RSs —
Last of all, we need doctors, too,
at least in every primary
health centre there must be two doctors - doctors who are. interested
in serving the people.
They can help when our •>wn knowledge and
training and that of the community health
workers its i inadequate.
Doctors are also needed as scientists to find •ut more about the
causes of diseases so as to discover ways to prevent the diseases
i
and to treat them.
In every district there should be at least one
hospital where modern scientific instruments are available and
specialists in various fields are available ti treat serious
Tney also need te provide training
eonditiens or rare diseases.
to newer nealth personnel and educate people aheut the causes of
Lil, health and the way to be healthy.
HEALTH PefeldES :If many docters teday to not do this it is also because
amongst ether factors the people do not know encugh to en su re i t>
We need ti knew what we need for being healthy and what we need to
>
*
o.
15
have proper, equitable access to health or the other benefits
that advancements in medical science have made possible.
The
Good health needs far more than doctors and drugs.
J
struggle for being healthy is part of the struggld against conditions
that make ill health possible. It is a struggle dor good food/
good water, a clean environment, .for good employment, & for
leisure.
It is a struggle for a better quality of life.
Science
gives us the knowledge and the possibility of making good health
care available today but to make this a reality, society must
be willing to reoi stribute available resources so that these basic
needs for all are met.
This then Is the true meaning of Health
for all Sy
Ad.
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IT?
4
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Con H 3^COMMlIWITY IirAlTH C U
^71, (First HoorJSt. Mark^ aoaa
BANGAlOae - 560 001
A PSM APPROACH TO PRIMARY HEALTH CARE
The Declaration ^f Alma Ata marked a histories step in the
history of health.
It was the first clear international decla
ration that health which is a state of complete physical, mental
and soci al—welIbeing,
and not merely the absence of disease or
infirmity, is a fundamental human right and that the attainment
of the highest possible level of health is a most important world
wide social goal whose realization requires the action of many
other social and economic sectors in addition to the health
1
*
s*ector' .
The Alma-Ata declaration was a major step forward for it
was beased on an understanding and implied that
( a)
'the main roots of poor health lie in the living
conditions and the environment in general, and more
specifically in poverty, inequity and ‘the unfair
redistribution of resources in relation to needs,
both
inside individual countries and internationally.
(b)
That the people have the right and duty to participate
individually and collectively in the planning and
implementation of their health care. 3
(c)
Primary health care, defined as ’’essential health care,
based on practical,
sci en ti fi cally sound and socially
acceptable method and technology. ..
at a cost that the
community and country can affort to maintain atevery
stage of their development in the spirit of,
self-reli
ances & self deterrr.ination. . is the key to attain the
target of health for all by 2000 AD'4.
Unfortunately despite the brilliant polemic and sweep of this
declaration, its implementation lags far behind,
and now 22 years
since its adoption in practical terms, at least in India,
great slogan has had little impact.
this
Unfortunately the World
Health Organization who gave this call, has its contacts limited
to the health ministries and to medical and allied prof es si on al s,
and it is to these sections that the task of implementing this
programme went.
One critic ruefully comments ’Handing over the
implementation of PHC to the medical establi shment was similar
to handing over the implementation of land reforms to landlords. .5
O^e outcome was to attach ’health for all by 2000 AD'
as a slogan
to already existing or on-going programmes or to set new series
"
i
2
The other major thrust of the present primary7 health
cave programme,
as it is in India, is the establishment of
primary health centres and the deployment of community health
workers-both at subcentres
and at village level.
run'into serious problems,
Not only is the number of health
This too has
workers that have been trained and deployed far short of what is
needed, but even those who are .deployed yield only a limited
quality of health service.
The selection, training,
monitoring
and motivation of the community health workers is so poor that most tend
tend to drop out & some even migrate and set up as quack medical
practioneers themselves.
’Community participation', one important
planned feature, is in most places completely absent.
Almost
no research, planning or trailing goes into identifying the
problems and working out the tactics, of health care delivery.
For the medical establishment, it is business as usual.
The last 10 years have seen the mushrooming of corporate private
hospitals and’ a number of private capitation-fee based medical
colleges.
A top few eminently ’successful' doctors preside
over medical
association, act on medical councils,
governments on health policy,
advise
serve on its commitees and working
groups, influence governmental decisions by virtue of their
physician-level personal contacts with decision makers and in
many a case even dominate research and private practice.
The
entire primary health care campaign and the Health for all by
2000 AD- slogans are seen as empty politician's slogans or at
best as the department of P & SM’s responsibility.
Clearly
no major change is likely to be contributed by these sections.
It must be recognised that members of the medical profession
can do little in their professional capacities to achieve this
goal.
Medical & paramedical professionals are well positioned
to investigate the causes and consequences of ill health.
However they can rarely tackle the root cause of ill-healthhunger, poverty,
shelter,
water,
sanitation, employment,
leisure
etc.. Without tackling these basic questions-primary healthcare
as spelt out by the Alma-Ata declaration is not realizable.
This di f f erentation between the wider concept of primary
health care and the narrower concept of primary health services
or basic medical services was not made in the original declaration.
-s
3
It is possible with adequate political backing and administra
tive will, to immediately achieve,
large areas of the country.
such medical care at least in
It is possible for’socially minded
doctors, helpted by donations or grants to provide such basic
medical services in remote rural areas or even in urban areas
where the poor have limited access to such health services,
There
is a record of numerous doctrs from a’wide variety of backgrounds
the catholic hospitals associations,
the people's polyclinics of
Andhra Predesh, the work at Nagapur,
at Chikmagalur etc., who
have undertaken such work.
Such work is a valuable contribution
but in terms of the actual contribution to the health of the
community as measurable by indices the impact has only been
Impact on health itself can only take place by the
marginal.
implementation of primary health care in its broader concept.
Though provision of health services and essential drugs are a part
of the concept of primary health care,
they are not the major part
or the focus of primary health care.
This should not however be interpreted to mean that health
professionals have no role in the implementation of primary health
The word 'doctor' is itself the derrivative of the word
care.
1 to teach'
The doctor and other health professionals are looked
upon as a source of knowledge about health and disease.
Today
many of the ideas prevalent about disease, both right and wrong
and most of the health policies have been contributed by the medical
professional.
To view disease as an affliction of an individual
by a germ and lose its social dimensions is the result of -a curative
bi asz
that the PHC approach sets itself against.
The result of
such a bias in’the sphere of health policy is to search fortechnological or managerial solutions to what are essentially social
i ssues.
The doctor has contributed to such a bias and the doctor
can contribute to its unmaking also.
The people's Science Movement and indeed all other individual
group's & organisations desirous of realizing the goals enchrived
in the Alma Ata declaration need to plan for intervention to
prevent the demise of a powerful concept-t'Heal th for All, by
2000,A.D." A great concept should not be allowed to dissolve
into platitudes.
One of the primary areas that people's science
movements
-
O
4
He’alth education has many limitations and pitfalls.
Much uf the health education current today i s ■ technical,
fragmented and culturally in-appropri ate, other than being for
that situation irrelvant.
Thus a health worker may deliver a
one hour lecture on diarrhoea, without ever mentioning that the
water source in that village should be safe.
Instead she would
probably preach a sermon on cleanliness, suggest using boiled
for water all drinking purposes and finish with suggesting
oral vehydration
therapy.
By the time she reaches the most
useful part, both sympathy and inevest would have been lost.
Or a class on nutrition may tell all mothers assembled that
they must give milk,
eggs,
fish,
fresh fruits & vegetables to
their children - when most of them are going hungry for want of
ability to purchase rise.
Even in many a people's Science
movement lecture we tend to leave out social causes and
possibilities of remedial collective action and instead stress on
technical causes and individual solutions.
It would, of course be of little use if health education
lectures were only polemical or philosophical in nature and
discussed and curative knowledge will need to be imparted.
But
where collective action is the only real solution and the basic
problem is a health determinant like water or. nutrition dr
sanitation, health education should be aimed at exposing such
causes and appropriate remedical collective action.
The
health professional should provide the technical information,
if such is needed,
to justify,
a PSM effort to organising such
action.
Could health by itself serve as an entry point for
collective action?
The health worker-can she become the agent
of social change?
Can oppressed people be organized around
and for health issues.
Though this debate is far from over
some Indian experiences have replied in the negative,
1 He al th
work they feel has only weak political implementation and
without a proper political context not much of genuine people’s
participation can be achieved in community health work done.
However most are agreed that 'health should be one of
the activities of a group trying to organise the rural poor
-s
o
s-
The reception and popular response to proper health
education is also limited by the dominant culture of seeking
a pill or an injection as an instant remedy instead of trying
f»r a. more scientific understanding of the cause of disease,
^hey come to the health professional for a 'cure'
and not for
Many health education strategies’therefore choose
knowledge.
to combine therapeutic services with oral education-both within
the governmental and in the non-governmental sections.
Thus
the women waiting to see a doctojr in the, queue before a primary
health centre are given an half-hour lecture before he arrives,
•
or while they are waiting for their turn.
Or else after seeking
the doctor they have to see a social worker who spends a few
minutes talking to her about her disease.
are rare events,
Both these of course
and only in an occassional centre, usually
run by a socially concious doctor do ‘they really occur?
Experiences in the pec-pig* s science movement, though
undoubtedly limited, have found greatest success where the health
education has been done in the form of a mass campaign.
media used has been popular lectures,
slide shows,
The
street-theatre
(the Kalajatha), posters and to a limited. extent video.
The
popular response from the audiente has been very positive but it
is difficult to evaluate the gains of such general health campaigns.
Campaigns focussed on specific issues especially on pro
vision of essential drugs and the drug policy have had a much
• greater impact.
The KSSP in particular by its wide dissemi
nation of books on essential drugs an,d on'‘hazardous or irrational
drugs, have been able to make a mark on drug consumption and prescription patterns,
lectures
To this end they have held seminars and guest
for doctor^,
campaigned in the local press,
used posters
and
news papers and kala.jathas to disseminate their views on 'T 3
drug policy.
Their successful efforts to expose multinationals
selling anabolic steroids by intervening in the usual 5 star hotel
drug promotional campaign also won them popular support and media
coverage.
Such a wide variety of activities and on such a
scale needs a major organisational network and this the KSSP
had.
The KSSP organisational growth is a result of- the wide
varieties of activities the KSSP takes up-covering issues like
environment,
science, education,
health, rural technologies
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6
a broad-based organisation has helped all PSMs in carrying out
effective health campaigns.
The K.R.V.P. the Lor
Vigyan
Sangatana are some of theother PSMs who have held such campaigns on
health.
Another factor in the success of many KSSP programme rs
their educational campaigns not only on health but also on environment, do not stop at awareness generation but go on to
mobilizing people for collective action.
The scope for such
health education campaigns which lead on to direct collective
interventions by the people have not been adequately explored
by other PSM groups & health activists rnaiinly due to their
organ! sational weaknessess.
But as the PSMs continue to expand the scope for such action
increases exponentially.
It is possible non to plan for campaigns
for total immunization or control of diabotical diseases.
It
is also possible and roeeded to campaign for implementing iodized
salt distribution in the Terai & other iodine deficient areas
of the north qhile at the same time opposing the ill advised move
to ban
common salt, commercialize salt production—handing it over
to large monopoly houses all in the name of preventing a wide
incidence of goitre that., is far from established.
It is possible today to campaign extensively for ensuring
provision of the 25 essential drugs within 1 km of any habitation
and for banning hazardous drugs.
In select areas it may be even
possible to launch health education combined with collective action
against diseases like gyirieawxm
infestations which are poten
tially easy to eradicate and even against di eases like leprosy,
te measles which are potent! lly
cable even within the present
system with exiting medic 1 knowledge.
Successful health education work however needs a lot of
careful planning and knowledge of local conditions and culture.
It also needs an analysis, and understanding of the health problems
involved.
Given the bi - s of the medical establishment and official
structures today,
one is seldom able to rely of official
documents and pronouncements alone to evolve a people's understending *f the issue.
a result one major area of people's
intervention has been to study health issues critically, subject
1
■i
7 ;v
*
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.
There are many groups notably the groups associated with
Medicos friends pircule, A.I.D.A.N. Helhi Science F*rum,'
Karala Shastra Sahitya Pari shat, F.M.R.A.I. who have made
major contributions in this regard#
Though due to their organisa
tional structure most such groups have limited themselves to presenting
critiques, such critiques are essential for future action.
ThdTe
critiques ould have formed the basis for collective action by
either groups J.ike youth movements, womens organizations e 1x2. but
in practice sUch a crcss-fertization has not occurred to any
significant degree.
Most such analytical, theoretical contributions are desk
JD secondary date or compilations from
work relying largely on
various published scurces.
There are however a number of
significant health surveys and field studies by hearth activists
which has formed the basis for critiques. Health problems
comsequent tn the Bhopal gas-tragedy, occupational disease in
selective areas & industries/s> the general health survey and the
study of-primery health centre- facilities in Kerala are csome
examples if such intervention. It needs be pointed out that
the majir medidal research institutes with elaborate renAarch '
facilities seldom study such topics#
The marked reluctance of
such institutes to undertake study •n areas of immedi ate
relevance to people, especially if the topic is likely t> be
controversial an$ go against local vested interests in well
known. Unless health activists intervene actively in such
areas of research work, the PW s and democratic groups will be
unable to intervene in both the formulation of health policy
• r even identify the deleter tus effects of fll c^ncieved
health or developmentalz strategies.
Even theoretical work, based on analysis of published data
has a significant role to.play.
The drug policy is ong area
where health activists^.in ;:ndia can take pride as being the
sole force to have oppossed the government’s consistent pro
industry and anti-health policies.
And most of this inter
vention is based on study done by various health activists
themselves.
Similarly on patent law ariS. on iodisation of salt,
official policies have been subjected to critical analysis and
G •critiques cr evolve al ternative, strategies,
There is an urgent necessity
for health activists to ■widen its contacts amung trained and
sincere health professionals who *san help,
A large number of
doctors, e-sperfrailly junior doctors and medical students an d
''
many with gr>od academic backgrounds are interested in a social
activity >f the medical system and willing to contribute to it.
Their participation in the work of p^i should be ensured.
Can PSM s go beyond health education campaigns*'(both general
health awareness and on sped fie issues) and beyond presenting^
critiques and critical reviwcs of health policy?
Can it attempt
to tackle the concept-of primary health care in its entirety?
Can it by its work raise the level of health in a measurable
fashion nr ocntribute to such* a rise in health status?
One approach to these questions is to work on a mo delto take up an area varying in size from a village to a taluk •
or district and in this area attempt to render primary health
Too often what is rendered is only-basic medical services
care.
and then in the long run the results are not adequately rewarding.
However there are attempts to integrate in such a model, basic
medical services with major health educational camnoiig'ns,
introduction of ;rscientific inputs to upgrade existing rural
technologies and launching rural development schemes that
generate emplc yment^ provision of better -nutrition not only
drough income generation but by a more optimal Kse of available
resources especially for children, provision of^safc drinking
water and elementary sanitation and above all literacy education
and scientific awareness.
The pe^pjbe1 s science movement is
better equipped than me st >gjtups to implement such an approach.
It has within if folds considerable experience in rural technologies
in literacy.
and non formal education, in running campaigns on
issues espei^Lly using loc-Sl art-fwrms as a vehicle for new
ideas, in drinking—water and sanitation work — an*d in running
basic health services.
It should be thos
possible for sucih
a model to the built up with the available experience in the PSM s.
7-
W
When building such models one deeds remember the past PSP4
experience, that success ^ul campaigns need a critical size for
raising enthusiasm & for success.
diversions,
If woifk is too ntLcroscopix>. in
success is less and the project merely peters off. *
9
O -
automatically replicable all over the country/ by virtue of
its being successful in one place.
Even for the model area to
succeed social inequalities will pose a problem but we need not
a-ssuinethey are insurmountable ones.
(Such a model cannot therefore
be posed as the road to success of primary health care) '.
Then what would such a model contribute?
It could by its
veiry presence and success help to pose the issue of an alternative
strategy to health care and development.
It could demonstrate
that health for all is possible - now, given the administrative and
political will.
It would help bring, by virtue of its experience,
the issue of health on to the agenda of national priorities -
where it is theie notionally but not in practical terms.
In
organizational terms it would mean mobilizing new sections into
PSM activities and adding a newer dimension to activi^i
at social change.
aimed
What we should not do when the PSMs-take up primary health
care work is to confine it to health services,
professional s.
and to health
Thereby we would be going back to locating health
i ssues as separate from other social problems and nurture the
belief that good health can be won by technological' or man acrerial
inputs alone.
PSMs can organize people around health issues
only - if they link it up.
^i th other issues of development -
especially literacy, education and employment.
One area of expanding PSM activity that offers immediate
scope for linking with the health issue is literacy.
li teracy.
of functional literacy as understood by
understanding of health.
The concept
us,
US/ includes an
Literacy, and education by themselves,
independent of all otherfactors have been shown to be major
determinant of health status.
Women’s literacy in particular
has been shown to affectz independent of other parameters, women's
health,
attitudes to family planning, number of children born and
infant mortality.
The process of imparting literacy is a useful
vehicle for the generation of scientific awareness of which health
awareness is an important aspect.
”
One major new area of contribution of PSMs is in adult
literacy.
With the landmark success of the Ernakulam campaign
and the subsequent initial experience of the on-going total
literacy campaign in Pondi cherry,Goa and Kerala it is likely that
by operation smiles - a project for 100% immunization in
Ernakulam district,
d own si grii fi c an tl y.
Diaorrheal deaths & mortality have come
In Pondisherry too a heal th ph asei s i j. y ei y
to follow the total 111e p acy c amp ai q n.
The coming Bharat Cyan Vidyan Jatha, being organized by the
people’s science movements of India isone major avenue for health
activists to enlarge the scope of their work.
The B.G.V.1?. aims
to organize one cultural groups of volunteers from all walks of life
in each of the 500 odd districts of Indi a«
In each of these
districts the jatha will give performances at 120 to 150 centres.
Iheir performance is aimed at creating an awareness of literacy
and science.
The»basic organizational task of the BGVJ i s to
organize 60, 000 centres all over India to receive thesetroupes.
Each centre will also identify a resource persons to give 10
lectures each onetopic- .
One of these topics is ’Being Healthy’ -
a basic talk expalining the causes of diseases and the need and
nature of primary health care.
The ..generation of such wide and diverse voluntary network
of activists by the people’s science movement opens up vast
potentials for future action by the peqpl e,7ssci ence movement.
people
Literacy is definitely the major follow-up action envisaged - and
definitely the issue we need to address ourselves to most urgently.
But it is not possible to open up actual teaching work in all
these 60,000 centres as follbw up,
nor will we be able to
sustain even the
active centres with a single point programme
of literacy alone.
Health is definitely one major thrust area,
for follow up work in these centres.
The follow-up work may
take the form of health education campaigns or even of intervention
in areas like immunization, guinea wof; eradication etc.
Or there may be areas where we could attempt comprehensive
primary health care.' It 1 s premature at this stage when the
60,000 centres exist only on paper to plan for a detailed followup but we need to start thinking about it.
We can however state
confidently that the very attempt to train 60,000 voluntures
to give a talk on primary health c^r^ in every village of India,
i s an unique attempt that is bound to throw
up a major manpower
resource for futurehealth activities.
I
THIRD ALL INDIA PEOPLE'S
SCIENCE CONGRESS
8-11, March 1990
Shri K. H. RANGANATH
Hon'ble Minister for Education, Agriculture and Forests
Govt, of Karnataka
has kindly consented to inaugurate the Congress on
I
8th March at 10 - 00 a. m.
Prof. C. N. R. RAO
Director, Indian Institute of Science
will preside
You are cordially invited.
I;
nue :
J. P. Youth Centre, Vidyanagar
i
Bangalore District
Karnataka Rajya Vijnana Parishat
Local Organising Committee
I
Programme of Inaugural Function
8-3-1990
10 a. m.
Prof. J. R. Lakshtnana Rao
Welcome
President, KRVP
Prof. B. M. Udgaonkar
About AIPSN
President, AIPSN
Shri K. H. Ranganath
Hon'ble Minister for Education,
Agriculture and Forests
Govt, of Karnataka
Inaugural Address
:
President's remarks
Prof. G. N. R. Rao
Director, 1.1.Sc. Bangalore
Dr. Narender K. Sehgal
Director, NCSTC, New Delhi
Role of NCSTC
Role of Dept, of
Science and Technology
:
Dept, of Science and Technology.
Govt, of Karnataka
Vote of Thanks
:
Shri M. A. Sethu Rao
Secretary, KRVP
Catalysed and Supported by
National Council for Science & Technology Communication
and
Dept, of Science and Technology, Govt, of Karnataka
H 3. 5
COMMUNiTY HEALTH CELL
47/1.(First Fioor)St. Merks Road
BANGALORE - 560 001
BACKGROUND PAPERvON HEALTH AND PSM'S
Presented at 2nd All India People’s Science Congress.
Caleutta.
BY DELHI SCIENCE FORUM.
India was s signatory to the
Alma Ata Declaration"it a
adopted by the World Hea1th Assembly in 1978. which gave the
call “Health for all by 2000 AD“. Today. 10 years after the
Alma Ata declaration, the state of health in India makes the
ti
country one of the most backward in this respect. The facilities
in some of our hospitals may be among the best in the world and
the same can be said about our doctors.
This. however, does
not determine the health ofnation. The only true index of a
nation’s health is the state of health of the vast majority
of people, andnot that of a privileged few. In this regard the
Government's own “Statement on National Health Policy” (1982)
states “The hospital based disease, and cure-oriented approach
towards the establishment of medical services has prodived
benefits to the upper crusts of societ specially those residing
in the turban areas. The proliferation of this approach has been
at the cost of providing comprehensive primary health care
services to the entire population, whether residing in the urba*
or the rural areas".
POST-INDEPENDENCE EXPANSION IN HEALTH SERVICES
However this should not detract from the fact that since
independence there has been improvement in many areas, both in
terms of growth in in rastructure andinterms of their actual
impact on the health status of our people, The following table
gives an account of the progress made.
Table
1
IMPROVEMENT IN HEALTH FACILITIES/CONDITIONS SINCE INDEPENDENCE
Year
1951
1961
Life expe
tancy at
32.1
41.2
Infantmort
ality rate
No. of
Population No. Doctors
hosptiaIs per bed
of
per lakh
180
2694
16 5
3094
3199
1930
PHCs
popln.
725
16.5
17.6
2800
ts
2
It is however important to understand both the content
and the process involved into this progress made in the health
sector,
There is a tendency to cite the above figures to make
out a case for positing that this progress has been adequate, and
hence no major policy interventions
----- ; arenecessary. The health
services at the time of Independence were a function of the socioeconomic and political interests
of the colonial rulers. Consequently they were highly centralised,
urban-oriented and catered
to a small fraction of the population,
Public health services
were provided only in times of outbreaks of epidemic diseases
like small pox, plague, cholera etc.
The post-independence era
witnessed a real effort at
providing comprehensive health care.
and in extending the infrastructure
of health service,
Even the West wemt through this rapid phase of improvement
of health services, after a period of stagnation, at the turn
of the century.
ln the early days of the
the bulk of workers who came to work in
Industrial Revolution
factories from the
countryside suffered from malnutrition,
communicalble diseases
and high rates of infant and maternal mortality.
When it was
.realised that the very suffering of the people was
s endangering
industrial production (and thereby profits), active steps were
taken to dramatically imrpve publicshealth services. Economists
who had considered medical expenditure as a mere consumption
item, realised.that allocation on health care was actually an
investment on increasing productivity of labour. Another
major thrust was provided in the aftermath of the Second World
War^ when with the rise of organised workingclass movements and
the consequent development of democratic consciousness in many
European countries the
concept of "Welfare States" was mooted.
For example the National Health Scheme in Britain, which is highly
regarded even today, took shape under the Labour Government just
after World War II. A rough analogy can be drawn with this and
the Indian situation after Independence. Consequent to the
transfer of power in 1947, the character, and as a result the
. long term interests, <of" the ruling sections changed and consequently their intereest and motivations were qualitatively
. different from that of the British. Their own interests requi. red a major thrust towards building of an infrastructure to
provide some basic facilities to the people.
This thrust was
-s 3
At the same time major scientific discoveries revolutionised
the treatment and prevention of many diseases.
These have
contributed greatly to the increase in life expectancy and
in reduction of mortality. The antibiotic era has made it
possible to control a larger number of infectious diseases^
for which no cure was earlier possible. Rapid strides have
been made in the field of immunisation, diagnostics, anaesthesia,
surgical techniques and pharmaceuticals.
This has had a
dramatic impact on mortality and morbidity rates all over the
world. There are pitfalls of an absolute dependence on tech
nological solutions to health problems, but it is definitely
true that in many instances newtechnologies have had a major
impact. However the imporvements in ourhealth delivery system
have not kept pace with the needs of a vast majority of our
people. So much so that the Government's "Statement on
National Health Policy" (1982) is forced to state "Inspite of
such impressive progress, the demographic and health picture
of the country still constitutues a cause for serious and
urgent concern".
BALANCE SHEET OF HEALTH
The following statistics give a picture of the state of
health of our people;
— Only 20% of our people have access to modern medicine.
—— 84% of health care costs is paid for privately.
— 40% of our child suffer from malnutrition.
Even when
the foodgrain oroduction in India increased from 82
million tonnes in 1961 to 124 million tonnes in 1983,
the per capita intake decreased from 400gms. of cereals
and 69 gms.
of pulses to 392gms. and 38 gms. respectively.
Due to inceeasing economic burden on a majority of the •
people, they just cannot bu£ the food that is theoreti
cally "available".
— Of the 23 million children born every year, 2.5 million
die within the first year. Of the rest, one out of nine
dies before the age of five and four out of ten suffer
from malnutrition.
—— 75% of all the diseases in India are due to malnutrition,
*"* •.4
50% of children and 65%
ficiency, anaemia-.
I
s-
women suffer from iron defi-
— Only 25% of children
are covered by the immunization
programme, 1,3 million children die of diseases which
could have been prevented by immunization.
— 1/3 of the total population of India is exposed to
Malaria, Filaria and Kalazar every year.
of TB
550,000 people die of
TB every year,
About 900,000
people get infected by Tuberculosis
every year
—nAbout half a million people
are affected with lepsory,
which is 1/3 of the total number of leprosy patientsin the world.
—* 70% of children
infestation.
affected by some intestinal worm
1.5 million children die due to diarrhoea
every year.
A comparison of Infant
Mortality Rates (i.e. number of deaths
under the age of one month
per thousand live births) of some
countries in 1960 andt 1985 shows that
many countries with a
poorer or comparable :record 20
years back are today much ahead
of India.
TABLE - 2
Country
Turkey
Egypt
I MR
in 1960
IMR
in 1985
190
179
84
Algeria
India
168
165
Vietnam
160
China
UAE
El Salvador
150
145
142
Jordan
135
Sources: *State of the World's Children’
inadequate
resource
93
81
105
72
36
35
651
49
W87 - UNICEF,
allocation
One of the principal reasons for the state
•
5
j
TABLE - 3
Plan geriod
% share of Health
Budget
3.32
1951-56
1956-61
1961-66
3.01
2.63
2wll
1966-69
1969-74
1974-79
2.12
1980-85
1985-90 •
1.86
1.92
1.88 (esstimated)
Sources GOI, Health Statistics of India, 1984..
The government spends just Rs.3/- per capita every month
on Health.
( This may be contrasted with the estimated average
expenditure, incurred privately, of Rs.15/- per capita every
month) The following table gives a comparison of the percentage
of govt, allocation on health.
TABLE
Country
4
% of central govt, expenditure
allocated to health (1|983)
India
2.4
Egypt
2.8
Bolivia
Zaire
3.1
3.2
Iran
5.7
Zimbabwe
Kenya
6.1
7.0
Brazil
7i3
Switzerland
ERG
13.4
‘
18.6
Source: The state of the World’s Children-1987.
Moreover, even these meager resources are not equitably
distributed, 80% of the resources is spent on.big hospitals and
research institutions which are situated in metropolitan cities
and large urban centres. They cater to less than 20% of the people.
On the other hand just 20% of the resourcesis ppent on primary
6
s-
TABLE - 5
I
COMPARISION OF NO. OF HOSPITAL BEDS IN RURAL AND URBAN
AREAS (As on 1.1.1984)
No. of Hospitals % of total
Rural
1994
26.37%
Urban
Total
5287
7181
73.63%
100.00%
No.of Beds %of total
68233
13.63%
432395
86.37%
500628
100.00%
Source: Health Status of The Indian People, FRCH, 1987.
Of the total number (just over 2 lakhs) of allopathic
physicians in the country, 72% are in urban areas. Further, only
15.25% of all health personnel work in the rural primary health
sector of the government. As a result of the highly inadequate
Govt, intervention in the health sector people are forced to take
recourse to the private sector in health care. By this kind of
an approach, health has been converted to a commodity to be
purchased in the market. Only those who can afford it can avail
of the existing health facilities.
perceived by the Govt,
It is thus clear that health is
as a low priority area with grossly inade
quate resource allocation, and a skewed pattern of utilisation of
these meager resources, ^his is afundamental problem in the health
sector which calls for rethinking retarding the whole developmental
process in this country*
Here another disturbing trend needs to be mentioned.
In the
last few years there has been large scale investment by thepriwate
sector on curative services. With encouragement from the government
for the first time in India big businesshouses are entering thefield
of health care.
In addition to the fact that they areexclusively
meant for the elite, the trend is also an indicator of a certain kind
of Philosophy within Goct. circles regafding health care. It is the
kind of thinking which draws inspiration from a World Bank report
which says ’’present health financing policies in most developing
countries need to be substantially reoriented. Strategies favouring
public provision of serv ces at little or no fee to users and with,
little encouragement of risk-sharing have been widely unsuccessful”,
(de Ferranti, 1985). This, in other words, is a prescription for
increased privatisation. The National Health Policy Statement says
"with a view to reducing governmental expenditure and fully utilising
■
-:
7
in providing health care to all. Increased privatisation
in health can only serve to exclude the most impoverished
, sections, pricisely the section who need health services the
most.'. The answer to theGovt's inability to find sufficient
resources for health programmes certainly cannot lie in
taxing, the community fof provision of health care.
LACK OF HOLISTIC APPROACH
Health services, in the traditional sense, are one of the
main but by no means the only factor which influence the health
status of the people. Today the concept of social medicine
recognished the role ofsuch social economic factord on health as
nutrition, employment, income distribution, environmental sanita
tion, water supply, housing etc. The Alma Ata declaration states
"health, which is a state of complete physical, mental and social
well bring, and not merely the absence of disease or informity, is
a fundamental human right and that the attainment of the highest
possible by level ofhealth is a most important world-wide social
goal whose realisation requires the action of many other social
and econokic sectors in addition to the health sector". Flowing
from this understa ding, health is not considered any more a mere
function of disease, doctor and drugs. Yet even today the existing
public health infrastructure in India is loaded in favour of the
curative aspects of health.
For a country like India, it is possible to significantly
alter the health status of our people unless preventive and pro
motive aspects are giben due importancfce. An overwhelming majority
of diseases can be prevented by the supply of clean drinking water
by providing adequte nutrition to all, by immunizing children against
prevalent diseases, by educating people about common ailments and
by providing a clean andhygienic environment. It has been estimated
that water-borne diesases like diarrhoea, poliomyeilitis and
typoid account for the loss of 73 million work days every year.
The cost in terms of medical treatment and lost production, as conse
quence, is estimated to be Rs.900 crores-which is about 50% of the
total plan allocation on health.’
Yet according to the Govt’s health policy statement (1982)
r-
-slO;-
:: z^z arunaer =taffea
- of
” up ‘th tO‘al r“ral P0PUlati°"-
“here these centres h«ve been
°pt to „ork ln rural
the
1 r ::-r.xr
scheme.
only as a last
„ealcal perso„
■’Ottvstlon of
prl~py hLuT V
of medical
P icary health centres. Unwillingness
UMiHlng„s, of
of doc6ors tQ
The currloulum1
and within this i
?rrs
Mnni
’ eauCation
r
favour of curative medicine
f
/
training medical students are
aUgnostic aids. ^uch tralnloo
5? ’ °" SOphlstlcatea
iU-egulpped to „ork ln c" d t’o"5""5 -T '"edl0’1
Moreover the
-Meh
x: “j :
sectors. ‘
‘
Prevailing in the rural areas.
"lth an aura °f
klng in service in the rural
It needs also to understood that
entry into medical colleges
IS by and large limited to those coming from
stratea, predominantly from urban areas, who a higher socio-economic
it difficult to conceive of working in rural consequently find
areas. Even when
uneploument among doctors is not
uncommonm doctors are unwilling
to take up jobs in PHCs. A two
pronged strategy is required to
tackle the situation. Medical
curriculum has to be reoriented
and entry into medical c
olleges needs to be regulated in a
manner which ensures ^rebalanced "mix" of students. -ide by side
incentives have to beworked
out to attract doctors to the rural
bsalth schemes. After
a i i i+-o
After
all
its
imoractical to believe that
is impractical
^rrer
doctors ^KxihKxxxxxixhBxitoxxxta^x,are
natuitally fired by
altruistic motives and with feeling of
"service to the poor'1.
At the same time, within the medical
fraternity, there is a strong
esitance m changingehthe age old concept of health
as function
f doctors and drugs. Implementation of recent cconcept of primary
demystificatio
MeaZZ
r 3 CSrtain
—>n of
the eatabllshe(J
„ed1Ml scxencc. But
and m the entrenched sectionsof the medical
•
d vested interest in maintaining the stutus
bureaucracy
fraternity there is
IL
-111
However all theseprogrammes need Cooperate through the rural
health scheme, but as they have separate administrative controls,
they are not accountable to the rural health scheme. As a result
there is needless duplication of administrative manpower, costs
and often confusion regarding aims.
While the basic aim behind the
vertical programmes of giving emphsis to problem areas is laudable,
they need to be administratively integrated with the rural health
scheme. Otherwise, they will continue.to wbtk.at cross.putposfs with
the rural health scheme, often at great cost to the available material
and human resources.
COMMUNITY PARTICIPATION
The slogan "Peoples" health in people "hands
has today
received universal support. Diverse agencies cutting across all
kinds of ideological positions
—> accept that community participation
is vital to the sustenance of any comprehensive health programme,
The Govt1s Statement on Health Policy also recognises this position
while stating "Also, over the years, the planning process hasbecome
largely oblivious of the fact that the ultimate gola of achieving
a satisfactory health status for all our people cannot be secured
without involving the community int the identification of their
health needs andpriorities as well as in the implementation and
management of the various health and related programmes". Unfort
unately there is a basic lack of clarity on the ceoncept of community
participation. Often, especially in official circles, it is taken
to imply that the community participates in collectively receiving
health services'
A strategy developed by the Govt, to bring about
community participation is the Community Health Worker (CHW)D scheme
he scheme involves recruitment and traing of a Community Health
Workers from every village community. The CHW is required to
interact with the PHC system on toehalf of the village community
he repr sents.
The scheme .was introduced in 1977, as part of the
Govt.'S Rural Heaith Scheme, nased on the recommendations of the
Srivastava Committee (1975). The guidelines for the selection of
dandidates for the CHW schemes are:
1) They should be permanent residents of the local community,
perferably women,
(iq 1981 it was recommended that all
14
leaps and bounds.
From a meager 0.14 Crores in the First Plan it
went up to 409 Crores in the Fifth Plan, 1426 Crores in the Sixth Plan
and finally to a proposed 3256 Croees in the Seventh Plan. Yet the
birth rate has remained static at around 33 per 1000, for the last
decade.
How then is the continued increase in expenditure on family
planning to be justified?
Actually the basic problem lies in the' inverted logic that a
falling birth rate preceds socio-economic development.
The
experience in countries all over the world hag shown that exactly
the reverse is true. The family planning programme as it stands
today, is another example of attempting to find technological
solutions to social problems which require societal measures.
Moreover, the family planning programme with its fetish for targets#
places an added burden on the health care delivery network, which
it is ill equipped to carry, As a result there is a further
whittling down of the already meager relief that the primary health
care system provides. As noted in the case of other vertical
programmes, the family planning programme too needs to function in
an integrated manner with the rural health scheme.
CRISIS IN PHARMACEUTICAL INDUSTRY;
Though there continues to be a greater emphasis on the curative
aspect of health even this area is plauged by a variety of problems.
This is examplified by the total anarchy which prevails into the
production and supply of medicines.
access to modern medicines.
Only 20% of the people have
There are perennial shortages of
essential drugs, while useless and hazardous drugs flourish in the
market. There are 60,000 drug, formulations in the country, though
it is widely accepted that about 250 drugs can take care of 95%
of our needs.
The market is flooded with useless formulations like
tonics, caugh syrups and vitamins while anti-TB drug production is
just 35% of the need. While 40,000 children go blind every year
due to Vitamin-A Deficiency, Vitamin-A production was just 50% of
the target in 1986-87. The production of Chloroquine has shown a
decline in recent years, at a time when 20% of the people are
exposed to Malaria every year.
2
15
turnover of the Pharmaceutical Industry has increased by leaps
and bounds and today, globally, it stands next only to the
Armaments Industry.
The growth of the Industry has been
phenomenal in India too. From a turnover of Rs.10 crores in 1947,
it rose to Rs.1050 crores in 1975-76 and today stands at
Rs.2350 crores.
In spite of the growth in Pharmaceutical production in the
country, however, morbidity and morality profiles for a large
number of diseases continue to be distressingly high. It is thus
clear that there is a dichotomy between the actual Health ’’needs'1
of the country and drug production.
It is also obvious that a mere
arithmetic increase in Drug production cannot ensure any significant
shift in disease patterns. Hence, if this dichotomy between drug
production and disease patterns is to be resolved, some drastic
measures are called for to change the pattern.
The Pharmaceutical Industry in India has developed along the
lines followed in developed countries.
The reasons for this are
twofold. First, the Industry in India being in the grip of MNCs,
drug production has naturally followed the pattern of production
in the parent countries of these MNCs. No attempt has been made to
assess to actual needs of the country. Secondly, the India/Drug
Industry caters principally to the top 20% of our population, who
T
X
his is also the section
have the purchasing power to buy medicines.
which is amenable to manipulationsby the high power marketing strategies
of the drug companies. Moreover, in this section/ disease patterns
do roughtly correpondent to that in developed countries, ^he
industry is thus able to ureglect the needs of 80% of the population
andyet make substantial profits. ^t sees no ned to change its pattern
of drug production and thrust of its marketing strategu.
One is
unlikely to see any change in these areaas unless the industry is
compleeled to change by stringent regulatory measures, by the
Government.
1
■
Further, drugs differe from other consumer goods, in that
ov
while the consumers have a direct say in the purchase of consumer
goofd, such is not case for drugs, Drugs are purchased on the
advice of doctors, Even in the caseof over the counter sales of
drugs, doctors and chemists have role in determining themarket
«
-s 16 : large the curriculam has very limited relevance to the existing *
situation in the country. On this the report of the Medical
Education Committee, Ministry of Health and Family Welfare says.
11
The present system of medical education has had no real impact on the
medical care of the vast majority of the population of India”. It
is thus the not suprrising that what doctors prescribe have little
relevance to the disease patterns in the country.
^hat is probably even worse is the fact that doctrs, after
passing out of teachinginstitutions, have almost no access to
unbiased dnurg information. As a result their prescribing habits are
moulded by information regularly supplied by drug companies.
^his information for obvious reasons, is manipulated to support the
production pattersn of the drug industry.
ulti tely what
medicines the patients gets is determined not by his actual needs
but by what the drug companies feel are necessary to maximise their
profits.
INCORRECT PRIORITIES OF GOVERNMENT
The problem is compounded by themanner in which the government
makes estimates for drug requirements.
he most important criterion
used for this purpose is based on ’market needs’.
Given the scenario
related above, this can neveif reflected the actual drug needs of the
Today, a need is created forvariovs inessential durgs,
country.
T
by salves prmotion campaigns conducted by drug companies.
hus for
ecample Vitamins and tonics in large doses are prescribed laonc with
antibiotics, ^his is a ’created need’, though Vitamins and tonics
are sameof thehighest selling products in themarket.
India accounts for about 18% of the world’s population, manyfactures andmarkets only 2% of the total global drug production,
out of which barely 30% are essential, to meet the drug needs
•n
to drug to treat 24% of the total global morbidity.
hefollowing
table gives us some idea of the shortfall in essential drug production.
(Though the gravity of the situation ismore than waht the table indi
cates, as the demand estimategiven for 1982-83-based on governmert
figures are a gross under estimation. Moreover for 1986-87 the
Chemicals Ministry has even stopped giving gurues for demand esti
mates, and supplies only figures fortarget of production 1/■
TABLE - 6
Chloramphenieol
. Ampicillin
Vitamin-A
300
111.46
300
71.60
200
MMU 77
142.27
52.00
3 80
140
158.45
69.34
T
T.
250
288.30
188.59
200
194.57
325
410
177.61
200
800
86.90
60
25.51
6 53.57
800
691.05
T
T
INB (anti Tuber
cular)
Chloroquine
Dapsone (Anti Leprosy)T
Diptheria Anti Texin MU
Sources Indian Drug Statistics, 1984-85 Ministry of Chemicals and
Fertilizers, GOI.
<
. & Annual Report Department of Chemicals
and Petrochemicals, GOI, 1987-88.
The Indian sector in the Pharmaceutica1 Industry(including
both private and public) has the capability to produce all
essential drugs,
a dominant role,
Yet the multinational sector continues to play
x he mercenary attitude of drug multinationals is
responsible for holding the- health of the country to ransom, They
market drugs in this country which arebanned in their parent count
ries.
They use the country to test new drugs with dangerious side
effects and in a variety of ways flout the law of the land with
inpunity. Health related industry has the second largest turnover,
owlr over, after the armaments industry. Today the predatory nature
of thepharmaceuticaIs industry appears ready to outstrip even the
x
amaments industry.
he conctol of drug multinational companies on the j
the Indian market is alsmot complete. T^ere are more than 50 MNCsc
in the drug market in India.
ifteen such companies control as mnah
as 31.8% if the total Indian market.
MNCs in theprocess have earned
huge pr fits while charging exorbitant prices for their products.
There have been persistant demands that the Multinational
companies should be nationalised. In fact this was one of the
recommendations of the Hathi committee set up in 1974 to go into
the problems of the Pharmaceutical Industry. MNCs are still being
allowed to operate in this country on the plea that they bring in
new technology. ^ettheir record in the last decade shows that their
contribution in this field has been less than the Small Scale Sector.
Today the MNCs reap super-profits by mainly producing inessential
drugs.
■Lhe following table gives an account of the contribution of
-:18;TABLE— 7
COMPARATIVE CONTRIBUTION OF MNCs AND NATIONAL
(Top 85 Cos.)
Class of Drug
essential
Total prod.
Cos
(Rs.in Crores)
MNCs(40)
National(45)
Antibiotics
256.5
Anti-T.B.
82.9
29.2
173.6
Anti-T.B.
(32.3%)
29.2
(6 7.7%)
Sera-Vaccines
4.0
1.5
0.5
(33.3%)
25.2
1.0
(66.7%)
inessential
SIMPLE REMEDIES
Tronics
32.0
Coudjh&Cold
55.7
Preparations
Rubs &Ba1ms
12.5
Vitamin
98.0
20.1
(6 2.8%)
41.4
(74.3%)
11.9
(37.2%)
14.3
(2 5.7%)
12.3
(98.4%)
78.8
0.2
(1.6%)
19.2
(18.6%)
Source ? ORG Retail S-‘urvey, April 85 to March
86.
(80.4%J)
The new drug policy
announced in December 1986, instead of
spelling out measures for control
of MNCs has granted them even
more concessions, ^t has allowed
increased profitability on
drugs and has reduced production
controls. 'Lhe recent trends of
import liberalisation
and peoduction and price decontrols are in
line with the present
over ments attitude to industry as a whole.
However the drug industry is
probably unique in that it has adirect
bearing on the lives of
almost everyone. The government has
takenifcbo account this
T " f°rCeS" are
fo «
»"a^<=es of
ovJZl93 policy
P°UCy "
hlCh
which
the
are
arugs. Ia , sltuatlo„ „ ere only one
drugs.
"e"tal
13
'*■■> interests of
is detri
detrimental
overwhelming majority of people.
ROLE OF VOLUNTARY AGENCIES
Probably the single largest <
contingent of Voluntary agencies
are involved in work in thehealth sector.
Unfortunately thenet output
of their work has not been
commensurate with theextent of their
presence. One of the major problems has been
themultiplicity of
19 s* aBe depedent on the quality of those heading such projects, which
ultifaately works as 3 constraint in replication of pioneering
efforts in different conditions,
Moreoverthe need to develope
models for replication are not recognised as a priority by most,
These problems are often compounded by the
miltip licity of dunding
agencies, each with differing perspectives, T'his results, at times,
in agencies having to modify their outputs to suit the needs of
funding agencies.
Compared to Government services the coverage by the Voluntary
sector in providing primary health care is negligible and will remain
so indeed, the basic responsibility forhealth care must rest only
with the state, ^ence the contribution of the v’oluntary section in
India needs to be assessed in terms.of the kindof innovative ideas andpro
programmes it has been able to throw up in thelight of its experiences.
With the voluntary sector three broad trends can be identified. dome
agencies are engared primarily in providing curative services.
There are others who have attempted to impakmented the concept of
Primary
ealt.h Care by also inclduing programmes aimed at community
participation and preventive care. " third set has taken up broader
issues like, land relations, agr cultural wagesm power structures
in villate communities etc.
in addition to health issues.
The latter two trends have come up with alternate models for
primary health care. Unfortunately very f of them aresuch as
can be replicated under different conditions all overthecountry.
The
reasons for this are many, but some may be highlighted. Most
a gencies depend heavily on the drive anh initiative of 2-3 indivividls. As replicability is not seen as a priority little thinking
has gone into formulating strate ins that do not depend on the
quality of a 2-3 project leaders. The costs involved, sources of.
funding and their impact on replicability ha-e also not been
worked out. Another notable trend is that, in looking for alternate
modesl, emphsis has been on "parallel" structures andmechanisms
outside the state run PHC structures-i.* the outlook is to build
new structures to by passor even run counter to the existing health
delivery network. *’or nationwide impact, such an enterprise would
neither be successful nor desirable, further, such fundamentally
differently structures may in fact be envisaged only under alter
native socio-economic structures and this, of course, is why the
need is felt by somehoalth groups to engage themselves in taking
— s 2Os —
in the purely socio-economic political dokain> PSMorganisations
work both to promote greater consciousness about the issue and to
creat working “models'1 -i.e. viable and replicable structures with
the potential for becoming nationwide alternative policies and
implementation mechanisms. In the health sector, as perhaps in
education too, this would necessarily involve working, in a broad
sesnes, within existing institutionsl&other structures and looking
for alternative modeIs&mechanisms for the State Health Delivery
System, with well-defined roles for PSM and other peoles1 organi
sations.
ROLE OF AIPSN
The AIPSM has the potential forintervening in a meanginful
way in the health sector, ^t has thetwin advantage of having an
All India reach and a relative homogeneity of purpose and approach.
There is also the in-built scope for exchange of views among
constitutent organ!sations.
Moreover already existing linkages
with organisations of medical and para-medical personnal can be
uch advanta es confer on the AIPSN the necessary
strengthened.
impetus to overcome many of the shortcomin s of voluntary agencies
broad direction of AIPSN's involvement in healt h
cited above.
should be along the following lines?
__ Policy issues? Work out its perspective on Health Policy, Drug
Policy etc. A campaign aimed at the policy makers can be
planned based on this perspective.
—Mass ca,paigns? Based on the AIPSN's basic understanding
regarding health some fundamental demands need to be formulated.
These can be taken up as campaign issues among the general
public.
Given the nascent stage of develppment of the Peoples
Science Movement in most stages, the campaign should be focussed
on a few key demands.
— Linkages with health delivery personnel? Lingages need to be
built with organisation of doctors, para-medical personnel,
medical representatives etv. Such linkages can work also to
attract these sections, involved in health care delivery, to
the Peoples Science Movement.
— Models ofor Primary Health Care? Initially in a few selected .
areas the AIPSN should develop models for Primary Health Care..
Based on the experience gained strategies for replication can be
-:21sThe most probelematic area in the Health Care Delivery
system in the country is the interface between the PHC system
and the users of this system i.e. village communities. The
AIPSN can have a major role to play in this area. It can play
the catalysing role in making the PHC systeip more answerable
to the community. It can also work towards sensitising communi
ties to issues to issues related to health, so that instead of
being passive receptents of Government servtes they can involve
themselves in the decision making process. such interventions
also require demooratisation of the political and administrative
set up, with much greater powers being reserved for local
b odies right down to the panchayat samities. Here a^ain the
AIPSN can play a major role in association with local democratic
organisations of thepeople. Given such a perspecpective the AIPSN
with its All India reach, is in a position to work out models for
primary Heaith Care which can be replicated all over the country.
— Reference
Debabar Banerjee, Health and Family Planning Services in India;
Pub,Lok Paksh, 1985.
Health Care Which Way to Go: Medico Friends Circle.
Statement on National Health Policy:Government of India, Ministry
of HeaIth&Family Welfare, 1982.
Health for All, an Alternative Strategy: ICSSR&ECMR, 1983.
Drug Industry And The Indian People: DSF&FMRAI, 1986.
H ealth Status of the Indian Peole: Foundation of Research in
Community Health, 1987.
State of the World's Children, UNICEF, 1987.
Meera Chaterjee, implementing Health Policy: Manohar, 1988.
J.E.Park, Text Book of Preventive and Social medicine; Pub.
Banarsidas Bhanot, 1986.
******★ *★ ***★ ***★
i
H 3
COMMUNITY HEALTH CELL
<7/1>(First FlooDSt. Marks Hoad
BANGAl OHE - 560 001
BUILDING THE NEU PARADIGM
♦
A Stud^-Refleetion-Action experiment on Community Health
In I ndia
Community Health Cell
4?/l St Mar-k’e Road
Bangalore 560 001
The Community Health Cell (CHC) is a Study-Reflection—Action
experiment drawing upon the rich and varied experience in
Community Health Care from all over our country. . In the
initial phase, two members of the existing team travelled
aLlbver the country interacting with Health and Development
projects. The team now continues interactions from its
base at Bangalore, Karnataka.
The Study-Reflection-Action experiment has been based on
interactions which are open-ended, non-formal, non-threatening
and a reflective exploration of past experiences and future
plans.
The purpose of the CHC experiment has been to build a
framework for an alternative approach to health care,
based on a diversity of micro-level experiences. The
attempt has been to look at philosophical ar numptions,
goals, methodologies, successes and failures, strengths
and weaknesses, opportunities and threats in order to
build the comoonents of a new paradigm.
A necessary first step of this approach has been the
experimentation within the team with a non-hierarchical,
participatory, mutually supportive effort in its working.
This has led to democratic decision making which has a
team-sustaining effect and smoother function. The team has
a few full timers,9 while the part-timers contribute at
... .2
■»
2
their convenience, such that their participation has a
flexibility ranging from half-a-day contribution,
through alternate day work, to even alternate week
contributions to the team, In addition, there are/a number
of associates on the CHC network, coming together off
and on.
The catalyst process has generated activity for the CHC
team, ranging from participatory reflections, perspective planning,
exploration, issue-raising, networking, documentation,
inputs into training programmes, workshops, seminars and
Action research on Community Health related issues.
The CHC team participates with individuals, whether health
professionals or otherwise, field based project groups,
Resource and Co-ordinating groups and Government agencies
interested in exploring Community Health Action in its
various dimension.
The topic range spans Rational Drug Therapy, Alternative
community health training,
medical education,/tnvironmental health issues, Health
Policy matters, Medical Pluralism and Integration of
Traditional Systems of Medicine in Health Caro and so on.
In short, anything of relevance to Community Health.
The definition that is emerging from our interactions
over six years is that
nCommunity Health is a process of enabling
people to exercise collectively their
responsibility to their own health and to
demand health as their right. It involves the
increasing of .the individual, f amily and
community autonomy over health and ..over.
organisations, means, opportunities, knowledge,
skills and supportive structure that .make
health possible11
. .. .3
3
To make Community Health a reality, the present health
superstructure has to be:
* more
!people oriented’
-x more ’community’ oriented
*
more socio-epidemiolcgically oriented
-x more democratic and participatory, and
9
* more accountable.
The paradigm shift is to be in our thinking of health and
health care from the orthodox medical model of health to
understanding, appreciating and practicing a social model
that will tackle health problems at its deeper roots.
This shift of emphasis should take place at all levels
and at all dimensions of existing health care planning
and management.
The Technological/Managerial components of the new
Paradigm includes
Appropriate Technology for Health
Community organisation and participation in Health
Community/Village Health Workers
-AInvolvement of Traditional Healers, Dais
■54-
and indigenous system
* Education for Health
-/r
Health with Integrated Development
-x- Community support to Health Care — finaneial/
resources•
... .4
4
The critical ..values/issues of the new Paradigm include:
*
Social Analysis, conflict management
Individual/Community autonomy
-x- Medical Pluralism
Accountability and socio-medical audit of health
services
* Demystification and skill transfer
* Community building efforts
*
Participatory Team decision making.
Despite some negative trends like Commercialisation of
medicine5 mushrooming of medicalised health projects 9
verticalisation of health efforts and cooption of
Health by status-quo forces, it is heartening to note
an emerging growth of people/project/group aware of the
deeper dimensions of Community Health symbolised by:
a . new approaches in Government policy reflections 9
b. a growing base of village health workers,
c . involvement of non-medical health activists in
health care issues 9
d. health issues bocoming part of the education
process, and
e e
health issues emerging in other movements, like
the Science, Environment and Women’s
movements and so on •
5
5
A time has come to take critical stock of the Community
Health Action reflection andecxperimentation in India
and identifying the enabling/empowering dimensions so that
groups like the People Science Network can build their
health action efforts within this emerging paradigm.
Ultimately all Community Health action initiators have
to ask themselves the following three questions.
1. Will uo work together to out pressure
tn the established medical system to commit
itself to this new vision of Health Care?
2. Will we work together to cut pressure
on ’Health Policy and decision makers’ to
move beyond policy statements and get
community health orientod programmes and
actions off the ground?
3. Will we work with the people and their
organisations to enable and empower them
to get the means, structures, opportunities,
skills, knowledge and organisations that make
health oossible?
All these are unanswered questions,
Micro level experiments
have shown that a lot is possible, but macro level change
requires a collective understanding and a collective
vision.
WE EARNESTLY HOPE THAT THIS PEOPLES ’ HEALTH SCIENCE
CONGRESS WILL BEGIN THIS
PROCESS,.
6
6
Ref ersnces
This working paper is based on five key papers of'
Community Health Cell which are available on request for
all those who wish to explore these ideas further.
1. Community Health in India (cover story)
’Health Action1, Vol 2, No 7, July 1989
(18)
2. Towards a Paradigm Shift
’LINK’ (Newsletter of A CHAN)
Vol 7, No 2, Aug-Sept 1988
(4)
3. Perspective in Health Policy and
Strategies for the State of Karnataka
A Community Health Cell response, 1988
(10)
4. People’s Involvement in Planning and
Implementation Process
A response to a Planning Commission process
by Community Health Cell, 1989
(14)
5. Towards a People Oriented Alternative
Health Care System.
Social Action, Vol 39, 3uly-Sept 1989
Numbers in brackets indicate pages.
Please write to author
C/osCommunity Health Cell
No 47/l St Nark’s Road
Bangalore 560 001 .
(14)
C-Orr) h
COMMUNITY IR V/fH C£LL,
47/1t(Firs* i-tcoG-A. Marks Fioad
001
BANGAkOrtt -
PEOPLE *S P7XRT ICIPATION IN HEALTHS
THE CATALYTIC ROLE OF THE
KERALA SASTRA SAHITYA PARI SHAT (K S S P)
V. Raman Kutty
INTRODUCTIONS
Community participation has been accepted as a
major factor in health development strategies in the context
of health for all by 2000 A..D.1 This marks a departure from
earlier paradigms where health was seen as a purely 'technoeconomic' problems technology being inappropriate and/or
unavailable, and if available, resources being constrained
so as to make access impossible for most of the population.
This rethinking has come in the wake of the WHO's adoption
of the policy of primary health care as the appropriate one
for reaching health for all, when it was realised that health
development in most of the third world followed inappropriate
models.
But community participation cannot be understood in
isolation from the realities of the social situation. If the
power structure of the society and the resource misallocation
that it has given rise to is ignored in promoting community
participation, then it is likely to degenerate into a passive
participation as 'beneficiaries', and not participation in
decision making. This would, only serve, in the name of
community participation, to legitimise exploitation in the
health field.
Non governmental organisations
(NGO's) are seen as
nodal agencies to promote participation by people in health
activities.
This is because in most developing countries,
government institutions
are apathetic to the real needs of
development in the rural sector.
Moreover, NGO's also seem
to inspire more confidence in the people than government
organisations which are often viewed with suspicion due to
various reasons.
(Here NGO is used in the sense of any
organisation other than profit making commercial concerns,
not connected with the government).
- ° 2 s-
these organisations, one can recognize 2 types: research and
analysis oriented, and action oriented.
But it also true that many NGO's do not offer a viable
• alternative in developrrent.
‘Lip service is often paid to
such phrases as ’community based' and ’community participation*.
Many projects are seen as offering neither responsibility nor
opportunity for decision making locally.
In many instances,
decisions are made nationally by the elite. Often foreign
managers and their salaries absorb a large percentage of the
available funds . At best these types of NGOs offer a bland
volutarism which smacks of charity; at worst they degenerate
into agencies subtly serving the interests of foreign organi
sations or governments in the country.
It is in this context that we propose the unique role
and experience of the Kerala Sastra Sahitya Parishat (KSSP)
as a model for development effort from the people in the area
of health.
HISTORICAL?
The KSSP was formed in 196 2 as an organisation of
science writeres in Malayalam. It evolved from earlier
societies in the fifties primarily concerned with the problems
of those who were trying to popularise science topics in the
local language.
Very soon it grew into a i association which
welcomed anyone interested in science and prepared to accept
the scientific method as a guideline to analyse problems of
man, life and society. This growth also meant that the orga
nization changed its style from detached deliberations of
intellectuals to active action oriented programmes and invol
vement at grassroots level.
It was sustained by a very
democratic style, of functioning and grew to have numerous
branches throughout the statec
The Parishat has a guiding philosophy which can be
4
summed up as 'science for social revolution' .
In other
words, the scientific method forces us to see (a) all processes
as constantly subject to flux or change, and (b) the potential
of science as an agent to bring about change in a desired
- ?3 : -
Thus the KSSP has been in the forefront of all major
movements in the state towards a more people-oriented policy
in areas such as energy, health, environment, and planning.
Notable among these are its involvement in studies on the
ecosystem of Kuttanad, on the pollution caused by various
industrial units in the state, and its championing of the
cause of preserving the silent valley, a veritable gene pool,
. against submersion by a proposed hydroelectric project.
This
latter struggle earned the KSSP many epithets, from friends
and enemies alike, notably that of being ’anti-development'.
But in the decade since the project was abandoned, most
people have accepted the wisdom of the KSSP in opposing the
silent valley project.,
The KSSP sees its involvement in health as part of
this overall scheme.
Its major thrust area in health has
been, for a long time, the need for a rational drug policy.
Kerala is a state where the demand for health care is being
exploited to the fullest extent by national and international
lobbies alike. It offers one of the major markets in India
where considerable amounts of irrational and even dangerous
drugs are being sold. This is the result of an unholy
alliance between profiteering firms and some not very dis
cerning doctors. The Parishat launched ics.campaign for a
rational drug policy with seminars, discussions and meetings
all over the state, taking the drug issue right to the people.
A major initiative was the seminar 'A decade after Hathi
committee' in 1985 in Trivandrum.
It can be said that the
KSSP was responsible for the revival of the Hathi committee
report from the quiet oblivion to which it seemed to be
delegated by the authorities.
Health activities initiated by the KSSP took many
forms .
1.
Some of these, over the years, have been:
organising of thousands of health classes for the
people in 1985,
- :4 ;-
4.
drug information packet for the doctors.
5.
the health survey in 1987, which was an occasion for
educating Parishat activists on the public health issues
in the state.
6.
the call for boycott of Union Carbide products following
the Bhopal industrial- disorder, and the campaign against
the callousness of MNC‘s operating in underdeveloped
c ountrie s,
7.
most recently, the initiative to utilize'-the 100% literacy
drive in Ernakulam district to make a campaign for 100%
.immunisation in the district.
The Parishat shares with other health movements in
India a strong critique of the existing health system, which
is characterised by hospital and curative orientation, urban
bias, and elitism.
But it does not subscribe to the view that
it is futile to attempt to reform it.
The KSSP has stated its
desire to see a dialogue between scientific practitioners of
different systems so that points of convergence may emerge.
But the KSSP does not support the view that modern medicine
is an alien science and should be rejected in toto.
The theoretical framework for the KSSP ’s health
activities can be summed up as follows
1.
Health of. the people cannot be seen in isolation from the
socio-economic
precesses around us.
to an equation of doctors, drugs.
2.
It cannot be reduced
and technology.
The increasing technological complexity of modern medicine
has led to an alienation of health care from the people
for whom it is intended.
This is turn results in exploi
tation of the people, by unscrupulous professionals,
companies,
and others in the health field.
is the best guard against such exploitation.
aims to arm the people with information.
Knowledge
So the KSSP
-:5 -
3.
'health for all ' cannot be achieved without
active support from the people not only as beneficiaries,
but also in the decision making process. So the KSSP
tries to act as a catalyst in inducing people’s particiUltimately,
pation in health.
The greatest advantage of the organisation over its
fellow groups active in the health field is that it is not
confined to health activities alone. Thus KSSP worker is
aware of the links between the campaigns for cleaner water,
better stoves , and the drive for promotion of oral rehydraHe sees the organisation push the campaign for 100%
ti on.
literacy to one for 100% immunisation, and how literacy helps
create the demand for immunisation. This is a unique role
fortunate to emulate,.
which very few other organisations are
Moreover, her? 1th activism in KSSP is not confined to
doctors or health professionals, The ’demystification* of
health is an important part of our strategy to take health to
the people. The grassroots level acceptance and democratic
functioning of the organization provide a better environment
for promoting health action.
bt-ing a:• mass organisation has its own
But being
Most? voluntary organisations in' India play a
SOME CONSTRAINTS:
problems.
complementary or substitute role. Because government organi
sations are inadequate to perform their wn tasks in health,
voluntary agencies try to replace them or substitute their
work in some areas.
They do most of the jobs which ought to
have been undertaken by the government agencies themselves.
The Parishat does not believe in this philosophy. We think
that in a democratic polity, polular pressure can and should
result in a more responsive role by government institutions.
This often means that some avenues of activity are resorted
to only as a
a last
measure. The KSSP is also particular not
last measure.
in major
major projects
to be involved
projects involving donor funding.
involved in
' >
___
<•
o
o
o
_
The KSSP, eventhcugh an organisation committed to the
ethos of science, has had very little opportunity so far to
initiate original research. This has been compensated to a
large extent by the involvement in action research as in the
development of smokeless chulhas or the health survey. The
Integrated Rural Technology Centre is a specific step in this
direction to initiate research appropriate to the needs of the
people.
In conclusion/ the KSSP in health strives to act as a
catalyst for people’s participation. Without this, we belrieve/
no programme in nrimary health care shall ever be successful.
REFERENCES
1.
Palmer C T and Anderson M J
Assessing the Development'of Community Involvement
World Health Statistics Quarterly 1986; 39.
2.
de Kadt E
Community Participation for Health - the Case of
Latin America
in Morley et al/ (ed):
Practising for Health for All
Oxford, Oxford University Press 1983.
3.
K Smith
Non Government Organisations in the Health Field Collaboration/ Integration/ and Contrasting Aims
Social Science and Medicine 1989; 29,3s 395-402.
4.
Thomas Isaac T M, B Ekbal
Science for Social Revolution - The Experience of
the Kerala Sastra Sahitya Parishat
Trichur, The Kerala Sastra Sahitya Parishat 1988.
A
£0(Y) H 3.g
A
PECPLES’ CLINIC w
EXPERIENCES
’•RAMACHAN1RA REDDY PEOPLES POLYCLINIC” as it is
now called is an institution which is serving people of
Nel lore District and its adjacent districts in its own
humble way.
It is managed by a trust. It may be inte-
resting for an activist in the health movement, to know
the experiences of a hospital whose basic
concern is common
man and his ailment.
BACKGROUND & DEVELOPMENT OF THE PEOPLES, CLINIC
Er.Ramachandra Reddy’s activities and the evolu
tion of the Peoples Clinic cannot be seen or understood
separately. They are so closely interrelated that
a brief
account of his activities is necessary to understand the
guiding philosophy behind the peoples clinic.
Inspired by the National movement in the thirties
when the country was politically electrified/
Er. Ram/ as
he is fondly called/ was drawn into the
struggle against
British. Coming from a very remote village of Nellore
Eistrict , he was able to see,
experience, appreciate and
understand the suffering of the vast masses of the rural
side. These people got very little food
to eat, practically no clothing on them. Enaciated to the bones.
No
worthwhile shelter. Literacy unknown.
Children utterly
malnourished. Production primitive. Superstitions ram
pant/ almost bordering on Tribal culture,
Added to this
is the attrocities of the landed
gentry/ the religious
clergies and the harassment of the police. He wanted to
- 2
With this background, he having become a doctor,
wanted to utilise his knowledge and technical skills in
the service of the downtrodden not only in the field of
medicine but in social. economic, educational, cultural
and political fields. His area of work also extended to
organise intellectuals.
He established Science Clubs, drawn
intellectuals(College teachers, doctors, lawyers etc),
into it and was able to inculcate scientific attitudes
through its activity.
He has grown to a stature that he played key role
to avert communal clashes in Nel lore Town. He became a
legend in his own lifetime.
The influence of his activities moulded the
thinking and working pattern of the doctors and staff
of the hospital. He caught the imagination of the
youth and mobilised them in the service of the downtrodden. The Peoples Clinic slowly
emerged and evolved
into an institution and with a philosophy of its own.
BEGINNING:
The Hospital was started with the team of three
doctors. Ofcourse, Dr. Ram's name is synonimous with the
clinic. He brought modern medicine in a revolutionary way
within the reach of the poor people. He and his team of
doctors did a lot of promotive. preventive and curative
work. on a very large scale. He himself being an eminent,
skilled and exceptionally genious doctor he was able to
train many doctors to become proficient
in their skills.
- 3 Taking note of the strong family traditions in
rural India, he used to utilise the services of the family
members in attending the sick/ instead of the hospital-aides.
He evolved a new concept of a family member attend a patient^
more or less as medical-aids/ with good results, In the
course of treatment/ he was able to communicate with the
family members of the sick people about health, hygenic and
pesthence etc. During this process he was able to convince
the people and dispel many a superstition in them, At the
same time. he would demistify the therapeutic wonders achie
ved by Modern medicine. At times when communicable diseases
(cholera, materia, filaria, small pox, meseals, chicken
pox etc.) become epidemics he used to go to the villages
and take the people into confidence and saw to it to prevent
in first place and to treat those who are affected. In a
very short time he was able to achieve spectacular results
in all these epidemical forms of diseases.
Another important area of his mass education is
nutrition. When people had mythical understanding about
food ("bread, apple/barly etc. are better food for sick
people”), he used to give proper perspectives in a relevant
situation.
Eventhough other doctors and staff members of
the hospital worked in the same direction as that of Dr.
Ram’s, the hospital got personified in him. We are zealousely
guarding the traditions set by Dr. Ram till now.
As the Hospital grow into an institution/ more
and more joined and to day it is a fully grown polyclinic
-4The doctors, 120 of them, trained in the above said tradi
tions. spread all over Andhra State. They have been able
to reach out the most needy and neglected sections of
the Society.
CURRENT ACTIVITIESs
Apart from the curative area of health. the insti
tution is engage^ in many other activities,
in the path shown
by Lt. Ram.
In the recent past. youth drawn from rural Nellore
was trained both in health education
and limited first-aid.
These paramedics guide the people in their respective Villages
to take necessary preventive steps amongst the
community
and guide those who need curative treatment
appropriately
and in time. They also give relevant information
to the
Health authorities and get various preventive measures
implemented in their Villages, These health workers have
got many achievements to their credit in
the fight
against diseases like cholera, malaria etc. and to get
immunization done on a large scale in rural Nellore.
In the field of health education our doctors
Used to educate patients and their families about mis
conceptions and misunderstanding,is (tonics. inj ections.
health drinks. food habits etc.) in the day to day life,
Most of times own prescriptions are bounded by W.H.O.
list of essential drugs. We scrupulously avoid
drugs, hazardous drugs and irrational drugs.
unnecessary
This method
is evolved through persistent discussion and education of
-5they can manage medical, surgical and obstritic problems.
It is such type of basic doctor. we feel, needed in the
present Indian situation , where the specialities are
mushrooming up, mostly taking Care of the rich, leaving
the majority of the poor to either lack of medical faci
lities or to the Fresh medical graduates, who were given
little training in Medical Colleges in dealing with the
rural medical problems. The paramedics are also trained
in such a way that most cf them cannot only attend to the
needs of the ward. O.P. , Operation Theatre but acquire
basic skills in the techniques of X-Ray,E.C.G.and Laboratory.
Through this institution of Health, we have immense
opportunities to penetrate into the closed groups of the
Society, (who have been shielded by various vested interests) and give than some out look cf health education and
scientific attitudes.
Through exhibitions. cultural programmes, book publica
tions and public meetings, our doctors are inculcating
scientific attitudes in common people. We are getting
good results in these fields. We found that people will
readily accept most of the scientific thinking in field
of health (breast feeding, ORT etc.) provided they are
properly communicated and convinced.
At times of natural calamities. our institution teams
rushed to those areas and helped the affected in its
own way (Great Bengal Famine of 1943, Rayalaseema Famine
of 1952.
Tragodly of Tidal wave of Coastal Andhra of 1977
-6rie have to go a long way in the aspects of preventive
health and the institution is gearing up for this task.
On curative side our work worth mentioning.
Daily on an
average 350-400 out-patients will get consultation and
treatment from the doctors. The in-patient turnover is
6,000 in a year, with its 175 bed capacity. The Major
surgical procedures done per year more than 1,200 and
the Minor surgeries will be to the tune of 5,000 per
year. This large turnover of patients on the curative
sector is one of the factors which makes the doctors
panetrate into the Society and reach the remote villages.
One of the main reasons for this large turnover is the
cost effectiveness. The modern medical facilities are
caterea to the needy at a low cost because of the sacrifice and industry of the doctors and staff and also be
cause of the ethical methods that are adopted.
In the conclusion. the
institution is being recog-
nised as the one for people. and they own it and protect
it. But all this is not achieved smoothly. It has to fight
against many odds, against conservative outlook, against
many attitudes. In one sentence it is a swim against current and it continues to be so. It is not possible without
the services of many and dedicated youth, who has come to
work here as doctors and paramedics.
With their dedica-
tion. determination and steadfastness, they worked in
whatever form demanded of them.
The tremendous mass support this activity received
from the people, sacrifices by various individuals and
'COMMUNnY hiALTH CELL
47/1,(rirst Fioor)St. Marks Road
BANGALORE - 660 001
SCIENTIFIC AWARENESS FOR PEOPLES BENEFIT_=_CHArS_CONTRIBUTION
—— — ————
Catholic Hospital Association of India is a national
organization of 2,222 member hospitals, dispensaries, health
centres and social service societies spread throughout the
Country0 Our member hospitals are noted for quality and
efficiency of services and utilization of latest technologies
and advancement in medical science.
Very often, missionary sisters and priests had started these
institutions in needy areas where suffering humanity had no
other option for health care. Some of them started in a very
humble way and grew into impressive institutions. It was the
compassion and healing spirit of Jesus Christ that motivated
them to go to the extreme rural areas and to the peripheries,
But as the years ;^.ssed, critical evaluation makes us
realise that some; of us have lost the original vision and
commitment to the people. Survival and maintenance of the
institution becr-me the focus of attention. Sophistication
and incorporation of advanced medical technology turned out
to be the answer to survival. Some of these modern changes
are not affordable by the poor majority and the fact remains
that we fail to realise the additional burden we place on the
poor due to this.
CHAI,holding on to its original vision, endeavours a
critical analysis of the health situation in the country
in relation to the socio-economic and political situation.
Very often many of the health problems, in a detailed
analysis, ultimately are due to an unjust distribution of
land, unequal sharing of profits, exploitatory marketing
systems and unfair wages. This leads to poverty of many and
surplus for a minority. It is this poverty-stricken
majority that have malnutrition, recurrent illnesses and
chronic diseases unattended adequately. It is the weak women
of this majority who will be doing hard labour inspite of
carrying a baby in an anaemic body. They will deliver a low
birth-weight infant which will continue to have a poor
weight gain and succumb to many infantile disease.
1
2
mosquitoes in plenty. They are fondled and cared for by
elders, who cough out tuberculous bacilli. Their weaning foods
are mixed with water drawn from the village pond which
carry any number of Rota Virus, Amoebic Cysts, Round Worm
Ova, Hepatitits Virus, Typhoid and even Cholera Bacilli.
o
Out of whatever little money their parents earn toiling
many hours in the hot sun, a good share is spent in the
local arrack shop which is run quite profitably by the rich
business class. This business class will see to it that no
saving schemes survive in the village as it.will make the
poor villagers stronger in facing any financial crisis.
Only when such saving schemes collapse, the poorest of poor
will fall at the feet of the money lender and become more and
more chained to him.
Health can never be a reality in such a vicious circle.
No amount of medicines or efficient medical staff can ensure
the total well-being of that community.
In the li^ht of the above analysis we realise that unless
people are made to take care of their own health, HEALTH
FOR ALL BY 2000 AD wa^Ll be a myth. It is this "enabling"
process that CHAI has been facilitating through many of
its programmes. Ultimately we want "empowered" communities
who can understand their health problems and take appropriate
remedial measures. We believe that the poor can do
"something" for themselves and they are "somebody" in
society. The poor man with a number of miseries, a great
deal of incapacities and innumerable needs, poses before us
as a man who has lost his dignity. We want people to
rediscover their dignity and self esteem. They should
also rediscover their potential in achieving remedial
changes.
Our awareness building programmes are aimed at raising a
critical consciousness" level of the community so that
they will be analysing, questioning and challenging people
on various relevant issues. Based on the community s
3
insisted upon, based on a prioritisation. T^se
in-rain niTi brine about maximum desirable chang
resources
activities Which will bring aoo
m society and those activities which reau
P input, deserve a high priority.
health activities It becomes a people's movement. It is
this movement we are facilitating through our oriental
sessions, training programmes, followup and
replanning of various projects. Many of our osp
getting reoriented in undertaking community based hea
have taken up
care programmes. Many institutions
. to increase
of local community health volun
organlse ■
national level we
;"Lherie::::e::-coi:ity health projects. «e
leaders of community
persons
also 1 ientlfy appropriate resource
-^“^^^“rtralning
strengthen regional resource
of the country and
more workers.
the isolated
CHAI has taken leadership in coordinating many of
promoting linkages among them.
health activists groups and
between people based
We also facilitate exchange programmes
Philippine s,SAARC
countries
such
as
movements
of
health
other
Countries, Latin America etc.
is to influence the doner agencies
Another attempt of ours
Holland, Switzerland, etc to
in America, West Germany,
based' health programmes rather
direct more funds to ’people
than sophistication of big institutions.
consumer item d.n
being
Drugs
one
RATIONAL DRUG THERAPY:
selection and use,
has
no
say
in
consumer
the
which the
This! consumer item
was our maj^r concern fopfnany years,
unknowingly. The prescriber
widely
or
misused
knowingly
was
ethical principles co- sidering
has to apply maximum
of the patient, cost benet.it ratio,
financial status <
t side effects, availability of
. .
actual indication
Through various oor? -entious, training
alternative drugs etc.
pUbllcatlon-HealthAotlon , »e have promote
programmes, our
essential drug and rational drug
the concept of
member hospitals have made a oor.noious attemp
Many of our
all banned drugs from their pharma ■.res.
to remove
have a "Therapeutics Commie -ee which
Some institutions
the
4
f
hospital formulary. Still the pressurising marketing
technics of many drug companies are influencing our
institutions. In the field of quality control of available
drugs we do not have enough facilities to monitor and report
promptly to member institutions. Even at Government level
only four states in India have adequately equipped drug .
testing labs and partial facilities in ten states, 10
states do not have any quality control test labs, To meet
this lacunae in service, and ensure the quality of the
drugs, CHAI is planning to start a central quality
control lab ef its own.
The necessity of public opinion andconsumer pressure on the
prescribing doctor, for the effective implementation of
rational drug therapy is quite significant. Our publications
including Health Action magazine continuously try to educate
the masses in this regard.
CHAI had initiated to bring together the producers ef
essential drugs who also believe in Rational Drug Therapy.
The plan is to form a cooperate body of these producers for
pooled procurement of bulk drugs and ensuring steady production
of good quality essential drugs at reasonable prices.
MT^tc^ np MEDICAL TECHNOLOGY : We are protesting against
misuse of any medical technology. The Amniocentesis for
sdx determination and descrimination to girls are strongly
condemned. When Ultra Sound Scanning and CAT scanning became
the fashion of the day an unhealthy trend to overuse them
was noticed. The Doctor-Medical Technology Axis was
unfavourable to the poor man. We also expressed our distress
in the growing commercial cooperate sector hospitals,
especially by the business groups and non-resident Indians.
The value system cultivated in these institutions is damaging
to the medical profession.
9
There are attempts to study .and campaign against unnecessary
surgical procedures such as Caesarean, Appendicectomy and
unnecessary lab investigations.
t
5
which if explained to mothers can save millions of dying
children. We had organized 9 regional workshops for
Paediatricians and Paediatric nurses in reorienting them
in diarrhoea management. Each hospital is supposed to
start an oral Rehydration Comer in their out-patient
departments and in the paediatric wards. An innovative
attempt to expose ORT to the general public was done in
the twin cities of Secunderabad and Hyderabad by starting
demostration counters at Railway Stations, Bus Stands,
Post offices, Museums etc. during last summer.
Immunization is another scientific technology that, has to
reach a-ery concon man for a safer future e^tfon
Socta1
mobilization for immunization is one area to which ChAI had
given emphasis last year. There was overwhelming response
from our member institutions for taking this
this up
up seriously.
We believe many of the herbal and home remedies practrce
through generations in various parts of the country are
effective. It is cheap and affordable to the people.
Scientific bases of its action is yet to be discovered.
gener
A lot of research if undertaken in due course mig
many effective indegenous drugs eg. Reserpine, Vincristine
etc.
We encourage tha
the practice of herbal medicine.
CONCLUSION : CHAI believes in peoples’ welfare throug
peoples' power. This power of the people generates from
awareness building and peoples’ organization. Science
movements contribute enormously to peoples’ awareness.
C-OfYi
H 'S-8
The Declaration of Alma - Ata
Primary Health Care is the key to health for all
In a world in which
four - fifths
of the population has no
access to any permanent form of health care, and in which millions
more
are
health
systems,
acceptable
Primary
12
with the
disenchanted
primary
level of
health
service
care
health for all.
Health
Care,
held at
September
1978,
drew
and
is the
the
embodied
in the
fundamental
far - seeing
concept
Alma - Ata.
Urgent national and international
them
to translate these principles into dynamic,
WORLD HEALTH ORGANIZATION
*
key to
The International
Alma - Ata
up
provided by conventional
in
achieving
an
Conference on
USSR from
6 to
principles of this
The
Declaration
of
action is needed now
practical programmes.
UNITED NATIONS CHILDREN'S FUND
Declaration of Alma-Ata
The International
Conference on
Primary Health Care
meeting in
Alma-Ata this twelfth day of September in the year Nineteen hundred
and
seventy-eight, expressing the need for urgent action by all
governments, all health
and development workers
and the
world
community to protect end promote the health of all the people of the
vorld, hereby
makes the following Declaration :
I
The conference strongly reaffirms
that health, which is a state of comp
lete physical, mental and social well
being and not merely the absence of
disease or infirmity, is a fundamental
human right and that the attainment
of the highest possible level of health
is a most important world-wide social
goal whose realization requires the
action of many other social and eco
nomic sectors in addition to the
health sector.
II
/he existing gross inequality in the
health status of the people, particu.
larly between developed and develo
ping countries as well as within coun
tries, is politically, socially and econo
mically unacceptable and is, therefore,
of common concern to all countries.
III
Economic and social development,
based on a New International Econo
mic Order, is of basic importance to
the fullest attainment of health for
all and to the reduction of the gap
between the health status of the
developing and developed countries.
The promotion a'd protection of the
health of the people is essential to
sustained economic and social deve
lopment and contributes to a better
quality of life and to world peace.
IV
The people have the right and duty
to participate individually and collec
tively in the planning and implemen
tation of their health care.
V
Governments have a responsibilk,
for the health of their people which
can be fulfilled only by the provision
of adequate health and social measu
res. A main social target of govern
ments, international organizations
and the whole world community in
the coming decades should be the
attainment by all peoples of the world
by the year 2000 of a level of health
that will permit them to lead a socially
and economically productive life. Pri
mary health care is the key to attai-
ning this target as part of develop
merit in the spirit of social justice.
VI
Primary health care is essential
health care based on practical, scien
tif ically sound and socially acceptable
methods and technology made univer
sally accessible to individuals and
families in the community through
their full participataion and at a cost
that the community and country can
ifford to maintain at every stage of
their development in the spirit of self
reliance and self-determination. It
forms an integral part both of the
country's health system, of which it is
the central function and main focus,
and of the overall social and econo
mic development of the community.
It is the first level of contact of indi
viduals, the family and community
with the national health system bring
ing health care as close as possible to
where people live and work, and con
stitutes the first element of a contin
uing health care process.
VII
Primary health care :
I. reflects and evolves from the eco
nomic conditions and socio-cultura|
and political characteristics of the
country and its communities, and is
based on the application of the rele
vant results of social, biomedical and
health services research and public
health experience ;
2. addresses the main health problems
in the community, providing promo
tive, preventive, curative and rehabi
litative services accordingly ;
3. includes at least : education con
cerning prevailing health problems
and the methods of preventing arid
controlling them, promotion of food
supply and proper nutrit on, an ade
quate supply of safe water and basic
sanitation, material and child health
care, including family planning, immu
nization against the major infectious
diseases, prevention and control of
locally endemic diseases, appropriate
treatment of common diseases and
injuries and provision of essential
drugs:
4. involves, in addition to the health
sector, all related sectorsand aspects
of national and community develop
ment, in particular agriculture, animal
husbandry, food, industry, education,
housing, public works, communica
tions and other sectors and demands
the coordinated efforts of all those
sectors:
5. requires and promotes maximum
community and individual self-relia
nee and participation in the planning*
organization, operation and control
of primary health care, making fullest
use of local, national and other avai
lable resources and to this end deve
lops through appropriate education
the ability of communities to partici
pate:
6. should be sustained by integrated,
functional and mutually - supportive
referral systems, leading to the prog
ressive improvement of comprehen
sive health care for all and giving pri
ority to those most in need;
7. relies, at local and referral levels,
on health workers, including physi
cians, nurses, midwives, auxiliaries
and community workers as applicable
as well as traditional practitioners as
needed, suitably trained socially and
technically to work as a health team
and to respond to the expressed
health needs of the community.
VIII
All governments should formulate
national policies, strategies and plans
of action to launch and sustain pri
mary health care as part of a compre
hensive national health system and in
coordination with other sectors. To
this end, it will be necessary to exer
cise political will, to mobilize the
countr's resources and to use availa
ble external resources rationally.
IX
All countries should cooperate in a
spirit of partnership and service to
ensure primary health care for all peo
pie since the attainment of health by
people in any one country directly
concerns and benefits every other
country. In this context the joint
who l unicef
report on primary health
care constitutes a solid basis for the
further development and operation of
primary health care throughout the
world.
X
An acceptable level of health for all
the people of the world by the year
2000 can be attained through a fuller
and better use of the world's resour
ces, a considerable part of which is
now spent on armaments and military
conflicts. A genuine policy of inde
pendence,
peaces,
and
disar
mament could and should release ad
ditional resources that could well be
devoted to peaceful aims and in parti
cular to the accelaration of social and
economic develpment of which pri
mary health care, as an essential part
should be allotted its proper share.
*
The Inernational Conference on
Primary Heallh Care calls for urgent
and international action to develop
and implement primary health care
throughout the world and particularly
in developing countries in a spirit of
technical cooperation and in keeping
with a New International Economic
Order. It urges governments, who
and unicef , and other international
organizations as well as multilateral
and bilateral agencies, non-govern
mental organizations, funding agen
cies, all health workersand the whole
world community to support national
and international commitment to pri
mary health care and to channel inc
reased technical and financial support
to it, particularly in developing cour
tries. The conference calls on all the
aforementioned to colloborate in int
reducing, developing and maintaining
primary health care in accordance
with the spirit and content of thi3
Declaration.
3rd All India People's Science Congress
Sub - Congress on Health Bangalore
Sth to 11th March
*
Contenporary Developments in Drug Industry
- Amitava Guha.
Com»i H vceu
/KfFfrst FfooOSt. Marks Hoad
Situations in drug industry in recent times
rapid changes. There has been high profile activities from the
Transnational(TNC) drug companies to affect the policies involved
in drug industry. Vigorous criticism from the people have influ
enced the making of policies in many countries. Even WHO had
formulated guidelines for drug policy. The greatest concern of
the world drug situation had been rational use of drugs, availa
bility of essential drugs, pricing and quality of drugs. It is
evidently clear that drug policy involves, number of policies.
In recent past there has been deterioration in all spheres of
policies and it was found that of all the things interest of the
country waso <seapj?jLficed first. It will be not only time taking
but most shocking task to unvail the anti-people and pro TNG
steps taken in the field of drug industry in recent past. It is
therefore attempted here to reflect some of the important areas
where immediate attention is needed to improve the damages done
in the areas related to drug policy.
Licensing Policy
On 8th May,1952 Drugs and Pharmaceuticals were put under
the first schedule of the Industries (Development & Regulation)
Act. According to this Act all manufacturers excepting the Small
Scale manufacturers would require to appeal for Registration
Certificate and Industrial Approval.
1st instance s
The licensing Committee in 1953 decided the term "New
Article” of IDR Act and parameters of exenption from Registration
Certificate was also decided. Between 1953 and 1966 only 17 TNCs
applied for such exemption which proved that all others violated
the decision. Therefore, to enforce I(D£R) Act, the Govt, had to
revise the exemption limit for fixed assets of the companies in
the following manner.
January, 1964 s Rs.25 lakhs
February, 1970 s Rs.l crores
April, 1978
s Rs. 3 crores
August,1983
s Rs.5 crores
2nd instance s
O
Q
O
o
Ct
It was again violated. The Govt, had to undergo a make
shift arrangement to glorify the laws and exemption was provided
under carry on Business licence - The objective w&s ”In the case of an industrial undertaking required to be
registered under Section 10 of the I(D&R) Act which has not been
registered within the time fixed for the purpose of carrying on
business of the undertaking after the expiry of such period".
3rd instance ;
In 1980 the Department Industrial Development appointed a
special Task force for studying the rampant violation of licensing
system. In 17th October, 1981 New Industrial Policy was announced.
The policy provided. Recognition of excess Industrial capacity
or Recognition of Excess Production (RIP) over the licenced
capacity. This was made even violating the Drug Policy of 1978
where it was stipulated that all foreign drug companies will
have to produce bulk drugs at least 20% of their total sales
turnover.
This liberalisation of the Govt, was also violated, A
2
produced 211 items without any valid licence., Therefore, the
ultimate was delicensingo
Delicensing s
Industrial policy declaration of 1980 stated that the
principal aim of licensing is
a) Utilisation of indigenous capital and materials for increased
productiono
b) To meet the requirement of national priority
c) To ensure uniform development of the industry
d) Import Substitution,
1978 Drug Policy imposed sectoral reservation system for
production of Drugs, 108 bulk drugs were declared as reserved in
the following manner.
Only for Public Sectors - 17 bulk Drugs
Only for Indian Sectors - 27 bulk Drugs
Open for all Sectors
- 64 bulk Drugs
This providentremendous incentive for the developmentof
technology and production of essential drugs by the Public Sectors
and Indian Sectorsr which was correctly observed by National Drugs
and Pharmaceutical Development Council. Against such observation,
the Govt, declared that "keeping in view of the need to stimulate
industrial growth and simplifying the industrial licensing policy
and procedures". On March 16, 1985 the Govt, declared a scheme of
anotherdelicensin9 • At that stage 12 drugs and in June '85/82 drugs were
delicenced The position became as
delicenced.
Life saving category
Essential category
Marginally Essential
Category
- 13 drugs delicensed
- 10 drugs delicenced
- 52 drugs delicensedo
Reseveration for both Indian & Public sector was confined to
only 18 drugs
In the meantime, the Indian sector had developed technology
for at least 66 bulk drugs out of which 22 were delicensedo
Consequence of delicensing was such The TNCs jumped to procure licences for those reserved
bulk drags and prompted the production capacity of many o
•
'* J '
/’ . This has not helped the improvement
of production. It was found that out of 90 monitored bulk drug
slight improvement was found in the production of 13 drugs and
only seven bulk drugs were produced more than the target but all
others were under produced till 1986-87* Therefore the shortfall
of production has to be made up by import while TNCs under utilised
their capacity. Govt.'s favour of TNCs interest were further
accentuated by decision of broad banding, which was for the first
time made applicable to drug industry. This allowed the TNCs to
manufacture at least 100 more drugs without obtaining any licence.
Despite all liberalisation production of essential drugs showed
a very little improvement. *Table-l
FE RA L ib c ra 1 i s at i o n s
Pointing the inadequacy of Foreign Exchange Regulation Act,
1947 the 47th report of the Law Commission on "Control and Punish
ment of Locial and Economic Offences" mentioned -
3
by shrewed and dexterous persons or sophisticated
means greately affecting public welfare but detection
is unusually difficult.
Based on these findings of Law Commission, Public accounts
aasea
Committee in 1968.recommended that the Govt, must take measures
in repairing the leakage of foreign exchange occuring in the cource
of imports and exports of goods through irvoice manipulation by
appropriate legal measures. Accordingly.a Foreign Exchange Regula
tion Bill was introduced in 1972. The objective of the bill was to
consolidate and amend the laws regulating certain payments, deal
ings in foreign exchange securities, transactions indirectly
affecting foreign exchange and import and export of currency
bullion and its proper utilisation in the interest of economic
development of the country. It was further assured that the effect
of the Act would be reviewed and amniendments would be made if the
measures are proved to be inadequate. But .Iways reviews were
made and changes were enforced contrary to the interest of the
country.
According to Sec. 29(2) of Foreign Exchange Regulation Act
1973 all companies (other than banking) incorporated abroad or
where non-resident involvement was more than 40% as well as branches
of such companies were asked to obtain Reserve Bank's permission
to carry on their activities. But the Appendix-I of the Act enlisted
./Drugs and Pharmaceuticals Industry in a totally unrestricted
manner”. Hathi Committee criticised this position and recommended
that a)
The multinationals should be directed to bring down their
equity to 40% and further progressively reduce it to' 26%.
and that too should be done in such a manner that majority
of the shares are diluted to the Government financial
institutions to avoid dispersed holding of the shares.
b)
To nationalise the multinational corporations.
The drug policy of 1978 could not do much in this aspect
but declared that 'multinationals who were engaged in production
of formulations only are required to bring down foreign equity to
40% forthwith*. This was Iso violated by the multinationals at
ease. Thereafter, the Govt, decided that no pressure would be
given to those multp.nationals who involve high technology in pro
duction. In reality large ngimber of the Indian drug companies
employ high technology in the manufacturing process. The OPPI then
appealed to the Govt, for extention of Article 14 of the Consti
tution of India to multinationals. The Govt, assured that "Equality
of law’1 would be provided although this evoked strong protest from
Indian drug companies. But the multinationals started diluting
shares little below 40% and thus became Indian Companies. Thus in
1988, excepting six all TNCs operating in India became Indian
companies and freely started grabbing the facilities enjoyed by
purely Indian companies.
This is ridiculous in the sence that even in most of the
developed countries the definition of foreign companies are very
strict. In Japan,, France, Australia, companies have more than
10% to 20% of non-resident equity capital is considered foreign
companies.
The pattern of equity dilution of TNCs are also dear that they
retain absolute decisive power. For example, May and Baker retained
40% of Rs.45 lakhs shares and remaining 27 lakhs share are distribu
ted among 61,314 share holders. The other way of retaining power by
4
_L
The fillowing articles which will be found 1„
in almost
all companies1s *
memorandum provides the absolute power to the parents whichl are
Power to appoint one third of non-reliving Director
Power to appoint and remove Managing Director
Power to appoint and remove Chairman of the Board of Directors
Power to appoint and remove the Vice Chairman
Power to veto any resolutions by.one of the ex-officio Directors
On the top, the Chairman is usually given a second or casting vote.
__ __
''p-v'+-;1 thb
th& memoranda c-usually found to 'have
such clause
These apart,
the
are -as — that no resolution shall be deemed to be passed by the Board
or Committee, unless a Director designated for this purpose from
the parent company cast an affirmative vote in favour of resolu
tion. It is evidently clear that no Board can function in detriment
to the interest of the parents who are the none but the supreme
policy maker, TNCs yet these companies are considred as 1 Indian
Companies1 by our Govt.
As a result, the principle observation of 47th Law Commission
of foreign currency manipulation remains unaltered. Following
illustrations will establish it
1.
2.
3 .
The out go of foreign currency by way of repatriation
)
has increased (See Table
Balance of export and import is not only negative but
)
outgo of hard currency has increased (See Table
Import oj _ raw materials to produce inessential and was
OTC drugs have increased.
Other danger the TNCs posses is that the potentially large
capital base of them along with the liberal licensing policy have
put the Indian companies to face most unequal compitition. The
TNCs in India have generated a large equity base and a very large
reserve capital which had increased delet/equity ratioato such
extent that the borrowing capacity of the TNCs have reached to
an enormous extent (See Table ) , No Indian Company can stand
against such'pwbrful capital base.
Company
Original
equity
Shareholders 1
Fund
Borrowing Equity
Debt ratio
Borrow
ing power
GLAXO
0 c02
47O36
7.90
150,18
79<»62
Warner
0o70
5,31
1.32
1s0o25
9.30
B urroughs
0.50
15.27
3.17
130.21
27,37
BOOTS
0.10
8.88
2.96
1s0.33
13.80
RICHARDSON
0.002
6.53
2.50
1 50.38
10.56
RECKIT
0.30
10 .97
l?0.00
21.94
CIBA
0.03
10.64
1s0c20
73.21
8.64
:: (5)::
Pricing Policy:- Pricing plays a major role in determining profit
Increase in price effects much more
in pharmaceutical industry*
in profit generation than the decrease in manufacturing and
marketing expenses. Therefore drug companies always try to incfease the prices of drugs even through they had faced a bitter
criticism all over the world.for over pricing.
In 1970 Hrffman-LaRoche preferred- to pay £ 1.6.million to British Govt, than to
reduce the excessive seeling price of Vallium and Librium. But it
was estimated by the Monopoly Commission that Roche made a profit
of £ 4’v / million from the sale of £ 6.8'million of these two
drug in that period.
Prices of drugs generally falls due to the expiary of patent
&nd increase of economy of scale so long as its consumption keeps
Choioramphenicol came down
expanding. We have seen the prices
to 50 paisa from Rs. 12/- in 1950 for e<gch capsules.
In recent past
same happened with Rifampicin within the span of five years prices
came down from Rs. 5000/- to Rs. 2500/- per Kg. of the bulk drug* Yet
the Govt, was convinced of the industry’s argument that prices of
drugs has not raisen in comparison to that for other commodities.
It its also falsely claimed by Oppl that the prices of drugs are
cheapest in India. We find that landed cost of finished formula
tion of essential drugs are higher those of the indigenous products.
Imported bulk
It is more applicable in the case of bulk drugs.
drugs are mostly cheaper than the indigenously produced ones. This
is a major reason for the drug companies crying for more number of
drugs be put under OGL.
Drug Price Control Order(DPCO) 1979 imposed price control
on 487 bulk drugs in three categories* The TNCs reacted in
different ways to thwart the. price control measures. They want
to court and procured injunctions for stay against Govt, order.
They openly violated Govt, order by less.or no production of
essential basic drugs. The TNCs nampaigned that the^frare not able
It
to earn profit by producing the drugs in India due to DPCO.
will appear from table no. that most of the TNCs improved their
performances in the years of 1986-87 and 1987-88 and excepting six/
all increased their assets. Aggrigate gross profit of the industry
was f ound -»-o be 17.4‘ percent during this period. Under the
circumstances the Govt, compromised with the Industry and declared
It was properly deserved by WHO in the World
new DpCO in 1987.
Drug Situation(1989)”Already prior to the‘new Drug Price Order/
the prices of all drugs showed a 30% mark-up and drug company shares'
W^re selling at a premium^ While declaring DPCO’87 the Govt,
could not clearly define the criteria for categorisation. They
only listed 26 drugs in category I but left the selection of
Category II drugs under a Committee. Although the Govt^ said in
DPCO’87 that the principle of keeping the-drugs under Category-I
is cover all drugs required under National Health. Programme but in
reality they considered only six out of eleven diseases covered
under National Health Programme.
Prior to fixing the list of drugs and ex' Category-II there
was intense lobbying by the industry to aiming to keep as many
drugs as possible beyond the price control category. As a result/
we find that the TNCs have by large enjoyed excellent exemption
will show that the 18 top TNCs
from price control. Table No.
functioning in India enjoyed price control exemption ranging from
30% to 98%.
It is also interesting to note that the Committee for
selection of Category-II drugs prepared certain criteria of which
we find that the Committee itself violated all these criteria while
selecting the drugs.. It was found that a large number of drugs
like Vitamin A/Vitamin-C/Chlorpropamide/Indomethacin/ Clonidine/
Hydralazine etc./were left. The Committee- declared that drugs
with a turn over-more that 50 lakhs per year would come under
price control. But this was not made applicable to drugs like
" 2 (6 )::
The Committee also decided that no monopoly or near —monopoly drugwould be left out of the list.
But drugs likejNeosprimDilosin/
Benedryl/ Haemaccel/Zolandin/ etc* which maintain almost monopoly
share in Sales were not considered.
The Committee selected 140
drug£ in the CategOry-II list, This also could not please the
7In the.
industry.
Protest came from all of them.
”
last one year
13 more -drugs were.dropped from the list and 20 others
---- j are in
active consideration. The Govt, also shifted a number of drugs
from Category-I to Category-II. This is not all the Committee
had to prepare another report in the mid 1989 which virtually
recomanded price de-control.
The system of leader price is enjoyed by the TNCs who are
mostly brand leaders of the high turn over drugs* The other
partners in the industry also pollow the leader pric e but provide
trade incentives at a high rate.
Therefore/ the consumers are in no way benefited out ot this
system. There was a system Of price equalisation and a fund was
maintained under the head Drug Price Equalisations Account.c
In Supreme Court TNCs were convicted as
This fund was abolished.
charging over the Govt*recommended prices. They wer< ordered to
refund the excess profit earn to DPEA but the fund stand/abolished
It is surprising to know that DPCO’S? had allowed these TNCs to
increase prices of almost all drugs for which they were convicted.
The other area which contradicts the national interest is the
cancellation of pooled price system*
The recent move of the industry which has almost convinced
the Govt* is total abolition of DPCO and ’self regulatory price
system1 would replace it. The Secretary of the Pharmaceuticals
Dept* has already announced that the Govt, is in favour of it..
The other concern is that in recent past all the new drugs
introduce are not only of me too nature but consist of a very high
Some of them cost Rs. 99 per capsule and Rs. 160 per vial of
price.
injection. We need to analyse whether we ne*-d them at this moment.
Development of science and technoldg y was ruthlessly suppressed
in India during the colonial period and the most important devise
used was the Patent System 1948 at the initiative of Nehru ’Patent
Enquiry Committee’ was formed under Justice Bauxi Teckchand. His
recommendations were placed by then Minister Shyama Prasad
Mukherjee who also tried to introduce a bill in 1953 to change
Later/ in 1957 another Committee was prepared with
Patent Act.
Justice N.Rajagopala Ayenger and the Chemical Technologist Dr. S.
Venkateswaran. They prepared”Report on the revision of the patent
Law. Based on this report attempt was made to introduce a new
Patent Act. which was successfully stalled by TNCs for 12 years
M.P.Mr.Zoachim Alva complaint that”More than 30 foreign drug
companies.have declared an unholy war against this bill;ultimately/ in the bill was passed and Indian Patent Act,’ 1973
■was born. This Act. has been considered as a model to. the 3rd
World countries. This act has greatly helped the Indian Drug
It does not allow any patent for drugs* Patent
Industry to grow.
is applicable only on process technology that too for a period
of maximum 7 years. This has help us to introduce number of drugs
before their global patent expired. Technologically Indian
Companies were free to develop technology for a large number of
drugs for which international patents were to expire much later
and they actually produced and marketed these drugs. To-day
horizontal transfer of technology helped a large number of small
companies to produce bulk drugs some of whom are involved in
export also. Similarly/ the national research laboratories also
developed number of technologies for bulb drug production^ This
would not have been possible in .absence of Indian Patent Actrl970„
There has been move from some, quarter to change Patent Act.
:: (7)::
»
Th., proponent of this change are suggesting this Act. has
been a bloch fop irnpont of rnodern technology. But they have
suppressed the fact that the technical colaboration agreements
by Indian companies have increased from 183 in 1970 to 1/041 in
1985.
In Pharmaceuticals out of 41 technological colaborations
during 1979 to 1985 Indian companies were .involved in 39 cases
where the Indian Patent Act. had not played any restrictive role.
Brazil raised the question of an international patent policy
In .1972 UNCTAD
in the 16th General Council of U.N. O. in 1961.
Conference at Santiago decided that clauses of Paris Convention
would be changed in favour of 3rd World Countries.
The UNCTAD draft prepared in 1975 was opposed by Group of
7•
In the conferences held from 1979 to 1985 despite opposition
from only two countries draft was approved. The whole matter was
talcen in GATT.
Question of Trade related Intellectual Property
Meanwhile USA developed rThe Omnibus Trade &
(TRIP) was raised.
Competitiveness Act* of which suoer 301 was imposed on Brazil/
Japan and India. Brazil was blamed for the reason that they had
kept pharmaceuticals out of Patent system.
In Ceneva Conference of GATT India surrendered by accepting
the Pumta-Del-Este resolution that in order to toake TRID available
national laws will be made available.
This betrayal and surrender
to the pressure of U*S. will ultimately result‘in to changing of
Patent Act in favour of the interest of TNCs causing a great harm
of self reliance and unlimited price escallation will follow in
quick succession.
Import Policy: Policy regarding import has been criticised by both
the industry and consumers,/ We find that there has been world wide
criticism of the TNCs for utilising transfer pricing arrangement
for earning high profit. The TNCs in India have been ignoring the
import restrictiong^put on bulk drug* intermediate and other
In many occasions they were either importing bulk
rain? materials.
drugs from their own parent organisations and charged a higher
price of the same bulk drug in our country while they have not
utilised the production capacity installed at their own factory
In 1978 drug policy canalisation of import was encourag
in India.
ed but later it was discarded in the mid eighties. The (table no )
shows how the TNCs have earned money by simple transfer pricing.
A difference of Rs. 24/338 per kilogramme becomes enormous when at
In 1987-88 import of 42 bulk drugs
ton of the drug is imported.
(7
were shifted from restricted items to General Licence category.
Out of this 42 drugs/Only 6 drugs were life saving and essential
and 10 drugs had no price control/ having unlimited profit potential e
Bulk drugs like Ibunrofcn/ Pyrazinamide/ Corticosteroids/
Ephedrine/ Methyldopa/ Chloroquin/ Chloramphenicol which are
manufactured here but import is also allowed. Man y TNCs who
enjoy monopoly over these drugs do not produce them here as import
is allowed and therefore enjoy an excellent scope of utilising
transfer pricing system.
Import of Refamplein has been in large quantities and is
exempt,of.excise duty.
Inspite of the technology being available
in India it is difficult to produce bulk drug as 105% import duty
imposed on the raw materials. Some instances of similar cases
are given bolow.
Bulk Drug
% of Duty IntermediF'te/raw-mpterials
T r imeth opr im
100%
3/4/5 Trimethoxybenzaldehyde
134%
Ref ample in
nil
Raw materials
10 5%
L-Dopa
nil
Vanillin
135%
Sulphadiazine
100%
Intermediate
135%
Corticostcriods 100%
Intermediate
135%
Chloroquin
ethoxy methylene diethyl
nil
malnate
% of Duty
25%
This indicates that the present import policy is discouraging
not only production but also development of indigenous technology.
Gom H 3. f Q
COMMUNITY HEALTH CELL
47/1, (First Floor)St. Marks Road
BANGALORE - 660 001
RESOLUTION ON UNIVERSAL SALT IODISATION PROGRAMME
Endemic goitre and Endemic cretinism are important Public health
problems in parts of India especially, in the sub—Himalayan belt.
To control this problem the Govt, of India started the National
Goitre Control Programme in 1961. The strategy used was to supply
iodised salt to people in the affected areas combined with
legislation to limit the use of non iodised salt in those areas.
s fhe manufacture of
iodised salt was entrusted to the Public
» Sector.
A review of the pol icy in 1981 found that the Nat ional
Goitre
Control Programme had not made the desired impact and a committee
was formed to recommend changes in Policy
if required.
required, This
committee? did not go into all the reasons of failure of the NGCP
1 ike virtual
absence of Public health education, failure
failure to
subsidise the? programme effectively, administrative failures
in
ures
check ing smuggling of non iodised salt etc.
Instead,
strangely
they took
the position that it was impossible to successfully
implement the programme if
it it is localised to a particular
region. Their panacea for all the ills plaguing the programme was
of non
'Universal
Iodisation7. This meant totally phasing out of
iodi sed common salt from the Indian market and replacing it with
Iodised Salt by 1992. An imoortant
important cornllArv
corol1 ary to this was
the
was
' Salt
throwing open of Iodised
’ ''
“ "
manufacture to the Private Sector,
thus ending the monopoly of Public Sector in this area.
We the del egates of the 3rd Al 1 India Peoples Science
have serious apprehensions regarding this new policy
following reasons:
Congress
for the
1) The escalation of
the scale of operations
is likely to
adverse!y affect people living in the goitre endemic areas.
The iodised salt manufactured Iby the private sector is likely
to find its way to the Metropol itan and other wel 1
developed
markets rather than to the real needy 1iving in the goitre
endemic areas.
•2) Even now the quality of control of
is not
iodised salt
sal t
effect i vel y
the
monitored.
With the quantum Jump
in
production, this would become much more difficult to enforce.
3)
and free market principles as sought to be
incorporated
into the new policy, by its very dynamics, wi 1 1
inexorable shift to the higher priced
cause an
iodised,
refined salt at the cost of cheaper iodised crystalI salt .
4)
The (cost of salt by current estimates may go up by
100-200%.
This would entail
an additional
burden of Rs.500 crores
annually
to the Indian consumer. This price differential
has
Privatisation
already resulted in smuggling of cheaper non-iodised salt into
"" • endemic
r G? cl
.
5)
supplied in support of
The
'Scientific evidence7
the new
been
policy has
questioned seriously and has not been rebutted
sat isfactori1y.
'newer7
Surveys purporting to show
endemic
areas as wel1 as the methods to prove the concept of
subcretinous brain damage have been chai 1enged on conceptual
and
grounds. It has also been pointed out that
methodological
consumption of iodised salt by a normal population may not be
as harmless as sought to be projected.
In
the light of these facts the delegates of the 3rd AIPSC feel
that the present strategy of Universal iodisation is one in which
the costs are borne by the consumers and the benefits accrue to
monopol i es.
the monopolies.
Moreover the new policy ignores the fact
that
with
endemic
goitre
and cretinism are problems
diverse
developmental and ecological causes. A programme to combat Iodine
deficiency should essentially contain flood control
measures,
deforestati on
checking
improvement, proper
use
deforestation,
soil
of
and fertilizers and general
pesticides
eco-restoration
in
addition to salt Iodisation. The Iodisation itself, in order to
succeed, should be confined and concentrated to endemic areas
only. The birth of babies with endemic cretinism is a tragic
resources.. In fact this is the problem which needs
waste of human resources
I ed urgently by a programme implemented vigorously
be tack
to t)e
tackled
in
such regions. The focus should not be allowed to shift from these
areas by the imperatives of the free market economy.
The 3rd AIPSC therefore, requests the Govt, of India to review
the current policy of Universal Iodisation and drastically revise
it. Before formulating a comprehensive new strategy an open
discussion should be initiated involving scientists,
social
workers, economists and peoples science and health movements
in
the country.
*
>■
THIRD ALL INDIA PEOPLEASCIENCE CONGRESS
8th - 11th March, 1990
at BANGALORE
First information brochure and invitation
SUB CONGRESS ON HEALTH
to
FIRST ALL-INDIA MEET OF HEALTH ACTIVISTS
People's Science Network is a network composed of
The All-India
People's Science Movements from all over the country who are actively
engaged in the building of a mass movement for creating scientific
awareness and in intervening in key areas to ensure that science and
technology is used for the benefit of the people.
The People's Science Movements have, to varying degrees and with
The broad
varying success, been involved in the field of health.
groups share on the health situation in the
understanding that these groups
country was formulated in the form of a background
paper at the
second All-India People's Science Congress held at Calcutta.
It was also decided, at that meet, to evolve a broader con sen sus
on health, to share the experiences of health activists and to evolve
a common action programme in issues and
out
areas
that
for
cry
immediate intervention.
It is in this background that we
are now holding this convention
’
of health activists from all over India, as part of the 3rd All-India
People's Science Congress at Bangalore.
The sub-congress on health
will start on 9th morning after the common inaugural programme on
Sth evening and will close with the plenary session on 11th.
We request
your active participation in the congress.
Objectives:
1 .
Sharing and critical
review of experiences of all voluntary
organisations and social activists in the field of health.
for
intervention
Discussions of main areas
oarxicicarion In ensuring health for the people.
and
people's
nteraction between groups ana individuals involved in health
ard
icti--is~
evolving
mechanisms
for
continued
interacticn
?n d e x c h- a nee of information.
4.
Plan action programmes for future people's participation with
specific reference to the on going Bharat Cyan Vigyan Jatha
and to future people's science movement activities.
*
2
Programme:
See
separate
sheet.
Participants invited:
AIPSN organisations and socially
conscious
health
professionals,
medical students and service doctors association sponsored by AIPSN
organisations.
Health activists
Health Home.
from
organisations
like
MFC,
Leading academicians and professionals who
are working on social dimensions of health.
Representatives of WHO, UNICEF
professional health bodies.
Delegate Fee:
and
VHAI,
have
Ministry
of
Rs.50.00
Address for Com munication:
Dr. Amit Sen Gupta
C/o.Delhi Science Forum
B-1 2nd floor, LSC
J-Block, Saket
New Delhi-110 017.
Phone:
665036/6862716
AIDAN,
Student s
contributed
to
Health
other
and
or
THE PROGRAMME
INAUGURAL
SESSION
- 8th March,
1990
10.00 AM
Key note address on
'HEALTH SITUATION IN INDIA*
Dr.D. Banerjee
Jawaharlal Nehru University,
SESSION II
1990
Sth March
Delhi
2.00 PM
AIPSN Annual Meeting
SESSION III - 9th March,
1990
9.30 AM
SUB CONGRESS ON HEALTH
SESSION
A
PEOPLE’S INTERVENTION IN HEALTH
Chairperson - Dr.B.Ekbal
9.30 am
PSM
Perspective on
Primary Health Care
Dr. T.Sunderaraman
10.00 am
The K.S.S.P & other PSM experiences
Dr. V. Ramankutty ,
10.30 am
The MFC experience
10.50 am
The Andhra
K.S.S.P.
Polyclinic experience
Dr.Sesha Reddy
11.15 am
The 'VHAI & AIDAN experience
Dr.Mira Shiva
11.45 am
Other Group experiences & discussion
1.00 pm
Lunch
SESSION
3
PRIORITY AREAS FOR PEOPLE’S INTERVENTION
Chairperson:
Dr.Mira Shiva.
2.00 pm
Drug
Policy
Amitava Guha,
FMRAI
2
2
3.00 pm
The National Health Policy 5 Vertical Health
Programmes
Dr.K.P.Ara v indan,
4.00 pm
KSSP.
Occupational Health
Dr.Amit Sen Gupta,
5.00 pm
Resolutions on
DSf
priority areas
10th March 1990
SESSION
C
WOMEN AND HEALTH
Chair person
:
9.30 am
Dr.Imrana Quadeer,
JNU
Theme papers
Dr.Mohan
Ram,
JNU '
Ms Vimal Balasubramanyan
12.00
SESSION
Resolutions on
Women and Health.
D - ACTION PROGRAMME ON PRIMARY HEALTH CARE
Chairperson
:
Dr.Sesha Reddy
2.30 pm
Presentation of Action Programme
3.00 pm
Discussion and
SESSION
finalisation
E - VALEDICTORY PLENARY SESSION
9.30 am
Presentation of Sub Congress Proceedings
Resolutions
remarks.
Valedictory
NB:-In addition to the above
programmes,
a)
Guest lectures in the evenings
b)
Poster
presentations.
there will be
Co^ H 3-II
community
- *f
PRIMARY HEALTH CARE
hcalth
<7/1, (Fi^t Floor) St.
cell
BANGAtQaE -SSOQoi
Discussions in this area essentially
essential 1y lcentered on
reported
proposals to do away with the Village Health
Worker
scheme.
(VHW)
Following is the substance of the discussion
It is believed that there is a r
move by the Government to
the VHW-Scheme. In c_.
our view, thisJ is a retrogressive scrap
step,
contrary to the spirit of the Alma-Ata Declaration ,
to
which
the
Government of India is a signatory. The VHW
1
is
an
important,
essential element of the Primary Health Care
the professed goal of Health for All by 2000 iapproach to achieve
AD.
The |---* *
perspective
behind this scheme is still
much valid and
needs to be reiterated, The basic rationale ofvery
VHW Scheme is
the
as fol 1ows:
a) Health Services are grossly inadequate in rural
b) Substantial
India.
proportion of health problems in rural India
are
and
training.
and the
coFle^tvi bee?Fhati?na1
WOrk
o*
promoting
collective health action by villaoene r-^r>
a. j
=uch a worker. Demystification of medical kno^edgl can done
be
effectively done through the VHW's work.
c) A health worker coming from the same r~
is socially and
culturally closure to the community community
and
accountable
—
d
more
to
the community.
projects Jx'
iin the
0oCernmentthBBctn^7^H
u,,\,',uu
NGO sector and
and some
some
PHCs
in
the
basic
the VHW scheme. If in India, the
Ues wUh
the®?® i
performed upto expectations, the
. not
the faUt
with
fault itseFf
1ies
departments and not with the scheme
Th/* *mp1 e(nenting
--- -. The
,h°U' *
therefore be implemented with f ol 1
sector iMW^^^Sr^n^nd^;
in different countries, validated
ration^ o?^^
1) Selection: There should be rz
no nepotism in the selection of the
VHWs. The VHW should be selected
of the people (like panchayats). by democratic organisations
2) TrainingIS The training of the VHW should be vastly
enable
ailments at the vill
vil1agers about < ’
practices.
educators of VHWs should
----- 1 L_
be wel1-versed in and should
---- J believe
in the philosophy and practice
of community health.
3) Drug Kits The drug-kit should be r
'
to deal with common,
expanded
simple ailments and the drug-supply
should
•
J
refjul ar and
adequate.
4) Simple, Tlow-cost, appropriate health
material should
be provided to VHWs to
‘ -- -J
1
educational, pictorial
enable them effectivel y
/Z/
carry out health education of villagers,
should be adapted for health education.
Local
art
5) The
doctor and other PHC staff should not look down upon
VHW but should provide adequate support.
forms
the
6)
Well
established, simple, universal remedies
allopathic systems of medicine should be taught.
7)
The VHW should draw his/her honorarium from the Panchayat and
the Panchayat should be provided with funds for this purpose.
Accountability to democratically functioning Panchayat is
superior to accountability to the health bureaucracy alone
since the PHC doctor is not in a position to really assess the
sincerity of the VHW.
8) The
•from
non-
much better trained and hence much more capable, active
VHW would have to spend much more time for health work on a
regular basis. It is unrealistic and unfair to except a poor
person to regularly spend a couple of hours a day for a
pittance of an honorarium especially when nobody in health
sector does substantial honorary work. Hence the honorarium of
the VHW should be substantially increased, even though the
element of voluntary service to the community is reaffirmed.
i
2
WOMEN AND HEALTH
Given below is the substance of discussions
and recommendations
in the area of Women & Health;
The areas requiring urgent attention are
those related to
systematic discrimination against women from birth
birth
ee.n
pro,
.v.n before
ion
..
in
or.^
before birth as seen in proliferation of sex X^ih'.t?™
tests and^femaTe
and female foeticide. Social discrimination against women
their^hZ^th in status*
results in deterioration of
several’ areas, and reSU1ts
eir health status. Thus women from 1lower
socio-economic
ower
b^kgrounds have to withstand a double burden. The issues whTch
inc1^e those which have wider social
and
economic implications.
PSM organisations <could
" ‘ work in more detail on some
areas and evolve demands for action
----- 1 and intervention;
of
these
Eg.fflil Y Pl anning : Women's I._
little
health has been given 1
ittle or no
Pri?7ity in the health planning
J process and implementation of the
has tended to be confined to
health programmes. Women's health
I
conf ined the
planning^or
child birth --elated
related issues"
1annlng °r CMld
Ironically*
issues.
^ami v pP
has substantial
Family Planning Programme
which1 has
substantial amounts of health
— ----budget
allocated to it has failed to show any decline
in the
birth rate. Over
above this,
practice of
Over and
and above
the practice
target Atting
of target
this, the
and
incentives have led to corruption of health workers and
WOand'iIS1* hSS "T?;?na 1 iSSd °ther asPects o* primary
health care ,and led to avoidable complications. In the Family
Planning programme terminal
i
geared at women are pushed in
— ----1 methods
the field. Mass sterilisation
programmes without any follow-up
measures have assumed serious dimensions, especially since
no
is being obtained.
informed consent
In
this background PSM
organisations could take it upon themselves to:
1) Monitor Family Planning Camps and insist
upon proper follow-up
measures. This iwould also involve a critical
— — — —»1 review of the
established and practical
----1 norms for such camps.
2) Ensure rational contraceptive care. This would include
provision
informed choice of method of contraception, <
of
availability
contracept ives and back up curative health services for
side
>
effects.
3) Demand for pproper back-up health services to
complications.
take
care
of
4) Demand for removal iof“ disincentives directed
at women ©9.
maternal benefits after
—second child, etc.
no
Use and Misuse of Science Sc Technology
1) Prevention, diagnosis and management of other
health problems 1 ike menstrual disorders, pelvicwomen specific
diseases, leucorrhoea, STD, cancer of the cervix, inf 1ammatory
menopausal
3
of
problems, :■
-- inferti1ity,
icomplication during child birth
have to be addressed
~a . — —4 care
**■ ■*
’
-------- 1 to with
greater
etc .
2) direct!
Eventhough
the
y hazardou^^u^/l^iaj^edlc^es^uired
useless,
hazardous
for
heal th
a^rd^irp^^es?^:^!
^dTc^s Sn XX"’ * at
foetus
are freely sold without warning on the 1abel/packing.
3) Whil e there is a prol iferat ion of sophisticated
technologies
relat ing to women, simple essential
pregnancy
procedures
eg.
testing kits, early abortion etc.
are
being
made
easily
not
accessible.
4) The increasing trend towards unnecessary
1 ike
hysterectomies, Caesarean sections etc. should surgeries
be effect ively
curtailed.
5) Women's organisat ions I
have already been protesting against
conduction of unethical1
trials and introduction of
reproductive techhologies. A widespread people's movementnewer
to
support this is necessary.
Literacys
schooling
1) Formal
standard.
to
girl children
at
1 east
upto
seventh
2) Proper/correct
education regarding menstrual
cycle,
and
reproductive process to school going and
non-school
going
girls.
Sexual Discrimination:
1) Demand for total ban on sex determination and
sex-presel ect ion
technologies,
de-privatisation of the
genetic
analysis
centres.
...
2) Protest <against
dowry, physical and mental violence
women, crimes against women , separation from marriage
providing maintenance, etc.
against
without
3) Equal
wages for equal work,1benefits such as maternal
1 eave,
etc. must be given by both formal and informal sectors.
consistent demand by PSM should be generated in this regard. A
Other Areas:
1) Women have a right to safe and adequate drinking water
annH
water,
sanitation facilities and efficient non-polluting cook-stoves
PSM organisations could provide informations and work out
and relourcli!'0^1^8 " MCh
*cco'''ding to local needs
2) PSM
could also take up specific health education
4
in
several
areas affecting women including the general heal th issues
the,women and their family members.
of
3) Specif ic studies may be undertaken for occupational
heal th
hak: ards in women's work such as nursing, agricultural
work ,
tobacco
and beedi-rol1ing, coir, prawn
shel1ing,
etc .
including domestic work.
4) Appropriate tools and technologies can be developed for
and made accessible at all levels.
women
5) Heal th education materials on women & health issues which is
al ready available Should be widely circulated and relevant
material should be evolved over a period of time in the areas
where material is not already available.
Finally, to give this issue a proper thrust, the AIRSN should
form a cell for women's health action to take up systematic work
in these areas related to women.
5
OCCUPATIONAL HEALTH
Given below iis the substance of discussions
& recommendations
the area of OccupationalI Healths
in
Identified areas where the AIPSN can do ground work:
1) Gather more data on prevalence of occupational
various parts of the country.
diseases
in
2) Review & popularisation of various acts pertaining to
health and safety.
workers
3) Demand occupational
health oriented
in
employed
factories and ESI scheme.
Doctors
training
for
4) Efforts be made to draw the attention i '
of Ministry of Heal th
towards occupational diseases and improve
I upon the severely
lacking diagnostic facilities.
5) The worker has the right to
know about the occupational
hazards in his work place,- AIPSN with its extensive reach can
strive to educate workers on this right. AIPSN
should also
support the demand on the ground of any working group
this cause and support the struggles taken up locally. towards
6) All the constituent member groups should collect
regarding <-any occupational
hazards in their area
the same to the coordinator
of
the committee.
------
7)
information
and report
ILO resolution should be implemented by Government of India in
letter and spirit.
8) Pictorial exhibition depicting common occupational hazards
prepared.
6
be
Conq H 3-13
Sri M.8.Ourupadaswamy
The Hon'ble Minister for Chemicals & Petrochemicals
COMMUNITY health cell
Government of India
" Marks iioad
47/l,(Fir*tFloor)St
BANGALOaE -56<> 001
MEMORANDUM ON PHARMACEUTICAL INDUSTRY
Sir,
The 3rd All-India reop
Ies Science Congress,
in pursuance to
Peoples
in the Health Sub-Congress notes with concern that
discussions
the new existing
isting drug policy, which was introduced in 1986, is a
retrogressive step and has negatedI even the tentative attempts of
the 1979 Policy to work towards a Rational Drug Policy.
It
is further noted that the 1986 Policy had not,
in any
substantial
manner, worked towards implementation of the long
standing
drug policy,
demands of the movement for a rational
These demands had included ensuring availability of essential
drugs, reduction of drug prices, banning of
irrational
and
hazardous drugs; and for encouraging self-reliance
in
the
Industry.,
Instead the 1986 Policy has resulted in further rise
prices,
less availability of
in
essential
drugs,
more
proliferat ion of
irrational
drugs and dilution of
existing
measurers which would ensure a level of self-reliance.
Front Government will
It
is hoped that the National
take
immediate measures to
implement the |promises made in
its
manifesto regarding implementation of a P
Rational Drug Policy and
thereby scrap the anti-people 1986 Drug Policy.
In this background we wish to submit the
consideration of the Government of India:
fol 1 owing
for
the
1) Whereas there is no Drug Policy in the country today but only
a pricing and 1icensing policy, it is necessary to formulate a
Drug Policy keeping in view the necessities of drug
National
production based on the morbidity/ mortality profile in the
country. The government must, on a priority basis, draw up a
list of drugs essential for the country as also the estimates
of demand for these drugs, and ensure their availability at an
affordable price.
.1.
2) Whereas it has Ibeen the policy to
use price control mechanisms
t o r—
ensure production control
--- - —Is, this has been seen to have
an
adverse effect on production of essential drugs.
Even
control
price
mechanisms have been diluted after the
1986 drug
policy resulting
in spiralling rise in drug prices.
It
is
necessary to strengthen price
control mechanisms and at the
same time to bring in
stringent production control
measures
which won 1 d compel manufacturers to
produce essential
drugs.
It maybe mentioned that the
1978 drug policy contained
product ion control mechanisms,
which were never implemented
and were formal 1 y abandoned in
the
1987 drug policy and
through other industrial
policy decisions. Further,
Further,
the
tentative attempts to encourage
have
generic
been
names
shelved due to stay orders
by Drug
D ~’
Immediate steps to r..=W. thi. ?^*en’d- by
are needed.
3) Whereas <an estimated 60,000 formulations
are today available
in the market , the WHO lists only 264
as
essential
drugs, and
the estimated
1ist of pharmaceutical
entities
with
useful
properties numbers less than / J
proliteration
of
a
1000.
This
drugs has resulted in a plethora
of
inessential,
-i
useless,
irrational
and hazardous drugs. 7Immediate measures should be
taken to ban al 11 irrational and hazardous
- --- > drugs in the market.
4) Whereas quality control facilities
are 1
country,
it
iis absolutely necessary tolargely lacking in the
immediately upgrade
such fac i1 it ies
—> on a priority basis.
government has
The
admitted,
that
drug-testing
f
acilities
are
woeful 1y
inadequate.
Strangely
however,
the government
now
is
attempt ing to shift its
responsibility on manufacturers for
drug testing, While manufacturers
are responsible for ensuring
drug production,
quality
is ultimately
it
the
Govt's
responsibility
to
ensure iquality control.
The
in
Lent
Commission report, in the _
aftermath
the J J Hospital deaths,
’
has
<clearly
’
brought out
the
<
■-—existing criminal
nexus between
drug manufacturers and officers
j
__
responsible
for
---drug testing.
This is an area which cries out for
immediate attention.
t°day Multinational r
5)
Corporations control an
an estimated
of the market their contribution towards
the production of
drugs and1
essential
introduction of new technology
is
negligible. MNCs del iberat^ly produce less
quantities of
while
drugs
essential
irr'ationa,yd^9sn'ai?dt°ontinue2to profits by over
imDdUCtiOh
of irrational drugs
impunity hazardous drugs which have been banned produce with
in 1their parent countries. In addition they r or restricted
overprice their
products through the mechanism of transfer
pricing, and
thereby also contribute to the drainage of
valuable foreign
exchange, Moreover they are primarily
in the
interested
formulation market and have deliberate!'
y
reduced
of
production
bulk drugs. Al 1
thp
tD be seen in the background of
fact that wh? . UNID0 has categorized India in the group the
of
countries which possess indigenous ftechnology to produce
al
1
essential
°dUCe
it is worth Pr
ror-J" SUCh
3 situa*i°n
—» a
situation it
the Hathi committee report o-F 197R
reiterating
report of 1975 which had
cal 1ed for
-2.
nationalization of the Multinational
Sector in the drug
Industry, <and* to
*
Pr°vide leadership role to the Public Sector.
It
is evident that FERA provisions which
_.i consider companies
with 40"Z foreign equity participation as Indian Companies,
have not made an impact on the control <of MNCs on the market.
6) Whereas, <succeeding drug policy statement have mentioned
the
leading role of the
. —. _ Sector in the Industry, the role of
— Public
the Public Sector has been gradual 1y marginalised. The policy
of
the Govt. which has contributed to this• needs
to be
reversed.
In addition the Public Sector, to be made more
eff ic ient,
needs to be rid of problems of icorrupt ion
and
bureaucrat ic
inefficiency.
The Public Sector has played a
major role in the <development of
seif-reliance in
the
industry, and needs allI encouragement .
7) Whereas, drug companies continue to, through this
extensive
promotional network,
j
*
j propagate
*
their products with the help of
false and misleading claims, .x.a_
there is no source
unbiased
information on drugs. Steps, legislative if rec
necessary,i should
be taken to put curbs on such exaggerated andJ false
‘ cl aims
by drug companies.
made
companies.
Concurrently the> lGovt.
should
regularly publish material
which provides to the medical
profession
information on drugs.
unbiased
The
INat ional
Formulary should be updated and the medical profession should
be
|
■
with independent and scientific'drugj
provided
information
as
is being done even in countries 1 ike Sri
Lanka and
Pak istan .
8) Whereas all products, other than allopathic formulations, are
today out of the purview of drug-testing and other control
mechanisms there is a need to remedy this situation. The above
practice has led to unchecked proliteration of all
such
products. All products sold as drugs should be brought under
the ambit of mechanisms for quality control, drug testing and
assessment of therapeutic benefits.
9) Whereas, there• are attempts to change the Indian Patent Act of
Indian Sector to
1970,
this Act has helped the
grow
significantly. Pressures are being put on the Indian Govt. by
the developed countries, specifically the US, to change
the .
Patent Act so as to allow MNCs easier access to the
Indian
market.
Any such change would immediately result in a steep
rise in drug prices and immensely harm development of
the
indigenous
drug
industry. All
such attempts should
be
restricted and no compromise should be made in this area.
10)Whereas, no centralized authority exists
to oversee and
mon itor functioning
of the drug
industry,
----- -------------------immediate steps
woul d be ftaken to set up a National Drugs and
Therapeutics
Authori t y
(NDTA). This
“
body should have representations from
al 1
sect ions and should have statutory powers. Such a
body
should al so be armed with powers to deal
with legislative
del ays which block a number of attempts to cover gaps in the
drug policy.
-3-
changes in
sections of
the people, in future all
only
after
a debate involving all sections. The present drug policy
'
should
be changed on the basis of a nationwide debate on the lines which
is now taking place on the issue of granting autonomy to AIR and
Doordarshan.
Yours Faithful 1y,
i
SI .No . ‘
Name
Pl ace
> Profession! Organisation I
i
I
i
J
I
I
I
I
I
■
:
i
I
I
I
i
i
I
l
!
I
i
i
i
■
i
:
i
i
I
I
I
I
!
-4-
:
i
Signature
<Sonn H
COMMUNITY HEALTH CELL
47/1, (First Floor)St. Marks Hoad
- 560 001
BANGA l O
MAJOR DECISIONS OF HEALTH SUB-CONGRESS
Fol 1 owing
f inal ised:
decisions
regarding
Action
Programmes
have
been
I)DRUG POLICY
Given indications that the Govt, is seriously considering changes
in the present Drug Policy, it has been decided to organise‘ a
signature campaign on this issue. The demands will be along the
lines of the resolution adopted on Drug Policy at Bangalore,
The
campaign sheet is attached separately. This may be duplicated by
language <and
xeroxing/cyclostyling or translated
into local
duplicated, depending on the exigencies of the local situation.
The signature campaign is to start on 7th April , i.e. World
April
Health Day. This should be continued till
15th. The
signatures should be mailed to the following address, and should
reach before 25th April s
Amit Sen Gupta
C/0 Delhi Science Forum
B-l, 2nd Floor, LSC,
J Block, Saket
New Delhi 110017.
The signatures are to be submitted to the Minister for
Chemicals, Sri Gurupadaswamy, on 2nd May
(date is as yet (
tentative)
by a delegation representing the AIPSN. On the same
i.e. 2nd May a "Demands Day" to be observed by the PSN
day
over the country. The demands shall
organisations all
be as
articulated in the resolution. The form of observing the "Demands
Day" will depend on the local situation. Broadly, it may take the
form of meetings, demonstrations before offices of
appropriate
authorities
like State Drug Control 1 er,
picketing
/leaflet
distribution at Chemists' shops, wearing of
Badges enumerating
demands etc. We would also like to know what other suggestions
you organisation has in this regard.
I
All
PSN organisations are to write to the Ministry of
Chemicals immediately, demanding action in the area of Drug
Policy, along the lines of the Resolution adopted at Bangalore. A
copy of the resolution along with a covering letter from your
organisation should be sent to the following address:
Sri M .S.Gurupadaswamy
Honzble Minister for Chemicals & Petrochemicals
Ministry of Chemicals & Petrochemicals
Shastri Bhawan
New Delhi 110001
A copy of tha above letter should be sent to our
that is mentioned previously.
4-
Del hi
address
r
IDUniversal Salt Iodisation Policy
On this issue a National seminar is to be organised
in
some time in June. The tentative venue is Jawaharlal Del hi,
Nehru
University
to be organised possibly in collaboration with the
Centre for Community Health and Social Medicine in JNU.
Efforts
will be made to invite experts in this area, including those
who
support as wel1 as those who oppose the programme .
The <attempt
‘
would be to arrive at a consensus regarding possible changes
►
in
the programme■
III)Other Areas
Discussions were Iheld at Bangalore regarding possible
scope for
intervent ions
in the areas of Occuppational
Health,
Women &
Heal th <and‘ Primary Health Care. While’no concrete
action
pl ans
were drawn iup, some basic guidelines were formulated
as possible
areas of intervention. These are given separately in the
summary
of discussions of the Congress. C
Some of these recommendations
1 can
be fol 1 owed up in the coming months.
IV)Bharat Gyan Vigyan Jatha
The BGVJ,
it was felt, is
i
an unique opportunity for expanding
contacts of the health movement within
--- 1 the AIPSN- Resources of
the AIPSN groups, both in terms of i--manpower and software, should
be made
use n
of 4. to train people
firuiSe
peop1e in propagation of health component
of
BGVJ. Details regarding how this activity
is
BbVJ.
to
be
operational ised shall be circulated once they are finalised.
.2.
-IM*7'
corn H S.ilj-
COMMUNITY HEALTH CELL
47/1, (First Floor)St. Marks Hoad
RESOLUTION ON PHARMACEUTICAL INDUSTR'pANGALQaE - 660 001
in pursuance to
I he 3rd Al I -India Peoples Science Congress,
discussions in the Health Sub-Congress notes with concern that
the new existing drug policy, which was introduced in 1986, is a
r - e t r o g r e s s i v e t e p a n d has negated even the tentative attempts of
the 1979 Pol icy to work towards a Rational Drug Policy.
It
is further noted that the 1986 Pol icy had not ,
in any
substantial
manner, worked towards implementation of
the 1 ong
standi ng demands of the movement for a rational
drug pol icy .
These demands Ihad included ensuring availability of
essent ial
drugs,
reduct :i on of
drug prices,
banning of
irrational
and
haz ar cl ous drugs;
and for encouraging seif-re I iance
in
the
Industry.,
Instead the 1986 Pol icy has resul ted in further rise
in
prices,
less availability of
essential
drugs,
more
irrational
pro! iferat ion of
irrational
drugs and dilution of
ex ist ing
measurers which would ensure a level of seif~rel iance.
.1 t
i s hcjped 11"iat th
t h e Nat i ona 1
Front Government
will
take
immediate measures to implement the promises made
in
its
manifesto regarding implementation of a Rat i on a1 Drug Fol icy and
thereby scrap 11ie anti-people 1906 Drug Pol icy.
The Congr'ess f i..i i' • the i' " n o t e s that:
1 ) Whereas there is no Drug Pol icy in the country today but onl y
a pricing and 1icensing policy, it is necessary to formulate a
Drug Policy keeping in view the necessities of
National
drug
product i on based on the morbidity/ mortality profile
in the
e
country„
The government must^ on a priority basis, draw
draw up
up a
Iist of drugs essential for the country as al so the estimates
of demand for these drugs and ensure their availability at an
a f f o i'-' d a b 1 e p r i c: e .
2)
Whereas it has been the policy to use price control mechanisms
to ensure production controls, this has been seen to have an
adverse effect on production of essential drugs.
Even price
control
mechanisms have been diluted after the
1986 drug
policy resulting
in spiralling rise in drug prices.
is
It
necessary to strengthen price control mechanisms and at the
same time to bring in stringent production control
measures
wh ich would compel manufacturers to produce essential
drugs.
It maybe? mentioned that the
1978 drug policy contained
product ion control mechanisms, which were never
implemented
and were formal1y abandoned in the
1987 drug policy
|
and
industrial
through other
policy decisions,
Further,
the
tentative attempts to encourage generic names have been
shelved due to stay orders obtained by Drug Companies.
Immediate steps to resolve this issue are needed.
3) Whereas an estimated 60,000 formulations are itoday available
in the market. , the WHO lists only 264 as essential drugs,
and
the estimated
1ist of pharmaceutical
entities with useful
proper 1.1 es 11 u mb ers less th a n a 1
1000
000.. This p ro1 if erat i on of
drugs has resulted in a plethora of useless,
i nessenti al
irrati ona I
and hazardous drugs. Immediate measures should
be
taken to ban all irrational and hazardous drugs in the market.
4)
Whereas quality control facilities
■Fac i I i t ies are 1argely 1 ack ing i n the
country ,
i t.
i s absolutely necessary to
immedi ately upgrade
such
facil it. ies on a priority basis.
The government
has
adm :i tted ,
t. h a t
drug-test ing
fac i1 i t i es
woeful 1y
are
inadequate .
however, the government
is
Strangely
now
attempt, ing to shift its responsibility on manufacturers for
drug testing, While manufacturers are responsible for ensuring
quality drug
production,
it
is ultimately
the
Govt's
responsi b :i. 1 ity
to
ensure quality control.
The
Lent in
Comm iss i on rep ort , in the aftermath of the JJ Hospital deaths ,
has clearly brought out the existing criminal
nexus between
drug manufacturers and officers responsible for drug test ing.
This is an area which cries out for immediate attention.
5) Whereas today Multinational Corporations control an estimated
60"Z of the market their contribution towards the production of
introduction of new technology
is
essential
drugs and
less quantities of
negligible. MNCs deliberately produce
essential drugs while they attempt to maximize profits by over
production of irrational drugs and continue to produce with
impunity hazardous drugs which have been banned or restricted
in their parent countries. In addition they overprice their
products through the mechanism of
transfer pricing ,
and
valuable
thereby also contribute to the drainage of
foreign
exchange.
Moreover they are primarily
interested
in the
formulation market and have deliberately reduced production of
bulk drugs All this needs to be seen in the background of the
fact that
the UNIDO has categorized India in the group of
countri es which possess indigenous technology to produce al 1
essent ial
drugs. In such a situation it is worth reiterating
the Hathi
Committee report of 1975 which had called for
national izat. ion of
Sector
in the drug
the Multinational
Industry, and to provide leadership role to the Public Sector,
is evident that FERA provisions which consider companies
It
with 40"Z foreign equity participation as
Indian Companies,
have not made an impact on the control of MNCs on the market.
6)
Whereas,
succeeding drug policy statement have mentioned
the
1ead i ng role of the Public Sector in the Industry, the role of
the Public Sector has been gradual 1 y marginalised. The policy
the Govt.
which has contributed to this needs to be
of
reversed.
In
addition the Public Sector,
Sector to be made more
efficient, needs to be rid of problems of
corrupt i on and
bureaucrat ic
inefficiency. The Public Sector has played a
major role
in the development of
seif-reliance
in
the
industry, and needs al 1 encouragement.
7) Whereas,
drug companies continue to, through this extensive
network, propagate their products with the help of
promotional network,
f a 1 se and misleading claims, there is no source of unbiased
informal ion on drugs. Steps, legislative if necessary
i--,
should
be taken to put curbs on such exaggerated and f al se
‘ claims
by drug companies. Concurrent!y the Govt .
made
should
regularly pub I ish material
which provides to the medical
prof ession
unbiased
informat ion on drugs.
information
The
INat ional
Formulary should be updated and the medical profession
should
be provided with independent and scientific drugj
information
is being
as
done even in countries 1 ike Sri
Lanka and
F'ak i st an 8)
Whereas al I products, other than allopathic formulations,
are
today out of the purview of drug-testing and' other control
mechanisms there is a need to remedy this situation. The above
practice has led
led to unchecked prol iferat ion of all
such
products. All products sold as drugs should be brought under
the ambit of mechanisms for quality control , drug testingI and
assessment of therapeutic benefits.
9)
Whereas,, there are attempts to change the Indian Patent Act of
t h i s Act has helped the
Indian Sector to
this
1970,
grow
significantly. Pressures are being put on the Indian Govt,
by
the developed countries, specifically the US, to change the
Pat ent Act
so as to al 1ow MNCs easier access to the
Ind i an
market .
Any such change would immediately result in a steep
in drug prices and immensely harm development of
rise
the
indigenous
drug
industry. All
such attempts should
be
restricted and no compromise should be made in this area.
IO)Whereas ,
no centralized authority exists to oversee and
mon itor function ing of the drug
industry,
immediate steps
woul d be taken to set up a National Drugs and Therapeutics
Authority
(NDTA). This body should have representations from
al 1
sect ions and should have statutory powers. Such a body
should al so be armed with powers to deal
with
legislative
del ays which block a number of attempts to cover gaps in the
drug policy.
The
Congress further demands that whil e in the past, changes in
drug policy have been made without consulting broader sections of
the people, in future all such changes should be made only after
a debate involving all sections. The present drug policy should
be changed on the basis of a nationwide
. .
. .
debate on the lines which
is now taking place on the issue of granting autonomy to AIR and
Doordarshan.
' ’I
KARNATAKA RAJYA UI3JMANA PARISHA'f
Indian Institute of Science Campus, Bangalore - 12.
/ *
Pnone: 34u50y
THIRJ ALE INDIA PEOPLE'S SCIENCE CONGRESS
UIDYANAGAR, BANGALORE
e - 11 March 1990
Dear Sir/Madam,
As you are already aware the Third All India People’s Science
'n
Congress will be held at Vidyanagar, Bangalore Dist. during
8-11 March 1990.
Delegates are requested to feeling the required proforma
already sent by our office and send it alongwith the delegate
fee of Rs.50.00 in the form of DD.
Your early reply enables
us to arrange for return tickets, if needed.
Vidyanagar is
about 25 KMs from Bangalore Bus station/Railway Station along
Bangalore Hyderabad Highway.
After 25 KMs one find deviation
arrowmark in right side indicating the route to Jayaprakash Narayan
You\t- Centre which happens to the venue of AIPS Congress.
Following City Buses with Red Board and route No:
You have to get down at Oayaprakash Narayan Youth Centre stop.
Actual venue meeting is located at about 3 KMs.
"
Arrangements
are being made to provide transport facility from the busstand
to Oayaprakash Narayan Youth Centre Vidyanagar.
Delegates will be received by our volunteers both at
city bus station and city Railway Station.
One
Vidyanagar as a ■Gather similar to that of Bangalore.
can manage with minimum luggage, A cot, bed and bed spread will
be provided.
Tentative programme of each session and invitation is enclosed.
With regards,
Yours sincerely.
(PI.A. SETHU RAO)
Hon. Secretary.
KAR/JA TQKA RAJYA UIJNANA PARISHAT
Indian Insticute of Science Campus? Bangalore
12
THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS
VIDYANAGAR, BA NG A L OR E
08-03-1990
Session
I
10-00
13-00
Inauguration
Session
II
14-00
17-30
AIPSN
Annual Meeting
09-03-1990
Session
Sub-Congress
III
09-30
13-00
Health
Self Reliance
Literacy
S ussion
IV
14-00 - / 17-30
Health
Self Reliance
Literacy
10-03-1990
Session
V
09-30
13-00
Health
Self Reliance
Literacy
Session
VI
14-00
17-30
Health
Self Reliance
Literacy
11-03-1990
Session
VII
09-30
13-00
Valedictory &
Plenary
SESSION 6 (L)
FUTURE PROGRAMME
CHAIRMAN
1.
Literacy status in India and its perspectives
Shri Lingadevaru Hateman®
2.
Functional involvement of PSMs
Dr. S.C. Behar
3.
Appropriate methodology in Non-Formal
Education of Girl- Child & Illiterate Women
Dr. Probal Sarkar
SELF RELIANCE CONGRESS
9th March 1990
Session 3(S)
0900-1300 H
Chairman : Dr. A.D. Damadoran
Conceptual Issues of Self Reliance
- Dr. Prabir Purkayastha, Dr. Venkatesh B. Athtreya
Research and Development in Scientific And
Technological Self Reliance
— Prof. A.K.N. Reddy
Scientific Institutions in S&T Innovation
and Manpower Generation
- Prof. S.K. Rangarajan
Scientific Institutions and Self Reliance
- Shri. Dinesh Abrol
Discussions
1300-1400 H
LUNCH
Sub Group 4 (S)
1400-1730 H
Theme Papers
Chairperson: Dr. A.A. Gopalkrishna
Theme Paper on Energy
— Shri. Ashok Rao
Theme Paper on Electronics
— Shri. K.P. Nambiar
Theme Paper on Natural Resources
- Prof. V.K. Gaur
Discussions
Sub Group 4(S.1)
1400 - 1730 H
Theme papers
Chairperson: Prof. M. Mahadevappa
Theme Paper on Agriculture
- Dr. S.K. Sinha
Theme Paper on Seeds
— Smt. Usha Menon
Theme Paper on Mass Consumption Goods
- Shri. Santosh Choubey
Discussion
1830 - 1930
10th March 1990
Session 5 (S)
0930-1300 H
Presentation by PSMs
Chairperson:
Presentation on Energy
- FOSET
Presentation on Electronics
- DSF
Presentation on Electronics
- PSD
Presentation on Oil Exploration
- PBVM
1300-1400 H
LUNCH
Session 5 (SI)
Chairperson: Prof. M. Mahadevappa
Presentation on Agriculture
- Dr. Pathiyoor Gopinath
Presentation on Agriculture
- Shri. Praful Chandra.
Session 6 (S)
1400 -1730 H
Action Programme on Self Reliance
Chairperson: Shri. S. Rajagopalan
Presentation of Discussions on Energy,
Electronics and Natural Resources
Presentation of Discussions on Agriculture,
Seeds and Mass Consumption Goods
Action programme and Resolution
HEALTH CONGRESS
9-3-1990
SESSION - (3.H) - PEOPLE’S INTERVENTION IN HEALTH
Chairman Dr.B.Ekbal
9.30
H
— PSM Prospective on Primary Health Care
Dr. T. Sundararaman
10.00 H
— The K.S.S.P & other PSM experiences
Dr. A. Ramankutty, K.S.S.P.
10.30. H
— The MFC experience
10.50 H
— The Andhra Polyclinic experience
Dr. Sesha Reddy
11.15 H
— The VHAI & AIDAn experience
Dr Mira Shiva
11.45 H
— Other Group experiences & discussion
13.00 H
— Lunch
SESSION - (4H) - PRIORITY AREAS FOR PEOPLE’S INTERVENTION
Chairperson: Dr. Mira Shiva
14.00 H
15.00 H
Drug Policy - Amitava Guha. FMRAI
— The National Health Policy & Vertical Health Programmes
Dr. K.P. Aravindan, KSSP.
16.00 H
17.00 H
Occupational Health
Dr. Amit Sen Gupta, DSF.
—
Resolutions on priority areas
10th March 1990
SESSION - 5(H) - WOMEN AND HEALTH
Chairperson : Dr. Imrana Quadeer, JNU
0930 H
Theme Papers-Dr. Mohan Ram JNU
Ms. Vimal Balasubramanyan
1300 H
Resolutions on Women and Health.
SESSION -6 (H)- ACTION PROGRAMME ON PRIMARY HEALTH CARE
Chairperson : Dr. Sesha Reddy
1400 H
Presentation of Action Programme
1500 H
Discussion and finalisation
March 1990
VALEDICTORY PLENARY SESSION
0930 -1300 H
— Presentation of Sub Congress Proceedings and Resolutions
Valedictory remarks.
Popular Science Lecture Programmes
08-03-1990
1830-1930 H
:(1A)
Dr. Bhaskar Datta
First 3 minutes
1830-1930 H
:(1B)
Dr. Raghavendra Gadagkar
Insects
1830-1930 H
:(2A)
Dr. A.G.V. Reddy
Geological Exploration
1830-1930 H
: (2B)
Prof. Rama Prasad
Water Resources
1830-1930 H
:(3A)
Dr. V. Raja Raman
Computers
1830-1930 H
: (3B)
Dr. J. Sreenivasan
Global Warming
09-03-1990
10-03-1990
Karnataka Rajya Vijnana Parishat
Indian Institute of Science Campus, Bangalore 560 012
THIRD ALL INDIA PEOPLE’S SCIENCE CONGRESS
VIDYANAGAR, BANGALORE
8-11, March 1990
8^ March 1990
SESSION : 1
INAUGURATION
10.00 - 13.00 H
Welcome Address
Prof. J. R. Lakshmana Rao
President , KRVP
About AIPSN
Prof. B. M. Udgaonkar
President, AIPSN
Inaugural Address
Shri K.H. Ranganath
Hon’ble Minister for Education,
Agriculture & Forests
President ’s Remarks
Prof. C.N.R. Rao
Director, IISc.,
Role of NCSTC
Dr. Narender K. Sehgal
Director, NCSTC
Role of DST(K)
Dept, of Science & Technology
Govt, of Karnataka
Vote of thanks
Shri M.A. Sethu Rao
Secretary, KRVP
COFFEE
1300 - 1400 H
Keynote Address 1
Health - Dr. D. Banerjee
Keynote Address 2
Literacy - Dr. M.P. Parameswaran
Keynote Address 3
Self RelianceDr. Prabir Purakayastha and
Dr. Venkatesh B. Athreya
LUNCH
SESSION : 2
1400 - 1630 H
Convenors’ Meeting
1630 - 1830 H
Discussion on Narmada Project
Popular Science Lecture Programmes — Refer to last page
J
LITERACY SUB CONGRESS
09-03-90
SESSION 3(L)
CHAIRMAN:
0930-1300 H
1. Literacy Programmes in Sth Five Year Plan
Dr. L. Misra
2. Relapse and Recurrence
JSN & Primary Education
Dr. A. K. Jalaluddin
3. Science & Literacy
Dr. Sanjay Biswas
1300-1400 H
LUNCH
SESSION 4 (L)
CHAIRMAN - Shri. S. Achyutan
1400-1800 H
Experience of Literacy Programme
i.
1978 NAE, A.K. Sinha
ii.
Gujarat
Dr. Ramlal Parikh
iii.
Karnataka
Shri. Madan Gopal
iv.
Tamilnadu
Shri. Ranjani Doss
v.
Kerala
KSSP
vi.
Pondicherry
Shri. Mathew Samuel
vii.
Rajasthan
Shri. RameshThanvi
viii
West Bengal
Shri. Sakharatha Abhyan
ix.
Srilanka, Ethiopia,
Mrs. Sadhana Saxena
Algeria, Tanzania, Cuba, Vietnam, China
Shri. B. K. Shukla
10-3-1990
SESSION 5(L)
0930-1300 H
PSM & LITERACY
CHAIRMAN: Dr. G. Ramakrishna
1300 - 1400 H
i.
Science and Content of Literacy
Dr. Anitha Rampal
II.
Unifying role of Science
Dr. Vinod Raina
iii.
Relevance of PSM Experience
Shri. R. Radhakrishnan
iv.
BGVJ & BJVJ
LUNCH
Dr. T. Sunderaraman
Phones: 61162716/665036
Grats: SC1F0RUH
INDI
SCIENCE
B~1 , 2nd Floor, LSC, J-Block, Saket , New Delhi
NETWORK
110017
To
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Dear
We thank you for your letter confirming participation at the 3rd
All India Peoples Science Congress at Bangalore. Please find
attached details regarding accomodation and travel arrangements
aqt Bangalore. If you have not done so already, please
communicate your travel plans to the following address.
Dr.M.A.Sethu Rao
Karnataka Rajya Vigyan Parishat
Indian Institute of Science Campus
Bangalore 560012
We look forward to meeting you in Bangalore.
Thanking You
Yours Sincerely
/Ur/
‘•y'77^
Dr .Amit/Sen Gupta
(for All
P £•
India Peoples Science Network)
Ji*, oj ft
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as
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Programme:
The programmee for the Al 1
given below :
08.03.90
India Peoples Science Congress is
10.00
14.00
Session-I
Session-II
13.00
17.30
Inaugural session
AIPSN Annual Meeting
09.03.90
Session-111
Sess ion-IV
09.30
10.03.90
Session—V
Session-VI
09.30
09.30
13.00 1 Paral1 el
17.30 I Heal th,
I Seif Pel iance &
13.00 I Literacy
17.30 I Sub Congresses
11 .03.90
Session-VII
09.30
13.00
14.00
as
Valedictory Plenary
session
Given below is the programme for the SUB CONGRESS ON HEALTH to be
held
India Peoples Science
in Bangalore as part of 3rd All
Congress:
SESSION Is PEOPLES INTERVENTION IN HEALTH
(9th March, 9.30 AM to 1.00 PM.)
Chairperson c Dr.B.Ekba1
9.30
PM.
10.00 AM to
1.00 PM
Primary Health Care and perspective of
Peoples Science Movement.
* Dr.T.Sunderaraman
the
Critical review of experiences of
various
.Unitations in the field of health
«• Presentations by representat i ves
of various organisations
SESSION II2 PRIORITY AREAS FOR PEOPLES INTERVENTION
(9th March, 2.00 PM to 5.30 PM)
Chairpersons Dr.Mira Shiva
2.00 PM
Drug Pol icy
* Sri.Amitava Guha
3.00 PM
National Health Policy and Vertical
Programmes.
* Dr.K.P.Aravindan
4.00 PM
Occupational Health
* Dr.Mahesh Mansukhani
Heal th
SESSION Ills WOMEN AND HEALTH
(10th March, 9.30 AM to 1.00 PM)
Chairpersons Dr.Imrana Quadir.
9.30 AM
Family Planning programme
* Dr.Mohan Rao
11.00 AM
Maternal and Child Health
SESSION IV s ACTION PROGRAMME ON PRIMARY HEALTH CARE
(10th March, 2.00 PM to 5.30 PM)
2.00 PM
Presentation of Action Programme
* Dr.T.Sunderaraman
3.00
Discussion and
Programme
PM
In addition to the above there will be:
a) Guest lectures in the evenings
b) Poster presentations
f inal isat ion
of
Act i on
KARNATAKA RAJYA.V IJ NANA PARISHAT
Indian Institute of Science Campus, Bangalore - 12.
Phone: 34u5Uy
THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS
VIOYANAGAR, BANGALORE
Q ■ 11 Plarch 1990
□ear Sir/Madam,
As you are already aware the Third All India People's Science
Congress will be held at Vidyanagar, Bangalore Dist. during ‘ o
B - 11 Plarch 1990.
Delegates are requested to Peeling the Krequired proPorma
already sent by our oPPice and send it alonguith the delegate
Pee oP Ils.50.00 in the Porm oP DO. Your early reply enables
us to arrange Por return tickets, iP needed. Vidyanagar is
abqut 25 KPIs Prom Bangalore Bus station/Railuay Station along
Bangalore Hyderabad Highway. Apter 25 KPIs one Pind deviation
arrowmark in right side indicating the route to Jayaprakash Narayan
You.fci Centre which happens to the venue oP AIPS Congress.
Following City Buses with Red Board and route No: /■
You have to get down at Jayaprakash Narayan Youth Centre stop. U? J X y J .'Ac?
Actual venue meeting is located at about 3 KPIs. Arrangements
are being made to provide transport Pacility Prom the busstand
to Jayaprakash Narayan Youth Centre Vidyanagar.
Delegates will be received by our volunteers both at
city bus station and city Railway Station.
Vidyanagar as a -eathex similar to that of Bangalore. One
can manage with minimum luggage, A cot, bed and bed spread will
be provided.
Tent at ive programme oP each session and invitation is enclosed.
With regards,
Yours sincerely,
(P). A. SETHU RAO^
Hon. Secretary.
Karnataka Rajya Vijnana Parishat
Indian Institute of Science Campus, Bangalore-560 012, India.
Telephone :
Telex : 0845-8952 KCST-IN
Telegram :
KRVP Science
340509
THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS, VIDYANAGAR, BANGALORE
KRVP
02.03.1990
Dr. Gopinath,
Community Health Cell,
W/l, St. Mark’s Road,
Banoalore 560 001.
Dear Sir,
Karnataka Rajya Vijnana Parishat is holding All India
People’s Science Congress at Vidyanagar during 8-11, March
1990. There will be three sub-congresses on Literacy, Health
and Self-Reliance. I am herewith enclosing the invitation
of inaugural function and the proforma for delegates.
I request you to kindly send the delegates with duly
filled up proforma along with delegate fee of Rs. 50/(Rupees fifty) only/delegate. About 10 members can be
accommodated with lodging facility at Vidyana g ar and
others can participate by making their own transport
arrangements from Bangalore to Vidyanagar.
This letter is in continuation with your enquiry
over telephone about the Third All India People ’s Science
Congress.
With
regards,
Yours sincerely.
(M.A. SETHU RAO)
Hon.Secretary
Recipient of NCSTC'S Prestigious Inaugural National Award 1988 for Popularisation of Science
Av
KARNATAK^RAJYA VIJNANA ..PARISHAT
Indian Tnstitute of ScienceOmnus, Ban a lore 12
Phone: 340509
THIRD ALL L^A^P^PL^_SCIENCE^NGRE^J1_JffiM;^B
8_- 11 March 199.0.
Name
Age
M / F
Sex
Residential Address
f
Occupation
Re si:
Phone
Defecate
Office “
•
D.D. No.
fee Rs.50/
Date :
sent on
: Yea / No
If yes, Please give details
. . To
Train No. • . •
Date
Return journey reservation
required
Rs.
:•
.sent on
ny DD No.
:
Mode of Transnort
Please give details
(Train / Bus / Air)
Any other information
I am enclosing a DD No.
favour of ’’the Secretary
Bangalore.
9
.... for Rs.50,/- drawn in
Karnataka Rajya Vijnana Parishat,
I
Signature
PS:
• ) be addressed to the Secretary,
All communications to
‘ ’
j Indian Institute of
012,
Karnataka.
560
Bangalo
KARNATAKA RAJYA VITNANA PARISHAT
Indian toTtitute of Science Campus, Bangalore
THIRD ALL INDIA
PEOPLE'S SCIENCE CONGRESS, VTOYANAGAP^J3ANGALORE
8
11 March 1990
The All-India People's Science Network is a network composed
the country who are
of People's Science Movements from all over
actively engaged in the building of a mass movement for creating
scientific awareness and in intervening in key areas to ensure
that science and technology is used for the benefit of the people.
concern that
The People’s Science Groups in the country have a
of Scientific and
although thecountry has built a certain level
development has underTechnological infrastructure, its subsequent
On the one hand,
gone considerable erosion in the recent years,
on the other.
the phenomenon of braindrain continues unabated,
scientific community of the country is accused of "not delivering
the
Hence, there is a thrust towards import of know-how,
the goods'' .
successes(no matter how limited) of Indian
often ignoring these
of the PSM’s in the country,
scientists . It is the contention
not have produced the desired
that evep though Indian S’cien.ee may
, attempts to bypass it are
result, within the desired time-frame
aetttaental « the country■ s interests. While
as scientists wejuust
-Wile as
learn from the body knowledge that is being perpetually expands
by the scientists all over the world, the Indian society requires
a sustained mechanism to contribute to and to absorb from this
With this in mind, we
understanding with the
endeavour in this congress, to share our
members of the Indian Scientific Community.
growing fund of scientific knowledge,
KRVP is now organising Third All India People's Science
Congress at Vidyanagar, Bangalore from Sth March to 11th March
will be parallel subcongresses
1990 > As a part of the cohgress these
on Health, Literacy and Self Reliance.
Obj ectivesg.
of all voluntary
1o Sharing and critical review of experience
field of health
organisations and social activists in the
-2i
- 2 2. Discussions of main areas for intervention and people s
Participation in ensuring health for the people.
3. Interaction between groups and individuals involved in
health activism and evolving mechanisms for continued
interaction a nd exchange of information.
4. Plan action programmes for future people’s participation
with specific reference to the ongoing Bharat Cyan Vigyan
Jatha and to future people’s science movement activities.
Programme^
ParticiD_a_nt s_ir-y itc d:
- AIPSN Qrganisations and Scientists, Engineers and Doctors,
Sponsored by AIPSN Organisations.
PSM activists and Members of Professional bodies and unions
concerned about issues of Scientific, Techno logical and
Industrial Self-Reliance
- Leading academicians, Journalists and Technocrats, etc.
Delegate,JFee: Rs.50.00; draft to be drawn in favour of
The Secretary, Karnataka Rajya Vijnana
Parishat, Indian Institute of Science
Campus, Bangalore 560 012.
Address for Communication,:
Sri. M.A. Sethu Rao,
Karnataka Rajya Vijnana Parishat,
Indian Institute of Science Campus,
Bangalore - 560 012.
Phone : 340509
* Vidyanagar is about 25 Kms. from Bangalore and has
dormitory lodging facilities. If accommodation in
hotels in Bangalore is required, Kqndly write to us
immediately.
KARNATAKA FATYA._yi JNANA PARI SHAT
Indian Institute* ~of Science Campus, Bangalore 12
THIRD ALL INDIA PEOPLE'S SCIENCE CONGRESS
BANGALORE
Phones
Off s 340509
Resis 321168
VIDYANAGAR
Mini ■■■ ■■■■"' ' ■ ■
Information to delegates & Invitees
1.
Our Volunteers with badges will be present at Bangalore
City Railway Station(city side) and Bangalore Bus Station
2.
Buses/llatadors with banners will be available from Bangalore
City Railway Station and there is a regular city bus to
Vidyanagar - Route No, 282
3.
(via Majestic)
On the way to Vidyanagar Buses will halt at KRVP/KSCST
office at Indian Institute of Science and will pick up
delegates
4.
Our volunteers will be present at the Airport and will take
invitees to the congress venue
5.
Mess at Vidyanagar will start from the evening of 7th March 1990
6.
For any assistance kindly contact
Shri G. Panduranga
&
Shri Visweswara
Asst. Administrative Officer
KSCST
1.1.Sc. Bangalore
Phoney
341652
343370
AM
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j vn WvVkYvv
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V\e_oA±k C'sO
C^-
Wcky A4^
■ "ji
SfiG^TARY
anon
rmv .^ OF SCIENCE CAMPUS
blAHiHiimE
IANSALORE-560 012.
_____
Science for the People!
Science for tbe Nation!
9“ ALL INDIA PEOPLE’S SCIENCE CONGRESS 2001
New College, CHENNAI 19™ - 22m December
Newsletter Day Three
th
Fruit processing, Gautam Ray , PBVM, FOSET
There is enough space because it can be consumed locally
despite the aggressive marketing of MNCs. Technology is
not the problem in this case. Marketing is the more
critical issue.
SCIENCE FOR THE PEOPLE
SCIENCE FOR THE NATION
CHENNAI-200 1
Onwards to day 3 of our Congress and the
final edition of the newsletter. People's spirits seem a
Globalization, Infrastructure and S&T
Free Markets, Unfree labour
Dr.A.K. Bagchi: I have no problem with the notion of
globalization as continous interaction between people.But
bit dampened by the December rains lashing Chennai.
today it is increasingly manifested as market
fundamentalism, as distorted markets. After 4 years of
Where are the vibrant cultural performances from
WTO in 99, developing countries of the world exported
our activists across the country? Why haven't we had
174 billion dollars of agri goods. Subsidies of rich to their
teams competing with each other for stage space
own agricultural sector is 360 billion dollars. So where is
after dinner as we did at the Nalanda Congress?
the free trade?
As we have not been getting much feedback
on the newsletter, we are assuming that you are
WTO converts process to product patents.
Consumers were benefiting from process patents. This has
bored by our long summary accounts of the plenary
been overturned in the name of free trade. There is a
sessions. We'll give you more cartoons and keep the
conspiracy to break the power of labour and to increase
the power of capital. There is growing restriction of entry
focus on the divergent perspectives of the delegates
on where they think the Science Movement should be
consolidating its energies in the years to come.
of labour from third to first world.
The Govt of India guarantees 16% profit for
foreign corporations which are given an absolutely free
S&t and livelihood interventions
run. Enron is the best example.
Dr. Raghunandan, DSF provided an overview of PSM
work in livelihood issues. Two dominant models for
intervention in SAT in rural areas: (i) small scale
industries that support capital-intensive urban
industries as their ancillaries 2) Gandhian approach of
KVIC industries. The PSMs have been trying to
evolve an alternative to both approaches. We find the
technology applied in KVIC to be household based with
very low productivity. Our focus is on using local
resources, local skills and sourcing local markets for
rural industrialization. There is a great need for
innovative application of SAT as technology for rural
industrialization is not available off the shelf. Our
approach avoids the pitfall of " big is best" and "small
is beautiful". Small units can be networked into big
system. The idea is not for the PSMs to set up
industries but to develop working models. This can
Dr.Ashok Jhunjunwala, Professor, IIT:
Infrastructural cost per telephone line for any operator in
India currently is Rs.30,000. To break even, each family
also be a weapon against globalization.
needs to spend Rs.1000 per month. Only 2-3% can afford
it today. If cost comes down to 10,000, 50% of the
Joginder Walia, Himachal :
After our intervention in organizing artisans, the
dollars per month is the expense per family which
percentage that went to middlemen has reduced. Now
artisans decide how their profits should be invested.
Soap sales, Sujatha, Kerala
We require know how even for simple technology. In
the IRTC produced soaps the main ingredient is
coconut oil as 60% of households use it. Marketing is
directly through women's groups.
population will be able to afford it. For the West, 30
everyone can afford. As the market is saturated, the
West is not going to develop low cost technology. We need
to do it. At IIT Chennai, we have developed CORDECT, a
wireless technology at 60% of current cost.
However the Cable TV line cost is 25 dollars per month in
US and only 2 dollars in India. This is because we use low
cost technofogy supplemented by human power. So we are
trying to develop the same for telephones and internet.
Health Session
Eloquent Silence
TINA to TIPA
br.B.Ekbal, Vice Chancellor, Kerala University and KSSP:
br. Amit Sen Gupta, bSF: The National Health
Policy has been released unilaterally by the Centre
companies is much more than that of countries indicates
without even consulting the State Governments when
the kind of world we live in today. This stark inequality
Health is supposed to be a state subject. The omission
certainly has an influence on health status of people,
The fact that the GbP of several Multinational
of the concept of comprehensive and universal health
directly through the implementation of the structural
care emphasized by the NHP 83 and by our commitment
adjustment programmes and indirectly through increasing
to the Alma Ata declaration of 78 points to an eloquent
silence.
poverty and unemployment.
The braft shows no ref lection of the current
There has been a 50% decline in spending on
health care in Sub Saharan Africa after SAP policies. In
understanding that Population policy never works
India, public health expenditure is only about 21% of total
without accompanying socio economic changes. The issue
health expenditure. In all developed countries, the
of rational drugs has not even been mentioned and
reverse is the case except for US where it is less than
appears to have been relegated to the Industries
half of total expenditure. There is no Alternative
Ministry. The fragmentary, technocratic and vertical
syndrome needs to be replaced by there is a People's
approach to health care is reflected clearly in the
Alternative syndrome. We need to fight for a National
document.
Health Policy with Primary health care as the basis,
The brief paragraph on women's health and the
complete absence of any mention of child health are
people's participation in health planning and a rational drug
policy.
very disturbing. We see this policy ultimately as a
prescription for health privatization as revealed for
instance through the intention to subcontract PHCs to
NGOs.
WAVC
1
A PAY
Informed facilitator or marketing agent ?
br.K.S.Reddy, JIPMER
Health care was in the hands of people before the age
of medical colleges. The doctor was only a facilitator.
Then he started to monopolize medical practise. Then
he went a step ahead and thought that he was God.
From there it was only one more step for medicine to
become a business. Only here the seller also sets the
demand.
The medical profession is now addicted to
profits and the doctor has become a marketing agent.
The medical student no longer makes connection with
the social context of medical practise. The Public
Sector has to be our focus and we have to make it
accountable. The State cannot wash its hands off
providinq accessible health care to all.
__ _______________ 0
Philosophy of globalization - "what is
mine is mine, what is yours is also
mine".
A.K. Bagchi
We are surprised at the breadth of governance failures across times, across governments and across
agencies from 92 upto 99. This one project could lead to the declaration of "Plan Holiday" by
Maharastra government.
High powered Godbole Committee that enquired into the Enron Power Project.
ILLFAAL
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In 1995, in its presentation
to the Government, Enron
promised a fixed tariff of
Rs.2.4 per unit. It sold
power to the Maharastra
Electricity board this year
at an average cost of
Rs.5.3 per unit.
Shanthanu
?
$
C •
Micro soft charges
Rs.22,000 for its MS Office
programme. We are working
to provide a similar
programme in local languages
for Rs.300 to each village
kiosk.
Ashok Jhunjunwala
Interview with P.Sainath on his Photo Exhibition
At the field level, our
So far 45,000 people have seen it in different cities.
work must be focused
What is important is that those who have seen it also
on interventions such
belong to the same class of women who are featured in
as literacy, Continuing
the photos. About 30,000 agricultural labourer women
Education, health to
saw it at the AIDWA Conference at Vizag. The response
more systematically
build the capacities
from students in women's colleges has also been
overwhelming. At Stella Maris, Madras, Kanoria College,
of elected Panchayat
Jaipur and Miranda House, Delhi the girls wrote poems in
members so that
the comments note book. I am very happy as I am just
about to take it to Pudukottai where it is being hosted by
decentralization
really means power to
the people.
Asha Mishra,
Samata
Coordinator
the quarry women where the first shot was taken some
years ago. I think it appeals to people as this is really a
hard hitting political document minus jargon.
A Satellite session was held in the office of the Accountants’ General (A&E) Tamilnadu in which Prof.T.R.Janardhanan, KSSP addressed a
gathering of staff on the topic of “Environment and Pollution” which also had an overwhelming response from the administration that they asked
for more such sessions in the future.
DELEGATE’S DISCOURSE....
AIPSN's struggles should be oriented towards
Our biggest task will be to fight American Imperialism
developing alternatives both materially and
conceptually for rural based self reliance. Our
which is wrongly being called globalization. We see its
brutal face in Afghanistan now. Our biggest and
campaign should be pressurizing the public sector to
immediate challenge is to safeguard the subcontinent.
regain its leading role within the capital intensive
Also we need to challenge the feudal and backward
sector. We also need to systematically campaign on
public policy issues like drugs and health
with American Imperialism. Finally, I feel we need an
Amitava Guha, General Secretary, FMRAI
Education Assembly just like the PHA, Dacca to carry
mentality of the fascist Indian state which is colluding
forward this campaign.
Rakesh Gairola, UP
At this Congress, our focus has been on preparing
I'm happy about the Congress. I don't see it as really
ourselves for an onslaught against globalization and
setting a direction as that is already there in the work we
liberalization. I feel that we need to mobilize the
are doing. This is more of an inspiration, a morale booster
rural poor to launch enterprises to counter the
for us. We need to intensify our work with poor women
and with Dalits as well - the most deprived section of our
invasion of foreign products. Also there are thousands
of small groups engaged in environmental struggles.
population.
Can we think of uniting the various groups to fight a
Vijayalakshmi, AP
combined battle against the degradation of the
environment ?
Our direction - towards building mass movements,
M.K. Prasad, President, AIP5N
initiating, associating with and cooperating in mass
We must continue to organize women who have come
Gurjeet, Punjab
into our movement through literacy in ongoing
struggles for social equality. We need to strengthen
"I feel that even this Congress should have been more
movements.
women through information and technology. How do
we build the leadership capabilities of women? How do
linked to our existing work on the field. It is still heavily
we struggle to build women's independent identity and
People have come from a great distance at heavy personal
a consciousness of their rights as women?
Pushpa, Bihar
cost and what we do here should meet their needs. About
English dominated, male dominated and lecture dominated.
the future, we actually just need to consolidate the work
we have been already doing in the areas of literacy
I feel that we must continue our anti-superstition
health, education, enterprises. We have not really been
campaign in villages. Also we need to think more into
how we can use Science and technology inputs to
consolidating programmatic action in the larger national
increase women's earning capacity and reduce the
Anita Rampal, BGVS
sense."
burden of their daily labour Our work must be more
intensely focused towards the needs of villages and
the rural poor.
I think that given the current attacks on history and
Narayanasamy, Tamilnadu
debates on Science and Reason. A strong assault on the
Released : Book “Health and
Healing” by Dr.Shyam Ashtekar on
Primary Health Care for village
health workers
&
Health Calendar by UP BGVS
Science it has become very important to bring back the
celebration of the so-called “Indian" Science by the
government is called for particularly as this is being
counterposed to "Western" Science which is actually a
product of Babylonian, Greek, Chinese and several other
civilizations.
What we are abandoning in the process is
actually our rights over the common heritage of human
science that we have also enriched. We really also need to
engage much more seriously with mobilizing progressives
within the scientific community as this is the primary area
of the Science Movement.
Prabir Purkayastha
- Media
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