COMMUNITY HEALTH PLANNING ORGANIZATION & MANAGEMENT VHAI CORRESPONDENCE COURSE/EXERCISES
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- COMMUNITY HEALTH PLANNING ORGANIZATION & MANAGEMENT VHAI CORRESPONDENCE COURSE/EXERCISES
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I
RF_COM_H_42_SUDHA
DRUG ACTION islgWORK NEWSLgPTER
Dr B Palaniappan
Prof of Obstetrics & Gynaoology
Kilpauk Medical College & Hospital
Madras 600010.
Dr Wishwas V Rane
2117, Sadashiv Peth
Pune 411030.
A
Dr J S Bapna
Head Dept of Pharmacology
Jawaharlal Institute of Medical
Research
JIPMER
Pond icherry.
Dr Ullhas Jajoo
Dept of Medicine
Sevagram Medical College
irdha, M S.
Dr Anant Phadke
Medico Friends Circle
50 LIC Quarters
University Road
Pune 400016.
Mr J 3 Hazumdar
F M R A I
1-3 Rajendra Sagar
Patna 800016.
Ms Framed Kulkarni
LIST
Mr Arun Deshpande
General Secretary
Vidyan Sanghatana
162/11 Railaay Lines
Katkan Blocks, Sholapur, M
Dr Amar Singh Azad
Gali No.3 Guru Nanak Nagar
Gurban Colony
Patiala 147001
Punjab.
Dr Surjit K Daa
FC Block, Flat No.53/5
Sector III Salt Lake
Calcutta 700064.
Mr Vincent Panikulangara
Law Service Society
House ho.150
P anamp illy -Nagar
Kerala 682016.
Dr Raj Anand
55 Kavi Apartments
Worli
Banbay 400018.
Ms Bhanumathy
Shyam Niwas
N“,2,5th Street,Krishna Kagar
Virugambakkam
Madras 600092.
esse
Thakorebhal Desai Smarak Bhavan
'.lia Bridge
.-inmedabad 380006.
Ms Padma Prakash
Lok Vidyan Sanghatna
Plot Ko. 18, A B 1 ho.2
Behind Aurora Cinema
Bombay 400019.
Mr Alan crammer
Mary Calvary Holdsworth
Memorial Hospital
Mysore 570021
Karnataka.
Dr A C Jesnani
K-8, .-ensey Colony
Dr Samir Choudhary
C I H I
Village Daulatpur
P 0 Amgachi, Via Joka
List 24 Parganas
W B 743501.
Dr Jmrana wadir
117, Utara Hand
J KU Campus
,iev Delhi 110067.
Dr Prem Chand ran Joins
Asian Community Health Action Netw
61 Dr Radhakrighnan Road
Madras 600004•
Mr Darehan Shankar
Dr Ron Seaton
St Ursula Bungalow
Red Cross Road Civil Lines
Nagpurt M S 440001*
Dr S Satyamala
C-152, D D A Flats
Saket, Lew Delhi 110017.
Dr B SkiSal /
Dr H N Antia
F R C H
84-A,H,G Tuadam Marg
Seaface Corner, Worli
Bombay 40C018.
Dr P K Sarkar
P 254, Block B
Lake Town
Calcutta 700089.
Sr Carol Huss
Medical Mission Sisters
Bibivadi<^ Pune.
• 3 G Kabra
„ead Research
Santakha Turlabjee
Charitable Trust
Jaipur 302004.
Ms Kania Mankekar
C-44 Gulmohar Park.
New Delhi 110016.
i\S 3/P
x/
Pari/hat Bhavan .^z
J3BjSSWTae»ergy:
T^Zv^drum.
37 •
Mr Claude Alvares
Ain id aval du
Para Goa 403506.
Mr Binayak san
C M 3 S
Post Dalli Rajuara Kondy
Diet Durg, M P 491 «’2S.
Dr Narendra Gupta
PRAlAS
Village Levgarh(Ueolia)
Via Pratepqorh
Rajasthan 512605.
Mr Chandrasuekar
4 xvaj Lakshmi Nagar
Velaoherry, Madras &00042»
Dr Mira Sadgopal
Kiehore Lnarati
Dr V S Mathur
Post Bankheri
P G I Medical Education & Research Diet Hoshangabad, M P 461990.
Chandigarh 160012.
Mr hajiv Tiwari
j Suleman Chambers
4 Battery Street
Behind Regal Cinema
Bombay 400039Dr A R Pat wardhan
Arogyn Dakahata Mandal
1913 Sadashiv Peth
Pune 411030.
Dr P K John
C M A I
Jayanagar
Bangalore.
Dr Ravi Narayan
Mr Druv Mankad
1877, Joshi Galli
Nipani 591237
Diet Belgaura.
Dr Rajeeh' Tand on
Society for Participatory Research in
45 Sainik Aarm
Asia
Kanpur, hew Delhi 110062.
Mr Dineeh Abrol
Delhi Science Porua
J-55 Saket
New Delhi 110017.
Dr A T "udani
C-35 Pano .sheel Bnolave
New Delhi 140017.
•Mr'M D Srinieah
P P 3 T Madras
c/o R Vijayalakshmi
17 South Niada Street
Triplicane, Madras 600005.
Conrad Mary
Palmers
De hritto Higher Secondary School
Dsvakottai
Ramnad Diet, T H 623303.
Smitu Kothari
Lokayan
Old Exchange Building
13 Alipore Road,
Old Delhi 110054.
Tony Cardoste
199-A, Altoporvoria
Bardea Goa 403501.
Mr Asish Kandy
OSDS
29 Rajpur Road
Old Delhi 110054.
4-?
Sr Rani/Mary Martin
Kulachavilakam
Anjengo P 0
Trivandrum 695309.
Mr Amitava Uuha
177 Griper Koad
P 0 Korina ar
Diet Hoogiily, W B.
Gampat Patil
Gnrib Dongri Sanghatana
984 Deccan Gymkhana
Pune 411004.
Dr D A Joseph
105 Hibbana
Pali Hjll Road, Bandra
Bombay 4OOO5O.
Gopikriahna
P W D Camp
Gillesgur P 0
Via xiaiohur 589101.
Mr ShIrish Batar
Deehpande Building
M G Road, Viahnunatjar
Bombivle 421202.
Dr M V Joseph
Chied Paediatrician & MCH Consultant
Cheriyapally Host ) it al
/vOttayam 1, Kerala.
Sr Anita
Davajeevan Health Centre
101—B “alluvar Street
Catroina Rcrtrertaon
Garden Reach Community r<ealth Program
BAM India, J-483
Paharpur Road, Garden Reach
Calcutta 700024.
Rajavailipuram
Thirunelveli list, T D 627359.
Me lirmala Susheele/Ms Shanawas Khar
Mr Al ok i'iukhopody tya
1-7-510/8D2
Oxfam
Hari Hagar Colony
J14 Mansarover Building
Ramnagar, Hyderabad 50’ 026.
90 Dehru Place, Kew Delhi 110019.
Sr Helena
Deeps Sad an
Karumlcula® P 0
Pulluvilla, Trivandrum.
Dr Mallikarjun Ti- pa
1 D S (I)
Aremallapur
xaluk Ranebennur
Diat Dharwad.
■<*nil Agarwal
C S E
807 Vishal Bhavan
95 D.hru Place, Hew Delhi 110019.
Madhu Kishwar
Editor, Man ugh i
C 1/202 Dajoat Eagar
New Delhi 110024.
♦ Dr 'Aohan Rao
Mit ranik etan
^aganom P 0
Kottayau, Kerala 685503.
Dr Lalit Khaura
lamluk P 0
Diet Mid nap ore
W B 721636.
Dr Kamala Jayaiwo
o/o Ms Jayax’flo
3-6-515 diraayat Jfagar P 0
Hyderabad 500029.
Jyotismony Samajd er
Medical College Students Hostel
22 Giribabu Lane
Calcutta 700012.
Satyabratakar
57 Anath Nath Deb Lane
P 0 BM Gachia
Calcutta 700037.
Ms Sumantha Banerjee
D-33 Press BnolaVe
Saket, New Delhi 110017.
Ms Kamala hnasln
House No.4
hhaeawandas Hoad, Lew Delhi 110001.
Firs ^anaja Ram Prasad
268, 5th Main Road
4th Block, Jayanagar
bangalore 560011.
Mr V N Vadhyar
Academy of Development Science
Taluka Karjat, Diet Kulaba
M 3 410201.
Dale ep Kamath
Joshi Mala, Shasbag
Selgauia 590004.
Ms butniia Banerji
8-4/110 Safdarjung enclave
New Delhi 110029.
Dr Molly Th os as
Prof & Chief Clinical Phannaoology
Christian Medical College & Hospital
Vellore, T
Dr 3 Srinivasan
53 Sector 12
R K Puram, New Delhi 110022.
HALO
c/o iSK Department
Medical College
Aurangabad, i‘l 3.
Dr Xj-shra
Gram Airman Handal
Sarvodaya Ashram
Soihodeora, Bihar 805106.
Shika Laksar
’’ational Herald Annexe
2nd Floor,
.Floor 24 Banaroidas Rotate
Tumarp ri, -elhi 110007.
Sr frntitl/Sr Angells
c/o Bishop's House
? 0 hunkuri, Raigarh List
M P 496225.
Ms C Rimini
Final Year Student
Ko.20/A Raman Street
Authoor, Salem Diet.
Mehtab 3 Banerji
National Institute of Nutrition
Hyderabad 500007.
Vlmal Balasubraraani&n
605/al Lancer Larracka
Secunderabad 500026.
A'ohay oang/Rani Bang
C>>etna Vikas
Gopuri, Wardha 442114.
Dr B Cowan
Principal
Christian Medioel College & Hospital
Ludhiana 141001, Punjab.
Anil Patel/Daxa i'atel/Asho: Bhargav/ Ashwin Patel/Rimitta Bhargav
Post iiangrol
Via Rajpipila, Diet Bnaruch
Gujarat 393145.
Janet Aitken
c/o B Imai encl u Las
p 0 Jagdishpur
V ia i ad hup ur( SP)
Bihar 815353.
Dr 0 A rranoia
Coordinator
Continuing Medical aduoation
C?JC, Vellore 632002.
Dr «J ay anti Deshpande
Yusuf Generally Centre
At Tara, Taluk Panrel
Dist Rai^ad, « S»
Dr Kagaraj Rao
Deputy Director
Lady Wellington TB Demonstration
Centre
Hempegwda Read
Bangalore 560009.
Kart Ik isanavat i
15 Chusha Society
Ahmedabaa 54.
Dr C Slvarats
Prof & Heal Dept of PSM
Bangalore Kedioal College
Bangalore.
Marie D*Souza
Janseva Mandal
Korit Road
handurbar 4 25412.
man Ganguli
a/o Biinalendu Das
P 0 Jagdishpur
Via wadh^pur SP,Bihar 815353.
Navnit i’oadar
Sarvodaya Kendra
Pindval, TaluK Duaraapur
i>ist Bulsar ^96050.
Rasmi Japadla
B-11,Shantiniketan Apartment
Vasta Devdi Load
Surat 395008.
s Sridhar
■5, V ikr'im 3aug
Pratap wanj, Boiiibay 400003.
1 Shard a
Women’s .Jostel
C M C<. hospital
Vellore 632002.
Satish dogulwar
o/o Sukhdev Babu Vike
*adaea-Besai Canj
list Gadohiroli 441207.
Vineet kayyar
Men’s Intern*s quarters
CMCH
Vellore 632004.
Di' Mrs V nahmathullah
Medical Mviaor
UPA31-aD*'S
Clenview Coonoor
l.ilgirs Diet, T i» 643101.
Dr 0eurge .Joseph
C5I :Icapital
Mundiapslly,Kunnafflthanati P 0
Thiruvalla, Kerala.
Fr Rupert Doeario .1 Team
Gyaua jyoti
Bangalore.
Rajiv Vohra,
Coordinat or
Ahisasa V idyalaya
GPP 221/3 Deen ^ayal U; adhyaya Marg
, ew fielni 110002.
Kr leoffray
Oxfam
p u Box 71
Dagpur 440001.
Stanely Patrick
International Courier
R/12-A Hauz Khas
Lew Delhi 110016.
Dr A 0 Menon
1032 High Point
45 Palace ^oad, Bangalore.
Sr Pillar
p 0 Dong jo, Via Soaia
Singuiiua Bist
4 *
Dr
Vaaanth Kumar Parigi
Consumer Sducation Centre
No.4 flesh Vilae
3-6-293, 1st Floor
Hyderabad 500001.
Dr Samuel Joseph
Medical Superintendent
MG1M Hospital
Kangazha, Kanjirapara
Kottayara 686515,
Dana Suri
1’ribune
Chandigaih.
Gauri
Sahel1
No. 10 Bast Nizamudin
New Delhi.
Dr Oabriel & Rev. Baa Wielen^a
T i» TheolOejioal Semiaaxy
Arasardi, Kadurai 625010.
halini Naik
PCO Centre
Spencer Junction
Irivandrum, Kerala.
1awy er’s C ol1ec tiv e
813 StocK Exchange ■ owers
Dalal Street Fort
Bombay 400021.
M D Srinivasan
PPST Madras
c/o R Vijayalavtami
17 South Niada Street
Triplioane,Madras 60005.
Fr Jose Xalliakel
Don Bosco Centre
Palluruthy, Cochin -6.
Forum against Opreesion of teornen
307 Yasmeen Apartmenta
Yashw nt ‘»a«ar.
Behind Vakoju Church
Vakola, Santa Cruz cast
Bombay 400055.
Achyut Yagnik
SETU
B-5 iedar A arttaents
hear Commerce College
Ahn edab ad.
An up am Ziohra
21 Gandhi Snarak iUdhi
Rajghat, Nev £elhi 110002,
Anthya Medlath
Sibylla Sharma Hablik
32 Rue Suffren
Pondicherry 605001.
K-Mi
Voluntary Health Association of India
Telegrams : VOLHEALTH
C-T4, Community Centre
Safdarjung Development Area.
New Delhi-1100W
r
1*1
COMMUNITY HEALTH CELL
326, V Main, I Block
Koram&ngala
Bangalore-560034 *
India
A-10. 80
m. 1.11.83
F.4-
New Delhi-110016
Telephones
UX-2
. 668071
' 668072
Nov. 1, 1933.
Report of the meeting of Stat^- VHA Organizing
Secretaries held at St. John !s Medical College,
Bangalore from 22nd August to 24th August 1983.
" TO GIVE IS TO RECEIVE AND TO SHARE JS TO GRCVI" - was proved
to be true when the Organizing Secretaries of State VHAs met at
St. John rs Medical College in Bangalore. It was not just a meeting,
but an experience of sharing views and news and exchanging of ideas,
experiences, achievements, failures and concern for one another.
The following is a. brief summary of the meeting*
Present were :
Andhra Pradesh :
1.
Bihar:
2. Mr. M. Zaman
Executive Secretary
Mr. Da Rayanna
Ex^cut ive Seerct ai'y.
3.
Dr. (Sr. ) Proma Dc-varaj
Vice-President
Gujarat:
4.
Mr. Kir it Shah
Executive Secretary
Karnataka:
5.
Rev. Fr. Bernard Moras
Secretary
6.
Miss Usha S.
Promotional Secretary
7.
Mr. S.M. Subraroanay Setty
Joint Secretary
Kerala:
8.
Mr. Jose Varghese
Programme Officer
Madhya Pradesh:
9.
Miss Marjorie Hill
Organizing Secretary
10.
Mr. Tushar Kanti Ray
Asst. Organizing Secretary
11.
Sr. Ros nr io Lopez
Secretary
12.
Mrs. L.N. Roy
■:' •
V
Meghalaya:
A-10,80
m. 1.11.83
:2:
Tamil Nadu :
15.
Sr. Muriel Fernand.ez
Exacut Ivb Secretary
16.
Mr, Baskaran
Joint Secretary
17.
Mr, Prppin S.
Programme Coordinator
18.
Mr, D.P, Poddar
Executive Secretary
19.
Kav, Fr. John Noronha
President
20,
Mr. Averthanus D^ouza
Executive Director
21 ,•
Mr. G.D. Kunders
22.
Dr. Ravi Narayan
23.
Dr. (Mrs) Thelma Narayan.
West Bengal:
VHAI: New Delhi:
Visitors;
welcome 1^toSsineeSn£)d!B OPen^
Vice President: VHAI
R- Awrthanus D^ouza with a
followed by the’ftaugura! ndSesPbyV
S0C^aries. role and leadership in promo-
tiS tteC?HA°I
2. r
Mr. Peppin S. was chosen as the recording secretary and
Mr. D.P, Poddar
was requested to help him prepare the final report.
3r”’
The attached, Agenda and. time table for tha meeting was
approved (Ann^xure I),
~
4. r”
The Secretaries
presented their reports highlighting the
following activities?
a)
Educ at ional
b) Organizational Development, and
c; Future Plans (see /Annoxur^ II)
5. Strategies for helping the weak State VHAs: There was a
detailed discussion
-1 on_ how-to develop the weak State VHAs. Tho following
weak State VHAs explained
their problems which wore carefully analysed "
.
------?
and discussed and some recommendations were made.
State/Region
Mizoram
Problems
- Inter cl -nominations
- Travelling
- Finance,
Recommndat ions
~ Organizing a seminar on
National Health Policy would
bring the people together and
help to involve and interest
organizations in Mizoram in
the VHA.
A-10.80
M. 1.11. S3
:3:
State/R^gion
Problems
Orissa
?•:
- Lack of interest
- No Organizing Secretary
- Lack of response from
the membors as they
receive no benefit from
th? 0 VHA
Recomm^ndat ions
- The meeting to bci held on 5th
Sept. 19^3 to revive and to
take stops for - better func
tioning will b..: attended by
Mr. A.D !Souza,
- appointing a full timo
PrOLiot io?ial Seerat ary.
- Travelling and Communi
cations.
Meghalaya
- Finance
- s&lf-supporting
J-L
-;No voluntary agency can become
self reliant — but it was felt
that it can be partly achieved
by initiating innovative
projects.
- F inance
Karnataka
-to discuss among the members
of the Board to find ways and
means to solve the financial
problems.
-To initiate fund raising pro
grammes, to develop batter
communications and more involve
ment of the interested Board
members.
It was felt that assistance from VHAI to the weak Stat© VHAs is
very important. The weak State VHAs should also s^&k the support of*
neighbouring State VHAs .
6- Updating Directories of State VHAs and the National Resource
Directory : The State.VHAs will collect information keeping the format
made by h P VHA.ns guide lines. State VHAs which are prepnring their State
directories, will, at the sam& time, feed VHAI with the information which
they are collecting to enable VHAI to prepare the National Resource Direc
tory. It was also said that the State VHAs desiring to bring out the
Directory should, try to do it by the end of December 1933.
T. _________
_ message of
National Health Policy: VHAI’s effort
to spread the
Health Policy
Seminar was appreciated, Mr. A.DJSouza
the National
.
—u through
—>—o— a --u**M4*
gave a oriel ^explanation about
•«
• the
•
ways and- methods by which this seminar
was conducted in Delhi. The State VHAs desiring to conduct seminars on
N.H.P shared information on how far they'have proceeded in organizing these
s-'miinars^and the various themes for these seminars were discussed. It was
very edifying to note that some State VHAs wanted to discuss this policy
at the district level too. The following State VHAs will be holding N.H.P.
seminar:
xlndhra Pradesh, Karnataka, Kerala, Tamil Nadu & West Bengal.
VHAI would s«nd mor© copies of the Statement on National Health Policy to
the State VHAs.
g
T»T,.
—. —
_— _
_________
..
■
A-10.80
SC 1J 1.83
:4:
continuing and on-going training to help them becon© more effective.
They expressed the hop? that VHAI would support them in this regard.
Aft^r much discussion
it
,--------------Was
agreed that one practical way
ffcrabiir?- two or three days of training with
of doing this would be to ccmbir^
the normal meetings of tho Organizing Secretaries.
nriri-i+-innOr+Of-t^' 31,038 “ Which t’h® Secretaries felt ths need of
aaaiDional training wor© :
Project planning and evaluation.
- Training methodologies.
- Accounts and Financial Management.
- General and office administration.
- Editing and reporting.
It was agreed that the next meeting of the Organizing Secretaries
would bn for five, days with 2 days devoted1 to organizational matters and
3 days to instruction and training in one of tho areas indicated.
10.
~^ataonship between VHAI and State VHAs: Many Secretaries
faCt that 1Wly activities were conducted
1 pfStates without the knowledge of the State VHAs.
Thi. has led in th® past, to many problems for the State VHAs.
VIPs +n miT3 str^ngiy insisted that requests frem members of State
the Stajnjl®h0£^.7tX arOUt-d throiJSh' or referred back by VHAI, to
adiuissionsto correspondence courses run by VHAI
qh i/i k -1 - ■
s Sm
“ta?at®d.to the respective State VHAs and the StatcZvHAs
should be involved in the follow-up programes.
Similarly, diagnostic studies (of~ medical institutions or health
+P^Sna^lfaS-ShOU:ki h* undertak«»
VHAI only with the’knowledge
_.£>
q .* and
_ so that the State
the partj.cipa'Gion oi the State thta
. VHAs can
Ws,
followup on tha assistance to.the institutions concerned’
requested to ensure that in all VHU activi™
there arc active VHas, these VHAs are kept fully
This will help to strengthen the State VHAs.
7
ties in
informed.
OrganizinP
on the report
of the WaS
last fel*
Secretaries
n^
to^F^^
? ^adraS:
tha^tha
report was
St.t(bVHAs aMv^' Pxcture.°f the original discussions, and some
tdtc Wlxs activities were mismtarproted viz. BVHA.. This was due to
b
“’/.pm. He»o., it
Dfr i irst seen and then cyclostylod.
dioidS tm Farm
5.
.v
:5:
12. rBright‘ Ideas: It was f< that th£. following bright ideas
could be tri^d in State VHAs :
Sale of VHAI books/mat erials
Developing library/documentation centre
at State level.
Youth organization.
Providing to mnnibors vaccines from Government.
Collecting personnel polici s of uhe member
organizations.
13.
Others;
a)
It was decided that each State VHA. will send the list
of members and the membership foes paid, to VHAI by
December 19$3.
Talk by Dr. Ravi Narayan on Community
Health;: It was
b) —--------------------------------------------------,< --------thought provoking and inspiring to hoar the sharings
of Dr. Ravi Narayan on community health in which he
said that health is a movement and a process and all
of us are only & means towards this end.
\
N^xt meeting/date and venue: Fr. John Noronha, President
.
of Most Bengal VLL; extended an invitation for the next meeting of the
Organizing Secretaries to be held at Sova Kendra, Calcutta, some time*
in August 1 9£4. Two days will be for the me-oting and two days for
sharing on "Communications 1’ to train the organizing secretaries as
agreed upon.
There b^ing no other business, the meting was concluded with
tnanks by Mr. Averthanus DfSouza.
S. Peppin
Tamil Nadu VHA
Recording Secretary.
A N N E X U R E
II
REPORTS B'RCM STATE VHAs
The Statb VHAs ar*' very dynamic and. active in realizing and
achieving the philosophy of VHAI movement with their innumerable acti
vities. A brief re port of the each State VHAs distinguished activities
which were shared by the respective organizing secretaries are given
below:
ANDHRA PRADESH
:
Reported by PIr. D» Rayanna
Activities
a)
Meetings: Six meetings were held in five districts and discussed
on "Eye Car^ Services ”, "Hospital and Educational Institutions
Bill", "Health Care Management" and "Bar^-foot Doctors in Clinic".
Attended the Organizing Secretaries meeting, VHAI General Body
meeting and CMAI Regional Conference.
b)
Seminars/Workshops: Th^ seminar on Human Relations and Communica
tions, Evaluation of Community Health, Wholistic H^jalth, and
Health. Education were organized. A village Health Workers con
vention was also held at Guntur having 215 delegatos from 20
districts.
c)
Visits: Paid visits to tho'member institutions in five districts
and also visited Sri Lanka.
d)
Other activities: Prepared a hand book for the Trainees in Telugu,
settled th«? disputes ov^-r hospital and oth/r institutions bill,
1932, planning mooting on National Health Policy, two AP VHA
board members nominated for fixing minimum wages, for non-governmont
health care institutions and finalized the directory information
sheet.
Future Plans s
BIHAR
- Seminar on National Health Policy
- Publishing AP VHA Directory
- Seminars and Workshops.
: Reported by Mr. Zaman
Activities
a)
Meetings: The meetings organized and attended by the organizing
secretary are Eastern Region meeting held at Calcutta and the
Annual meeting for the members.
b)
W Qr hops /S <-.minar s: Lb prosy Laboratory workshop and motivational
achievement seminar were organized.
c)
Visits: Paid visit to.Fatwab Government Health Centro, Primary
Health Centre, Sitagarh dispensary and Pawva Health ccntro.
d)
Other activities: Gave talk on Health for AH, Consultancy on
Hospital Administration, Diagnostic Study of Holy Gross Hospital,
distributing polio vaccines, D.P.T., T.T. D.T. Dapsone Tablets
and vitamin A Solution and conducting CHTT programme and amend
:2:
Future Plans:
- Seminar on National-Health Policy
- Physical assessment workshop for nurses
- Preparing the Directory
- Wholistic Health Seminar.
GUJARAT:. 1 •
Gujarat ywi besidos having a ;pluralistic approach towards canmunity
health,’i.e. through Mahila mandats, BaIwadi teachers, private practi
tioners, collaboration with the Government and through personal health
has conducts and organized th© following activities.
health education
They are CHTT course at£5Skhavar, village, health workers convention for
3 days and low cost audio-visual seminar in health moss ages for 1? days.
It also conducted a small but beautiful meeting of all the -agencies
working in South Gujarat, Health education camp which covered 33
villages, and. .a health education camp for Adult education teachers.
Future Plans:
- Upgrading Diagnostic skills seminar
- Community Health in slums
- Lost Cost Audio-visual Seminar
- C HP T • Programme
- Health Education Progranme
- Lost Cost Standard Therapeutics (L0CC6T) Project.
KARNATAKA
The organizing secretary of VHAK has organized and attended
the following meetings. 'Ther<' wore two workshops on Health Education
in Hospitals with an Exhibition. The Organizing Secretaries mooting
and the Annual General Body meeting of VHAI and a seminar on ’Fund
Raising'/ were also attended by the Organizing Secretary. About 28 member
institutions wen visited and the other activities of VHAK were putting
up an exhibition on 'World Health Day" April ?th, at St. John!s Nodical
Collcgo, .and promoting the sale of Nutrition Education Kit.
Future Plans :
- Holistic Health Workshop
- Seminar on National Health Policy
- Workshop on Health Education
- Visiting member institutions
- Fund raising.
KERALA
In.the year 1982-83 the KVHS was handicapped to carry out many
programmes as there Was a crisis. Hence the restructuring of th©
organization became the sol..’ activity of the association. There v^ere
nine Governing Board meetings which brought light in to the bright
functioning of VHAK with a new structure.
Future Plans :
- Seminar on National Health Policy
- Workshop on Ccmmunity Health
- Workshop on Personnel Management in Health
related institutions.
"Workshop on planning health service
:3:
MADHYA PRADESH :
Report
by Marjorie -and T us bar
Activities:
a)
Meeting: The Organizing Secretary of MP VHA attended the con
ference organized by Caritas for Donar Agencies and VHAI annual
.meeting.
b)
W or ks hops /Seminars: Four workshops and seminars were conducted
on Achievement Motivation, Community Health, Development and
Wholistic Health. A conference for village health workers was
also organized. Participated in, the CHIT and MIBE workshops
on Community Health and citizenship.
c)
Other activities:
- Drug campaign movement
- Mov^^nt against Lathyris -cu.
Future Plans:
- Visits to member institutions
- continuing workshops and seminars
- follow up of CHIT workshop.
MEGHALAYA:
The following were the activities of Meghalaya VHA. It has
enlisted 13 n^rw members in Garo Hills and appointed, a full time promo
tional Secretary in order to carry out many more programmes and make it
very active. Organized two training programmes on V.H.Ws. Five eye
camps were conducted with 108 eye operations in collaboration with the
Government and R^d Cross. Meghalaya VHA has a future plan of giving
more VHtfs training and one day VHA conference in Shillong.
MIZORAM
Mizoram VHA was started in 19^0 and has ten mamb^rs only. The
’Health care in voluntary sector, is carried out by various churches.
The Homoeopathic dispensary run by MVHA is considered as one of the
best dispensaries. The other activities of MVHA ar^, running type
writing and short-hand school, MGH programme and rendering health care
to the students. Fr. Thomas gav^ talks to the school students on
Community Health Car-^ and conducted five days seminar on ”Health Care
according to Homoeopathic System” at Pastoral Centre> Shillongi The
future? plans of MVHA are to produce health care literature in Mizo
-language and to have a meeting of all the MVHA members in November 1933The VHAI personnels Mr. Srinivasan and Fr. ToiiJpaid a visit to MVHA
in 1982.
CRISSA:
The Orissa VH/1, though it tried its level best to, organize few
programmes in the year 1982-83, they could not be accelerated due to
lack of porsonnfel and other fejw problems. Yet it did conduct a workshop
on Health Education successfully and has a plan of organizing many
programmes like oth^r State VHAs.
:4:
TAMIL NADU :
Reported by Mr. Peppiri.
Activities
a)
Meetings: The Tamil Nadu VHA General Body meeting,. VHAI General
Body meeting, and three* Governing Board meetings, were attended.
Organized a meeting to discuss about the Mini Health Centres and
Community health work and met the Health Secretary with
Dr. K.S. Sanjeevi and Dr. Roddy.
b)
Works
Organized
x .jiT.A
--- hops/Seminars:
■
------ - — workshops, on Basic
.. Advanced
Villas
i.A., and
ano. Wholistic Health. Two training programmes for Village
T.J.rwbwv.r-.
—U 1_
_■»
ni. j -i s
Health.Workers,
and
Child T,Health Programme and three Health
Mother
Education seminars wuru organized.
c)
Visits: Visited members institutions in 3 districts.
Future Plans:
- Seminar on National Health Policy
- Collecting information for National Resource
Directory
- Organizing training prograjnmes for village
health workers
- Seminars on H&.a.lth Education, T.A., Community
Health and Ddvdlopndnt
- Solving the problems related to Mini-health
centres
- Visiting member institutions and neighbouring
State VHAs.
WEST BENGAL
of WB vt'^'in0!*^^*^
a)
.
’the activities of the Organizing Secretary
Meetingsj There were eight meetings organized and attended by
the Organizing S-’icr-tary of TO VHA. They are namely follow-up
meeting of the trainees. Eastern Region VHA meeting. Nomination
Board and General Body meetings, Ankuran Board meeting,
Vllil General Body meeting, faculties meeting, WB VHA Executive
Board meeting, L.W.S. meeting and ANKURAN Board meeting.
b)
Programmes attended and participated: BHfS Eye camp programme,
workshop for teachers and parents of hearing impaired children:
bangiya Unnayan Parishad, seminar on N.H.P. by C US CM and Q-DA
workshop on Calcutta slum and Calcutta Bustee Development.
c)
AJorkshops: .TMSE village health workers training
Mt.MGH/orkshop for CASA (2) Health and nutrition for
LSII, ..vH Nutrition for GRS and 40 days residential programme on
Community Health and. Development.
d)
Cthgr activities: ■Di>v3loping marketing unit of books/audio visual/
handicraft s/m- die in? developing ©mploymant exchange cell, provi
ding scholarships. Exhibition and demonstration, preparatory
steering committee meeting for seminar on N.H.P. and visited
9
J
Ip-5
COMMUNITY HEALTH CELL
826, V Maim I Block
Koramfengala
Bangalore-560034
India
/
VOLUNTARY HEALTH ASSOCIATION KAMTAkAKA
5th March 1 9U
Dear Friends,
The following information is sought on tuberculosis,
VHAI is talong
this theme in the National Meeting in April, 1984 to take certain soncrete
steps in this direction.,
The following information is sought from each of you to help you better:
1.
List of names and addresses of people involved in the TB work who could
contribute as resource persons.
2.
List of resource centres where training in TB care could be imparted for
different levels of health personnel in the field.
3.
4*
5.
Incidence of TB in your area/district c
Prevalence of TB in your area/district
Percentage of TB cases diagnosed as having TB (case finding rste)
6.
Percentage of TB cases on treatment (case holding the rate)
7. Default rate in your area
S.
9.
Primary and Secondary drug resistance to commonly used anti-TB drugs
(figures as well as impressions )
Problems that you see associated with TB care at your institutional level.
Some questions
1.
2.
3.
4.
5.
6.
Are there anti-TB drug shortages in your area ? What do you think
are the reasons ?
What facilities under the National TH Programme are supposed to be
available to Voluntary Health Institutions in your area from the
Government ?
What attempts have you and other member institutions made to obtain
these facilities ?
What has been your experience ?
What is the average cost of commonly used anti-TB drugs, their individual
prices and cost of the total course of the regimes that you advocate,
please specify the duration and the drugs reconmiended ?
In what specific areas do you thinkKwe in VHAK and VHAI could help ?
Thanking you for your co-operation,
With best wishes,
Sincerely yours>
/
y
VOLUNTARY HEALTH ASSOCIATION‘KARNATAKA
Sth March 1984
Dear friends.
April 7th being the World Health Day we request you to organise
suitable educational and publicity programmes through different media to
educate the people on these topics and other subjects related to the health
and well being of the children.
VHAK, Bangalore.
Help regarding this could bo obtained from
'
The World Health Day is. on April 7th and W.H.O. has chosen the theme
’’CHIIDRENS’ HEALTH TOMORROW’S WEALTH" for this World Health Day.
are our most precious resources.
Children
The quality of life in‘tomorrow1 s India"
’/rill be determined by the well being and proper development of the children
of today.
Therefore, the main points to be highlighted are:
(i)
Immunisation of all children to prevent the major childhood diseases
(Diphtheria, Polimelitis, Tetanus, Tuberculosis, Whooping cough and
^basics)
(ii)
Maintaining a growth chart of the child by the family to know whether •'
he/she is growing normally or is suffering from malnutrition or from
some other disease.
(iii)
Breast feeding to prevent the unnecessary malnutrition.
(iv)
Popularising the oral rehydration therapy an inexpensive and effective
way to enable a mother to help her children when they suffer from
dehydration as a result of diarrhoea.
Besides, maternal and child
health care services improving the child*s nutritional status and
motivation of families to adopt healthful ways of living and
(v)
Small family norm also need emphasis.
With best wishes.
Sincerely yours,
Usha S.
Promotional Secretary
^THAK
I
VOLUNTARY HEALTH ASSOCIATION. ICARNAT^A.
S'bh March 1984
Dear Friends,
This is
just to remind you about the General Body Meeting
whish is tentatively fixed for April 1 5th 1984.
In ■'.n.ew of this
a questionnaire was sent to you- to be duly filled :m and. return
to us. I am sorry to say that only 12 members have responded so
far. I request you all to kindly fill up the questionnaire and send
it back to us before 1 5th March 1984. These questions will help you
to participate actively by preparing before you come fo/ the meeting.
Sincerely yours.
Usha Sc
Promotional Secretary
VHAK
.Aon,-Fri.
f
9.00—5.30 p.m.
ph . 652007
'• ' 652008
GRAM : "VOL HEALTH"
NEW DELHI-110016
With the Compliments
of
VOLUNTARY HEALTH ASSOCIATION
OF INDIA
C-14, Community Centre (Opposite l.l.T, Main Gate)
Safdarjung Development Area
New Delhi-11 001 6
Voluntary Health Association of India
C’14, Community Centre
Safdarjung Development Area
New Delhi-110016
A/ 7
w
At m
'J\z
/hv
Telegrams : VOLHEALTH
New Delhi-110016
Telephones :
COMMUNITY HEALTH CELL
V Mein, I Block
------KbrahUngala
B8ngalore-560034 y
India
- ---Sept. 22, 1983,
ADS/pt/6-2
To:
ip/A
-The Menibors of the Executive Board of VHAI
- Office bearers of all State VHAs
- Organising Secretaries of all State VHAis
- /ill staff of VHAI.
Fron:
The Executive Director, VHAI.
Re:
VHAI1s intervention in public interest litigation.
The question of VHAI becoming impleaded in public interest litigation
in matters concerning social justice in health care has assumed an immediacy
because of VHAI's known position on many issues and also because many people
perceive VHAI to bo the natural focus of such concerns.
Wo have boon approached on several occasions to lend our support to
plaints that have been filed in the Supreme Court.
Iho Executive Board of VHAI will be discussing this question at its
forthcoming mooting at the end of September. However, wo sco this as an
issiio on which a wider debate will be both useful and necessary. You vrill
recall that the General Bodv Mooting of VHAI at Nagpur reconmendod a wider
"decision promoting forum" to be involved in making larger decisions. Since
the state VHAs are the widest base of VHAIj it is appropriate that you discuss
this question at your Board mootings and send us your responses at the
earliest.
My colleague, Mr. Aspi Mistry has prepared a very thoughful and
care full y considered note cm this subject. I am happy to share this note
with you. It can serve as the basis for your deliberations.
I look forward to receiving your response.
With every good wish.
Yours sihbcrcly,
/A M i
/ M
uM
f /
Averth^nus D1 Souza^ ^^
Executive Director.
Encl:
Note on VHAI1 s intervention in
public interest litigation.
A-10/79
pt:2i.9.»83
A NOTE ON THE LEGAL ASPECTS OF HEALTH ISSUES JND VHAI'S
INTERVENTION
“
1.
With the new concept of "Public Interest Litigation", any public
spirited individual, who may not be personally involved, can move
the court on benalf of an oppressed or exploited individual or a
group of persons. The Supreme Court of India held recently that
it is necessary to democratise judicial remedies, remove techni
cal barriers against easy accessibility to justice" and that it
would 'readily respond oven to a letter addressed by such an indi
vidual acting pro bono publico.
2.
Further, as a result of several recent judgements of the'Supreme
Court, Articles 14 and 2] of the Constitution have acquired a new
dimension related tc, the concept of the fundamental right to life
and liberty: ’Life’ is no longer to be interpreted as ’biological’
or ’animal* life. But it must mean life in human conditions, which
presupposes the reasonable necessities required to sustain such life.
3. The expansion of the concept of ’locus standi’ and this now phase
of judicial activism must be seized as a challenge and an opportunity
by those groups who arc working for social change and justice. In
-.act, various activist as well as non—political social action groups
have taken'up the challenge-through iss ues of bonded labour, women’s
oppression, workers’ health, environment and many others. The courts
have.become one more forum through which to spread awareness, and.
public interest litigation has become a part of the growing movement
——
for democratic rights and civil liberties,
~
4. Health issues, and
and- more precisely the right to good health.
health, have to be
seen in the context of this larger movement; wK "c health is defined
not as absence of disease, but the» "well-being of body, mind and
community" - in fact an integral
ingredient of the fundamental
right to life.
5- In the various activities of VHAI, whether it be community health,
training, health care education, low cost drugs, etc., the underlying
emphasis has boon to generate community supportive programmes that
work through the participation of the community using creative methods,
appropriate technology and are based on the education and awareness of
the people, not only about health issues, but of the complete reality
situation of the community. In short, the thrust has been towards
the creation of a health movementT rather than the sotting up of
projects or institutions.
6.
In the building up of such a movement it has already been inevitable
that networks with other like-minded individuals, groups and insti
tutions have boon formed. Just as health issues cannot be completely
.divorced from the other vital problems affecting the lives of people,
the health movement cannot be isolated from the larger movement for
A-10/79
pt:2l.9.'S3
2
:
7.
As part of the process of strengthening such linkages, VHAI would
have to address itself to the health dimensions of the problems
and issues taken up by these groups, as -well as educate and moti
vate them to sec specific health issues as an intrinsic part of
the paradigm within which they may at the moment be working. If
the health dimensions of these problems, or the specific health
problems taken up by these groups become the subject matter of public
interest litigation, they may seek the intervention of VHAI in the
legal process. Two groups have already approached us. Judging by
the present trend to use the courts as a forum for justice as well
as spreading awareness, more may do so in the future.
8,
Viewing the question from the broader perspective, that is in terms
of the larger movement and responsive interaction with other groups,
there could be no objection to an intervention by VHAI, ix* principle.
But in order to make this intervention significant, relevant, and
with maximum impact, it is necessary to arrive at a set of criteria
on the basis of which the extent and nature of the intervention in
each specific case cai be determined. For reasons to be detailed
a little later, VHAI’s involvement in actual litigation should be
the exception rather than the rule.
9. Before coming to the details of how this intervention can be made
in practice, it may be pertinent to make a brief mention of the role
of expertise in such a situation. Very often the issues that come
up before the courts require specialised technical knowledge in order
to be resolved correctly and the court of course is not equipped to
handle such matters. It has therefore to depend on so-called ’experts’
in the field. It is a sad commentary on the state of the scientific
establishment in our country today that the majority of these experts
are persons who by and large owe their positions or continue in them
at the pleasure of their political patrons and arc hardly independent
researchers or scientists.
To give a simple example, if the Supreme Court has to decide whether
a drug ’x’ being marketed by a multinational ’ y« is hazardous andshould bo banned by the Government of India, in the defence of their
case, company ’y1 together with the entire multinational lobby,
acting in concert with the Drug Controller, could produce overnight
a battery'of ’export1 opinion to show that drug ’x* is not only nothazardcus, but is absolutely essential for the good health of the
poorest sections of the people of this country. Thus, however
public-spirited the petitioner may be and however sympathetic the
judges are to his rational approach to the problem, scientific and
expert opinion would have to prevail. And while it'may be common
knowledge as to who has buttered the experts’ bread, it would be
impossible to prove it in a court of law.
In such a situation, expertise can only be matched with equal expertise.
In this, VHAI has an important role to-play which other individuals and
non-health groups cannot. It can throw its weight ani prestige against
the establishment ’experts1 by mobilising through its wide (even
international) network, counter expert opinion. In.the above example
it can:
A-10/79 _
pt:2l.9.,S3
3
c)
claim to represent what is really in the public interest
where health is concerned.
It is therefore essential that VHAI should use its expertise, knowledge
and prestige in a careful and discriminating manner in truly important
cases, to take a stand in support of the public interest and in opposition
to powerful but vested interests in the health industry, against whom
the ordinary citizen is powerless.
10, As mentioned earlier, besides issues which are specific to the area of
health, VHAI may be called upon to contribute in tackling those problems
which have a health angle. The following issues are some of those which
have been taken up by various groups and which have a health dimension
to them:
Problem/lssue
Health aspect
Workers rights
Environment:
D ef ore st at ion
- occupational hazards
- occupational health
destruction of food
resources of local people,
especially tribals
destruction of water
resources
destruction of medicinal
plants and vegetation.
Pollution
polluted water and air
affecting health directly.
Industrialisation and
conflict over natural
resources'
right to local'water and
land resources, which arc
often diverted for industr-ial use, directly affoct-ing health of local people.
Nuclear Energy
radiation hazards
- to workers
- to public at large
Exploitation of bonded labour, tribals,
payment of minimum wages, etc •
labour extracted at the
cost of deterioration in
health of labourers.
11. For an organisation like VHAI, working in the area of health, it is not
possible to directly take up those issues which ai*e in fact at the root
of health problems - water resources, food production, land distribution,
education aid the way people treat or mistreat each other (exploitation
and oppression). By intervening in support of those social action groups
who are taking up these issues and providing them with the health data
connected with*thcse problems, VHAI can enable these issues to bo tackled
in their fuller perspective - as directly affecting the health - and
therefore the fundamental right to life of these exploited sections of
society. For a health organisation to successfully intervene (for instance)
A-10/79
pt:21.9.!83
: 4
recourse to the court of law, can compel the government to provide
good health to its citizens. But the courts can be persuaded to
strike down those acts of government or private parties that take
away the good health of the citizens or contribute to its deteri
oration by depriving them of the means required to sustain it.
The directive principles have no legal force in the positive forward
direction. But violations of the principles of state policy fall
within the province of judicial review and action.
12.
There are various ways in which VHAI can make an intervention in the
legal aspects of health issues and these may bo listed in ascending
order of involvement.
a)
Specialised documentation of information related to the legal
aspects of health: statistics, nows items, research papers,
laws, acts of parliament and state legislatures related to health,
case-law, precedents and judgements in this country and abroad,
law related to associated issues - civil liberties, environmental
problems, etc. Such a documentation would involve an active
and planned search for data and sources, rather than a passive
classification of information that may drop into our laps.
b)
Providing the above information to groups who have taken up
issues at the legal level, as well as compiling special data
for particular groups at their specific request, or at our
initiative.
c) Building a network of lawyers, social workers, doctors, conmunity
health workers, nurses, etc., who would, if necessary, be willing
to give their services and expertise for use in litigation, as'
well as be ready to testify in the courts cither as witnesses,
experts, orally or through affidavits.
13.
d)
Prepare comprehensive material (rather like a ’’white paper”)
on issues which are the subject"matter of litigation, specially
for the judges hearing the case, and submit it to the court as
an ”aide-memoire” or background paper to help it in arriving at
a decision. (This was done recently in the pavement dwellers
There is of course
case by Claude Alvaros, of RUSTIC (Goa).
a possibility that the court may impload VHAI or the authors of
such a document as a party or atleast ask them to place the
same facts on records, through affidavits.
o)
Give affidavits and evidence in support of potitioners/plaintiffs.
f)
Intervene directly in suits and petitions filed by other groups
as petitioners or respondents.
g)
Initiate original petitions/lawsuits on our own or with the help
of other groups.
As can be observed steps (a), (b) and (c) would lay the firm ground
work for stops (d), (o), (f) and (g). Steps (d) and (c) may lead to
direct involvement while steps (f) and (g) entail a conscious and
planned intervention. At least some of the following criteria should
be satisfied if VHAI has to got directly involved in litigation:
i)
The issue should be important enough:
.V...
A-10/79
ptiSI.?.1^
5
or.
b)
ii)
isj an incomparable opportunity to spread awareness, cduuut.
it_ _
education
about the problem and it is felt that the courts particularly
would be an appropriate forum for this.
The issue affects a largo number of people or vast areas of the
country and is a serious problem. So much so^ that not to get involved
would be an abdication of a moral duty of VHAI as a social organ17.ati on n
The problem, though not very serious, or affecting a large number of
people, involves crucial questions of law affecting the rights of all
people and it is inportant to have a precedent clearly established
for further action.
E.g. fraudulent claims for Vit^E preparations may not be a serious
problem or affect the Vast majority of people, but the basic 'point
at issue could be the right of the consumer' to be correctly informed
and his right to compensation due to damage, physical or mental,
caused by misinformation. If these rights arc upheld and the principles
of compensation laid down by the court, it opens the avenue for
action in more serious cases.
iv)
Whatever be the issue, VHAI should be in a position to muster enough
background, on it, and have done its home work carefully before
plunging into legal waters. Similarly if VHAI has to intervene in
somebody clse’s petition/lawsuit, it must ensure that the original
petitioners have done their groundwork well. The scope of the
intervening petitioner is usually restricted by the scope of the
original petitioner’s case.
v)
As far as possible, issues taken up at the legal level should be
linked to or backed by movements and field work at the grass roots
level. Recourse to the law should not become a substitute for mass
work or taking the issue directly to the people; Very often the final
decision in the court may be against the people, but if there is a
people’s movement supporting the case, temporary reliefs,obtained from
the courts, can give precious time for further mobilisation and
creating awareness.
vi)
The issue is serious enough and there is no time or possibility to
organise people around it, and the law is the only immediate recourse
available.
vii)
As far as possible VHAI should get involved in litigation with other
groups and social organisations, rather than in an isolated manner.
viii)
There is a reasonable probability of achieving at least partial
success, and creating awareness about the problem involved through
the skilful use of the mass media, even in the event of failure.
VHAI should not got the reputation of being ’’litigation-happy” or being
involved in nil sorts of frivolous, publicity oriented law suits.
6/
A-10/79
pt:2l.9.,S3
ix)
:
6
VHAI should examine its own strengths and weaknesses which may
bo exposed to the public in the course of a legal battle. For
instance, in a case in which multinational companies arc involved
as our adversaries, they would'oppose any attempt on our part to
expose their foreign loyalties, by bringing'in the (extraneous)
issue of us being foreign funded. In short, the fall -out from
negative publicity should also be assessed. In any case, our
stand on foreign funding should bo very clear and defensible,
and our sources be able to stand up to public scrutiny, if
necessary.
x) Legal advice
have to- be
a as
as to the legal position,
. T’. would
-------— taken
responsibilities and obligations of the Board members of VHAI
as well as its employees, when VHAI as a corporate entity is
party to a litigation. To what extent are individuals in
VKAI indemnified, etc.
xi) VHAI should also realistically estimate the costs in terms of
manpower and money that each actual involvement in litigation
would entail. A large portion of at least'one person’s time
would have to be devoted to the litigation, and he/she would
have to constantly liaise with the legal experts, the health
experts and VHAI. While public spirited lawyers may work
without remuneration, some' payment would have to be made for
secretarial help, clerkage, starrp fees, duplicating and xerox
ing documents, bocks, travel (sometimes to other parts of the
country to collect material or data).
Ii these criteria are kept in mind, it becomes obvious that VHAI would
halo to bo extremely discriminating in its choice of issues or legal
intervent ion.
14,
To sumarise the above points:
i)
The new concept of ’Public Interest Litigation1 and the expanded
interpretation of ’life’ and ’liberty’ give ample scope for
public spirited organisations like VHAL to got involved.
ii)
VHAE should, in principle, agree to intervene in this process,
with respect to health issues and health dimensions of related
issues. VHAI should sec itself as part of a larger movement
in this respect.
iii)
In practice, VH/I’s intervention should be limited to important
issues and in co-ordination with other responsible groups and
institutions, selected on the basis of certain well thought out
criteria.
Qi)
^nirwr**s*il*^
^fTT^HIWWlW^y^
^rii/hhiolffTHW^
^iTiiiin»ii>»',1,T*^
its office to the newly constructed building
[i FWt
I
I
H i
o
inaugurated by
Shrimati Mohsina Kidwai
Union Minister of Health and Family Welfare
blessed by
His Grace The Most Rev. Angelo Fernandes, D.D.
Archbishop of Delhi
on January 24, 1986.
VHAI
assists
in
making
Community Health
a reality for all the people of India,
with priority for
the less privileged millions,
with their involvement and participation
through the voluntary sector.
Our vision of health care is contained in two words : Community Health.
We believe in people.
We believe in HEALTH BY THE PEOPLE.
We promote Social Justice in the provision and distribution of health care.
We say that Public Money marked for health must be reasonably shared with all the people.
We encourage a Referral System that starts with Primary Health Care.
We encourage people to demand health as a Human Right.
We believe in research, higher knowledge and the advancement of health science.
We have firm faith in sharing.
If the oppressed do not have primary health care, it is not because our country does not have sufficient
knowledge and resources. It is because our wealth of knowledge and skills are not shared.
We say all goods and services should be equitably shared with the whole community.
We support the nation's goal of Health for All.
VHAI is for all of India.
VHAI is a federation of voluntary health associations at the level of States, Regions and Union Territories
linking over 4000 health institutions and community health programmes.
Can VHAI have noble spiritual ideals, being open to one and all ?
Our principle has been to emphasise areas of agreement,
us are also social, political, economic and religious.
The answer is a resounding YES.
People are not merely individuals. All of
There are large areas on which virtually all good people agree
the practice of virtue such as love, friendship, charity,
justice, including social justice,
mercy, prudence, courage, temperance,
service of neighbour, especially of the poor, the deprived and the weak,
decency, humility, personal and family fidelity,
observance of reasonable laws, repentance and spiritual healing,
the building of community,
reaching out to world community.
VHAI finds working together inspiring.
Both singly and in groups we bring the best of our heritage to bear upon the goals we jointly pursue.
Our way of life is a noble religious expression.
We join hands and hearts to do all we can together.
We encourage the freedom of each one's personal call.
We promote the highest spiritual accomplishment and commitment.
KALPANA PRINTING HOUSE
PH : 669407
w
HEALTH
VOLUNTARY
1981-82, Circular No.1
9th September 19Si
ASSOCIATION,
iTy,'*?
;2e- v Ma'nr I Block
Korsmangaia
e«ng.ior.-56Q034 -
Dear Erlends,
KARNATAKA
For circulation to
all members
CEU.
India
Greetings from the Executive Committee
!
NEW V.H.A.K. OFFICE:
By this time you might have come to know that the V.H. A.K.
Office, which was housed from its very beginning at the C.S. I.
Hospital, Bangalore, has been transferred recently to the
St. John’s Medical College Hospital Campus.
Q^r sincere thanks
to the Management of C.S. I. Hospital, Bangalore, for providing
us with their facilities for so many years.
We would request you
in future to address all correspondence to us at:L
THE V.H.A.K. Office,
St. Johnfs Medical College Hospital,
Sarjapur Road,
Bangalore-560 034-
CHAl\I® OF I1CNCRW SECRET/iRY:
lit the last Executive Committee Meeting of the V.H. A<K«,
Dr. Ravi Narayan, MD, DTIPH, DIH, FRIPHH, was nominated as the
Honorary Secretary of V.H. A K.
However, due to his other prior
commitments and non-availability,
office.
he is unable to take up this
I have been requested to officiate as the Honorary
Secretary of V.H. A. K. for some time.
As the Administrator of
St. Iota’s Medical College Hospital, my schedule is heavy.
Yet I hope that with your co-operation I will be able to further the
the objectivee of the V.H.A.K. in a greater measure.
VISIT OF THE V.H.A.I. NATOONAL EXECUTIVE COMMITTEE:
The V.H.A.I. National Executive Committee has scheduled
its meetings on 2nd and 3rd Cfetober !81 at C.S. I. Hospital,
Bangalore.
The members are to especially consider the successor
to Er. James Tong, S. J., the Executive Director of V.H. A. I.
It
would be nice if members of the V.H.A.K., particularly those
who are resident in Bangalore, could meet the V.H.A.I. National
Executive Committee Members over a cup of tea.
I therefore
-2SEMINAR CN LCW CCST DRUGS AND DRUG POLICY:
A Seminar is slated for 3rd October 1981, to coincide
with the visit of the V.H.A.I. National Executive Committee.
Please find enclosed the detailed programme for the Seminar.
Day
: Saturday, 3rd October 1981
Time
Venue
: 9»3O am to 4 p.m.
: St. Johnrs Medical College
Last date for receipt
of Application: 30th Sept. 1981
With every good wish,
Yours sincerely,
l3CLo 5^^
Er. Bernard Moras
(Honorary Secretary)
*
SEMMAR
ON LOT COST DRUGS Al© DRUG POLICY
<
Date .
Saturday, 3rd October 1981
Time
9*30 am to 4 pm
Venue
St. John’s Medical College,
Bangalore -560034*
Dear Member,
The V.H.A.I. .goal has been and will always be a
Community’.
’Healthy
We $e$k ’to promote social justice in the provision and
distribution of health care’.
With the increasing euphasis on ’’Primary
Health Care” we are all in an increasingly important quest for priorities.
We are seeking clean water before antibiotics, food before vitamin pills,
vaccination before kidney machines, mother’s milk before powdered baby
foods mixed with dirty water, and health for villages and slums
more hospitals for the affluent suburbs of capital cities.
before
The dilemma
before many of our members is how to shift priorities from our commitment
to hospital systems to our increasing commitment to community health
care systems i
One of the big problems we are facing in our hospitals is the
increasing cost of drug bills.
Drugs are becoming the mainstay and main
cause of expenditure in our hospital system.
Any shift of. priority can
only result from a concerted action on our part to look at drug policy
and drug costs and see whether we, as a group of voluntary health workers,
can do anything to reduce the drug bills as a first step towards shifting
priorities.
Can we change our prescribing policies?
cost drugs?
Can we produce lew cost drugs ?
Can we stock low
The ICMR/IGSSR study on ”Health for all - an alternative stategy”
warns us that eternal vigilance is required to ensure that the health
care system does not get medicalised, that the doctor-drug-producer
axis does not exploit the people and that the abundance of drugs does
not become a vested interest in ill health.Car we
V.H.A. Members do anything about this
individually and collec tively ???
To find an answer to this growing problem we have organised
a seminar for all members on October 3rd, at St.John’s Medical College,
Bangalore.
Join us to discuss the following issues I!
-
The pattern of drug production should be oriented to the disease
«■
-2possible prices.
How may we bring about this?
One of the most distressing aspects of the health service today
is the habit of doctors to overprescribe or to prescribe glamorous
and costly drugs with limited medical potential. Can the medical
profession in our hospitals be made more discriminating in ,
prescribing habits ?
The small scale drug industry needs to be encouraged and expanded
subject to strict quality control.
Gan we produce low cost
alternatives -jn our hospitals, health projects and village communities?
fifteen thousand branded drugs are on sale in India. But a Government
Committee on Drugs and Pharmaceutical Industry (1975) believes that
health needs can be met by only 116 drugs.
Can we agree to a simple
standardised low cost pharmacopia for the Voluntary Health Sector?
A Government Committee looking at drug costs has recommended
acceptance of
- A basic drug list
- Goneric Prescribing practice
- Bulk purchasing
- Local formulations
- Use of indigenous drugs.
Taken separately, each policy is a powerful weapon for change;
taken together, they build into an integrated staategy.
Can we
consider these and accept them to change the drug scene in our
hospitals ?
These are many of the issues we will discuss together
in the workshops.
Please send representatives from your hospital/
health centre institution to share with us your experiences and ideas.
The Seminar is open to all Health /idministrators. Doctors, Nurses,
Pharmacists, Paramedical Workers and Voluntary Workers associated
with Voluntary Health Care Agencies. Please send information
regarding your participation to the Honorary Secretary, Voluntary
Health Association (Karnataka), St. John’s Medical College Hospital,
Bangalore-560 034*
Looking forward to your participation.
KINDLY MAIL (before 30th Sept. 1Q81) to:
THE HCNCEWY SECREWY,
V.H.AK. Office,
St. John’s Msdical College Hospital,
Sarjapur Road,
BANGALCRE-560 03/.
Dear Pr. Moras,
The following persons from our organisation will attend
the Seminar on Low Cost Drugs and Drug Policy:
1
2
3
4
5
6
Please find enclosed the Registration fee of Rs.15/-
per participant./ The participants will pay their Registration
fee on arrival.
normally
Chr participants are /resident outside .Bangalore.
persons may kindly be accommodated at St. John’s Medical
College Hospital.
Yours sincerely.
Name:
Designation:
Organisation:
(Please Note that only limited accommodation is available
at St. John’s Medical College Hospital, for 1 day.
Nominal Rates :
Lodging
: Rs. 10/-
Boarding
: Rs.9/-)
w
■u
Voluntary Health Association of India
Phones : 668071,
66807 Z
40, Institutional Area, (Near Qutab Hotel)
South of III, New Delhi-110016
Measures for Rationalization, Quality Control,
Pharmaceutical Industry in India.
Grams : VOLHEALTH
New Delhi-110016
and Growth of Drugs and
The New Drug Policy which has been in the process of being formulated
for the last several years was finally announced by the Chemicals Minister
on December 18,1986.
io ruiiy
Policy, it is
To
fully understand the implications of the New Drug Policy,
necessary to look back at the Drug Policy of 1979, and what followed it.
The 1979 Drug Control Policy Order was the result of the recommendations of the Hathi Committee.
The main recommendations were as follows:
1.
2.
3.
4.
5.
6.
7.
Nationalization of multinational drug companies.
Establishment of a National Drug Authority.
Priority production of 116 essential drugs.
Abolition of brand names and introduction of generic names.
Revision and updating of the Indian National Formulary.
Strengthening of quality control.
Elimination of irrational drug combinations.
A few of these recommendations were modified and included in the
Drug Control Policy Order of 1979. The mark up on three categories of
essential drugs was fixed, production ratios between bulk drugs and formulations set down, sectoral reservations made and decision to use generic
names for 5 commonly used single ingredient drugs taken.
The industry, while managing to sidestep most of these controls,
(increasing its profits substantially
/ and flooding the market with over
40,000 brands), continued to complain about itsj ’’poor growth”. It was this
o
and not the growing realization by the health and
- —J consumer groups
which
has brought about the Chemicals Ministry’s reformulation of the policy.
By this time, health and consumer groups were making serious at
tempts to increase awareness about the need for a Rational Policy. They
had realized that the ’’health needs of the country and the drug production
did not match”; (there were shortages of essential and life saving drugs; ir
rational and hazardous drugs continued to flood the market; marketing
practices were unethical and double standards existed in the drug informa
tion given to doctors and consumers; every fifth drug in the country was
substandard.
These factors were never seriously considered by the Chemicals
Ministry. The working Group and the Steering Committee of the National
Drug and Pharmaceutical Development Council, set up in 1983 to look into
matters related to the industry, did not deal with those issues which con
cerned people’s interest in its report (fortunately for the consumer, the
report of the NDPDC was rejected by the Parliamentary Drug Consultative
Committee).
But the trend was clear. The Chemicals Ministry would be assessing
the drug needs of the people and formulating the policy, not the Health
Ministry. Industry’s interests would prevail over people’s interests.
During the four years that the Chemicals Ministry took to decide on
the New Policy, views of health personnel and consumers, both at national
and international level were available. WHO’s model list of essential drugs,
was drafted in 1977 by experts from many countries, including India, to
help governments develop their own National Essential Drug Lists. In
November 1985, the WHO called for a conference of experts of Rational
Drug Use in Nairobi to discuss the issue, and provide guidelines. Drug
Regulatory Authorities, representatives from industry, government officials
and health activists met for the first time in pharmaceutical history on a
common platform to express concerns and to dialogue. At the World
Health Assembly in May 1986, Resolution on Rational Drug Use was passed
- to which India was a signatory.
There was no dearth of consumer’s views, editorials, articles in the
newspapers, magazines, programme on government’s own ’’Voice Box" Doordarshan statements, and memoranda of several hundred meetings and
workshops across the country aired the deep concern and anguish at the
existing pathological drug situation and the need for urgent changes.
We and our policy makers also had ( and still have) the example of
Bangladesh before us which inspired by the Hathi Committee Report, for
mulated its Drug Policy based on WHO recommendations. The results of
the Bangladesh Policy over the last four years are obvious:Drug prices have decreased.
National Essential Drug List and Graded Essential Drug List
have been drawn up.
Essential and life saving drugs are being produced, as a
priority.
They are easily available even in the remote areas due to a
2
more streamlined drug distribution.
1707 Hazardous and Irrational drugs have been withdrawn.
Production of only essential drugs is allowed and not a single
foreign company has left, in fact their turnover has increased.
New ones want to enter the market.
Sectoral reservations exist. Foreign companies are not allowed
to produce those simple and low technology drugs which
Bangladeshi companies are capable of producing.
Bangladesh is saving millions of Takas by Non import of non
essential drugs and import of essential and life saving bulk
drugs through international tenders.
Quality control has improved.
India as compared to Bangladesh is much better placed. Our
pharmaceutical industry according to UNIDO belongs to category V i.e., it
has a capability of total self reliance in drug production.
We have a
rapidly growing Indian private, public, and small scale sector. And yet why
are we spending more than ever before on drug imports? Why are there
shortages of essential and life saving drug? Why has growth of quality
control and drug control mechanism not kept pace with growth of the
industry? Why are safe drugs that are banned elsewhere and even within
our own country, allowed to be produced, promoted and prescribed, when
safer, cheaper and more effective alternatives exist? Why are profits of
the industry put before health of the people?
The reasons were many, The industry’s views had always been
available, This time, consumers’ reasons, based on actual health needs,
were also available.
The expectations therefore from the New Drug Policy were very
high - they were high because the health and Chemicals Ministries, and
the Prime Minister’s Secretariat were aware of the crying need for includ
ing the health dimension.
In the New Drug Policy, the choices have been knowingly made, and
priorities clearly reflected. The purpose of the reformulation is stated very
clearly in the 2nd paragraph of the summary of the policy statement :
’’there has been a considerable change in the pharmaceutical sector since
1978 policy and it was considered necessary that the new thrust and direc
tion should be given in the policy frame to subserve the objective of
growth of pharmaceutical industry in the desired are as”.
If earlier the policy makers could plead ignorance of consumers’
views, this time there is a reflection of sheer apathy and callousness.
Our most serious objections and criticisms are outlined below:
3
The Process of Decision Making
,
The drugs in the market are produced because the consumer supposedly needs all of them. Yet the consumers’ views and presence were
conspicuous by their absence in the formulation of the policy, The consumer is not mentioned even among the constituents of the National Drugs
and Pharmaceutical Authority where the need for an industry representative
has been felt and assured. In announcing the Policy, even the Parliament
was bypassed. The Chemicals Ministry, obsessed with growth of the
industry, made no effort to have systematic serious scientific debates and
discussions with academic circles, medical colleagues, and medical
establishments. The health perspective was never considered important. The
nation’s essential drug list was not drawn up.
As far back as 1975, the Hathi Committee, seeing the chaos in interministerial coordination, had recommended the formulation of the Na
tional Drug Authority. It was only in 1986 that the decision to have a
National Drug and Pharmaceutical Authority (NDPA) has been even
seriously considered.
While this at first glance seems a good move, on reading further
any remaining optimism and hope for a rational drug policy evaporates.
This apex body has yet to be formed. Only representation from the in
dustry has been assured. This is the body ’’which among other things,
would go into the question of rationalization of existing formulations in
the market including the banning of formulations of harmful nature and
better control over the production of new drugs”.
It is incomprehensible how the industry . representatives (obviously
, Small Scale Sector) will allow any
from different sectors
OPPI,, IDMA,
decision to be taken against their own interest;; that the representatives of
chemists and druggists would allow decisions to be taken regarding
withdrawal of those irrational trade commission.
Suppose the miracle occurs and the NDPA does draw up a list of
drugs needing to be weeded out - its recommendations are not binding.
The NDPA is only an advisory body, which simply means that only those
decisions that are in the interest of the power faction will be taken
seriously. If there are any furthering people’s interest, they will be totally
disregarded, as has been the case with all previous reports and
recommendations.
Regarding Availability of Essential and Life Saving Drugs
The first step in rationalizing a policy - the formulation of an es
sential drug list, has been dispensed with altogether, inspite of the exist
ence of the Hathi Committee Report, (which way back in 1975 drew up a
list of 116 drugs), and WHO Technical Reports 615, 641, 685, 722
4
(providing model lists and guidelines for selection of essential drugs).
It is extremely doubtful that it will be the concept of a National
Essential Drug List that will guide the selection of the new category II
drugs, when the urge and pressure is there to keep the "Drug Price Con
trol Basket” as small as possible. All the essential drugs that should be in
category II will probably never be included.
Previous experience with price decontrol has shown very clearly that
drugs do not become any cheaper.
While the new category I is supposed to include drugs required for
National Health Programmes*- it is not clear whether this means drugs for
the National Health Programmes like TB,
Leprosy,
Malaria Control
Programmes, or Drugs for the National Health Services which will require
painkillers, anti-helminthics (anti-worm), antibiotics. If it is the former then
who will decide which anti TB drugs should be included, if it is the latter
who will decide which drugs required for primary health care should be in
cluded and what criteria be used for their selection ?
Presuming that extremely rational categories I and II drug lists are
drawn up - who will set the targets to ensure the necessary production ?
past exercises have clearly indicated that there has really been no effort
made even to assess the actual requirements of drugs needed for the Na
tional Health Programmes. TB, which is a recognized major public health
enemy, is included in the Prime Minister’s 20 Point Programme. To deal
with it we have a "National TB Control Programme" and two National
Institutes-the National TB Institute at Bangalore and madras Chemotherapy
Centre, to provide guidance and training. Inspite of this even rough es
timates of the anti TB drugs required are not available. The Health Minis
try and ICMR could have really played a meaningful role. What is the
*
National Health Programmes include:
National Family Welfare programme
Expanded Programme on Immunization
National Malaria Control Programme
National programme for Prevention of Visual Impairment and
Control of Blindness
National Tuberculosis Control Programme
Integrated Child Development Services Scheme
National Filaria Control Programme
National Goitre Control Programme
National Programme for Diarrhoeal Diseases Control
National Nutrition Programme
National Leprosy Eradication Programme
National Anaemia Prophylaxis Programme
National S.T.D. Control Programme
5
result of their omission ? One glance at the assessed target demands
shows the existence of warped priorities - no increase till 1990 is shown
in the estimated production of INH, which is one of the most basic and
important anti TB drugs.
Lest it be thought that increased INH demands are not expected be
cause of the newer anti TB drugs like Rifampicin and Ethambutol in the
market - this is not true. The policy estimates increased demand of anti
TB like PAS, a drug which is not merely bacterio-static but considered ob
solete because of its side effects.
So the crunch of the matter is that even if rational categories I
and II lists are drawn up, adequate production of these drugs may not be
assured. Inspite of increased mark up to 75% and 100%, it will be more
remunerative for the industry to produce non essential, largely irrational
drugs whose prices are decontrolled.
One of the major demands of consumer and health groups has been
that it should be made mandatory for all pharmaceutical units to produce
at least 50% of their drugs as essential drugs. This has not even been
considered in the New Drug Policy when even the 1978 Drug Policy had
recommended that 20% of all production should be of essential drugs. The
demand for this production control should have come from the Chemicals
Ministry itself. It should by now have the painful awareness of our nation
having the largest number of pharmaceutical units (8000 producing the
largest number of formulations 40-60000) in the world which in no way en
sures the production of the right drugs, in right amounts.
HAVING AN ESSENTIAL DRUG LIST IS AS IMPORTANT AS ENSURING
ADEQUATE PRODUCTION, DISTRIBUTION, AFFORDABILITY, AND
QUALITY ASSURANCE
Regarding withdrawal of Irrational and Hazardous Drugs
It is well recognized that to ensure quality control, for streamlined
drug and storage distribution, dissemination of unbiased drug information
and to limit the confusion in the minds of the doctors as well as
consumers, it is critical that the number of drugs formulation be restricted
to a manageable number. This is specially important with regard to multi
ingredient fixed dose combination drugs, since neither are all the various
ingredients and their action often known to the prescribing doctor, and the
dispensing chemist but chances of adverse drug reaction, and drug costs
also increase. While inclusion of only 6 combination drugs is considered
justifiable in the WHO’S Essential Drug List, 60-70% of our drugs are sold
as multi ingredient fixed dose combination drugs.
The large number of drugs available makes it even easier for the
drug industry to pass off as necessary numerous irrational and often haz6
ardous drugs, which are banned in most other countries,
safer and more effective alternatives exist.
and for which
Amongst the major policy decisions of the Bangladesh Drug Policy
was the decision to withdraw around 1707 drugs. Hazardous drugs were to
be banned confiscated, withdrawn immediately and destroyed, and irrational
drugs withdrawn in a phased manner within a 6 month period, giving in
dustry the opportunity for reformulating such combinations. In India, enaction of drug bans has been such as to allow the industry ample time to
manufacture and dump these products in the market. The sales of these
banned drugs are allowed till a much later date. In the absence of a
functional drug control machinery such bans are meaningless.
Judge Mr. L.N. Mishra at the hearing of the Banned Drugs Case in
the Supreme Court last year observed that the Central Government., and
the health ministry have taken no responsibility in trying to ensure
withdrawal of the banned drugs and remained passive onlookers at the
deteriorating state of affairs. When this has been the state of affairs in
the past - we have little or no faith in NDPA's capability to ensure a
meaningful rational selection of drugs and withdrawal of irrational and
hazardous drugs.
It is important for the health personnel to know this - as voluntary
boycotts may be the only tool in the hands of the people.
Regarding Drug Prices
Increase in drug prices is the most definite decision and outcome of
on category I drugs will increase from
the New Drug Policy. Mark up
40% to 55% and that of category II from 75% to 100%, for other drugs
it will definitely be much more. When the health budget is so meager i.e.
mere 2.8% of the total budget ( far from the 10% as recommended by
the Mudaliar Committee - with most of it being spent, on salaries and
medicines - it is obvious that any increase in drug prices of even essential
and life saving drugs will leave even less for the actual health care serv
ices than before.
Had the drug industry really been in such an economic mess over the un
remunerative pricing structure:
pharmaceutical shares would have steadily gone down and NOT UP.
there would have been a cut in sales promotion expenditure which is
13 to 15% on an average.
companies would not have been able to give cash discount of 4 to
15%
*
Mark up includes the cost
trade commission.
of packaging,
7
distribution,
storing and
for drugs such as Orisul, Ledermycin, Terramycin, Antepar.
While the Bangladesh Drug Policy resulted in the fall of drug prices,
ours has been the opposite. What is worse is that this has been so without
the associated assurance of availability of essential and life saving drugs
and withdrawal of hazardous drugs.
Regarding Drug Distribution
When non-availability of essential and life saving drugs in the
periphery and also within the towns and cities has been identified as one
of the major problems associated with drugs, it is unbelievable that no
policy decision regarding streamlining the drug distribution has been taken~
We know how meager the health and drug budget for primary health
care has been in the past and how great is the need to increase it. We
are also aware of the present need to ensure effective distribution and
availability of the essential drugs.
fi
Drug dispensing is mostly in hands of private chemists and druggists.
When the amount of trade commission, not the rationality and essentiality
of drugs guides the stocking and dispensing of drugs in the pharmacy - the
responsibility on the existing government, health infrastructure and health
services to ensure effective distribution increases.
Regarding Quality Control
The first step to ensure quality control would be to restrict number
of formulations in the market and ensure that only or mainly single in
gredient drugs are available in the market.
If licenses are given indiscriminately, if Good Manufacturing Prac
tices are not strictly enforced, if the number of formulations are not
restricted to a manageable number - it is impossible to ensure quality
control. Setting up of costly quality control labs only to assess the quality
of known irrational drugs, will be a sheer wastage of public money. People
need rational drugs of quality and not quality hazardous drugs.
Certification Scheme
I
Theoretically the use of recognized institutions with proven expertise
and testing facilities to certify that the formulators adopt Good Manufac
turing Practices and produce quality drugs is a good idea - but in practice
the effective certification scheme may have more to do with the purchas
ing power of the formulators and the purchaseability of the certifiers
rather than the nature of their facilities and expertise. Concerned consumer groups and citizens groups will be forced into counter checking if
they want assurance of quality of the drugs they purchase. If they do get
8
implemented, closer scrutiny over introduction of new drugs, standardization
of monitoring of adverse reaction would be welcome. It should be pointed
out that where new drugs are concerned the drug control authorities have
shown a lot of caution. As pointed out earlier, our main problem has been
with the hazardous and irrational drugs and formulations already in the
market.
Regarding Generic Names
When majority of drugs are multi ingredient combination drugs and
when the Supreme Court’s decision on the case regarding allowing of sales
of all single ingredient drugs as generic drugs is still pending, intentions of
printing generic names on the labels are laudable. Way back in 1978 Hathi
Committee had strongly recommended that drugs be sold under interna
tional nomenclature and not brand names - since after all in medical
education, medical literature, international journals, international tenders
etc., only generic names are used. Again, all drugs in the market, whether
brand or generic should anyway be of standard quality.
Unbiased Drug Information
The New Drug Policy has nothing to say about making of package
inserts mandatory, printing or rubber stamping of consumer caution in
regional languages, especially for drugs potentially toxic for pregnant or
lactating women, children, elderly etc. This is extremely important in our
social context since over 60% of the drugs are bought over the counter.
Inclusion of measuring spoons for antibiotics and other life saving drugs for
paediatric a usage has not been enforced.
Clear labeling is important for effective communication.
The New Drug Policy says nothing about screening of promotional
material, ethical marketing practices and the need for a advertising code.
Tailpiece
i
*
As the emphasis of the New Drug Policy is the growth of industry
through economics of scale, the government has further delicensed drugs
and brought 31 more bulk drugs and formulations under broad banding*.This
will not only ensure that essential drugs become scarce and costlier, but
also that the already astronomical number of formulations available will
become even larger, more irrational and more hazardous, and will be
pushed with newer therapeutic claims.
Broadbanding means that companies can produce drugs and formula
*
tions having similar processes without needing special licenses. That is
companies can make changes in multi ingredient formulations even if the
major ingredient does not come under broadbanding.
9
Ideally, the health of a country depends on more than curative care
- it includes prevention, promotion and rehabilitation. However, in the ab
sence of such ideal situation, curative care and thus drugs assume almost
importance in reducing the level of ill health. When the health of the in
dustry is given more weightage than the health of the nation and its
people in a National Drug Policy, the commercialization of health is
complete.
*
10
RECOMMENDATIONS
1.
*
The National Drugs and Pharmaceutical Authority must constitute an
expert committee to draw up:
(a)
Essential Drug List based on WHO criteria
(b)
Graded Essential Drug List for use by different levels
health personnel and institutions
(c)
Rational Drug List constituting those which are recommended
in the medical text-books
(d)
Priority Drugs to ensure their production, distribution
availability for use in National Control Programmes.
of
and
The same Committee can screen and monitor all the drugs and for
2.
mulations in the market in order to weed out irrational and hazardous
drugs and combinations. It is particularly crucial in a situation with unac
ceptably poor drug control and an ignorant ill informed illiterate majority
population.
Formulary, which has not been updated since 1979,
3.
National Drug Formulary,
should be updated annually and provide therapeutic guidelines and compara
tive costs.
4.
All sales promotion material on drugs, including package inserts,
prescription guides and advertisements should be screened, and monitoring
for ethical practices must be ensured.
5.
Sufficient financial, infrastructure and administrative support and
power be made available with the Drug Control Authorities to ensure
availability of only ’Quality Drugs’ in the market.
There should be Mandatory Production Control to ensure at least
6.
75% of the total production of all manufacturers to be from the Essential
Drugs Category. This should be raised to 90% in the next five years.
Incentives should be given for higher (than sanctioned
7.
capacity)production of Essential/Priority Drugs when needed and deterrent
punishment to those producing less than the sanctioned capacities.
drug prices or price decontrol should be effected
8.
No revision of
without an independent study to assess the production costs, profitability
and viability of the drug industry and the purchasing power of the
majority.
11
9.
A National Corporation for the Distribution of Essential and Life
saving, Quality Drugs should be created to ensure streamlined distribution
to peripheral health units and consumers.
People’s pharmacies should be
set up where drugs will be sold without any extra or local taxes.
The Government must ensure implementation of the Ratios of Bulk
10.
to Formulations Production along with the two year limit for foreign com
Indian companies
panies to start bulk drug production from basic stage.
should also produce bulk drugs from basic stage within the next 5 years.
No new licenses should be given without the above conditions being
fulfilled.
encourage concomitant development of basic
The Government must encourage
11.
chemicals industry to ensure the availability of raw materials at interna
tionally competitive prices with the next 2-5 years.
The import of bulk drugs should be discouraged where indigenous
12.
production capabilities exist. The OGL facility for bulk drug import should
be withdrawn.
The import duty on raw materials and fine chemicals
should be judiciously lowered to encourage production of drugs from basic
stage.
All foreign companies (including Ex-Fera) should be directed to bring
13.
down their foreign equity to atleast 26%.
Instead of general dilution
through public, the public sector institutions and financial agencies must be
asked to acquire the disinvested equities.
To meet the national priority drug requirements in a self-reliant
14.
manner, sectoral licensing reservation should be strictly implemented to
strengthen public sector and wholly Indian companies. DGTD registration
and delicensing schemes should be withdrawn forthwith and unimplemented
capacities reviewed and cancelled to secure effective role of each sector
of the industry.
Incentives on R&D should be disaggrated and differential incentives
15.
be given to companies in different sectors as well as for different nature
of R&D. No incentives should be allowed on research for non essentials.
Public sector should be encouraged (through additional R&D support)
16.
to maintain its lead on indigenous technological development.
No change should be allowed of the present patents act of 1970 by
17.
joining the Paris Convention or otherwise, as this will be highly detrimen
tal to the technological (and industrial) development of the National Sector
of Drug Industry and the Nation in the long run.
12
Comprehensive Drug Legislation should be provided alongwith
18.
adequate administrative support to ensure effective implementation of a
National Drug Policy.
More streamlined centre state, inter-departmental
coordination for effective and relevant drug production, drug control, and
drug supply is urgently required.
19.
The Government should introduce generic names for all drugs, with
assured quality and with abolition of brand names in a phased manner.
20.
The Government must consolidate the Indian Systems of Medicine
(ISMS) for availability of essential and quality drugs from these systems.
7
13
COMPARISON OF PREVIOUS RECOMMENDATIONS WITH THE GAZETTE
NOTIFICATION OF JULY 1983
BANNING
26
DRUGS AND
COMBINATIONS
You can compare the drugs which were recommended for banning by experts with the drugs that were actually banned, by following the lists
horizontally from left (the first recommendation) to the right (the ban
order). Many of the recommendations were not followed.
(
Many of the banned drugs and combinations
market.
Recommended by subcommittee of
Drug Consultative Committee:
Drug Technical Advisory Board
Report, 25 May 1982
are still available in the
Gazette Notification of Drug
Controller of India July 23, 1983.
No. X 11014/1/83.
To be weeded out immediately, 1980.
1. Fixed dose combination of
Steroids
75. Fixed dose combinations of
14. Fixed dose combinations of
steroids for internal use except
steroids for internal use except
combinations of steroids with other
combinations of steroids with other
drugs for treatment of asthma.
drugs for treatment of asthma.
2.
Fixed dose combinations of
amidopyrine
1. Fixed dose combinations of
amidopyrine.
3.
Fixed dose combinations of
chloramphenicol.
16. Fixed dose combinations of
15. Fixed dose combinations of
chloramphenicol except preparation
chloramphenicol for internal use except
of chloramphenicol and streptomycin.
combinations of chloramphenicol and
streptomycin.
4.
Fixed dose combinations of
Ergot.
17. Fixed dose combinations of
Ergot except combinations of its
alkaloid ergotamine with caffeine.
16. Fixed dose combinations of
Ergot.
5.
Fixed dose combinations of
Vitamins with anti inflammatory
agents and tranquillizers.
2. Fixed dose combinations of
vitamins with anti inflammatory
agents and tranquillizers.
2. Fixed dose combinations of
vitamins with anti inflammatory
agents and tranquillizers.
3. Fixed dose combinations of
atropine in analgesics and
anti pyretics.
3- Fixed dose combinations of
atropine in analgesics and
anti-pyretics.
6. Fixed dose combinations of
atropine in analgesics and
anti pyretics.
1. Amidopyrine
7.
Fixed dose combinations of
analgin.
8.
Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
5. Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
5. Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
9.
Fixed dose ct mbinations of iron
with strychnine, arsenic and
yohimbine.
6. Fixed dose combinations of iron
with strychnine, arsenic and
yohimbine.
6. Fixed dose combinations of iron
with strychnine, arsenic and
yohimbine.
10. Fixed dose combinations of
7. Fixed dose combinations of
sodium bromide/chloral hydrate with
sodium bromide / chloral hydrate
other drugs.
with other drugs.
7. Fixed dose combinations of
sodium bromide / chloral hydrate
with other drugs.
11. Fixed dose combinations of
tetracycline, analgin with vitamin C.
13. Fixed dose combinations of
tetracycline with vitamin C
12. Fixed dose combinations of
tetracycline with vitamin C
72. Fixed dose combinations of
ayurvedic drugs with modern
drugs.
8.
Fixed dose, combinations of
Ayurvedic and Unani drugs with
modern drugs.
13. Fixed dose combinations of
phenacetin.
9.
Fixed dose combinations of
phenacetin.
(Excluded)
(Excluded)
(Excluded)
8. Phenacetin.
14. Fixed dose combinations of
chloramphenicol with streptomycin.
(Excluded)
(Excluded)
15. Fixed dose combinations of
penicillin with streptomycin.
(Excluded)
(Excluded)
16. Fixed dose combinations of more
than one anti histaminic.
(Excluded)
(Excluded)
\
Recommended by Sub-Committee of Drug Technical Advisory Board
Drug Consultative Committee 1980
Report, 25 May 1982
Gazette Notification of Drug
Controller of India July 23, 1983.
No. X 11014/1/83
>-
To be weeded out over a specific time
7.
Fixed dose combinations of
anti-histaminics in anti-diarrhoeals.
70. Fixed dose combinations of
anti-histaminics with anti
diarrhoeals.
9. Fixed dose combinations of
anti-histaminics with anti diarrhoeals.
2.
Fixed dose combinations of
penicillin with sulphonamides.
77. Fixed dose combinations of
penicillin with sulphonamides.
10. Fixed dose combinations of
penicillin with sulphonamides.
3.
Fixed dose combinations of
anti-histaminics with tranquillizers.
(Excluded)
(Excluded)
4.
Fixed dose combinations of
tranquillizers,anti histaminics and
analgesics.
(Excluded)
(Excluded)
5. Fixed dose combinations of
vitamins with analgesics.
6.
Fixed dose combinations of
paracetamol with anti-histaminics
and tranquillizers
7. Fixed dose combinations of
prophylactic vitamins in anti TB
drugs except INH with vitamin B6.
12. Fixed dose combinations of
vitamins with analgesics.
(Excluded)
18. Fixed dose combinations of
prophylactic vitamins with anti TB
drugs except combination of INH
with vitamin B6.
11. Fixed dose combinations of
vitamins with analgesics.
(Excluded)
17. Fixed dose combinations of
vitamins with anti TB drugs except
combination of Isoniazide with
Pyridoxine Hydrochloride (Vitamin B6)
Additions to DCC List :
4. Fixed dose combinations of
strychnine and caffeine in tonics.
-4. Fixed dose combinations of
Strychnine and caffeine in tonics.
13. Fixed dose combinations of
14. Fixed dose combinations of
hydroxyquinoline group of drugs
hydroxyquinoline group of drugs
except preparations which are used
except preparations which are used'
for the treatment of diarrhoea and
for the treatment of diarrhoea and
dysentery and for external use only.
dysentery.
Additions to DTAB List :
18. Penicillin skin/eye ointment.
79. Tetracycline liquid oral
preparations.
20. Nialamide
21. Practolol
22. Methapyrilene, its salts.
Addition to Gazette Notification 1984
23. Methaqualone
Liquid Oral
24. Oxytetracyline
Preparations
25. Demeclocycline Liquid Oral
Preparations
Addition to Gazette Notification 1985
26. Combination of Anabolic Steroids
with other drugs.
t
IfL-?
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40, INSTITUTIONAL AREA, SOUTH
NEW DELHI - HO 016
OF I I T
65 58 71
66 50 18
T , u
Telephones : 66 80 71
66 SO 72
FAX : 011-676377
Grams "VOLHEALTH" NEW DELHI-110 016
May 23,
1989
Dear Sir,
24th May is observed as Ban Hazardous Drugs Day by the Health
and Drugs Activists in India. Globally it is commemorated as
Dr. Olle Hansson’s Day the day one of the greatest health
campaigners of our time passed away at the age of 49. This
Swedish Paediatric Neurologist was fighting literally till on
his death bed to get hazardous drugs removed and to demand
patients right to information and was responsible in a big
way for getting, Ciba Geigy to withdraw ’Mexaform’* and
•Tendril’** from the world market, having led a boycott of
doctors against the manufacturers. He faught as a medical
expert on behalf of the several thousand SMON (sub acute
myelooptic neuropathy) victims in Japan for compensation a
long legal battle that was ultimately won.
VHAI will be releasing its revised edition of Banned Bannable
Drug List to mark Dr. Olle Hansson’s fourth death anniversary.
AIDAN to commemorate Dr. Olle Hansson’s Day is bringing out
a low cost booklet on 6 hazardous drugs. All India Drug
Action Network is a network of health groups, consumer groups,
people’s science movements.
On this day the world over his book MInside Ciba GeigyM will
be released by IOCU. "It is dedicated to those who at the
time of conflict choose to listen to their conscience rather
than their boss”. The book has special significance for
those in corporate sector and government and non government
sector who are increasingly having to act under orders in
a way which is not in the interest of the people and
against their conscience. The book is a reminder of vzhat
their silence can mean to thousands and millions of ignorant
patients.
The hazardous drugs focussed upon this year are:
11 Chloramphenicol Streptomycin and Steroid Combinations11 •
Both these drugs were banned by the Drug Controller of India
on 3rd November 1988, 8 years after the sub group of the Drug
Consultative Committee had recommended that the above combi
nations of steroid and chloramphenicol be weeded out immediately.
*
*★
Hydroxyquinoline/clioquinol
Oxyphenbutazone
VHAI assists in making community health a reality for all the people of India.
VHAi
: 2:
Lyka Labs, Deys Chemicals, and Roussel and Indoco have
obtained stay orders against the ban orders of the highest
drug control authority in the country i*e. the Drug Controller
of India*
Following the EP* experience it is obvious that people
Cannot wait for years and years to see the government
implement its own ban orders* Urgency of Drug legislation
reiorm is obvious*
It is hoped that the MANUFACTURERS of the above combinations
will show their social responsibility in stopping production
and sales of these potentially hazardous drugs.
SOCIALLY conscious doctors are requested not to prescribe
the above drugs as well as the products of those manufactures
who challenge ban orders to ensure their continued profits*
The CONSUMERS as an exercise in knowing the medicines pres
cribed should make it a practice to read the contents
ingredients and refuse any combination*\isually given for
diarrhoeal conditions and fixed combination of steroids
(note this is only for combinations
given for asthma etc*
and not steroid ALONE)*
Consumers have a right to information and should know why
these drugs were banned by the Drug Controller of India after
the matter was reviewed by the Drug Technically Advisory
For more details a note on Dr* Olle Hansson and his work
and his contribution towards Responsible Drug Marketing is
attached*
A note on why Chloramphenicol Streptomycin and Steroid
combination have been banned is included, along with the
names of the various Brands and Manufacturers of the above
two combinations*
'
11/
r
DR. MIRA SHIVA MD
HEAD OF DIVISION
PEOPLE'S EDUCATION FOR HEALTH ACTION
*High dose Oestrogen Progestrone combination
**Chloramphcnicol b. Streptomycin
A
rj-4 a 10
l’nfo/ers/13.8.1988
INFORMATION
DOCUMONTATICIJ
Vj-IAI,_Institutional Area, South of ITT, New .’.elhi-110 016.
Neme of the paper
-Economic Times
Financial Express
Indian Express
Statesman
Sunday Observer
Times of India
Indian Express
Telegraph
The Hindu
Date
Subject
(Delhi) 6/
(Delhi)
(Delhi)
(Delhi)
(Delhi)
(Delhi)
(Bombay)
(Calcutta)
(Madras)
■^ /Ban on sale qf\
< 5 fixed drug
combinations
From P. A. Francis
BOMBAY, Sept. 26.
The government has decided to ban
the sale of 5 widely used fixed dose
combinations of drugs, it is learnt.
These combinations though found to
have harmful side effects, are being
marketed by many companies
throughout country.
The fixed dose combinations are:
1. Fixed dose combinations of tran
quillisers with analgesics and anti
pyretics.
2. Fixed dose combinations of
cyrazinamide and other anti- ;
tuberculosis drugs.
3. Fixed dose combinations of essen- :
tiai oils with alcohol with higher than .
20 per cent proof.
4. Fixed dose combinations of anti
ulcer drugs (cimetidine, ranitidine, etc) ■
with other drugs.
5. Fixed dose combinations of :
chloroform with other drugs.
According to informed sources the ;
proposed ban of these combinations j
j would mean that the drug units will
, have to withdraw many of their established products from the market and
reformulate them.
The sources here said that the reason I
for the proposed ban of the use of
chloroform in cough syrpus is its
carcinogenous effect on patients.
Many drug companies abroad have
already stopped using chloroform in
cough syrpus several years ago.
Drug companies are also marketing a
number of formulations of analgesics
with tranquillisers currently.
Diazepam is the largely used tranquil
liser in most of these preparations.
4
Ranbaxy and Wockhardt, two large
Indi/n drug companies have already
reiyrmulated their analgesic prepara
tions now without diazepam.
<
f
VOLUNTARY
x»
-IE A LI' H AS S 0 CI AS i 0! <
AND
Ache -3
i>-
ALL INDIA DRUG ACTION NETWORK
40, Institutional Area, (Near Qutab Hotel)
South of IIT, New Delhi-110016
ALERT
r——
665018
Ph.Nos. :668071
668072
E^ CAMPAIGN FOLLOW UP
PEHA-l(l)
October 5, 1988
?
Dear friend,
Over 3 months have passed since the ban order regarding high dose EP
drugs was issued.
- Today high dose EP drugs tablets and injections are being freely sold
oy/er the counter without prescription and warning.
— Names of brands and manufacturers has still not been announced over
the AIR and Doordarshan.
— A large number of chemists and doctors in different parts of the country
are not aware of the ban order.
-L withdrawal of stocks has been made. It cannot
attempt- at
- No serious --1
be left to voluntary withdrawal, but checking of continued sales of
these banned drugs are needed. Even when these continued sales have
been bought to the authorities no action has been taken.
- While the fact about continuation of sales has been admitted
in the Parliament by Ms. Saroj Khaparde no action against those violating
the ban order has so far been taken.
- The hearing regarding ban order covering tablets; as well as injections
is ooinp to take place in Bombay High Court on tthe 10th of October.
We have°gathered that UNICHEM will probably challenge the banning of
high dose EP injections.
Dr. Godbale of Unichem has also stated that Unichem stopped production
of high dose EP in April. The question we would like to ask is, when
the ban order was issued only on June 15th, how come Unichem stopped
production in April itself. Were they aware of the ban order coming?
2...
1
- 2 -
Writing of the dosages of estrogen-progesterone content per tablet do
purposely to make it sound, ambiguous and purposely create a loophal through
which high dose EP injections could slip out. If something is hazar .
, the
route of administration does not make matter where hazardous nature oc i t
drug is concerned.
On 22nd August ’88 Ms. Saroj Khaparde while answering the unstarred
question 3699 in the Lok Sabha has clearly indicated that the ban or
for high dose EP combinations. She stated that, ’’Manufacturers of th
dose combinations other than oral contraceptives has been directed tc
forthwith stop manufacture and sale of these combinations and also f.
the stocks of the said formulations from the market”.
.4 raw
No where have ’tablets* alone been mentioned.
She stated that a press note regarding ban was published in many lea
newspapers and publicity was also given in news bulletins of the All
Radio and Doordarshan.
Unfortunately mentioning high dose EP has no meaning for majority of
consumers and prescribers unless the brand names and manufacturers; no
clearly given.
re
I am enclosing Ms. Saroj Khaparde’s answer in the Parliament and will
you informed about the latest developments. If" we can get_ ~
EP tablets
injections off the market inspite of the ban order,. it- would set a precedent
for other hazardous drug.
A committee to review 5 combination drugs is mee£ing in Baroda 6th an
October. The list of these drugs is attached. In the Parliament the
these drugs had been announced and the review is being done at the be:
the drug companies.
Regarding banned drugs the list of 27 drugs given in the Parliament
majority of the drugs banned in 1983. These drugs have been included
to increase the list. I am enclosing the list to emphasise the point
no action in this area will be easily forthcoming unless there is he
pressure.
Tne EP hearing in Bombay High Court will be on the 10th of October.
Dr. Shiraz Rahimtoola’s address :
C/0 Law Charter
14-K, Hamam Street
Fort, Bombay 400023
Ph.Nos.:27:
27?
With warm regards,
Yours sincerely,
Dr. Mira Shiva
Coordinator
All India Drug Action Network o peOp] e* s Education for Health Action
Encl. Parliament Question on EP
List of 5 combination drugs to be banned
List of 27 dru3s banned as stated in the Parliament
of
of
; ic
ving
LOK_SABHA
P& P Vn ' (FEHA)
V h A 1
TO, BE. ANSuHRED ON HIE 22ND_AUajST,. JO88
STEPS TO..STO?_SALE OF. BANTIED^ES.TROOEN . A'iD F.ROGESTERONF
99.
SHRI,,0,., J/.ADHAV REDDY:
ST.ra..MANIK .REDDY:
SHRi J’PAKASH CHAJTDRA:
SHRI. M . RAGHUiv ’A. REDDY:
f
■'SHRI JOLANBH/il PATEL:
SRRW'TI GEETA AOG1ERJEE.:
P RCR. RA/vipiI SHbLA WRE:
SHRT..S/v^ARAZ
^KLVXIAS MUTTEMljAR;
SHRIM/iTI, J^OPAAdASINGIT:
Will the Minister of HEALTH AND FAMILY WELFAJ1E
be ploased to state:
?rf.T
;■
whether Government’s attention has been drawn to the news
■neo appearing in the Indian Post dated 22 July, 1988 wherein it
'
stated that despite the ban imposed on 15 June, 1988 by
jvernment on high dose oral formulation of Estroocn and
ogestorone, the drug is freely available with chemists in
in
rious parts of the country, particularly in Bombay and Pune;
if so, the action Union Government propose to take to stoo
..o sale of the banned drug in the country and to confiscate th-’
■-ock lying with manufacturers: and
if not, the reasons therefor?
. A N S v; E R
/••^NISTER 0F..STATE IN .THE.MINISTRY.OF HEALTH AND FAMILY V/ELFARE
(.KUMAR! .SAROJ..KII.AP/'jPDE)
Yes, Sir.
. . .2
2
•he manufacturers, of these high dose combinations
(other than oral contraceptives) have been directed
to forthuitti stop manufacture and sale of these combinations
snd also to withdraw the stocks of the said formulations
from the market.
State Drugs Control Authorities who are licensing
authorities for manufacture and sale of drugs under the Drugs
and Cosmetics Act and Rules thereunder have been requested to
ask the manufacturers to stop manufacture of high dose
combinations of Oestrogen and ProQestins (other than oral
rootracectives) and ensure that such combinations are not s old
by Chemists and Druggists in their States and to return the
stocks with them to the concerned manufacturers.
Some ccnsiwaj?
organisationst Indian Drugs Manufacturers Association, Organ!action of Pharmaceutical Producers of India and Indian Medical
Association have been informed of the issue of Notification
hy the Government to Ran manufactute and sale of combination
of Oestrogen and Progestins and to give wide publicity of the
hen to their members.
A press note regarding ban was published in many
leading newspapers and publicity was also given in news
b'j lie tins of the All India Radio and Doordarshan.
Press & R rb’nmopt Um>
LQK
.
P.EHA-- VH AI
SABHA •
UNSTARRED C^STI0N^„49^
.
TQ RF ANSWERED ON. THE__5^H _g^T^MBERj_J5988
BAN ON HAWUL AND INgFJCTO/EJDHjGS
%
4^03.
S4RI: JAGZuNNATH PATNAIK:
' -
J\gJRLIDHAR MANE:
aim /MARSINH ,JBATHAV^
Will -the Minister of HEALTH AND FAMILY WELFARE
’ ,0 .be pleased to state:
whether any approach has been made by certain Statesto
(a)
certain
categories of drugs which are 'narmtul an^inoff ec civ.
- ban
recommendations
of the Drugs Consultative Commituee;
as per
f-
i
(b)
if so, the details thereof; and
(c)
the action taken by Union Government in this regard?*
A N S W E R
i
i
THE MINISTER OF HETJLTH AND FAMILY WREFARE (SHRI MQTJLAL VOR^)(a) to (c)
i1
A sub-committee of the Drugs Consultative
Committee is engaged in screening the formulation moving in ■.
the market from the angle of safdty, efficacy and rationality,
based on ‘the recommendations of the expert committee.
I
Government have so far prohibited marketing of 27 cacegories
of formulations which is annexed,
/
!
The screening ox
formulations is a cqntinuous process.
i
I
i
i
i
k'
i
i
*
i
[
$
Armexu-re
TABLE
Amidopyrine
'Fixed dose combinations of Vifamine with anti-
1.
2.
inf lamator agents and transqullisers.
Fixed dose combination of Atropine in Analgesics
2.
and Antipyretics.
Fixed dose combination of Strychine and Caffes-ne
4.
in tonics.
combinations of Yohhnbine and Strychnine
Fixed dose
vrith Testosterone and Vitamins.
Fixed dose combinations of Iron with Strychnine,
5.
6.
Arsanic and Yohimbine•
7.
THwcfl dose combination oi Sodium Bromide/Chloral •
hydrate with other drugs.
9.
Phenecatin.
9.
Fixed dose combinations of
10
anti-diarrhoeals.
combinations of Penicillin with Sulphonamides.
Fixed dose
Fixed dose combinations of Vetracyclme with Vitamin C.
11.
12.
15.
Fixed dose
anti-histaminics with
combination of Vitamins.with Analgesics.
of Hydroxyctuinoline group
Fixed dose combinations
of Drugs except preparations which are used for the
treatment of diarrhoea and dysentry and for external
use only.
14.
t
Fixed dose combinations oj_ Staroids for internal
use except combination of Steroids with other drugs
for the treatment of Isthma.
15.
Fixed dose combinations of Chloramphenicol for
internal use except combination of Chloraraphanicol
and Streptomycin.
..o 2/-
- 2 -
17.
,
,
Fixed dose combination of Ergot.
combinations of Vitamine with anti-T.3.
Fixed dose
, except combination of Isoniazide with Pyridoxine
drugs
Hydrochloride (Vitamin B 6 )
18.
Pencillin skin/eye ointment.
16.
19.
Tetracycline liquid era! .preparations.
20.
Nialamide.
21 .
Practolol.
22.
salts.
:
Kathapyrilene, its
23.
Melfliaqualone .
24
25.
26.
27.
Oxytetracycline Liquid Oral Preparations.
Demeclocycline Liquid Oral Preparations.
Combination of inabolic Steroids
with other drugs.
Fixed dose combination of Oestrogen and Progestin
I
■(other than oral contraceptives) containing per
tablet estrogen content of more than 50 meg.
.(equivalent to Ethenyle Estradiol) and oi proges me
.content of more than 3 ng (equivalent to Norethisterone Acetate).
,
1
J
Voluntary Health Association of India
Phones : 668071,
66807 Z
40, Institutional Area, (Near Qutab Hotel)
South of IIT, New Delhi-110016
Grams : VOLHEALTH
New Delhi-110016
Measures for Rationalization, Quality Control, and Growth of Drugs and
Pharmaceutical Industry in India.
The New Drug Policy which has been in the process of being formulated
for the last several years was finally announced by the Chemicals Minister
on December 18,1986.
.
To fully understand the implications of the New Drug Policy, it is
necessary to look back at the Drug Policy of 1979, and what followed it.
The 1979 Drug Control Policy Order was the result of the recommendations of the Hathi Committee.
The main recommendations were as follows:
1.
2.
3.
4.
5.
6.
7.
I1
Nationalization of multinational drug companies.
Establishment of a National Drug Authority.
Priority production of 116 essential drugs.
Abolition of brand names and introduction of generic names.
Revision and updating of the Indian National Formulary.
Strengthening of quality control.
Elimination of irrational drug combinations.
A few of these recommendations were modified and included in the
Drug Control Policy Order of 1979. The mark up on three categories of
essential drugs was fixed, production ratios between bulk drugs and for
mulations set down, sectoral reservations made and decision to use generic
names for 5 commonly used single ingredient drugs taken.
The industry, while managing to sidestep most of these controls,
(increasing its profits substantially and flooding the market with over
40,000 brands), continued to complain about its "poor growth". It was this
and not the growing realization by the health and consumer groups which
has brought about the Chemicals Ministry’s reformulation of the policy.
By this time, health and consumer groups were making serious at
tempts to increase awareness about the need for a Rational Policy. They
had realized that the "health needs of the country and the drug production
did not match”; ^there were shortages of essential and life saving drugs; ir
rational and ha|zardous drugs continued to flood the market; marketing
practices were unethical and double standards existed in the drug informa
tion given to doctors and consumers; every fifth drug in the country was
substandard.
These factors were never seriously considered by the Chemicals
Ministry. The working Group and the Steering Committee of the National
Drug and Pharmaceutical Development Council, set up in 1983 to look into
matters related to the industry, did not deal with those issues which con
cerned people’s interest in its report (fortunately for the consumer, the
report of the NDPDC was rejected by the Parliamentary Drug Consultative
Committee).
But the trend was clear. The Chemicals Ministry would be assessing
the drug needs of the people and formulating the policy, not the Health
Ministry. Industry’s interests would prevail over people’s interests.
During the four years that the Chemicals Ministry took to decide on
the New Policy, views of health personnel and consumers, both at national
and international level were available. WHO’s model list of essential drugs,
was drafted in 1977 by experts from many countries, including India, to
help governments develop their own National Essential Drug Lists. In
November 1985, the WHO called for a conference of experts of Rational
Drug Use in Nairobi to discuss the issue, and provide guidelines. Drug
Regulatory Authorities, representatives from industry, government officials
and health activists met for the first time in pharmaceutical history on a
common platform to express concerns and to dialogue. At the World
Health Assembly in May 1986, Resolution on Rational Drug Use was passed
- to which India was a signatory.
There was no dearth of consumer’s views, editorials, articles in the
newspapers, magazines, programme on government’s own "Voice Box" Doordarshan statements, and memoranda of several hundred meetings and
workshops across the country aired the deep concern and anguish at the
existing pathological drug situation and the need for urgent changes.
We and our policy makers also had ( and still have) the example of
Bangladesh before us which inspired by the Hathi Committee Report, for
mulated its Drug Policy based on WHO recommendations. The results of
the Bangladesh Policy over the last four years are obvious:Drug prices have decreased.
National Essential Drug List and Graded Essential Drug List
have been drawn up.
Essential and life saving drugs are being produced, as a
priority.
They are easily available even in the remote areas due to a
2
more streamlined drug distribution.
1707 Hazardous and Irrational drugs have been withdrawn.
Production of only essential drugs is allowed and not a single
foreign company has left, in fact their turnover has increased.
New ones want to enter the market.
Sectoral reservations exist. Foreign companies are not allowed
to produce those simple and low technology drugs which
Bangladeshi companies are capable of producing.
Bangladesh is saving millions of Takas by Non import of non
essential drugs and import of essential and life saving bulk
drugs through international tenders.
Quality control has improved.
India as compared to Bangladesh is much better placed. Our
pharmaceutical industry according to UNIDO belongs to category V i.e., it
has a capability of total self reliance in drug production.
We have a
rapidly growing Indian private, public, and small scale sector. And yet why
are we spending more than ever before on drug imports? Why are there
shortages of essential and life saving drug? Why has growth of quality
control and drug control mechanism not kept pace with growth of the
industry? Why are safe drugs that are banned elsewhere and even within
our own country, allowed to be produced, promoted and prescribed, when
safer, cheaper and more effective alternatives exist? Why are profits of
the industry put before health of the people?
The reasons were many, The industry’s views had always been
available, This time, consumers’ reasons, based on actual health needs,
were also available.
The expectations therefore from the New Drug Policy were very
high - they were high because the health and Chemicals Ministries, and
the Prime Minister's Secretariat were aware of the crying need for includ
ing the health dimension.
1
In the New Drug Policy, the choices have been knowingly made, and
priorities clearly reflected. The purpose of the reformulation is stated very
clearly in the 2nd paragraph of the summary of the policy statement :
’’there has been a considerable change in the pharmaceutical sector since
1978 policy and it was considered necessary that the new thrust and direc
tion should be given in the policy frame to subserve the objective of
growth of pharmaceutical industry in the desired areas”.
If earlier the policy makers could plead ignorance of consumers*
views, this time there is a reflection of sheer apathy and callousness.
Our most serious objections and criticisms are outlined below:
3
The Process of Decision Making
,
The drugs in the market are produced because the consumer supposedly needs all of them. Yet the consumers’ views and presence were
conspicuous by their absence in the formulation of the policy, The consumer is not mentioned even among the constituents of the National Drugs
and Pharmaceutical Authority where the need for an industry representative
has been felt and assured. In announcing the Policy, even the Parliament
The Chemicals Ministry,
was bypassed.
obsessed with growth of the
industry, made no effort to have systematic serious scientific debates and
discussions with academic circles, medical colleagues, and medical
establishments. The health perspective was never considered important. The
nation’s essential drug list was not drawn up.
As far back as 1975, the Hathi Committee, seeing the chaos in interministerial coordination, had recommended the formulation of the Na
tional Drug Authority. It was only in 1986 that the decision to have a
National Drug and Pharmaceutical Authority (NDPA) has been even
seriously considered.
While this at first glance seems a good move, on reading further
any remaining optimism and hope for a rational drug policy evaporates.
This apex body has yet to be formed. Only representation from the in
dustry has been assured. This is the body ’’which among other things,
would go into the question of rationalization of existing formulations in
the market including the banning of formulations of harmful nature and
better control over the production of new drugs”.
It is incomprehensible how the industry .representatives (obviously
from different sectors - OPPI, IDMA, Small Scale Sector) will allow any
decision to be taken against their own interest; that the representatives of
chemists and druggists would allow decisions to be taken regarding
withdrawal of those irrational trade commission.
Suppose the miracle occurs and the NDPA does draw up a list of
drugs needing to be weeded out - its recommendations are not binding.
The NDPA is only an advisory body, which simply means that only those
decisions that are in the interest of the power faction will be taken
seriously. If there are any furthering people’s interest, they will be totally
disregarded,
as 1has been the case with all previous reports and
recommendations.
Regarding Availability of Essential and Life Saving Drugs
The first step in rationalizing a policy - the formulation of an es
sential drug list, has been dispensed with altogether, inspite of the exist
ence of the Hathi Committee Report, (which way back in 1975 drew up a
list of 116 drugs), and WHO Technical Reports 615, 641, 685, 722
4
r
(providing model lists and guidelines for selection of essential drugs).
It is extremely doubtful that it will be the concept of a National
Essential Drug List that will guide the selection of the new category II
drugs, when the urge and pressure is there to keep the ’’Drug Price Con
trol Basket” as small as possible. All the essential drugs that should be in
category II will probably never be included.
Previous experience with price decontrol has shown very clearly that
drugs do not become any cheaper.
While the new category I is supposed to include drugs required for
National Health Programmes*- it is not clear whether this means drugs for
Leprosy,
the National Health Programmes like TB,
Malaria Control
Programmes, or Drugs for the National Health Services which will require
painkillers, anti-helminthics (anti-worm), antibiotics. If it is the former then
who will decide which anti TB drugs should be included, if it is the latter
who will decide which drugs required for primary health care should be in
cluded and what criteria be used for their selection ?
Presuming that extremely rational categories I and II drug lists are
drawn up - who will set the targets to ensure the necessary production ?
past exercises have clearly indicated that there has really been no effort
made even to assess the actual requirements of drugs needed for the Na
tional Health Programmes. TB, which is a recognized major public health
enemy, is included in the Prime Minister’s 20 Point Programme. To deal
with it we have a ’’National TB Control Programme” and two National
Institutes-the National TB Institute at Bangalore and madras Chemotherapy
Centre, to provide guidance and training. Inspite of this even rough es
timates of the anti TB drugs required are not available. The Health Minis
try and ICMR could have really played a meaningful role. What is the
1
*
National Health Programmes include:
National Family Welfare programme
Expanded Programme on Immunization
National Malaria Control Programme
National programme for Prevention of Visual Impairment and
Control of Blindness
National Tuberculosis Control Programme
Integrated Child Development Services Scheme
National Filaria Control Programme
National Goitre Control Programme
National Programme for Diarrhoeal Diseases Control
National Nutrition Programme
National Leprosy Eradication Programme
National Anaemia Prophylaxis Programme
National S.T.D. Control Programme
5
result of their omission ? One glance at the assessed target demands
shows the existence of warped priorities - no increase till 1990 is shown
in the estimated production of INH, which is one of the most basic and
important anti TB drugs.
Lest it be thought that increased INH demands are not expected be
cause of the newer anti TB drugs like Rifampicin and Ethambutol in the
market - this is not true. The policy estimates increased demand of anti
TB like PAS, a drug which is not merely bacterio-static but considered ob
solete because of its side effects.
So the crunch of the matter is that even if rational categories I
and II lists are drawn up, adequate production of these drugs may not be
assured. Inspite of increased mark up to 75% and 100%, it will be more
remunerative for the industry to produce non essential, largely irrational
drugs whose prices are decontrolled.
One of the major demands of consumer and health groups has been
that it should be made mandatory for all pharmaceutical units to produce
at least 50% of their drugs as essential drugs. This has not even been
considered in the New Drug Policy when even the 1978 Drug Policy had
recommended that 20% of all production should be of essential drugs. The
demand for this production control should have come from the Chemicals
Ministry itself. It should by now have the painful awareness of our nation
having the largest number of pharmaceutical units (8000 producing the
largest number of formulations 40-60000) in the world which in no way en
sures the production of the right drugs, in right amounts.
HAVING AN ESSENTIAL DRUG LIST IS AS IMPORTANT AS ENSURING
ADEQUATE PRODUCTION, DISTRIBUTION, AFFORDABILITY, AND
QUALITY ASSURANCE
Regarding withdrawal of Irrational and Hazardous Drugs
It is well recognized that to ensure quality control, for streamlined
drug and storage distribution, dissemination of unbiased drug information
and to limit the confusion in the minds of the doctors as well as
consumers, it is critical that the number of drugs formulation be restricted
to a manageable number. This is specially important with regard to multi
ingredient fixed dose combination drugs, since neither are all the various
ingredients and their action often known to the prescribing doctor, and the
dispensing chemist but chances of adverse drug reaction, and drug costs
also increase. While inclusion of only 6 combination drugs is considered
justifiable in the WHO’S Essential Drug List, 60-70% of our drugs are sold
as multi ingredient fixed dose combination drugs.
The large number of drugs available makes it even easier for the
drug industry to pass off as necessary numerous irrational and often haz6
r
ardous drugs, which are banned in most other countries,
safer and more effective alternatives exist.
and for which
Amongst the major policy decisions of the Bangladesh Drug Policy
the
decision to withdraw around 1707 drugs. Hazardous drugs were to
was
be banned confiscated, withdrawn immediately and destroyed, and irrational
drugs withdrawn in a phased manner within a 6 month period, giving in
dustry the opportunity for reformulating such combinations. In India, enac
tion of drug bans has been such as to allow the industry ample time to
manufacture and dump these products in the market. The sales of these
banned drugs are allowed till a much later date. In the absence of a
functional drug control machinery such bans are meaningless.
Judge Mr. L.N. Mishra at the hearing of the Banned Drugs Case in
the Supreme Court last year observed that the Central Government., and
the health ministry have taken no responsibility in trying to ensure
withdrawal of the banned drugs and remained passive onlookers at the
deteriorating state of affairs. When this has been the state of affairs in
the past - we have little or no faith in NDPA’s capability to ensure a
meaningful rational selection of drugs and withdrawal of irrational and
hazardous drugs.
It is important for the health personnel to know this - as voluntary
boycotts may be the only tool in the hands of the people.
Regarding Drug Prices
Increase in drug prices is the most definite decision and outcome of
the New Drug Policy. Mark up
on category I drugs will increase from
40% to 55% and that of category II from 75% to 100%, for other drugs
it will definitely be much more. When the health budget is so meager i.e.
mere 2.8% of the total budget ( far from the 10% as recommended by
the Mudaliar Committee - with most of it being spent, on salaries and
medicines - it is obvious that any increase in drug prices of even essential
and life saving drugs will leave even less for the actual health care serv
ices than before.
Had the drug industry really been in such an economic mess over the un
remunerative pricing structure:
pharmaceutical shares would have steadily gone down and NOT UP.
there would have been a cut in sales promotion expenditure which is
13 to 15% on an average.
companies would not have been able to give cash discount of 4 to
15%
*
Mark up includes the cost of packaging,
trade commission.
7
distribution,
storing and
for drugs such as Orisul, Ledermycin, Terramycin, Antepar.
While the Bangladesh Drug Policy resulted in the fall of drug prices,
ours has been the opposite. What is worse is that this has been so without
the associated assurance of availability of essential and life saving drugs
and withdrawal of hazardous drugs.
Regarding Drug Distribution
When non-availability of essential and life saving drugs in the
periphery and also within the towns and cities has been identified as one
of the major problems associated with drugs, it is unbelievable that no
policy decision regarding streamlining the drug distribution has been taken.
We know how meager the health and drug budget for primary health
care has been in the past and how great is the need to increase it. We
are also aware of the present need to ensure effective distribution and
availability of the essential drugs.
I
II
Drug dispensing is mostly in hands of private chemists and druggists.
When the amount of trade commission, not the rationality and essentiality
of drugs guides the stocking and dispensing of drugs in the pharmacy - the
responsibility on the existing government, health infrastructure and health
services to ensure effective distribution increases.
Regarding Quality Control
The first step to ensure quality control would be to restrict number
of formulations in the market and ensure that only or mainly single in
gredient drugs are available in the market.
If licenses are given indiscriminately, if Good Manufacturing Prac
tices are not strictly enforced, if the number of formulations are not
restricted to a manageable number - it is impossible to ensure quality
control. Setting up of costly quality control labs only to assess the quality
of known irrational drugs, will be a sheer wastage of public money. People
need rational drugs of quality and not quality hazardous drugs.
Certification Scheme
Theoretically the use of recognized institutions with proven expertise
and testing facilities to certify that the formulators adopt Good Manufac
turing Practices and produce quality drugs is a good idea - but in practice
the effective certification scheme may have more to do with the purchas
ing power of the formulators and the purchaseability of the certifiers
rather than the nature of their facilities and expertise. Concerned consumer groups and citizens groups will be forced into counter checking if
they want assurance of quality of the drugs they purchase. If they do get
8
i*
implemented, closer scrutiny over introduction of new drugs, standardization
of monitoring of adverse reaction would be welcome. It should be pointed
out that where new drugs are concerned the drug control authorities have
shown a lot of caution. As pointed out earlier, our main problem has been
with the hazardous and irrational drugs and formulations already in the
market.
Regarding Generic Names
When majority of drugs are multi ingredient combination drugs and
when the Supreme Court’s decision on the case regarding allowing of sales
of all single ingredient drugs as generic drugs is still pending, intentions of
printing generic names on the labels are laudable. Way back in 1978 Hathi
Committee had strongly recommended that drugs be sold under interna
tional nomenclature and not brand names - since after all in medical
education, medical literature, international journals, international tenders
etc., only generic names are used. Again, all drugs in the market, whether
brand or generic should anyway be of standard quality.
Unbiased Drug Information
The New Drug Policy has nothing to say about making of package
inserts mandatory, printing or rubber stamping of consumer caution in
regional languages, especially for drugs potentially toxic for pregnant or
lactating women, children, elderly etc. This is extremely important in our
social context since over 60% of the drugs are bought over the counter.
Inclusion of measuring spoons for antibiotics and other life saving drugs for
paediatric a usage has not been enforced.
Clear labeling is important for effective communication.
The New Drug Policy says nothing about screening of promotional
material, ethical marketing practices and the need for a advertising code.
Tailpiece
As the emphasis of the New Drug Policy is the growth of industry
through economics of scale, the government has further delicensed drugs
and brought 31 more bulk drugs and formulations under broad banding*.This
will not only ensure that essential drugs become scarce and costlier, but
also that the already astronomical number of formulations available will
become even larger, more irrational and more hazardous, and will be
pushed with newer therapeutic claims.
*
Broadbanding means that companies can produce drugs and formula
tions having similar processes without needing special licenses. That is
companies can make changes in multi ingredient formulations even if the
major ingredient does not come under broadbanding.
9
Ideally, the health of a country depends on more than curative care
- it includes prevention, promotion and rehabilitation. However, in the ab
sence of such ideal situation, curative care and thus drugs assume almost
importance in reducing the level of ill health. When the health of the in
dustry is given more weightage than the health of the nation and its
people in a National Drug Policy, the commercialization of health is
complete.
10
RECOMMENDATIONS
1.
The National Drugs and Pharmaceutical Authority must constitute an
expert committee to draw up:
(a)
Essential Drug List based on WHO criteria
(b)
Graded Essential Drug List for use by different levels
health personnel and institutions
(c)
Rational Drug List constituting those which are recommended
in the medical text-books
(d)
Priority Drugs to ensure their production, distribution and
availability for use in National Control Programmes.
of
2.
The same Committee can screen and monitor all the drugs and for
mulations in the market in order to weed out irrational and hazardous
drugs and combinations. It is particularly crucial in a situation with unac
ceptably poor drug control and an ignorant ill informed illiterate majority
population.
National Drug Formulary,
3.
Formulary, which has not been updated since 1979,
should be updated annually and provide therapeutic guidelines and compara
tive costs.
4.
All sales promotion material on drugs, including package inserts,
prescription guides and advertisements should be screened, and monitoring
for ethical practices must be ensured.
5.
Sufficient financial, infrastructure and administrative support and
power be made available with the Drug Control Authorities to ensure
availability of only ’Quality Drugs ’ in the market.
6.
There should be Mandatory Production Control to ensure at least
75% of the total production of all manufacturers to be from the Essential
Drugs Category. This should be raised to 90% in the next five years.
7.
Incentives should be given for higher (than sanctioned
capacity )production of Essential/Priority Drugs when needed and deterrent
punishment to those producing less than the sanctioned capacities.
8.
No revision of
drug prices or price decontrol should be effected
without an independent study to assess the production costs, profitability
and viability of the drug industry and the purchasing power of the
majority.
11
9.
A National Corporation for the Distribution of Essential and Life
saving, Quality Drugs should be created to ensure streamlined distribution
People's pharmacies should be
to peripheral health units and consumers.
set up where drugs will be sold without any extra or local taxes.
The Government must ensure implementation of the Ratios of Bulk
10.
to Formulations Production along with the two year limit for foreign com
panies to start bulk drug production from basic stage.
Indian companies
should also produce bulk drugs from basic stage within the next 5 years.
No new licenses should be given without the above conditions being
fulfilled.
11.
The Government must encourage concomitant development of basic
chemicals industry to ensure the availability of raw materials at internationally competitive prices with the next 2-5 years.
The import of bulk drugs should be discpuraged where indigenous
12.
production capabilities exist. The OGL facility for bulk drug import should
be withdrawn.
The import duty on raw materials and fine chemicals
should be judiciously lowered to encourage production of drugs from basic
stage.
All foreign companies (including Ex-Fera) should be directed to bring
13.
down their foreign equity to at least 26%.
Instead of general dilution
through public, the public sector institutions and financial agencies must be
asked to acquire the disinvested equities.
14.
To meet the national priority drug requirements in a self-reliant
manner, sectoral
sectoral licensing reservation should be strictly implemented to
strengthen public sector and wholly Indian companies. DGTD registration
and delicensing schemes should be withdrawn forthwith and unimplemented
capacities reviewed and cancelled to secure effective role of each sector
of the industry.
Incentives on R&D should be disaggrated and differential incentives
15.
be given to companies in different sectors as well as for different nature
of R&D. No incentives should be allowed on research for non essentials.
Public sector should be encouraged (through additional R&D support)
16.
to maintain its lead on indigenous technological development.
No change should be allowed of the present patents act of 1970 by
17.
joining the Paris Convention or otherwise, as this will be highly detrimen
tal to the technological (and industrial) development of the National Sector
of Drug Industry and the Nation in the long run.
12
Comprehensive Drug Legislation should be provided alongwith
ISadequate administrative support to ensure effective implementation of a
National Drug Policy.
More streamlined centre state, inter-departmental
coordination for effective and relevant drug production, drug control, and
drug supply is urgently required.
19.
The Government should introduce generic names for all drugs, with
assured quality and with abolition of brand names in a phased manner.
20.
The Government must consolidate the Indian Systems of Medicine
(ISMS) for availability of essential and quality drugs from these systems.
13
COMPARISON OF PREVIOUS RECOMMENDATIONS WITH THE GAZETTE
NOTIFICATION OF JULY 1983
COMBINATIONS
BANNING
26
DRUGS AND
You can compare the drugs which were recommended for banning by
perts with the drugs that were actually banned, by following
' "
the lists
horizontally from left (the first recommendation) to the right (the ban
order). Many of the recommendations were not followed.
Many of the banned drugs and combinations are still available in the
market.
Recommended by sub-Committee of
Drug Consultative Committee:
Drug Technka! Advisory Board
Report, 25 May 1982
Gazette Notification of Drug
Controller of India July 23, 1983.
No. X 11014/1/83.
To be weeded out immediately, 1980.
1. Fixed dose combination of
Steroids
75. Fixed dose combinations of
14. Fixed dose combinations of
steroids for internal use except
steroids for internal use except
combinations of steroids with other
combinations of steroids with other
drugs for treatment of asthma.
drugs for treatment of asthma.
2. Fixed dose combinations of
amidopyrine
1.
3.
Fixed dose combinations of
chloramphenicol.
76. Fixed dose combinations of
75. Fixed dose combinations of
chloramphenicol except preparation
chloramphenicol for internal use except
of chloramphenicol and streptomycin.
combinations of chloramphenicol and
4.
Fixed dose combinations of
Ergot.
17. Fixed dose combinations of
Ergot except combinations of its
alkaloid ergotamine with caffeine.
16. Fixed dose combinations of
Ergot.
5.
Fixed dose combinations of
Vitamins with anti inflammatory
agents and tranquillizers.
2. Fixed dose combinations of
vitamins with anti inflammatory
agents and tranquillizers.
2. Fixed dose combinations of
vitamins with anti inflammatory
agents and tranquillizers.
6.
Fixed dose combinations of
atropine in analgesics and
anti pyretics.
3. Fixed dose combinations of
atropine in analgesics and
anti pyretics.
3- Fixed dose combinations of
atropine in analgesics and
anti-pyretics.
7.
Fixed dose combinations of
analgin.
8.
Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
5. Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
5.
9. Fixed dose cc mbinations of iron
with strychnine, arsenic and
yohimbine.
6. Fixed dose combinations of iron
with strychnine, arsenic and
yohimbine.
6. Fixed dose combinations of iron
with strychnine, arsenic and
yohimbine.
10. Fixed dose combinations of
7. Fixed dose combinations of
sodium bromide/chloral hydrate with
sodium bromide / chloral hydrate
other drugs.
with other drugs.
77. Fixed dose combinations of
13. Fixed dose combinations of
tetracycline, analgin with vitamin C.
tetracycline with vitamin C
7. Fixed dose combinations of
sodium bromide / chloral hydrate
with other drugs.
Fixed dose combinations of
amidopyrine.
7. Amidopyrine
streptomycin.
(Excluded)
72. Fixed dose combinations of
ayurvedic drugs with modern
drugs.
8. Fixed dose combinations of
Ayurvedic and Unani drugs with
modern drugs.
13. Fixed dose combinations of
phenacetin.
9. Fixed dose combinations of
phenacetin.
(Excluded)
Fixed dose combinations of
yohimbine and strychnine with
testosterone and vitamins.
12. Fixed dose combinations of
tetracycline with vitamin C.
(Excluded)
8. Phenacetin.
14. Fixed dose combinations of
chloramphenicol with streptomycin.
(Excluded)
(Excluded)
15. Fixed dose combinations of
penicillin with streptomycin.
(Excluded)
(Excluded)
16. Fixed dose combinations of more
than one anti histaminic.
(Excluded)
(Excluded)
Recommended by Sub-Committee of Drug Technical Advisory Board
Drug Consultative Committee 1980
Report, 25 May 1982
To be weeded out over a specific time
10. Fixed dose combinations of
1. Fixed dose combinations of
anti-histaminics with anti
anti-histaminics in anti-diarrhoeals.
diarrhoea Is.
11. Fixed dose combinations of
2. Fixed dose combinations of
peniciliin with sulphonamides.
penicillin with sulphonamides.
Gazette Notification of Drug
Controller of India July 23, 1,983.
No. X 11014/1/83
9. Fixed dose combinations of
anti-histaminics with anti diarrhoeals.
10. Fixed dose combinations of
penicillin with sulphonamides.
3. Fixed dose combinations of
anti-histaminics with tranquillizers.
(Excluded)
(Excluded)
4. Fixed dose combinations of
tranquillizers,anti histaminics and
analgesics.
5. Fixed dose combinations of
vitamins with analgesics.
(Excluded)
(Excluded)
6. Fixed dose combinations of
paracetamol with anti-histaminics
and tranquillizers
12. Fixed dose combinations of
vitamins with analgesics.
(Excluded)
18. Fixed dose combinations of
7. Fixed dose combinations of
prophylactic vitamins with anti TB
prophylactic vitamins in anti TB
drugs except combination of INH
drugs except INH with vitamin B6.
with vitamin B6.
11. Fixed dose combinations of
vitamins with analgesics.
(Excluded)
17. Fixed dose combinations of
vitamins with anti TB drugs except
combination of Isoniazide with
Pyridoxine Hydrochloride (Vitamin B6)
Additions to DCC List :
4. Fixed dose combinations of
strychnine and caffeine in tonics.
•4. Fixed dose combinations of
Strychnine and caffeine in tonics.
13. Fixed dose combinations of
14. Fixed dose combinations of
hydroxyquinoline group of drugs
hydroxyquinoline group of drugs
except preparations which are used
except preparations which are usedI
for the treatment of diarrhoea and
for the treatment of diarrhoea and
dysentery and for external use only.
dysentery.
Additions to DTAB List :
18. Penicillin skin/eye ointment.
19. Tetracycline liquid oral
preparations.
20. Nialamide
21. Practolol
22. Methapyrilene, its salts.
Addition to Gazette Notification 1984
23. Methaqualone
24. Oxytetracyline Liquid Oral
Preparations
25. Demeclocydine Liquid Oral
Preparations
Addition to Gazette Notification 1985
26. Combination of Anabolic Steroids
with other drugs.
■w
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40, INSTITUTIONAL AREA, (NEAR QUTAB HOTEL) SOUTH OF I. I. T.
NEW DELHI - 110016
Telephones :
Gram : "VOLHEALTH" NEW DELHI-110016
Dear friend,
The following material is being sent to you as part of our effort
towards a Rational Drug Policy and Rational Drug Use.
The negative impact of the recently announced National Drug Policy
whose formulation and announcement has violated the norms of democratic
decision making, is going to be far reaching on Public Health.
We request you to share and discuss the Drug Policy and its im
plications for health with your friends and colleagues.
Please communicate your disappointment and your recommendations
in writing to the following Ministers:
The Prime Minister, South Block, New Delhi 110011.
Shri R.K.
Jaichandra Singh,
State Minister
Petrochemicals, Shastri Bhavan, New Delhi 110001.
of
Chemicals
and
Shri Vengal Rao, Ministry of Industry, Udyog Bhavan New Delhi 110001.
Shri P.V. Narasimha Rao, Ministries of Health, and Human Resources and
development, New Delhi 110001.
Ms. Saroj Khaparde, State Minister of Health’and Family welfare, Nirman
Bhavan, New Delhi 110011.
Shri S.S. Dhanoa, Secretary, Ministry of Health, Nirman Bhavan, New Delhi
110011 Your local Parliamentarian and the Media.
Since some critical decisions regarding the New Drug Policy are still
being taken, your timely intervention and prompt action will be a sig
nificant contribution to the campaign.
For more information on the drugs issue and drug Campaign work,
please do write to us.
With best wishes,
Yours sincerely
Dr. Mira Shiva
Coordinator
Low Cost Drugs & Rational Therapeutics cell, VHAI
All India Drug Action Network
JL
^VOLUNTARY HEALTH^ASSOCIATION OF I
AND
mt
ALL INDIA DRUG ACTION NETWORK
40, Institutional Area, (Near Qutab Hotel)
South of IIT, New Delhi-110016
PEHA-1 (1
October 14, 1988
To,
All the AIDAN members
Dear Frien'1,
You must be in receipt of my letters dated 12th July, 21st September and
5th October 1988.
For those of you who may have not received the earlier communication here
.is a brief summary.
Following the Gazette Notification dated 15th June 1988 announced to the
public on 30th June 1988 high dose E.P. drugs were banned. It was announced
over the TV and the AIR about the banning of these drugs but no brands and
manufacturers were mentioned, inspite of repeated requests and protests
and no stocks were withdrawn.
On 12th September ACASH filed a writ petition no”.4127 of 88 in Bombay High
Court asking or withdrawl of stocks and announcement of the brands banned.
Later ACASH filed another writ petition asking for a fresh notification for
the ban of high dose EP injections.
Justice Lentin gave a interim stay order stalling manufacture and sales of
all high dose EP formulations, tablets and injections.
Thus Bombay High Court can issue orders only for Maharashtra jurisdiction
in a letter dated 21st September 1988 the DCI has given orders to all State
Drug Control Authorities to withdraw stocks and stall all sales of high dose
EP INJECTIONS AND TABLETS. The hearing that was to take place in the Bombay
High Court on 10th of October has been postponed till 19th October. Unichem
(as well as OPPI most probebly) have decided to contest the interim stay
order that bans the injections. Since major sales were of tablet and not
of injection with the banning of high dose EP, on the horizon Organon and
Unichem had apparently stopped production in April Unichem*s EP unit was
working three shifts a day and by April they had flooded the market and made
their products available to chemists as well as doctors.
'Sr
..2..
*
-2-
Since the EP case is the first case in which Public Hearings were held and
a drug banned following that a precedent in the interest of the consumer
has been set. What is at stake for the drug manufacturers is not marginal
profits from sales of some high dose EP injections but a loss of face in
public eye fear of consumer movement getting further strengthened from this
victory. It is for this reason that the drug manufacturers are back in the
arena - contesting.
The four high dose EP injections available according to the Government counsel
in Maharashtra High Court are
EP Forte
‘4enstrogen
Cyclenorm
S.G.Forte
Unichem
Infar (Organon)
Highland Pharma
Sigma
A comment on the Gazette Notification
A copy of the Gazette Notification of 15th June is again being sent to you.
While the Preamble clearly states that satisfied about the hazardous nature
of the drug and its lack of therapeutic value high dose EP formulations are
being banned. It is the second paragraph alone which is included as section
27 states that high dose EP (other than Oral Contraceptives) containing per
tablet estrogen content of more than 50 meg. (equivalent to Ethenyle
Estradiol) and of progestin content of more than 3 mg (equivalent to
Norethisterone Acetate).
Ambiguity of Interpretation:- Looking at the two paras in totaly it appears
that all formulations having EP content more than that of oral contraceptive
are banned, since the dosages of estrogen and progesterone given per tablet
are those of oral contraceptives.
In reality
The preamble and the second para are quite independent and the EP ban is
only applicable for tablets as is being contested in Bombay High Court by
Law Charter on behalf of ACASH.
A clarification was sought from the DCI, Dr.Prem K Gupta and Deputy DOI,
Dr. Das Gupta whom I met yesterday.
It seems that the main argument against high dose EP is that of misuse and
that no health or consumer groups during the public hearing even mentioned
about the misuse of injections and therefore injections have been spared
since the hazardous argument is not convincing.
The onus of provung it is hazardous will be on the petitioners.
..3..
Since this fight has been a six year long battle and since we cannot give
up at this stage it is essential that all AIDAN members do whatever is in
their capacity to do. ACAS’’ being a member of AI')AV and have taken on
the responsibility of the legal battle cannot fight alone without the support
of the entire network.
There are actions required at two levels:
(1)
LTV^L Avr> STATE LEVTL
As many individuals, organisations, doctors forums, consumer groups,
legal aid groups, social activists, etc.etc. should be told that under DCI’s
letter to State Drug Controller dated 21st September 1038 (as told by DCI
himself) all injections and tablets of high dose ED are banned.
(2) If any high dose EP is found being sold the name of the Chemist should
be sent to the State DRug Controller with a copy to me and Law Charter.
(3) Any sales of high dose E? is a violation of section 26A of Drugs and
Cosmetics Act under which the chemist can be put behind bars for 3 years
or Rs. 5000 fine.
You must insist on legal action by the State Drug Controller at least against
few chemists or druggists violating the ban order, if they are doing so
inspite of having received the information.
(4) v e will have to collect enough evidence to prove that even injcctioons
are being and have been misused because we know they are being misused, but
in the court documentation would be required.
(5) Protest against formation of another committee to review the ban.
(II) AT A NATIONAL LEVEL
The matter is now with the Health Ministry an Expert Committee is being formed
as admitted by DCI, who will be on this committee is not known, I will keep
you informed about this.
In Bombay I had discussions with a few members of forum against oppression
of women and we all felt that legal battles pertaining to Women & Health
cannot be faught singly e.g. the EP case, Sex Determination, Net en etc.
Since several womens groups are deeply involved in these issues a collective
strategy will need to be evolved. Please send your views.
The situation at the National level and the changes in WHO do not inspire
much confidence.
..4..
»
-A-
There is a proposal to have and AIDAN meeting after the ’•'"C meeting in .erala
venue is Alleppev. Since distances arc so much some ATD.W members find it
difficult to travel so far. I personally feel it is important for us to
meet.
The 'IFC meeting is from January 27th-28th and the Core group from 30th 31st.
The dates for AIDAN meeting could be 1st - 2nd February. Findly give your
feed back, since Dr. Ekbal of KSSP will have to be informed as they are taking
responsibility for local arrangement.
With regards,
Yours sincerely,
Dr. ''lira Shiva .'ID
Coordinator
All India Drug Action Network
J8
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(c)
ANS WJLR
THE
i
MINISTER OF HEALTH AND FAMILY WELFARE (SHRI MOiILAL VORjQ
A sub-committee of the Drugs Consultative
Committee is engaged in screening the formulation moving in ;
(a) to (c)
and rationality,
the market from the angle of safdty, efficacy
based on the recommendations of the expert committee.
Government have so far prohibited marketing of 27 categories
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of formulations which is annexed♦
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Note :—Government of India M
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the following notification p:
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1. G.S.R. 49(E), dated 31-1-198
2. G.S.R. 322(E), dated 3-5-198
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iNEW DELHI, WEDNESDAY, JUNE 15, 1918/JYAISTHA 25, 1910
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3699.
TO. BE ANSWERED CN .THS. 22>p_<VjaJST,. J.988
SIS’S TO. STCP ,SAI,E OF BA\TJED„ ESTROGEN
3699.
P.ROGESTERON'-
.aiRI.. C., J/AEF/.V REDDY:
.SNRI_.MANIK .REDDY:
.SiRI „PRAKASi CWWRA:
SHRI M,. P/JGHU'A .REEDY:
SHRI YOHANBHAI PATEL:
.SHRTAYvTT. GEETA AOCHE.RJEE:
SHRI .S/JE’AP/tZ zWyD:
SHPI VILAS WTTFJVTtAR:
S^RIYZiTI. Ay-NO.PA^A^SII'XRI:
Will the Minister of HEALTH AixrD FAMILY WELFARE
r
be pissed to State;
(*)
whether Governmentfs attention has been drawn to the news
item appearing in the Indian Post dated 22 July, 1988 wherein it
is stated that despite the ban imposed on 15 June, 1938 by
Government on high dose oral formulation of Estrogen and
Progesterone, the drug is freely available with chemists in
various parts of the country, particularly in Bom? ay and Pune;
if so, the action Union Government propose to take to stop
(b)
the sale of the banned drug in the country and to confiscate the
stock lying with manufacturers; and
(c)
if not, the reasons therefor?
A n s r; e r
TIE /.^NISTER OF. STATE. .IN .THE..MINIS/J®. F-TOYJ^ARE
(NUMARI..SAROJ.
(J
Yes, Sir.
YJp.E)
.. .2
f
- 2 -
16.
17.
18.
19.
Fixed dose
with anti-T.B.
combinations of Vitamine
Fixed dose
with Pyridoxine
except combination of Isoniazide
drugs
■ochloride (Vitamin B 6 )
Hydri
skin/eye ointment.
Pencillin
oral preparations.
Tetracycline liquic.
20.
Nialamide.
21
Practolol.
22.
23.
24.
25.
combination of Brgot.
Mathapyrilene, its salts.
Methaqualone•
Oxytetracycline
Liquid Oral Preparations.
Demeclocycline Liquid
Oral Preparations.
26.
with other drugs.
Combination of Lnabolic Steroids
Fixed dose eolation of Oestrogen and Frogestln
27.
(other than oral contraceptives) contain per
tabiet estrogen content oi «
terone Acetate)•
.
*
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P & P Un - (PEHA)
V h A 1
J-ii'ATARREJ_q Lr STTONJ Io ,„ 36?.^
TO BE AMSViERED CN .THE 22J'D_zVJGlJST,, J,?88
STEPS TO STOP ,SAJ,E OF BA\TIED ESTRCGEN A'Jp. FROGESTERONF
3IRI. C. A'ADH/.V REDDY:
3699.
SHRI MANIK REDDY:
JTAKASH .Q4AND.RA:
SHRI Mr P/.Gm’A .REDDY:
SHRI MOHANBHAI PATEL:
• ••
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PROF . PAMKPJS4HA /<ORE:
SHRI ,S;j^AP/2: zW/ip:
.Si.P-Lyj.U,S WTTEMiAR:
SiRB'ATJ /,y^QPAVA_SI.!'.'GI-I:
Will the Minister of HEALTH A?nj FAMILY WELFARE
be Phased to state:
/-M ' c^T
whether Government’s attention has been drawn to the news
item appearing in the Indian Post dated 22 July, 1988 wherein it
is stated that despite the ban imposed on 15 June, 1988 by
Government on high dose oral formulation of Estrogen and
Progesterone, the drug is freely available with chemists in
various parts of the country, particularly in BoirJ ay and Pune;
(b)
if so, the action Union Government propose to take to stop
the sale of the banned drug in the country and to confiscate the
stock lying with manufacturers; and
(c)
if not, the reasons therefor?
A N S v; E R
.TIE ffiNISTER OF STATE. IN .THE.MINISTRY.OF .HEALTH ZM) F/MILYJ7HJ/.FE
(KUA’ARI. SAROJ. KHA^JEE)
(J
Yes, Sir.
. • .2
k
I
i
2 —
(b) & (c.b.
The manufacturers, of these high dose combinations
(other than oral contraceptives) have been directed
to forthwith stop manufacture and sale of these combinations
".nd also to withdraw the stocks of the said formulations
from the market.
State Drugs Control Authorities who are licensing
authorities for manufacture and sale of drugs under the Drugs
and Cosmetics Act and Rules thereunder have been requested to
ask the manufacturers to stop manufacture of high dose
combinations of Oestrogen and Progestins (other than oral
ontraceotives) and ensure that such combinations are not sold
by Chemists and Druggists in their States and to return the
stocks with them to the concerned manufacturers,
Some ccnsi'ffB?
organisations, Indian Drugs Manufacturers Association, Organ!r.ction of Pharmaceutical Producers of India and Indian Medical
Association have been informed of the issue of Notification
hy the Government to Ban manufacture and sale of combination
of Oestrogen and Progestins and to give wide publicity of the
ben to their members.
A press note regarding ban was published in many
leading newspapers and publicity was also given in news
bulletins □f the All India Radio and Doordarshan.
t
VOLUNTARY HEALTH ASSOCIATION OF INDIA
AiND
ALL INDIA DRUG ACTION NETWORK
40, Institutional Area, (Near Qutab Hotel)
South of III, New Delhi-110016
PBHA-1
(1)
November 24, 1988
Dear Friends,
2 more drugs BANNED
1.
This is to inform you that Fixed dose combinations of
Chloramphenicol Streptomycin and Steroid combinations
___
\ The Drug Controller of India has
have ____
been\
banned.
written to the state drug controllers to get the stocks
withdrawn, Please inform your circle along with the
brand names.
High Dose SP
The Bombay hearing dates have not been communicated, and
based on Justice lentins Interim stay order against sales
of injection High dose EP stands illegal.
3.
665013
Ph.Nos. :668071
Patent Case
There is heavy pressure by U.S. government to get India to
change it Patent Act of 1970 and become signetary to the
Paris Convention. There are several implications: Patent
will instead of process become for ’product4 thereby totally
blocking any indigineous effort to produce the same product
through a new process.
Patent duration is at present 5 years after when others
can produce the same drug chemical etc. - Under Paris
Convention - all innovation will be blocked for 20 yrs.
Compulsory licensing will be done away with. Under this
clause if a patentee is not working his patent as is
usually done government can give permission for others
to produce the same product.
Under Paris Convention a MNC will be allowed to import the
product and this will be considered equivalent to working
of the patent - What is probably most serious is the
Priority Right i.e. if any patentee patents his product in
any of the 96 countries who are signataries of the Paris
Convention the date of patent in all countries is supposed
to be this i.e. any other innovation in any other country
will be considered as having been made later.
668072
y
-2A one day seminar was held in Delhi organised by the National
Working Group on Patent Laws, of which I am a part along with
Dr. Narendra Mehrotra and Dr. Dinesh Abrol.
For the first time scientists, researches, voluntary organi
sations, consumer bodies, national labs, Indian drug industry
and judiciary came together to protest against the arm twisting
being done of our government.
US has already exerted trade sanctions against Brazels Cofee
imports a similar threat is being given indirectly.
Hl !
The questions today is of self reliance and non interference
by outside government in our internal matters. In view of
the PepsiCo deal clearance and in view of attempts to exclude
seeds and food live forms out of purview of the patent act the implications are serious and a threat of creation of serious
food dependency exists.
In view of some major changes in the drug, health and economics
seen it is imperative. A meeting after MFC Core Group meeting
would be the most appropriate.
As mentioned in my last letter, it would be very good if
we could briefly discuss some of the major health issues and
concerns our involvement with them besides drug related
activities.
4.
On 24th of November the National protest against
Amaocentisis is being organised by several health and
womens and consumer groups.
5.
Department of Food and Civil Supplies has formed a
- consumer protection council - there is a string possibility
that the drug issue as regards consumers may be taken up by
them.
6.
A large number of mass organisations are ready to be
involved in health action - more link up with like
minded organisations and individuals.
7.
Two reports of Cholera epidemic available:
i. VHJLI
ii. Crime goes unpunished by Mahamari Janch Samiti (Rs.5/-)
The above was an effort of concerned professionals and concerned
citizens to assess the problem extent of the problem the
misguided management of the problem. Since Disha in Gujrat,
KSSP in Kerala have done similar studies, reports should be
definately shared.
..3..
-3-
8> Kindly immediately confirm about the return reservation
of the AIDAN meeting.
9. There is a suggestion that the drug action groups of south
to also come to the AIDAN meeting - some of whom have not
directly been associated with AIDAN.
I am enclosing DCI’s letter and Gazette Notification banning
steroid combination and Chloramphenicol and STREP combination
plus the appropriate sections from our Banned Bannable drug
list so that you can inform others in your area and your
local press about the brands banned/ and to ensure withdrawl
of stocks.
With regards^
Yours sincerely/
///A-- f
Dr. Mira Shiva MD
Coordinator
Low Cost Drugs & Rational
encl:
Jg
Gazette Notification
DCI’s letter
Therapeutics
No .16-4/88-DC
From
The Drugs Controller, India
Directorate General of Health Services
To
Dr. flira Shiva,
Voluntary Health Association of India,
40, Institutional Area,
,
South of I • I
Neu Or-lhi-110016
New Delhi, dated 21-11-88
Madam,
A copy of the Govt, of India Notification No.
X.11014/2/68-$fS&PFA dated the 3rd November, 1988 as
published in the Gazette of India under G ,S .R .No.1057(E)
dated the 3rd November, 1988 prohibiting manufacture and
sale of (i) Fixed dose combinations of corticosteroids
with any other drug for internal use; and (ii) Fixed
dose combination of Chloramphenicol with any other drug
for internal use, is enclosed for information0
Yours faithfully,
(DR oPREM K. GUPTA)
DRUGS CONTROLLER (INDIA)
ift.
(giaiet
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EXTRA
WPT II—^ly4
PART II—Sectio
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15. Fixed dose
internal use."
combination o
combinations of
Note : Government ol India Mini
tion No. G.S.R. 578 (E), d
following notification publish
nary, Part 11, Section 3(i) ,
1. G.S.R. 19(E), dated 31-1-
2. G.S.R. 322 (E), dated 3-5-
8. G.S.R. 863 (E), dated 221. G.S.R. 700(E), dated 15-0
863(3T) HRT^F 22-11-1985
HT .
. fa .
700(3T)
fiRRT
15-6-1988
MINISTRY OF HEALTH AND FAMILY W ELFARE
New Delhi, the 3rd November, 1988
NOTIFICATION
G.S.R. 1057 (E)Whereas the Central Government is now satisfied that
long terms use of steroids in fixed dose combinations drugs for treatnient of asthma is likely to involve risk to human beings and^such formu
lations do not have therapeutic justification :
And whereas the Central Government is now also satisfied
dose combinations of chloramphenicol lor internal use is likely
risk to human beings :
And, whereas the Central Government is satisfied that it is
expedient in jmblic interest to prohibit the manufacture and
drugs aforesaid.
that luxcd
to involve
necessary and
sale of the
Pi inleu Py the Manatjer, Govt, of
and published by the Control
DRUG
ACTION
FORUM,
-
JrtW®
KARNATAKA
57, "SONI"
Tejaswinagar, Dharwad - 580 002
SONI
KARNATAKA INDIA
Carps Kittux 591115
Belgaum
25 Nov 1988
Dear Friend,
The third meeting of the DAF—K will be
held on Sunday, the 4th Dec 1988
between 10 ara an 4 pea at the office
of the People’s Trust (102, 1 Main Road,
Lo*et palace Orchards, Bangalore 560003).
Please wake it convenient to attend
the meeting.
rs sincerely,
Gopal Dabade
Convenor
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40, INSTITUTIONAL AREA, SOUTH OF
NEW DELHI- 110 016
I IT
i 66 80 71
Telephones : < 66 80 72
(66 50 18
Grams :
"VOLHEALTH" NEW DELHI - 110 016
FAX 011-676377
> y
PEHA-1 (14)
December 9, 1988
Dr. Gopal Dabade
Kittur, Bailhongal *I0c
Belgaum Dist
A.P# 591 115
Dear Gopal,
I am looking forward to meeting you on the 4th. I hope
the AIDAN circulars are reaching you. rI am glad you.
Vanaja, Gopi & Alida have been so active on the drug*front.
Because of a lot of new staff and Initiation of new projects
my having to travel so mych for VHAI work with Baby Food,
Ameniocentisis, legislation expected in the Parliament session,
being part of the National Working Group on Patents - I have
not have too much time available for drugs alone.
I realize others too have been busy with several things,
but we need to get together to be update, information about
what is going on regarding drug action and the recent changes.
See you on 4th.
I will bring a copy of VHAI drug film.
With regards.
Youm sincerely.
Dr. Mira d iva
Coordinate'
Low Cost Drugs & Rational Therapeutics
& AIDAN
Dr. Vanaja Ramprasad
cci
Dr. Dara Amar
Mr. Gopinath c/o Community Health Cell
Jg
Alida.
VHAI assists in making community health a reality for all the people of India.
INDfA
VOLUNTARY HEALTH ASSOOIA'I ION 01
AL'D
ALL INDIA DRUG ACTION NETWORK
f
40, Institutional Area, (Near Qutab Hotel)
66501.3
South of IIT, New Delhi-110016
’668071
Ph.Nos.
66SO72
PEHA-1 (1)
November 8,1988
To,
All the AIDAN members
Dear Friends,
Some of your have written regarding going ahead with the AIDAN meeting
after the MFC meeting. Dr.Ekbal called up today and it was not
possible to further delay to hear from others who are yet to reply.
So 1st and 2nd of February is being fixed for AIDAN meeting since
none has been held in the south.
Since representative from DAFWB and most of the R.H.J. people will
also be there, we could save on seperate travel costs.
We will be reviewing of the drug work done by AIDAN and individuals
organisation.
As in Wardha specific responsibilities will have to be taken.
Regarding reviewing of the Drug Policy, Drug Pricing, EP case follow
up.
Essential drug shortage - Continued non availability of essential drugs
for TB, Kalazar etc. needs to be seriously looked into.
Legal drug issues and as related to Drugs and Cosmetics Act.
in the Patent Act.
Pending changes
Drug utilization studies - These are needed very much and we need to discuss
different simple ways of doing some.
Reviewing of Drug Educational material, in English, regional languages
videos. A lot of drug educational material has come out in the recent few
years and it should be promoted and not duplicated.
Experience of using these are probably more important e.g. by Media Collect
ive in their drug Jatha and of others in popularizing the issue.
Epidemic Control - I was wondering whether AIDAN should discuss something
about epidemic controls eg. Cholera, Dengue in Delhi, Kalazar in Bihar,
West Bengal, Japanese B Encephalitis in Assam and Eastern U.P. These things
are going to get worse and I feel Rational Care in these situations will
be required more and more. It is just a suggestion.
..2..
I
-2Regarding Rational Drug Use in Medical Education
VHAI was to have organised the international consultation last year but
due to problems with external affairs clearance it was postponed and later
held in Phillippines. Having discussed with numerous people about the value
of a national consultation on Rational Drug Use in Medical Education recogni
zing that there is a great need (as there is most issues) it does not appear
to be a very high priority with most. It could be included in the agenda
and if it is felt to be of relevance, VHAI could organise a workshop later.
Bulk Purchase Initiatives
Since several groups have gone into bulk purchase and distribution e.g.
LOCOST; CDMU,West Bengal; CDMU,Orissa; CHMU, Bihar; Madras (some like°Ratnagiri into production) if these groups feel the need they could meet as a
special interest group, specially since Poddar, Dr. Rane and hopefully Cheenu
will be coming.
Concerns related to further
Drug and Health Policy changes that may not be in the interest of the people,
and the people, and the policy changes that are required or those policies
that are existing that need to be implemented should ideally be discussed.
I feel briefing the Hospital Bill Defamation Bill in relation to peoples
health needs to be discussed.
The AIDAN Coordinating Committee will of course need to sit and discuss
organisational matters eg. relationship with NCCRDP, AIDAN’s financial situ
ation, advantage and disadvantages of functioning as a loose knit body,
our successes of our failures, our relevance, future mode of functioning.
Anant, I can pay for AIDAN, related correspondence from my pocket if we don’t
have any money, jAs pointed out by many of you, it is not appropriate to
use VHAI resources for 2-.
it. While
T" ' several organisations are involved in
the drug issue and may not necessarily see eye to eye with each other, there
is undoubtedly consenses; on the key drug related issues.
‘_
I will be going down south around 26th December and i_
l..o on 12
returning
12th-13th
January following the drug workshop in Tamil Nadu and leaving againi around
21st of January for a workshop
* *
- -Bangalore with IMA. Since I have to travel
in
so much please do not delay your replies, I can only see your replies on
my return.
We all have a lot on our platter and therefore its absolutely essential
that we undertake those drug activities collectively which need collective
action others can be easily undertaken by individual organisations. There
is a need for solidarity and from the looks of things the drug health,
economic and political situation is going to deteriorate. Undoubtedly the
responsibility on the shoulders of those involved in such work like Drugs,
Bhopal etc. is going to increase.
If this can be done through MFC or tany other
’
organisation democratically
functioning organisation and if it is felt that~a network such as AIDAN
has no future role, or a very limited role we should not feel bad but
..3...
-3-
i
continue the work required. AIDAN has contributed very significantly at a time
there was no one else speaking of these issues and fighting for them.
We have all matured and know the difference between that which is difficult
to achieve and that which is impossible. The role of AIDAN as I see it would
be much more in linking up the drug issue much more with the health issues as
was often stated by Dr. Ashwin Patel in our initial meetings. If collectively
it is decided that we need to continue our thrust in drug work very specific
responsibilities and different strategies need to be adopted for the next phase.
Please respond at the earliest to me and write directly to Dr. Ekbal (Medical
Collegee Hospital, Calicut 673 008, Tel: (Hos) 61531 (Office) 63919) and to
Dr. Narendra Gupta (PRAYAS, Village Dengarh (Deolia) Via. Partabgarh Chittorgarh,
Rajasthan 312 605). If you wish to attend the AIDAN meeting. For return reser
vations contact Dr. Ekbal and you will have to send the money required for the
ticket.
For communication after working hours ( Resd C4/14 SDA, New Delhi-110 016
Tel: 011-665003).
I personally don’t think there is any harm in letting other drug enthusiasts
come - since will be mainly dealing with issues - organisational matters can
be dealt with seperately by the Coordinating Committee.
Some friends wanted to visit the Silent Valley, please plan this for after
2nd evening and again inform Dr. Narendara & Dr. Ekbal.
With regards,
Yours sincerely,
Dr\ Mira Shiva MD
Coordinator
Cost ^ugs
Ratio^^,Therap^Ujtic^ ,.
hole
CC
let h) H
jg
Lt
CL/’Cell
d'1'
7)c^.
//•C C/ c
^VOLUNTARY HEALTH ASSOCIATION OF INDIA
AN 13
ALL INDIA DRUG ACTION NETWORK
40, Institutional Area, (Near Qutab Hotel)
South of IIT, New Delhi-110016
PEHA-1 (1)
665018
Ph.Nos. :668071
November 24, 1938
Dear Friends,
2 more drugs BANNED
1.
This is to inform you that Fixed dose combinations of
Chloramphenicol Streptomycin and Steroid combinations
have been banned. The Drug Controller of India has
written to the state drug controllers to get the stonks
withdrawn. Please inform your circle along with the
brand names.
2.
High Dose £P
The Bombay hearing dates have not been communicated, and
based on Justice Lentins Interim stay order against sales
of injection High dose EP stands illegal.
Patent Case
There is heavy pressure by U»S« government to get India to
change it Patent Act of 1970 and become signetary to the
Paris Convention. There are several implications: Patent
•will instead of process become for ’product4 thereby totally
blocking any indigineous effort to produce the same product
through a new process.
Patent duration is at present 5 years after when others
can produce the same drug chemical etc. - Under Paris
Convention - all innovation will be blocked for 20 yrs.
Compulsory licensing will be done away with. Under this
clause if a patentee is not working his patent as is
usually done government can give permission for others
to produce the same product.
Under Paris Convention a MNC will be allowed to import the
product and this will be considered equivalent to working
of the patent - What is probably most serious is the
Priority Right i.e. if any patentee patents his product in
any of the g^countries who are signataries of the Paris
Convention the date of patent in all countries is supposed
to be this i.e. any other innovation in any other country
will be considered as having been made later.
668072
I
-2A one day seminar was held in Delhi organised by the National
Working Group on Patent Laws, of which I am a part along with
Dr. Narendra Mehrotra and Dr. Dinesh Abrol.
For the first time scientists, researches, voluntary organi
sations, consumer bodies, national labs, Indian drug industry
and judiciary came together to protest against the arm twisting
being done of our government.
US has already exerted trade sanctions against Braxels Cofee
imports a similar threat is being given indirectly.
The questions today is of self reliance and non interference
by outside government in our internal matters. In view of
the PepsiCo deal clearance and in view of attempts to exclude
seeds and food live forms out of purview of the patent act the implications are serious and a threat of creation of serious
food dependency exists.
In view of some major changes in the drug, health and economics
seen it is imperative. A meeting after MFC Core Group meeting
would be the most appropriate.
As mentioned in my last letter, it would be very good if
we could briefly discuss some of the major health issues and
concerns our involvement with them besides drug related
activities.
4.
On 24th of November the National protest against
Amnocentisis is being organised by several health and
womens and consumer groups.
5.
Department of Food and Civil Supplies has formed a
- consumer protection council - there is a strdng possibility
that the drug issue as regards consumers may be taken up by
them.
6.
A large number of mass organisations are ready to be
involved in health action - more link up with like
minded organisations and individuals.
7.
Two reports of Cholera epidemic available:
i. VHAI
ii. Crime goes unpunished by Mahamari. Janch Samiti (Rs.5/-)
The above was an effort of concerned professionals and concerned
citizens to assess the problem extent of the problem the
misguided management of the problem. Since Disha in Gujrat,
KSSP in Kerala have done similar studies, reports should be
definately shared.
..3..
-3-
8. Kindly immediately confirm about the return reservation
of the AIDAN meeting.
9. There is a suggestion that the drug action groups of south
to also come to the AIDAN meeting - some of whom have not
directly been associated with AIDAN.
I
I am enclosing DCI’s letter and Gazette Notification banning
steroid combination and Chloramphenicol and STREP combination
plus the appropriate sections from our Banned Bannable drug
list so that you can inform others in your area and your
local press about the brands banned, and to ensure withdrawl
of stocks.
With regards.
Yours sincerely,
.Ar/..
Dr. Mira ShiVa MD
Coordinator
Low Cost Drugs & Rational
I
encl:
Jg
Gazette Notification
DCI's letter
Therapeutics
✓
67 t-yrZ: ..
*•
.
No.ie-4/88~0C
Fr©m
The Drugs Controller, India
Directorate General of Health Services
«
To
□r. Mira Shiva,
Voluntary Health Association of
40, Institutional Area,
South of I • I .T•,
Net Delhi-110016
India,
New Delhi, dated 21-11-88
Madam,
A copy of the Govt, of India Notification No.
X • 11014/2/88-DMS&P Ff{ dated the 3rd November, 1988 as
published in the Gazette of India under G .5 .R .No.1057(E)
dated the 3rd Novrmber, 1988 prohibiting manufacture and
sale of (i) Fixed dose combinations of corticosteroids
with any other drug for internal use; and (ii) Fixed
dose combination of Chloramphenicol with any other drug
for internal use, is r-nclosrd for i"formation0
Yours
faithfully,
(DR oPREM K. GUPTA)
DRUGS CONTROLLER (INDIA)
■^he (Safcet
EXTRA
UBT H—
IWRT II—Secti
HTt^TT
PUBLISHED
H. 575]
No. 575]
Hf
NEW DELHI, THURSDAY
TtT HPT ’T' fH^T Tty
Tf Wlcf
T^T
Separate Paging is given to this
separate
^TF^T HTT if
fc*n,
PT.^T.pT.
T TTHrT % ftftr
T7T nrfeH
105 7(H) :—
ht HT H HTTHH
HTiri^Tf ntz TT
Ti'-frq- h <^r
fno THRH^fH-rrn
hr
t
afk
HTTHTT I (T
2824 GI/88
nrar
hhtutt
sfterfirift T? fq-^THP
’5
HIE GAZETTE OF INDIA : EXTRAORDINARY
[Part
II—Sec . 3(i)]
W:%?'T
srfafa 3?R tWtfT HPTTft 5?fafa^H, 19 40 ( 19 4 0
H 23) TT UTT? 26T STO TTvT VrfcTTT q;? 5?qfa
fn, %?n^ trt R T
3TR TpT'TrT
^fa^TT H. Hf.^F.fa. 578(3?), anfar
2 3 ^TvTff, 1983 *T fa^fafaa 3?tx
EFTO:—
HRJft if
14 3?fa
RTH TC fafHfafacT
^cT ^fir^HF
15
7MV ^Tlfat, HW:—
n
"14.
fao; farft sr^r 3?tafa
ara
nrar a aam i
1 5- HorTfe TTTFT fv?^ fr^F
3ffafa ^7 HP? ^HrOTTfTTFH T faqa
WFHHq-m |
[tf .
. 11014/2/8 8-ft. FTR . rrjf 3?R rff rrtp (T ]
’■-ffarft faTRTf TFT,
*o
rrfacf
facqq-:—'♦qnr ??^r<
3ffa Tfa^rT ^q-pj?
’T.
Rf.^r.fa. H. 5578(3?),
rfRF^ 23
7 8(3T), arfta
23 ^TFf,
^rrf, 1983 T? ^TljfrcIT ’flTO
TFSTTH, HHFtTFT'T, HPT 2, ’sr1^ 3(i) h sFnfaa fatafafaa srfa^F3?f 5TTF farrr W, ST^fa :—
Hr.^r.fa. 4 9 (ar) <fRR- 3 1- 1-1984
2. ST . Tf. fa. 322(31) cTRl^
3-5-1984
3. HF. SR . fa . 863(3?) arfm 22-11-1985
4. ^r.qrr.fa. 700(3{) cTRl^ 15-6-1988
1.
[hth II—SP3T 3( i) ]
h
Now, therefore, in exercise of
Drugs & Cosmetics Art, 1910 (23
makes the following further amend
Lu™ r,° India, i" the Mmistiy o
o/8 (E), dated 23rd of July, 1983
In the Table under the said
ing items shall be substituted name
••14. Fixed dose
internal use.
combination
15. Fixed dose combinations of
internal use.”
Note : Government of India Min
tion No. G.S.R. 578 (E), d
following notification publish
nary, Part 11, Section 3(i) ,
■ J. G.S.R. -19(E), dated 31-12. G.S.R. 322 (E), dated 3-53. G.S.R. 863 (E), dated 22•1. G.S.R. 700 (E), dated 15-6
MINISTRY OF HEALTH AND FAMILY WELFARE
New Delhi, the 3rd November, 1988
NOTIFICATION
G.S.R. 1057 (E).—Whereas the Central Government
--------- is now satisfied that
long terms use of steroids iin fixed
” ' dose combinations
___
drugs for treatment of asthma is likely to involve risk to human beings' and such formu
lations do not have therapeutic justification :
And whereas the Central Government is now also satisfied that fixed
dose combinations of chloramphenicol lor internal use is likely to involve
risk to human beings :
And, whereas the Central Government is satisfied diat it is necessary and
expedient in public interest to prohibit the manufacture and sale of the
drugs aforesaid.
Pi inleu Py the Manner, Govt, of
and published by the Control
I
VOLUNTARY HEALTH ASSOCIATION Ol
INDIA
AND
; ALL INDIA DRUG ACTION NETWORK
40, Institutional Area, (Near Qutab Hotel)
South of IIT, New Delhi-110016
I
PEHA-1 (1)
\|os
Ph.Nos.
6650IS
*668071
November 8,1988
668072
To,
All the AIDAN members
Dear Friends,
Some of your have written regarding going ahead with the AIDAN meeting
after the MFC meeting. Dr.Ekbal called up today and it was not
possible to further delay to hear from others who are yet to reply.
So 1st and 2nd of February is being fixed for AIDAN meeting since
none has been held in the south.
Since representative from DAFWB and most of the R.H.J. people will
also be there, we could save on seperate travel costs.
We will be reviewing of the drug work done by AIDAN and individuals
organisation.
As in Wardha specific responsibilities will have to be taken.
Regarding reviewing of the Drug Policy, Drug Pricing, EP case follow
up.
Essential drug shortage - Continued non availability of essential drugs
for TB, Kalazar etc. needs to be seriously looked into.
Legal drug issues and as related to Drugs and Cosmetics Act.
in the Patent Act.
Pending changes
Drug utilization studies - These are needed very much and we need to discuss
different simple ways of doing some.
Reviewing of Drug Educational material, in English, regional languages
videos. A lot of drug educational material has come out in the recent few
years and it should be promoted and not duplicated.
Experience of using these are probably more important e.g. by Media Collect
ive in their drug Jatha and of others in popularizing the issue.
Epidemic Control - I was wondering whether AIDAN should discuss something
about epidemic controls eg. Cholera, Dengue in Delhi, Kalazar in Bihar,
West Bengal, Japanese B Encephalitis in Assam and Eastern U.P. These things
are going to get worse and I feel Rational Care in these situations will
be required more and more. It is just a suggestion.
<2k
..2..
-2Regarding Rational Drug Use in Medical Education
VHAI was to have organised the international consultation last year but
due to problems with external affairs clearance it was postponed and later
held in Phillippines. Having discussed with numerous people about the value
of a national consultation on Rational Drug Use in Medical Education recogni
zing that there is a great need (as there is most issues) it does not appear
to be a very high priority with most. It could be included in the agenda
and if it is felt to be of relevance, VHAI could organise a workshop later.
Bulk Purchase Initiatives
Since several groups have gone into bulk purchase and distribution e.g.
LDCOST; CDMU,West Bengal; CDMU,Orissa; CHMU, Bihar; Madras (some like Ratnagiri into production) if these groups feel the need they could meet as a
special interest group, specially since Poddar, Dr. Rane and hopefully Cheenu
will be coming.
Concerns related to further
Drug and Health Policy changes that may not be in the interest of the people,
and the people, and the policy changes that are required or those policies
that are existing that need to be implemented should ideally be discussed.
I feel briefing the Hospital Bill Defamation Bill in relation to peoples
health needs to be discussed.
The AIDAN Coordinating Committee will of course need to sit and discuss
organisational matters eg. relationship with NCCRDP, AIDAN’s financial situ
ation, advantage and disadvantages of functioning as a loose knit body,
our successes of our failures, our relevance, future mode of functioning.
I
I
Anant, I can pay for AIDAN related correspondence from my pocket if we don’t
have any money. As pointed out by many of you, it is not appropriate to
use VHAI resources for it. While several organisations are involved in
the drug issue and may not necessarily see eye to eye with each other, there
is undoubtedly consenses on the key drug related issues.
I will be going down south around 26th December and returning on 12th-13th
January following the drug workshop in Tamil Nadu and leaving again around
21st of January for a workshop in Bangalore with IMA. Since I have to travel
so much please do not delay your replies, I can only see your replies on
my return.
We all have a lot on our platter and therefore its absolutely essential
that we undertake those drug activities collectively which need collective
action others can be easily undertaken by individual organisations, There
is a need for solidarity and from the looks of things the drug health,
economic and political situation is going to deteriorate, Undoubtedly the
responsibility on the shoulders of those involved in such work like Drugs,
Bhopal etc. is going to increase.
If this can be done through MFC or any other organisation democratically
functioning organisation and if it is felt that a network such as AIDAN
has no future role, or a very limited role we should not feel bad but
..3...
-3-
continue the work required. AIDAN has contributed very significantly at a time
there was no one else speaking of these issues and fighting for them.
H'H
We have all matured and know the difference between that which is difficult
to achieve and that which is impossible. The role of AIDAN as I see it would
be much more in linking up the drug issue much more with the health issues as
was often stated by Dr. Ashwin Patel in our initial meetings. If collectively
it is decided that we need to continue our thrust in drug work very specific
responsibilities and different strategies need to be adopted for the next phase.
Please respond at the earliest to me and write directly to Dr. Ekbal (Medical
Coliegee Hospital, Calicut 673 008, Tel: (Hos) 61531 (Office) 63919) and to
Dr. Narendra Gupta (PRAYAS, Village Dengarh (Deolia) Via. Partabgarh Chittorgarh,
Rajasthan 312 605). If you wish to attend the AIDAN meeting. For return reser
vations contact Dr. Ekbal and you will have to send the money required for the
ticket.
For communication after working hours ( Resd C4/14 SDA, New Delhi-110 016
Tel: 011-665003).
I personally don’t think there is any harm in letting other drug enthusiasts
come - since will be mainly dealing with issues - organisational matters can
be dealt with separately by the Coordinating Committee.
Some friends wanted to visit the Silent Valley, please plan this for after
2nd evening and again inform Dr. Narendara & Dr. Ekbal.
With regards,
Yours sincerely,
DrfMira Shiva MD
Coordinator
Ratioi^l^Therap^Ujtic^y ,
Low Cost Jugs
dote
ddn-(- d e
7/ z-
ad U
ecdx
jg
XJL-C(
I1,
A
Arid
//C’G/(
a
L Cl .
C
-dC(r
rd
1/
/ri.
Phones :
9.0|—/;30 p.m.
Gram :
66 50 18
66 80 71
66 80 72
“VOLHEALTH”
NEW DELHI-110016
Voluntary Bealtb AsCoaation of India
Voluntary Health Association of India
40, INSTITUTIONAL AREA, SOUTH OF I. I.T.,
NEW DELHI - 110 016
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40,
INSTITUTIONAL AREA, SOUTH
NEW DELHI - 110 016
OF
I IT
65 58 71
, u
66 50 IS
Telephones : 66 s0
66 SO 72
FAX : 01 1-676377
Grams "VOLHEALTH" NEW DELHI - 110 016
May 23, 1989
Dear Sir,
24th May is observed as Ban Hazardous Drugs Day by the Health
and Drugs Activists in India. Globally it is commemorated as
Dr. Olle Hansson’s Day the day one of the greatest health
campaigners of our time passed away at the age of 49. This
Swedish Paediatric Neurologist was fighting literally till on
his death bed to get hazardous drugs removed and to demand
patients right to information and was responsible in a big
way for getting, Ciba Geigy to withdraw •Mexaform1* and
’Tandril’** from the world market, having led a boycott of
doctors against the manufacturers. He faught as a medical
expert on behalf of the several thousand SMON (sub acute
myelooptic neuropathy) victims in Japan for compensation a
long legal battle that was ultimately won.
VHAI will be releasing its revised edition of Banned Bannable
Drug List to mark Dr. Olle Hansson’s fourth death anniversary.
AIDAN to commemorate Dr. Olle Hansson’s Day is bringing out
a low cost booklet on 6 hazardous drugs. All India Drug
Action Network is a network of health groups, consumer groups,
people’s science movements.
On this day the world over his book "Inside Ciba Geigy" will
be released by IOCU. "It is dedicated to those who at the
time of conflict choose to listen to their conscience rather
than their boss". The book has special significance for
those in corporate sector and government and non government
sector who are increasingly having to act under orders in
a way which is not in the interest of the people and
against their conscience. The book is a reminder of what
their silence can mean to thousands and millions of ignorant
patients.
The hazardous drugs focussed upon this year are:
"Chloramphenicol Streptomycin and Steroid Combinations11.
Both these drugs were banned by the Drug Controller of India
on 3rd November 1988, 8 years after the sub group of the Drug
Consultative Committee had recommended that the above combi
nations of steroid and chloramphenicol be weeded out immediately.
Hydroxyquinoline/clioquinol
Oxyphenbutazone
VHAI assists in making communit/ health a rea'ity for all th6 people of Irdia.
VHA!
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Lyka Labs, Deys Chemicals/ and Roussel and Indoco have
obtained stay orders against the ban orders of the highest
drug control authority in the country iee* the Drug Controller
of India*
Following the EP* experience it is obvious that people
pannot wait for years and years to see the government
implement its own ban orders* Urgency of Drug legislation
reform is obvious*
It is hoped that the MANUFACTURERS of the above combinations
will show their social responsibility in stopping production
and sales of these potentially hazardous drugs.
SOCIALLY conscious doctors are requested not to prescribe
the above drugs as- well as the products of those manufactures
who challenge ban orders to ensure their continued profits*
The CONSUMERS as an exercise in knowing the medicines pres
cribed should make it a practice to read the contents
ingredients and refuse any cornbination*\isually given for
diarrhoeal conditions and fixed combination of steroids
given for asthma etc*
(note this is only for combinations
and not steroid ALONE) .
Consumers have a right to information and should know why
these drugs were banned by the Drug Controller of India after
the matter was reviewed by the Drug Technically Advisory
Board*
For more details a note on Dro Olle Hansson and his work
and his contribution towards Responsible Drug Marketing is
attached*
A note on why Chloramphenicol Streptomycin and Steroid
combination have been banned is included/ along with the
names of the various Brands and Manufacturers of the above
two combinations•
DR* MIRA SHIVA MD
HEAD OF DIVISION
PEOPLE’S EDUCATION FOR HEALTH ACTION
*High dose Oestrogen Progestrone combination
**Chloramphenicol
Streptomycin
I
DR. OLLE HANSSON’S,DAY
BAN HAZARDOUS DRUGS DAY
It was on 23rd May 1985 that Dr. Olle Hansson passed away
in a hospital in Stockholm.
He was just 49.
For almost
272 decades this paediatric neurologist by profession had
faught a long lonely battle against the multinational giant
Ciba Geigy. He was instrumental in getting Ciba to with
draw its products mexaform and entrovioform from the
world market.
Not merely did he contribute to the Academic world by being
the first to show the association of optic neuxtis (blind
ness) with consumption of this drug way back in 1965 but
he also challenged the incorrect facts promoted by the
manufacturer that the drug was not absorbed from the guto
Through various tests conducted by him he showed that the
drug was absorbed, metabolized, in the body and its meta
bolites excreted in the urine.
This information was
critical in being able to associate the neurological side
effects with the consumption of the drug.
It was due to his extensive research, writing and work on
clioquinols that led the Japanese SMON victims to invite
him as an expert on their behalf, in their fight for
compensation.
(SMON i.e. sub acute myeln optic neuropathy
left over 11000 people crippled, blinded or with loss
of Bladder control over the discharge of urine and stools•
For eight years in Tokyo High Court a legal battle for
compensation was faught by the victims themselves with the
help of socially conscious lawyers, doctors, and experts
like Dr. Olle Hanssoq, and ultimately won. A
major international conference on Drug induced suffering
was organised later at Kyoto at which Dr. Olle Hansson
spoke emphatically about the consumers ’Right to Information *♦
The clioquinol tragedy next to the Thalidomide disaster was
the second major drug Induced tragedyo
Even though the
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manufacturers faught tooth and nail in trying to prove that
SMON was caused by virus and had some genetic etiology, it
was only due to a concerted effort on part of the victims
and the professionals this case could be faught and won o
Dre Olle Hansson was not satisfied Just seeing the victims
compensated, he continued his tight to see that such a
thing did not recur in any other country where the drug
was being consumed in large amounts by the uninformed public•
In 1976 he initiated a boycott which in Sweden was joined by
over 2000 doctors who refused to prescribe any Ciba Geigy
product till it withdraw these potentially hazards and
therapeutic doubtful drugs from the world market, and
the company lost 75 million kroners in Sweden i.e. their
entire turnover in 1980. Doctors from Norway, Finland,
By November 1982 the sales
and Denmark joined the Boycott.
of Ciba Geigy fell by Y3 rd and it was this which forced
Ciba Geigy to withdraw
mexaform and Enterovioform from
the world market proving once again that the only argU ment
that seems to make sense to the industrial houses is with
economic
argument linked^ Today a number of western
^with loss;
countries as well as Bangladesh, Pakisthan, Nepal, Sri
Lanka, Malaysia have banned the clioquinols in their
markets. In India over 150 brands are freely available.
j
5
Stricken with Cancer from his hospital bed he faught for
withdrawl of yet another hazardous drug Ciba Geigy’s Tandril,
(Oxyphenbutazone)• This was following receipt of incri
minating internal documents^where over 1036 deaths due to the
drug had been documented - while only 200 had been reported
to the drug regulatory authorities. The product while
allowed in India only for acute goutyarthritts and cervical
spondylosis continues to be used extensively for prolonged
periods for diverse indication from arthritis, dental pain,
post operatively. It is given to the elderly and the
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of Oxyphenbutazone
children. Hundreds of combinationwith analgin exist and
are widely consumed. These are sold without warning
and if any warning is given it is in a medical jargon no consumer caution is given. Clba Geigy subsidiary
Suhrld Geigy continued to sell oxyphenbutazone product
suganril stating that it was an Indian company and the
marketing policies of the International Head Quarters
did not bind them. In India over 100 brands of oxyphen—
butazone and Phenylbutazone are freely sold.
Dr. Olle Hansson continued his work right till his death.
He had all the elements of a great health campaigner
scientifically sound facts, persistence, perseverance,
honesty, integrity coupled with humility. The moral support
and inspiration that he provided to the drug activists across
the globe is unimaginable. On this day he is remembered with
respect, love and gratitude for all his selfless efforts,
for being such a Inspiring teacher, a role model and a
dependable friend. There can be no greater tribute that we
can pay than for us to be able to continue fighting the
battles for safeguarding peoples health against profit
oriented vested interest more effectively against.
Like every year the health and drug activists commemorate
Dr. Olle Hanssons death anniversary as "Ban Hazardous Drugs
Day". For the past two years the focus was on high dose
EP combination because of the EP case. This year the two
drugs in question are the fixed dose combinations of
chloramphenicol streptomycin and of steroids.
Way back in 1980 the Drug Consultative Committee had recommended
their IMMEDIATE withdraw!. It was only on 3rd November
1988 that the fixed dose combinations of the above therapeutic
category was banned after the matter was reviewed by the
Drug Technical Advisory Board. (PLease see Gazette Notifi
cation attached). It is with a sense of dismay that it was
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found out that the manufacturers have as in the EP case
appealed for a stayorder against the ban and a stay has
been granted*
Chloramphenlcol-Streptomycln is a combination of two anti
microbial agents greatly misused in diarrhoea, when over
60% of the diarrhoeas are viral In origin, not requiring
any antibiotic♦
Chloramphenicol while considered^ useful in Typhoid is not
recommended for simple diarrhoea because of the association
of serious almost fatal toxicity of the drug leading to
Agranulocytosis fall of white cell count which are required
for fighting infection and sometimes total bone marrow
shut down*
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Extensive misuse of antibiotics like chloramphenicol has
led to emergence of drug resistance as was evident in
Mexico when over 3000 people died of Typhoid before emergence
of resistance to chloramphenicol was detected* Emergence
of drug resistance to Typhoid has been reported from
different parts of the country*
Furthermore, the use of Streptomycin in a combination for
diarrhoea when adequate amount its single ingredient pre
paration for TB is not available is unwarranted^ This is
specially so when its therapeutic role is marginal and when
better antimicrobials for specific conditions eg» Shigella
dysentry, amoebiasis, giardiasis, and anti helminthics for
worms• Gross over use of a potentially hazardous combination
for non specific diarrhoea is not just a matter of misuse
it is bad medicine• Unfortunately in India as in many other
developing countries these drugs have been promoted for
precisely such trivial condition*
AIDAN and its member organisations call for implementation
of the ban (It had taken over 7 years in the case of high
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dose EP)• Academic Bodies eg* IAP, IMA have also made
their stand on the above drug adequately clear and called
for their removal* Increasing medical evidence against
the combination and pressure for medical professionals eg*
medical lobby against unethical marketing has led to a company
like Parke Davis^S/ithdrawing its popular Chloramphenicol
Streptomycin combination,Chloro Strep,from the world
market* A large number of other manufacturers continue to
produce and sell these products (List attached)•
Having been deeply involved with the entire EP case AIDAN
feels that the ban orders will continue to be flaunted and
stay orders continue to be granted unless drug legislation
reforms are brought about, specially ensuring that the onus
of proof of safety lying on the manufacturers, other than
the onus of providing lack of safety lying on the drug
control authorities•
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It is a shame that with the New Drug Policy of 1986 which
after 4 years of "policy formulation" was presented to the
nation as "measures" for Rationalization for the Growth
of the Pharmaceutical Industry", except for the increase in
drug prices,no other measures eg* ensuring availability of
essential life saving drugs of good quality, with adequate
information was ensured*
Of the three combinations,(1) High Dose EP (2) Chloramphenicol Afc
Streptomycin (3) Steroid combination, drugs banned - stay
orders were granted to all three drugs•
There is absolutely no alternative left to the people but to
register their protest at such shameful behaviour by boy
cotting such companies which are challenging the orders of
the highest Drug Control Authority in the country i*e* Drug
Controller of India. It is obvious that these manufacturers
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in the interest of profit are keen to sell their products
even when they have been recognized as potentially hazardous
and legally banned.
The companies who have obtained stay orders are Lyka
and Deys Chemical, Roussel and Indoco*
It is hoped that the manufacturers will implement the ban.
Till then socially conscious doctors are requested not to
prescribe their products and people should request their
doctors not to prescribe any products of the above
manufacturers and prescribe an alternative. People must
have a say in what cannot get pushed down their throats
in the name of medicine. Since it is not possible for the
authorities to ensure the ban orders the people must do so
in the interest of their own health and the health of
their family members.
dr. Kira shiva md
COORDINATOR, AIDAN
40 INSTITUTIONAL AREA
SOUTH OF I.I.T.
NEW DELHI 110 0016
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REPORT MADE FOR ANNUZ\L GENERAL BODY MEETING-1988
P E H A Section
Staffing;
1987 saw the departure of Dr. All, our Pharmacology
Consultant, Dr. Sanjay Dixit, Programme Officer, PEHA,
Minakshi Saxena, Incharge, INIS program.
Full Time programme staffs
There were only 2 full time
programme staff in the section i.e. Taposh and Dr. Mira Shiva.
A lot of Taposh's time went in organising of the physical
arrangement of the National Village Health Worker’s Convention.
He has since mid 1987 been made responsible for PEHA’s Tobacco
Campaign. Dr. Manjunath joined us in December 1987 for
Traditional Medicine work and has been involved in assessing
the Traditional Health scene in the country.
Part-time Consultants 2
1. Dr. Susy Aya Ram who joined us in December 1986 was involved
mainly in Traditional Medicines work for most of 1987, in
bringing out Rational Drug Use booklet and the poster, She is
presently involved in evolving VHAI’s working strategy for
National Health Programme focussing on Blindness Control and
Iodine Deficiency.
2. Dr. A.T. Dudani joined us as part time consultant on
September 1987 to help with the work on Pesticides and the
Parliament.
3. Dr. W.V. Rane joined in October 1987 to help with Drug work
and he has been involved in updating the Banned Bannable Drug
List and the Lentin Commission.
With most of the activities being undertaken by PEHA as well
as most of the team members being new — a substantial amount of
time went in working out the priorities and the action strategies
based on 1. the need of the hour to face some of the unmet
health challenges.
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2. the demand from groups and organisations and
individuals.
3. Our own knowledge base, capabilities and skills
and sense of concern.
1987 saw the Traditional Medicine work which was initiated
several years ago as part of Holistic Health work by Sr. Carol
and team, taking shape. Dr. Susy, coordinated the Hardwar
meeting on Traditional Medicine brought out the report and
also the 'Birds Eye View' of Traditional Medicine, helped bring
out the special issue of Health For the Millions on Traditional
Medicine. She and Dr. Ali participated and contributed in the
Digha meeting on Tribal Medicine and Dr. Ali presented a paper
at the first International Conference on Unani Medicine.
Trciditional Medicine Workshops
1. Organised by LSPSS, All India Folk Practioners Conference
at Malaivada, Gadcharoli, from 5-8 February, Dr. Manjunath
participated.
2. MPVHA-VHAI collaboration - State level workshop on
Traditional Medicine.
resource persons.
Dr. Susy and Dr. Manjunath were
3. State level workshop on alternative system of medicine
organised by OVHAI and HIRDA with Dr. Manjunath as the
Chief resource person.
At a planning meeting on documentation of Indigeneous Science
of Nutrition, Dr. Vanaja Ramprasad was asked to Coordinate
the activity. Major activities visualised in this area are
related to compilation of information, documentation production
of need based material integration of the key concepts related
to traditional medicine in various training programmes and
health activities of VHAI. Details will be discussed in the
note on Traditional Medicine by Dr. Manjunath.
Pesticide
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which are very few in number. Mr. Ravi Nair was taken on a
3 month contract to compile information on the Pesticide issue.
Dorly a Swiss Volunteer has been helping since 1987’on once
a week basis on the same and is working on bringing out a
simplified backgrounder fona pesticide information and action.
Dr. Dudani since his joining is mainly responsible for
pesticide work and besides visiting agricultural universities
and participating in various pesticide related meeting he has
contributed significally by bringing out a pesticide report
as a VHAI—DST collaboration. Details of pesticide work will
be discussed in the note on Pesticide by Dr. Dudani.
Tobacco
The anti—tobacco activities of PEHA were ultimately launched
in 1987 for which Taposh iRoy is mainly responsible. The
activities have involved compiling of information, documentation,
making linkages, bringing out anti-tobacco posters, sticker,
backgrounder material holding of anti tobacco workshops,
AIR panel discussion, and approaching Health Ministry, ICMR,
WHO for No Smoking Day activities and for long term tobacco
campaign against and what WHO calls "tomorrows epedemic".
In
view of increasing dumping of cigarettes in developing countries
and their agressive marketing misuse of media, with main
targetting at the young people and use of precious agricultural
land for purposes of growing tobacco instead of food - the
issue of Tobacco has to be dealt with seriously collectively
not because of "tobacco" per se but because of the ramfications.
Taposh will deal with the details of Tobacco work.
Baby Food Campaign
The Baby Food code which was adopted by the Health Ministry
on December 19th 1983 under public pressure was passed as a
Bill in the Rajya Sabha in 1986. The code was to have been
presented in the Lok Sabha and sent for Presidential assent
before enactment as and an Act & Law of the land. India is
a signatory to the World Health Assembly resolution of May 1986.
o o /] o o
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Information Service).
The Baby Food companies are gradually
switching to aggressive marketing of commercial weaning foods,
provision of gift of milk foods tins to new mothers through
maternity homes so as to create unhealthy future dependency.
This amounts to unethical marketing. The scope of the code
covers promotion of feeding bottles, feeding nipples, provision
of gifts and educational maternal. This fact is little known
by most people including the health professionals.
The Baby Food code has been followed up and its implementation
monitored by PEHA. The various organisation groups and State
VHAs have been kept informed about the developments. Press
Release regarding delays in presentation and enactment of the
Code for Protection and Promotion of Breast Feeding Code have
been issued.
Monitoring of the implementation of the WHO code
in different key cities has been coordinated by us - this has
been done as part of a world wide monitoring and also to form
the basis of demand for enactment of the Bill.
This has been done in view of the increasing commercialization
of child core, an increasing dependence on artificial and
processed foods, great proliferation of Baby Food supplements
as well as the heavily promoted so called health, high protein
foods, which are associated with creation of warped attitudes
towards food nutrition and child care resulting in negative
changes in dietary habits and negative impact on health.
Today the issue of Baby Food is not just a ‘Tins vs Breast
Milk* debate it is obviously a commercial business hitting
at the very roots of healthy child care and nutrition practices.
The three issues which WHO is under heavy pressure from the
industry lobby and the governments of the main exporting
countries are Tobacco, Baby Food and PHARMACEUTICALS. PEHA
in involved in all three. By the very native of this issues
which involve aggressive marketing, the presence of powerful
multinationals and the corrupt influence of health, response
has to be based on the involvement of large number of health
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in these issues tocbay it is possible that tomorrow we will
have to be involved much mere in issues related to medical
technologies, that arc not necessarily in the interest of the
people. The criteria and guidelines to assess their utility
value and social relevance will need to be drawn up.
Low Cost Drugs & Rational Therapeutics
Involvement with drug work has continued inspite of an
extremely negative drug policy, the failure to take any
decision on the EP.
Our case - major thrust was shifted from policy intervention
to attempts at influencing Academic and professional bodies
eg. Indian Medical Association, Indian Academy of Paediatrics,
Indian Association of Public Health. The work in 1987 has
involved support of State VHA's and their drug work; involve
ment with other like minded organisation. Peoples Science
Movements; involvement with the 4 EP public hearing and the
DTAB, supporting the formation and work of Karnataka & Tamil
Nadu Drug Action Network; struggling to ensure rationality in
formulation of our Category I & II Essential Drug List with
the Kelkar Committee, raising questions in the parliament,
building linkages, network, calatyzing new action, contributing
as resource person, advisor and consultant at various meeting,
seminars and consultations and dialogues with the industry,
bring out drug education material; and bringing together various
groups around Lentin Commission organising a Press Conference
to highlight the implications of the Lentin Commission report
for the Nation. From the time we started our clinical assessment
workshops in 1979 to deal with rational therapeutics tics till
now we have come a long way.
The grimness of the situation and depth of the rot continues
to shock us, as more and more facts are discovered. Yet the
past few years have seen very significant social mobilization,
and drugs issue is increasingly recognized as a public health
problem an important health issue. Drugs issue countinues to
be handled by the Industry Ministry and disowned by the Health
0 n° O o° °o
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possible forum have been used to focus attention on the issue
and to enlarge the pool of individuals deeply concerned about
people and their health, who are willing to take stands and
act when time calls. The drug work has gone on as VHAI, as ’
AIDAN as Action for Rational Drugs in Asia (ARDA), as National
Campaign Committee for Rational' Drug Policy (NCCRDP) and HAI
and even in my individual capacity when the issue of Banner
begins to take priority over the issue of drugs.
Parliament
Attempts at raising questions in the parliament, dialoging
with individual parliamentarians and on all party meeting of
parliamentarians our drug issue had been made in the past
years. With joining of Dr. A.T. Dudani - several question
related to various aspect of health have been raised in the
Parliament and information saught.
more with this.
Dr. Dudani will deal
N^wer Health Technologies
Use of Medical Technology has potential of being used against
the interest of the people, as was made evident by the
Amneocentesis for Sex Determination which was being followed
by female foclicide. With increasing use of Biotechnology
and genetic engineering and high Tech. Medical technologies
the confusion over choices will be compounded and criteria
for assessment needs to be evolved now.
As part of the discussion on technology mission on Immunization
a meeting with Mr. Sam Pitroda called by department of Bio
technology to discuss OPV & KPV was organised. Since India is
to switch over from oral polio to injectable polio, the need
was felt to attempt a review of the existing literature of
which very little is easily available at present. Za brief
report after compiling and analyzing the existing information
will be brought out, to form the basis of our discussion with
others in the voluntary sector to do some collective thinking
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National Health Prcgr<?mmes
Child Health, TB Care and Diarrhoea Care have been given
attention by VHAI in the past and concern regarding Goitre
problem and nutritional blindness expressed from time to time.
The three National Health Programmes being taken up seriously
by PEHA ares
1. Iodine Deficiency disease control
2. Preventable Blindness control
3. Diarrhoeal disease control programme/
Rational Diarrhoea Care.
The former two will be discussed in detail by Dr. Susy.
As regards Diarrhoeal Diseases the National Control Programme
is in the process of being formulated an excercize which
started in 1985. A task force has been meeting in which I
have been involved. The KAP study undertaken by UNICEF has
shown that a significant percentage of the mothers do give
some fluid or the ether and it is the ignorance and irrational
management of diarrhoea by doctors that needs to be corrected.
VHAI's ORT study results had also highlighted the need for
doctor education not just in matter related to ORT but also
use of anti diarrhoeals.
What will be the role of the voluntary health sector in the
National Diarrhoeal Disease Control Programme in education/
communication, training, setting up of ORT clinics etc. needs
to be evolved amongst ourselves.
VHAI Organisational Programmes
National Health Policy Seminars
Helped in the Following three National Health Policy
Workshops.
Himachal Pradesh
3-6, December 87
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Nationa.! Village Health Workers Conver:tion
Taposh was Incharge of physical arrangements and cultural
programme, and Mira Coordinator of the programme planning.
VHAI's Orientation Workshop on
Primary Health Care, Jamkhed
Mira contributed as a resource person.
Support of State VHAs
Bihar-VHA
Orissa
- Workshop on Rational Drug Use.
Dr. Susy and Dr. Mira were resource persons.
Dr. Susy attended the GB meetingo
One day workshop on Rational Drug Use as
part of the GB meeting 1988. Mira Contributed
as a resource person.
Karnataka
Minakshi Saxena attended the GB meeting on
behalf of VHAI.
(Due to the technology mission
meeting and Lentin Commission work the program
to go for this GB was cancelled).
jg/22.4.1988
Dr. Mira Shiva MD
* Head of Division
Peoples Education for
Health Action
r
REPORT PREPARED FOR ANNUAL GENERAL MEETING,
1988
REPORT OF INFORMATION & DOCUMENTATION, JANUARY-DECEMBER,1987o
GOAL
The main objective of the Information Section isz ’’To provide
Health and Health related infermatien to our staff for their
various programs, campaigns and publications; To support the
various state VHAs and the small Rural and Urban Health groups
and to other action groups who promote Health in the community
and to provide continuing education to all Health & Development
workers".
FUNDING
For the first time the Information Division got a three year’s
funding from Asia Partnership in Human Development, Hongkong.
USERS
We have a wide range, of users - Development Workers, Middle
Level Groups, Activists Academic Institutions, Journalists,
Researchers, National, International Organizations, Government
Departments, U.N.Organizations etc.
T^INUNG PROGRAM
In collaboration with APVHA we conducted a Documentation Work
shop in Secunderabad,March’87 for 12 participants.
In July’87 we organized anether Documentation meeting with the
collaboration of TNVHA, & KVHAs for 25 participants.
PUBLICATIONS
1.
2.
3.
A major portion of eur time was spent in the preparation of
the book "BASICS OF DOCUMENTATION".
We prepared a paper on "Preservation of Materials in the
Library’5.
Compilation of different types f materials entitled "New
Drug Policy & Rational Drug Policy1’.
PREPARATION OF IMPHCRC
Started the preliminary arrangements for the International
Meeting of Primary Health Care Resource Centres.
HEALTH EXHIBITION AT VHV7 CONVENTION
In October’87 we organized a massive Health Exhibition consisting
of all the States & Union Territories of India. It was opened by
Ms.Tara Ali Baig. Displays included Low-Cost appropriate Health
technologies. Herbal Medicines, from various states. Health Educa
tion Materials, Puppets, etc. nearly 100 groups participated in
the exhibition.
OUR GUEST PROGRAM
-
2 s-
INFORMATION KIT
Selected materials were sent as 'Information Kit' to VHAI's
core resource persons.
OTHER AREAS
1.
Our Information Team attended various workshops and conferences'
in Delhi as well as other States.
2.
'Sharing for Action' program - Staff members who conduct or
attend programs share experiences and ideas with other VHAIStaff
3.
4.
5.
Video & Film & Slide Shows.
Provided information for ’Health For The Millions'
Visits to various groups/government departments.
INFORMATION & DOCUMENTATION
-oOo1988 PROGRAMS (JANUARY-APRIL)
In February we organized an "International Meeting of Primary Health
Care Resource Centre" cosponsored by AHRTAG/UK, from 25-27 February,
1988, at VHAI, New Delhi. A core group met two days prior to the
meeting to work out the details. 22 Participants from 7 Countries
Bangladesh, Brazil, Britain, Kenya, Malaysia, U.S and India attended
the meeting. It also included Representatives from the Ministry of
Health, UNICEF and WHO and International, National and grassroot
level organizations. The main purpose was to form a global network
for the free flow of information from higher*to lower levels and vice
versa.
During this time we released the book 'BASICS OF DOCUMENTATION'
mainly intended for small groups. This book is the first of its
kind for the Voluntary Sector.
c
A followup of this meeting was held in VHAI to chart out the details
and to prioritize the activities of VHAI in this area. It was decided.
1.
To have an information cell in each SVHA.
2.
To continue organizing training programs in Documentation to
help small groups to streamline their existing materials.
3.
To play a "weather station" role in identifying problem areas,
creating awareness on vital issues/alert news etc.
Sharing programs with other organizations.
Strengthening and expanding the global network.
4.
5.
In the end of March, we organized a Documentation Training Program
for RUHSA as part of their Staff Development Program. We also
visited Karigiri's SLR & TC and RUHSA's Development Program.
-oOo-
20.04.1988.
Mrs.Chandra Kanapiran
d worn sick
1987
The role of the Communication Division is to bring out a
wide range of health education material y partly in
collaboration with other Divisions and partly on its own.
These are meant for health workers at three levels, grassroot, middle and macro.
K^IJIATBRI^S
The new materials brought out by the Communications Division
in 1387 are:
I.
Publications for long-term projects of VHAI: (1 ) School
Health Programme (revised); (2) Suliul
School Health Curriculum
(Hindi and English); (3) Year Planner; (4) Rational Drug
Poster; (5) Rational Use of Medicines; (6) Status Report
?R'iUUitCldU’
Report, on Traditional Medicine Retreat
(o; rosters for anti-smoking campaign; (9) Basics of
Documentation; (10) Personnel Policies
II. Publications for -Special Projects: (1) Elements of
■UU+Ui ^?alth ?op-cy; (2) Position papers on National
Health Poiicy; (5) Posters for NHP Workshop; (4) Flashcards for VHW Convention
III.Others: (1) Better Child Care (Nepali); (2) Feeding and
care of Infants and Young Children;
--- 7 (j) Catalogue 1987;
(4) Health for the Millions; (j)
(5) rus
Fosters on Firecrackers
are dangerous; (6) VHAI Tree Foster.
In addition, several books were reprinted. These include’
Ban?a^e Brugs, Rational Drug Policy, Where There
is Ho Doctor, Better Care of Diarrhoea and VHAI Brochure.
££^W^^FOR J.988
Vmr 0M-i5eer started on the following manuscripts o You and
’
lour Chiid; Better Care of Disabled Children; "Better
Care of
bne Mentally Handicapped; Better Care at Birth• 2 Cervical
Cancer (Hindi); Child to Child and -^etter Cere of Malaria.
We expect to bring out most of these this year.
pro^ects ori hand include National Health Policy Workshops
Reports, Report of the Village Health Workers Convention
P
XT
iT h;
?heCnrZss
vxj.V
JylCbo,
brochure giving details of new publications
6 malled 1=0 Potential interested parties is in
_____ xU
COMMUNITY HEALTH DIVISION
- Activities at a glance i
------- TRAINING
c
---------
CONSULTANCY]
zzizzz:___
_
For national & inter
national organisations
seeking help on
matters cf health and
programming.S/_______
’A1
Vitaman
1)
(Jodhpur)
2) Environ
mental
sanitation
(Unicef -3)
3) Swedish
Inter
national
Develop
ment
Agency.
xl/
School
Heap, th
NHP
Work
shops
Nurse
Anaes
thesia
___ _
Non-he al th
Organ!sation s
| DCHM
Request
Work4r
RUHSA j shops
Regional
Meetings
for ini
tiating
School
Health
Progra
mmes .
Teachers
Training
for
starting
ch-to-ch
activi
ties .
Follow
up of
Region-al
meet
ings.
Follow
up of
Tea
chers
Train
ing
I___yz__
To create
awareness
on health
issues
amongst
1 develop
ment
groups 1
Note s A chart prepared for Annual General Body Meeting 1988.
Corre sp
course
nity he
Plannin
nisatio
Managem
_____
To im
the s
of co
nity
Healt
Manag
for p
coord
indul
out-r r
progr
SALES PROMOTION ACTIVITIES OF 1987
Sales promotion is one of the most recent•additions to the
VHAI activities. The need for this rose from the fact that
. we need to go deep into areas and projects where our materials
could be of immense use. Now with the new direct taxes
Amendme: t Act 1987 we can channelise the profits and gains of
our sales to other activities of VHAI. This will help us to
meet some of our expenditure for other departments.
Different methods were adhered to in implementing this
programme. First was personal visits to institutions and
individuals and holding discussions about the publications,
future plans and sharing about the overall functioning of VHAI.
This exercise was also done, to gather feed back on our publi
cations which in turn would help us review our materials.
Visits were paid to organisations in Bombay, Pune, Calcutta
and Delhi during 1987.
The second step is to set up sales outlets of VH-\I materials
in other important cities. This should help reach more and
more people and our materials better exposed. We have been
ble to set up sales counters in FRCH, CED(few titles), and
HVHn in Bombay, Maharashtra Arogya Mandal and Students Book
Stall in Pune. In Delhi CMAI and ISI keep our materials. In
Bangalore Streelekha and in Bihar Vikas Gramodyog have shown
interest in keeping our books, like CINI. A mention is.::.-: to
be made here that most of the state VHAs also keep VHAI
materials for sale. Some of these centres are very active but
some others not so much.
Of late we have realised th..it VHAI can no more sell our
materials at the subsidised races. After careful' evaluation
of the problem we have come up with a new price list of our
materials. The third step in the promotion activity is related
to this revised price list. VHAI has not sold any publications
through the book trade channel so far. This is a vast area
where we want to enter. Book trade in India is a very developed
field so we cannot shun away from it. We plan to approach the
trade channels with our materials and strike deals with them
on commercial lines by permitting necessary trade discounts
and‘inc ent ives•
Our fourth step in sales promotion is exhibitions- We had been
exhibiting our materials in important gatherings, like the
World Book Fair- International Conference on Clinidal Nutrition,
CHAI Convention etc. This helps getting in contact with many
new people and organisations.
The major ideas of action for future can be summarised as
follows :
a.
Setting up sales counters in more places;
personal visits to more organisations in various states;
b.
participation in exhibitions and conferences;
c.
a. trade deals with distributors and wholesellers;
undertaking publicity through advertisements/ write ups and
e.
information mailing.
DTSTRIBUTION SERVICES
1987 marked a new phase in the distribution service.
The
whole distributions set up has been re-arranged/reorganised.
The sales and display part of the section moved into the
Mezzanine floor and the packing and despatching to t e
Basement.
This has given a better and congenial atmosphere
for the visitors and customers.
The oerformance of the section was also very encouraging.
The sales figures of 1987 (Rs.13,41/213.55) was almost
double compared to 1986 (Rs.7,68/628.60).
This was marnly
because for the first time the Ministry of Health & Family
Welfare showed their direct interest in our publications
by their bulk purchases.
In addition to the VHAI publications/ we also bought,
relevant health education materials from other organisations
like WHO/ CMC/ Literacy House, NIPCCD, ICMR, OUP, CHETNA etc.
for our distribution.
The non-availability of the TALC materials was a big handicap
for us.
But
the situation has changed of late and we have
But the
received the Master copies of 8 sets of slides and we expect
the rest of them also soon.
The distribution services is also providing the supporting
sections by making available
EStSSSn
programmes like
—
education materials required for th.
the prograimes
C.H.T.T., Health for Non-Health NGO’s, National Health Policy
Workshops etc.
The Distribution Services collected free materials from
Goitre
UNICEF on Infant Nutrition, Mother and Child rtealtn, c_.
etc. and ■distributed it to other organisations.
•!< -k ~k -k 'k *
• >4k ...I
REPORT MADE FOR ANNUAL GENERAL BODY
MEETING-1988
ANTI TOBACCO AW DRUG AW/-1RENESS CAMPAIGN
- Taposh Ranjan Roy
In June 1979 in Sweden, at the fourth world conference on
Smoking and Health, Dr. Halfdan Mahler, Director General of
the WHO in his opening address had said, "THE SAD FACT IS
THAT IN THOSE COUNTRIES WHERE PEOPLE HAVE THE LEAST TO EAT,
WHERE POVERTY IS GREATEST, WHERE ILLITERACY IS MOST WIDESPRE^........ MORE AW MORE PEOPLE ARE BEGINNING TO SMOKE
EACH YEAR, ADDING TO THEIR ALREADY INTOLERABLE BURDEN OF
ILL HEALTH AND TO THEIR ENORMOUS PROBLEMS OF SOCIAL AND •
ECONOMIC DEVELOPMENT. IT IS TRAGIC THAT MOST OF THE TIME
THE PEOPLE IN THESE COUNTRIES DO NOT HAVE A CHANCE TO KNOW
THE HARM THEY ARE DOING TO THEMSELVES"o
Cigarette Smoking and Tobacco chewing is the major avoidable
cause of ill health and premature mortality in countries where
this habit is prevalent. The WHO is of the opinion that,
failing immediate action smoking diseases will appear in
developing countries before communicable diseases and
malnutrition have been controlled and that gap between rich
and poor countries will thus be further expanded., The habit
of tobacco consumption is believed to be a major stambling
block to the .successful achievement of the goal 'Health for
All by 2000 AD'.
India is the third largest producer of this crop in the
world. Eighty percent is consumed at home and only twenty
percent exported• According to government figures about a
million deaths are caused annually in India by diseases
directly related to tobacco consumption.
oo Q
o
<Lj o
More and more young people are taking to this habit Thanks to the unscurpulous and unethical marketing practices
of the cigarette companies.,
At VHAI it was felt that ~ concerted awareness and education
programme be undertaken for school children, who are the most
■ vulnerable lot (first level). The second level would involve
lobbying and pressurising the. government to implement WHO's
guidelines on smoking control strategies. This would go
side by side of utilising media for awareness and pressure
building.
VH/iI could also play a major role in networking
on a national level with all other groups involved in Antixobacco Campaign and also networking with international agencies.
Another major area of concern which will be taken up in the
second phase along with Anti Tobacco Campaign is ’Drug Abuse’.
In recent years India has become the major transit and market
for Narcotics. Earlier in India only poly drug (Ganja, Charas,
Afeem etc) were abused and Narcotics like heroin only passed
through the country, from the ’Golden triangle'(Burma, Laos
and Thailand) and the ’Golden Creseht1 (Pakistan, A-fganistan
and Iran). With stricter controls in the west and in south
east, India is now emergin as a major market.
In Delhi and Bombay alone there are above one lakh Drug Addicts
each. In Delhi it is estimated that there are 10,000 drug
pushers and 2000’ children who abuse drugs, The popular drug
that is abused in India is 'Brown Sugar'., or 'Smack'. This
is a crude form of heroin, Opium is extracted from the popy
plant, Opium is a crude mixture of number of chemicals. The
chief being Morphine, Heroin is made from morphine in laboratories,
Smack or Brown Sugar is its crude form, mixed with
chalk. glucose or sometimes with rat poison.
The sad fact is that, this drug is slowly eating, and killing
our most resourceful generation, i.e. the Youth, This is a
problem that has to be recognised n’ot only by health institutions
but by each and every sane individual.
It is not too late.
The
o Q o
0^/0
alone is not going to solve the problem - but a strong
preventive awareness programme will to a large extent.
DRUG ADDICTION KILL IT BEFORE IT KILLS YOU
Phase-I.
87-88
- Building a strong data base Researching for creating need based
educational material-networking with
groups in India.
Phase-IIo 88-89
- Workshops in Delhi schools
- Close liaisoning with State VHAs
- Visiting tobacco action groups and
vigarette manufacturing units.
- Preparation of our exhibition kit
- Production of our information pack
- Drug awareness.
Taposh Ranjan Roy
Programme Incharge
Anti-Tobacco Campaign
People's Education for Health Action
jg/20.4.1988
MODULE
CAMPAIGN
NETWORKING
Health organisations
Schools and Colleges
Youth Clubs
Womens Groups
Social organisations
Service Clubs
Consumer Bodies
Government Departments
- COLLATION/DISSEMINATION OF
INFORMATION PRODUCTION OF
|Ministries, nongovernmental
NEED
BASED MATERIALS
’ organisationsz universities, etc.;
A
Information pack
Posters/Stickers
Handouts/pamphlets
Audio visuals
Exhibition kit
ORIENTATION AND AW2\RENESS
WORKSHOPS IN SCHOOLS AND
STATE VHAs
Central
i Smoking Control Agency
POLICY INTERVENTION
fv-
Implementation of WHO
Guidelines on smoking control
\
V
Ii
Stronger legislation on
Vmarketing and production
P S
KEY G R 0
UTILISATION OF MEDIA
\
Mass Primary
\
\ Community
publicity
media health
Schools\\ leaders
Awareness
care
'^Voluntary \ pressure building
system
^Health &
'I
/other
I organisation
^ORGANISING NATIONAL NO
a TZ
TOBACCO DAYS
People
i
i
Basic features cf a proposed
national programme structure and
organisation
-INCORPORATING SMOKING CONTROL
STRATEGIES IN SCHOOL HEALTH
PROGRAMMES AND CUPTIICULAMS
0
REPORT MViDE FOR ANNUAL GENERAL BODY
_________MEETING, 1988
Dr. T.N. Manjunath
It is common knowledge that India has a rich tradition and
culture.
This is true with it health care system also.
The vzest is looking for wome viable alternative in health
care in terms of Safety and cost-effectiveness. India with
its enormous potentials of various traditional systems of
medicine, which has been taking care of its populations for
the past several centuries. And went through several trial
and errors and stood the test of time.
Modern
medicine has been on the scene for the last 200
years only. And modern pharmacology is only 50 years old.
Even though modern medicine has made major breakthrough in
the management of acute infections, surgery and medical
emergencies, of late it has been realised and acknowledged
that it has its own limitations like increasing cost of
health care, increasing adverse effect of synthetic drugs.
With this it has been realised that Traditional Systems of
Medicine have a role in the formal health services.
Voluntary Health Association of India with its large network
in the country is trying to re-vitalise our traditional
systems of medicine through the institutions working in the
voluntary sector.
VHAI is working to create awareness and motivate policy
makers, planners, government indigenous medical institutions
and finally the masses through its various programmes; as
a follow-up action plan drawn at Hardwar Retreat in July *87.
1988
Phase I - Networking
1. Identify institutions working in Traditional
Systems of Medicine in the Voluntary Sector
°2°
2. Orientation and awareness building workshops
through Various State VHAs.
3. Practical need based training to help health
• and non health groups to run traditional medicine
based health care with some component of destern
System of Medicine incorporated in it.
4. Production of need based education materials on
Indigeneous health care systems.
Slides
Posters
Herbariams
Herbal drug museam
Mobile
1989 ?. 1. Work towards the
!l
Permanent
National Policy on Medicinal Plants”.
2. Draw the attention of National, International
and Non-governmental organisations.
Importance of
Medicinal
Plants
V
Deforestation
leading to
extinction of
medicinal flora
Dr. T.N. Manjunath
Programme Officer
Traditional System of Medicine
People's Education for Health Action
jg
Large scale
cultivation
and coneervation
of medicinal
plants
Information
Orientation Workshops
village level
National level
International level
V
Encourage
Herbal
T
H
A
RADITIONAL
I
MEDICINE
cottage Industries
Policy Interventions
’National Policy on
Medicinal plants’
Introdiigticq of
TSfi at''PHC level
!
I v I
Encourage Communi
herb gardens
n A2?Z2.KALJ4. ;4L/rH
Program
1.Diarrhoea
Diseases
Control
Programme
PROGRAMMES
Activities
Thus
far
VMAI involved in
• National Program
1988 and beyond
Seminars and workshops s
The silent Emergency -
Formulation
backgrounder to be
Better Care in
Diarrhoea/Severa1
produced by VHAI NGO Education and Training
by VHAI team .
Handouts/Taste of
Dro Mira Shiva (Collaborate with
Tears
Community Health)
Pesters
2.National TB
Better Care in TB
Rational TB Care - Hayden
Control
Programme
Posters - TB series
Hall, VHAI and NTI,
Field Area s Darjeeling
Workshops
GB Theme in Ooty
Theme f&r MFC
Annual Meeting
Saacl"il issue of
TB
3. Immunisation
Programme
HFM issue
Participated in
Technology Mission on
Polio
Backgrounder on
Vaccine production
and use
4.STD Control
Programme
Better Care in VD
5.Leprosy
Control
Programme
Better Care in
Leprosy
2
6. Prevention of Visual
7. Family Welfare Programme
Impairment and Control
of Blindness
Vitamin A Prophelaxis - Backgrounder s
’’The Vitamin A Story”
Posters
Questionnaire for Information from
grass root workers
Workshops
Dialogue with Govt. Officials
Field studies
GJ
e»
State VHA input
in the Programme
Baseline survey of Vitamin A deficiency
problems related to delivery of
Vitamin A in specific area
Suggestions for improvement in strategy
Dialogue
STATE VHA
VHA I
GOVT.
School Health
Education for signs of Vitamin A
deficiency and its prevention
8. National Goitre Control Programme
Better Care in Goitre
Poster Series
- Magnitude of the problem
- Production, distribution of iodised salt
- Signs of iodine deficiency
- Why to use iodised salt
- Backgrounder
- Workshop
9. National Malaria
Control Programme
Poster Series
Better Care in Malaria
VHAI is participating in an expert
Committee on malaria, for producing
health education materials.
Voluntary Health Association of India
40, Institutional Area,
(Near Qutab Hotel), South of IIT,
New Delhi-110016
Telegrams: VOLHEALTH
>1
'Zi
0/
New Delhi-110016
Phones: 668071,668072
PRICE LIST OF VHAI PUBLICATIONS w.e.f. 1st APRIL- 1988
Code No.
CH-8
CD-I
CD-4
D-l
Title
Price(Rs>
Where There Is No Doctor (E & H)
Better Child Care
(in all major Indian languages)
60.00
Feeding and Care of Infants and
Young Children (E 6c H)
A Taste of Tears
33.00
6.00
15.00
D-2
Better Care During Diarrhoea
(in all major Indian languages)
5.50
D-4
Better Care in Leprosy
(in 5 languages)
8.00
D-5
D-7
Better Care in iVD(major Indian langs)
Better Eye Care
11
“
,l
H
it
ii
Better Ear Care
10.00
A Manual of Learning Exercises
Helping Health Workers Learn
15.00
A Manual of Child Nutrition
25.00
Banned and Bannable Drugs
Management Process in Health Care
Teaching village Health workers
18.00
New Titless School Health Curriculum (*E & H)
9.00
School Health Programme
9.00
Rational Use of Medicines
14.00
Basics of Documentation
104.00
Hello Doctor, Here’s a Challenge
Medicinal Plants of India
12.00
Anti Smoking ( a set of 3)
12.00
D-8
HC-2
HC-3
NE-4
RT-3
SA-3
VH-2
Poster s
ii
it
8.00
6.00
72.00
81.00
54.00
15% rebate will be available to the general customer.
25% rebate will be available to State VHAs and other
Voluntary Organisations.
Packing charges will be 5% of the cost of materials upto
Rs.1000/— and 3% for cost of materials above Rs.1000/-*
Postage/freight will be charged at actuals.
9.00
Voluntary Health Association of India
40, Institutional Area,
zy.
Telegrams: VOLHEALTH
New Delhi-110016
(Near Qutab Hotel), South of IIT,
o/
New belhi-110016
Phones: 668071,668072
PRICE LIST OF VHAI PUBLICATIONS w.e.f. 1st APRIL- 1988
Code No.
CH-8
CD-I
CD-4
D-l
Price(Rs)
Title
Where There Is No Doctor (E & H)
Better Child Care
(in all major Indian languages)
60.00
6.00
Feeding and Care of Infants and
Young Children (E 6c H)
A Taste of Tears
33.00
15.00
5.50
D-2
Better Care During Diarrhoea
(in all major Indian languages)
D-4
Better Care in Leprosy
(in 5 languages)
8.00
D-5
Better Care imVD (major Indian JLangs)
10.00
D-7
Better Eye Care
D-8
HC-2
II
II
Better Ear Care
A Manual of Learning Exercises
HC-3
NE-4
Helping Health Workers Learn
RT-3
SA-3
VH-2
Banned and Bannable Drugs
Management Process in Health Care
Teaching village Health workers
18.00
New Titles? School Health Curriculum ( ’E & H)
9.00
School Health Programme
9.00
Rational Use of Medicines
14.00
Basics of Documentation
104.00
Hello Doctorz Here’s a Challenge
"
11
11
8.00
H
6.00
15.00
72.00
25.00
A Manual of Child Nutrition
81.00
54.00
n
Medicinal Plants of India
12.00
9.00
ii
Anti Smoking( a set of 3)
12.00
Poster s
15% rebate will be available to the general customer.
25% rebate will be available to State VHAs and other
Voluntary Organisations.
Packing charges will be 5% of the cost of materials upto
Rs.1000/- and 3% for cost of materials above Rs.1007/-*
Postage/freight will be charged at actuals.
Voluntary Health Association of India
Telegrams: VOLHEALTH
40, Institutional Area,
(Near Qutab Hotel), South of IIT,
New belhi-110016
>1
<
'zi
o/
kA
1A’
New Delhi-110016
Phones: 668071,668072
PRICE LIST OF VHAI PUBLICATIONS w.e.f. 1st APRIL- 1988
Code No.
CH-8
CD-I
CD-4
D-l
D-2
Title
Price(Rs)
Where There Is No Doctor (E & H)
Better Child Care
(in all major Indian languages)
60.00
Feeding and Care of Infants and
^oung Children (E & H)
A Taste of Tears
33.00
6.00
15.00
Better Care During Diarrhoea
(in all major Indian languages)
Better Care in Leprosy
(in 5 languages)
5.50
D-5
D-7
Better Care in.iVD (ma jor Indian langs)
Better Eye Care
"
"
"
10.00
D-8
Better Ear Care
6.00
HC-2
A Manual of Learning Exercises
15.00
HC-3
NE-4
Helping Health Workers Learn
72.00
A Manual of Child Nutrition
Banned and Bannable Drugs
Management Process in Health Care
Teaching village Health Workers
25.00
81.00
54.00
New Titles s School Health Curriculum ( ’E Sc H)
9.00
School Health Programme
9.00
Rational Use of Medicines
14.00
Basics of Documentation
104.00
Hello Doctor, Here's a Challenge
Medicinal Plants of India
12.00
Anti Smoking( a set of 3)
12.00
D-4
RT-3
SA-3
VH-2
Poster g
H
ti
it
ii
8.00
8.00
M
18.00
15% rebate will be available to the general customer.
25% rebate will be available to State VHAs and other
Voluntary Organisations.
Packing charges will be 5% of the cost of materials upto
Rs.1000/- and 3% for cost of materials above Rs.l003/-«
Postage/freight will be charged at actuals.
9.00
I
u>’'VOLUNTARY
HEALTH
A-43 E, Munirka,
ASSOCIATION
( DELHI )
New Delhi - 110 067
Telephone
665^25
January 19H8
( A Summary report of activities from 1985 - 1987 for
presentation to members and friends of the Association)
I. PROPAGATION OF HEALTH IN SCHOOLS
(a) Seminar on introduction of School Health
Date
Place
Participants
Programme:
: October 19S5
: Modern Child Public School, 1'
=
'
Nangloi
Principal & teachers of 15 schools
~•*-> and
10 selected volunteers from village
Nangloi.
Resource
persons
: Mrs. Purabi Pandey
Dr.Ruth Harnar
Dr .Mira Shiva
Air Vice Marshal Dr.J.K.Sehgal (Retd)
Dr.Amala Rao
First Seminar on School health was organised at Nangloi
during the 1st week of Oct.85. Representatives from 15 Private
schools from that area and 18 volunteers from village Nangloi
att&nded the Seminor. The Seminar was conducted at Modern Child
Public School, Nangloi. Dr.Ruth and other staff members of VHAI
introduced the topic to the participants and stressed the need
of introducing School health programmes in their schools.
(b) One day Workshop on Health
Date
Nov. 3Z
Place
Sury^ Public School,
Participants
Principal3 and teachers from 8 sc hoc 1.5
of West Delhi,.
Resource
persons
Dr•J.K.Sehgal
Padam Khanna
*85
Nangloi
Purabi Pandey
The one day workshop on School Health was conducted at Surya
Public School, Nangloi ca Nov.3, *85. Work in Sogth Delhi Schools
started from Nov.l, f85.
Following were the sessionsgiven by the Resource persons:
o
2
Mrs. Purabi Pcr.dey
Dr c Seu. gal
Padam Khanna
: General introduction and significance
of SH.
: Importance of good ventilation in
class rooms. Proper size of class
rooms. Ar. guate number of toilets
and safe drinking water.
s Pole of Parent-teach er relation;
student-teacher relation; parent
child relation in health programmes.
(c) Survey of Schools
■
In a Preliminary Survey of the schools, 'nearly 100 schools
were contacted in South and West Delhi. The Principals of these
schools were interviewed to assess the degree of cooperation they
would extend to ^HAD’s Health Programmes.
While discussing with
the Principals the main point emphasised was the relevance of
the background of the children studying in the school as VHAD
wanted to focus their attention to low and middle income groups
only. Such schools generally did not have or had only marginal
health programmesr Most of the schools charged very low fees
from children and even then faced lots of difficulties in collec
ting the fees in time.
^fter assessing the cooperation extended
by Principals and managements 26 schools were enrolled as Associate
members.
(d) Data collection on Immunisation: Status and the result£
Jan.lS6 - March *86
Date
South & West Delhi
Place
: 35
No.of schools
covered
5000
No.of children
A proforma to collect details on illness, morbidity and
Immunisation in family of school children was prepared and
printed and circulated to 35 schools covering nearly 5000
children in South and West Delhi. The children were asked to
take the proforma home and fill it with the helpl of their
parents as the Questionnaire contained many queries regarding
immunisation and illness in the family. Eighty per cent of the
children returned the Questionnaire duly filled in and they
were then coded and analysed.
The result is as follows:
Contd...3/-
3
About 31% were not able to give the necessary information;
15% did not have any kind of immunisation, The rest varied
between typhoid only; trippie antigen only; BCG only; Poli^
a*d trippie; Polio, trippie & BCG. Whenever there was an
incidence of illness, they all consulted a doctor (an allopath,
homoeopath or a vaid).
Five per cent suffered major illness
and were treated in hospitals, All of them followed t^e
prescriptions of the doctors,
(e)
Teachers Training Proqr^mmp:
Date
: May 23-23,
Place
: Lajpat Bhawan
No.of parti
cipants
Resource
pers ons
'P6
23
: From Safdarjang Hospital, R• A. K. Coll ege
of Nursing, r
Red Cross, NIP CCD, VHAI
§ individua Is.
Materials
CHEB, UNICEF,
VHAI
A Teachers 1 Training Programme was organised to train
teachers on School health education in South Delhi, West Delhi
and Trans Yamuna areas. 23 teachers from 12 schools participa tec. in the course conducted between May 19 and 2 3, 1986 at
Dajpat Bhavan.
A notice regarding the programme was circulated in the
schools and an opinion poll was conducted regarding the suitable
dates. May 19-23 was chosen, An application form and the
curriculum were circulated. Out of 50 applications received,
25 were chosen to attend the course. 23 teachers completed the
course and received the Certificates. Study materials from
VHAT, UNICEF, CHEB were given to the teachers. Resource persons
were selected from the staff members of Safdarjang Hospital
R.A.K. College of Nursing, Indian Red Cross, NIPCCD, Sanadhan
and VFUI and they conducted lectures on topics like First Aid,
identification of minor ailments in school children, naturopathy
and other allied subjects.
Teaching aids like slides, posters
and photographs were also used for effective visual impact
Contd . . . 4/-
4
The training helped the teachers to identify the children
who suffered from minor ailments in their classes.
They also
x*e£)lised the, importance of- health education in the curriculam a*-1
a preventive measure against minor
(f)
ilments.
Competitions
Date
Place
Participants
Nov.*86 - March ’S?.
Schools in South and West Delhi and
Trans-Yamuna.
Nearly 5000 children from 30 schools.
It was proposed to hold the competitions during Nov. 1 86 March ’87. Accordingly, entries for contests in drawing, essays,
slogans and debates were invited from schools. Nearly 5000
children from 30 schools participated in these events. The
drawings especially on personal hygiene, environmental sanita
tion and balanced diet gave a clear indication of the growing
awareness in the children these important aspects of health.
It was a gigantic task to sort out and judge the entries and give
suitable prizes as most of the children did well and projected
the themes given to them clearly. Though the date given for the
competition on health was Nov.,86, the programme had to be
prolonged as the schools had thei^bwn programmes of tests,
examinations, etc. during that time. Parents were aJsD present
at the time of prize distribution. Posters and books on health
were exhibited anc the children staged skits and speeches on
Health during the programme. Many parents praised the VHAD for
their efforts in creating health awareness among the school
children in this manner and extended their whole hearted cooper?
tion in future programmes.
(g)
School health meetings
Date
Place
Participants
: March 186 - April ’87.
10 Schools in South and West Delhi,
: Parents, teachers, students representatives.
Resource persons: Mr.Jayant’ Jha
Purabi Pandey
Con tel.. . 5/-
5
During this period, school health meetings were organised
in 10 schools of South & West Delhi to pirn health programmes.
Mrs.Purabi Pandey and staff members of VHAD had long dialogues
’ with many parent ; and teachers of these 10 schools.
AS many schools do not have even basic amenities like good
toilets, managementswere of the opinion that VHAD should
help them in getting these amenities at affordable costs. Most
of these schools are run in tents. They wanted to know the ways
and means of getting supplementary nutrition for their children.
They also expressed the view that, along with preventive measures,
curative cate should also be given importance through health
education. (VHAD ha's' now decided to give curative care to these
schools in a limited way).
(h) Second Teachers Training Programme
Date
Pl gee
May 19 - 23, 1987
Bal Bhawan
Participants
67 teachers from 20 schools of South,
West and Trans-Yamuna areas of Delhi.
Resource Team ; College of Nursing (AITMS-) z CHEB,De,Lhi ACmn,NIPCCD
Delhi Rural Devi Authority and experts
: CHEB, UNICEF, WHO & W. F
Materials
The Seco nd Teachers1 Training was organised during the
month of May 1987. The response from schools were overwhelming.
67 teachers were trained in the sec nd course. The training was
given mostly in the same pattern as that of the first one, except
that they were given training in communication techniques also by
the stafffaembers of CHEB. In almost all the schools, the
cleanliness check-up of the students has become a daily routine.
The teachers are trying to integrate health edunatiori with the
other subjects. These changes have been noticed after the
training of the teachers.
(i) A core of Resource persons and school children
: Oct.‘87 onwards
Date
Place
In 26 Associate member schools of VHAD.
Resource persons: Selected individuals and doctors who have
undergone training in communication
techniques.
Posters,
slides from Jan Vigyan Jatha of
Materials
Delhi Science Forum and books from VHAI.
Children of Associate member schools & 2
Participants
Tea ch ers.
- 6 Along with the teachers 1 involvement in educating the
children on health,
VHAD felt the need to give special attention
to Primary School children on health awareness orogrammes with
the help of a panel of other resource ,pe rs ons .
Vhu-kD is arrang
ing monthly lectures in each school on • different health subjects
with the help of visual aids such as suitable posters and slices
and with a Question-answer session at the end of the session.
The teachers are requested to take up the subject during the
month and the children are given tasks on that particular subject
covered by a core of resource persons.
The growing familiarity
with a core resource team is helpful t^.the school and the
ch ildren.
(j) Puppet & Magic shows on Health
Da te
;
Sept. *87 onwards
Piece
All the 26 member schools in South &
West Delhi.
es rticipants
Children/ teachers, ang^arents at times.
Puppetteers and magicians of Song & Drama
Division, Ministry of Information and
Broadcasting, Government of India.
Resource persons;
These shows were organised with a view to instil a sense
of awareness of health and hygiene through the medium of enter
tainment.
With the help of dong & Drama Division, VHAD is dole to
arrange puppet and magic shows in all the member schools free of
cost every month. The theme of these shows are health or
national integration. The children are really very enthusiastic
in this kind of learning end they look forward to these. While
enjoying theshows, they get the messages also.
(k) School Heeltb Mirror
A wall paper school Health Mirror in Hindi and English has
been used in member schools to stimulate awareness and discus
sions on subjects such as pensonalrhygiene, nutrition, care of
eyes, ears, tee^h, accidents, environment, food, etc.
Contd...7/-
0
7
((JO
n . of children suffering from minor ailments
and chronic diseases
Date
:Oct - Nov 1987
:/ill the member schools
Place
Participa nts : Consultants, teachers. VHAD members
and staff
Asystematic attempt to identify minor and
chronic ailments among children and to establish a curative
system was begun during this period.
With the assistance of teachers who had
training from VHAD in earlier courses, the staff prepared a
list of children iii member schools suffering from minor ailments
or chronic problems. This was submitted to the doctor members
of VH/D, who prepared a plan for curative services in member
schools. The system aims at providing arrangements for period
ical check-ups, prescription and advice and follow up action.
Laboratory tests are offered at a members unit. These steps
to be implemented from January 1988 are expected to create
a comprehensive school health services package in the ne ar
future.
The medical team for this work is inspired
by Dr B^K^Ghosh, Dr Nalini Abraham and member doctors K.Ganesan
and R.R,Prasad.
1I>
JOINT PROGRAMMES WITH MEMBER ORGANIZATIONS
(a) HEAnTH Camp
Date
Place
May 5,
:
Partners:
Partici paints
1985
-
New Horizon School, Nizamuddin
Sujan Mohindex' Hospital
Sewa Delhi
Samadhan
Children 350
Women
200
75
Men
Residents of Jhuggi Jhonprj. areas of
Nizamuddib and bastis of Ajmeri gate were invited to this
camp.
It was held at the New Horizon school,whose
management cooperated enthusiastically. A team of doctors from
Sujan Mohinder Hospital examined all the patients and gave
s
breathlessness and disabled Polio victims.
(b) Reorientation Programme for Public Health Nurses
©at©
: November 17 - 19,
1986
Place:
: Bhim Na gar 1(8' uth Delhi)
Participants : 25 public health nurses
Organizers
: Trained Nurses Association (Delhi) VH7JD
Resource Persons
Materials
: Doctors from Safdarjang Hospital,Bhim
Nageri Health Centre, RAK Nursing College,
T.B•Hospital and senior public health
nu rs e s
s CHEB and UNICEF
An Orientation programme was organized by TNA(De_hi)
and VHAD
during the month of November 1981 for 4 days for the
public health nurses who are involved in school health programme
of the Municipel Corporation of Delhi. The public health nurses
were given instruction by the resource team on how nurses could
educate the children while they were treating them and how effective
it would be
education on particular ailments
were suffering. The preventive measure would be
from which
absorbed by the child as it had already suffered due to ignorance.
The four day workshop was appreciatec by the participants'
who expressed their desire to participate in such workshops as it
increased their enthusiasm and spirit of service by being able to
share their difficulties with other participants.
Health Camp
Date
: Dec 4,1906
Place:
: Palla Village, Alipur Block(North)
Participants: 60 Village women from 4 village projects
Sang^"0
Delhi Grameen Ma hila
Resource Persons
: Chairman,BalBhavan,Staff of DRDA,Delhi
Administration,Block Development Officer
Alipur and VHAD Field staff'
Sixty women from 4 villages gathered at Palla for 3
days. They were- introduced to new hon conventional ways of cooking
in solar cookers, smokeless chulhas and food preservation methods.
The doctors from Delhi Administration gave advice rn family planning,
immunization and on prevention of minor ailments. The Block Officer
gave the d tells regarding vocational training courses available
to the villagers with government help. Ms Tara Ganc hi, special
9
(d)
Health Camp
Date
Place
Participants
Organizers
Resource Persons
Sept 22 to 26,
s
19 87
Dakshinpuri
: 30 women from resettlement colony
: VH/J? member, INDIRa SEWA KEMDRA
: Dr Usha Bannerjee
Col R.N.Bannerjee
Dr Lalita Krishnan
Mr Sharma
Ms S.R.Sharma
Family Planning Association of India
Thirty women from Dakshinpuri Participated in this
camp.
They were exposec to non conventional way of cooking in
solar cookers. They brought their own vegetables and pulses
ano cooked them in these cookers
on oral
The Resource Team advised tuem
oral rehydration
rehycration theraoy
them on
immunization, minor ailments, balanced
diet and
balanced diet
and on cheap nutrit
ional foods. National Co og
Society sponsored
Ms Sharma gave them
sponsored Ms
op Society
details regarding cooperative movements. The women showed lot
of interest in this subject and they planned to register a society
o
their own,The FPAI film on Health & Hygiene was appreciated.
The- women were taken round,Delhi and introducer to hosp
itals where they could receive specialized treatment, if and
when necessary.
TIT. INFORMATION CUM DOCUMENTATION
CUM SERVICE CENTRE
Some spade work has been done in
establishing this Centre.
Further progress has been made in the
clippings on health from leading
pertainig to the health issues^in
end of 1987. Paper
newspapers end journals
since
^ntry and in
Information regarding'funding and
on de—addiction centres were also colic ctec .
Delhi arc being maintainer:^
.
<a)_liesldantial_associations_ and Mmunity centres
Information retarding the activities of 35 associations were
coUected by circulating proformas to Presidents and 3.c„tories
at Residential societies and incharges of community centres
and personal meetings with them. The main objective of this
activity was to sssesss the manpower potential for leadorshl
?
Farther,man power support
to VHAD involvement in school health
programmes could be
assured.
and action towards promotive, health.
10
Indian systems of medicine and tested home remedies is also
expected from contact with office bearers and members of these
associations.
(b) Collection of Information on availability of technical
assistance to the public from non governmental and
government Bodies
De te
:
1985
r>
1987
VHAD has been able to collect a lot of information regarding
the availability of technical assistance and vocational training
to the public, particularly women and youth from the Gbvt
and other agencies* These informations have been shared with
participants in VHAD camps and workshops. Some of the agencies
with whom contacts have been established are listed below.
However this is notn the full and comprehensive list of contacts
made.
1. Sulabh
, Pa lam Gaon, New Delhi
low cost latrines
Bio gas units
2 . Delhi Administration
7 Lancer Road, Delhi
- Non-conventional Energy use
t Mori Gate
- Tree planting, poultry,pisci
culture. Cattle raising
3. D R D A
4 o Delhi Science Forum
Saket, New Delhi
5. South Delhi Polytenic
South Ext Part I,N.Delhi
y
on of science in
life, films, posters, books
Nutritional Food
6. SAHAN, Shaeed Jit Singh Marg
- Vocational Training for
Institutionsl^rea, N.Delhi 110016
mentally retarded
7. National Institute of Health and
Family Welfare, Munirka/N.d. 110067
8. Servants of the People SocietyLa j pat Bhavan,N.D.110024
9. Sri Aurob indo Centre, Addchni
New Delhi 11 00 16
10. Delhi Administration, MSO
Building,ITO,New Delhi
Heelth films
Yoga and Naturopathy
Health Foods and yoga
Food preservation
11. Amarjyoti Trust, Karkardooma - Artificial limb fitting end
vocational training for disabled
New Delhi
12. Family Planning /^sociation
Munirka, N.Dell0067
Immunization/ Family Welfare
13. Parivar Kalyan Sansthan,Safdarjang
Enclave,New Delhi 110029
ii
it
11
Collection of pos ters/slides/
films eto
has been collecting posters, slid s, books and other
Visual aids from WHO, UNICEF, CHEB, Delhi Administration,
Ministry of Human Resource Development, VHAI and Delhi Science Forum
Forum and other agencies in Delhi ano in other states and in
particular from those involved in non formal education. VHAD
has been using these materials for its training programmes and
for exhibition in schools
IV.
PARTICIPATION IN PROGRAMMES OF MEMBER ORGANIZ/^TIONS
AND ON REQUEST FROM OTHERS
On request VHAD provided avclunteesr to make a health
survey and report o n the health status of the destitute
women at Tilak Vihar in early 19S5.
VHAD hed been participating in programmes conducted by
member and non member organizations and was able to assist them
in availing the technical assistance
agencies.
from govt and non govt
VHAD staff members have also learnt a lot from attending
the workshops and seminars conducted by member organizations
from time to time.
Representatives of VH^D have also participated in workshop
in Calcutta organized by Habitat Centre ano visited the
in Need Institute (CINI) West Bengal
Vo
Child
VHAD STATE training
Selected members of the staff have attended a Documenta triion
Course at Hyderabad and an orientation Course on Primary Health
Card at Jamkhed, Maharashtra inMarch-April and August 1'9*7
VI.
PARTICIPATION IN VHAI MEETINGS
Staff have participated in the following VHAI meetings:
State VHA meeting
s September 1986
General Body meeting
: April 1937
VII.
CONSIDERATION OF NEW PROJECTS
An Inter—College Debate at the Delhi University is pr-opos ed .
Preliminary steps have been taken.
A proposal to
set up a Resource Centre at Nangloi is
under consideration, Two Principals Mrs Me her and Mrs Roy hoove
extended help. Objective is to meet the need of a neglected
area.
An impressive school health exhibition with the ass is tance
- 12 with assistance from VHAD staff.
An active voluntary support was given by VH.Jj staff during the
National village Health Workers Convention at New Delhi in
October Igg?.
A drawing competition was conducted in all the merrber schools
during November 1987 on behalf of Appropriate Health Resources
and Technologies Action Group Ltd, London at VHAI's request.
( Jointly prepared by VHAD staff Ms ASmat Ara Khan
and Ms Janaki Sarma)
z
Voluntary Health Association of India
Telegrams : VOLHEALTH
40, Institutional Area,
(Near Qutab Hotel), South of IIT,
New belhi-110016
kA
'Vio
/z.
New Delhi-110016
Phones: 668071,668072
PRICE LIST OF VHAI PUBLICATIONS w,e,f. 1st APRIL- 1988
Code No.
CH-8
Title
Price(Rs I
Where Tnere Is No Doctor (E & H)
Better Child Care
(in all major Indian languages)
Feeding and Care of Infants and
Young Children (E & H)
60.00
6.00
D-l
A Taste of Tears
15.00
D-2
Better Care During Diarrhoea
(in all major Indian languages)
5.50
D-4
Better Care in Leprosy
(in 5 languages)
8.00
D-5
Better Care imVD(major Indian langs)
10.00
D-7
”
"
Better Eye Care
II
II
Better Ear Care
A Manual of Learning Exercises
11
8.00
H
6.00
CD-I
CD-4
D-8
HC-2
33.00
15.00
72.00
25.00
HC-3
NE-4
Helping Health Workers Learn
RT-3
SA-3
VH-2
Banned and Bannable Drugs
Management Process in Health Care
Teaching Village Health Workers
18.00
New Titless School Health Curriculum ( ’E Sc H)
9.00
School Health Programme
9.00
Rational Use of Medicines
14.00
Basics of Documentation
104.00
Hello Doctorz Here’s a Challenge
Medicinal Plants of India
12.00
9.00
Anti Smoking( a set of 3)
12.00
Poster s
H
ii
A Manual of Child Nutrition
81.00
54.00
15% rebate will be available to the general customer.
25% rebate will be available to State VHAs and other
Voluntary Organisations.
Packing charges will be 5% of the cost of materials upto
Rs.1000/- and 3% for cost of materials above Rs.l000/-«
Postage/freight will be charged at actuals.
d i ’CsH
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Part B
(Group Learning)
Discussion
1 hour
1. You are the Warden of an orphanage and there are 100
children from 1-10 years of age in your Centre.
a. How would you measure the growth and •c’cvelopweht'"of the
children?
b. What signs of nutritional deficiences would you look out
for in these children?
2. You are a primary school teacher in a village, you would
like to take some classes for the children in you class on Health
a. What topics will you take?
b. How will you present theni to the children?
2
3. During your visit to the families in the village you come
across the following problems, What: would you like to find out
about the causes of these problems?
What advise^ would- you give to the parents of the child?
a* A two year old ^child with Diarrhoea
be A four year old little girl v-.’ith Malnutrition
c. A young man with two light coloured skin patches on his back
d. An old woman who is having fever, cough and sputum for many
months
4. You have been in a village for over one year, you want to do
something about many health problems of the people, However you
know that you may get transferred in about 14 months time,
a. What are the activities you can initiate in the area of health
in the village
b. How will you' ensure that the work continues after you are
transferred?
IV'
COMMUNITY HEALTH AND DEVELOPMENT COURSE
(COMMUNITY HEALTH CELL)
90 Minutes
6
Phase I - Evalnation
his evaluation is an attempt to explore some of the learning
experiences you have undergone during the Phase I of our
course, it consists'of two parts. The first one helps
you to assess your individual', learning. The second part
which you are expected to attempt in discussion with some
of your colleagues is a means to assess group learning.
ve
PART A
■
■■■
"
'
'"lC‘
/1
■
- (Basics)
1. Describe in five lines what you understand from the words:a) Community:-
I
b) Health
c) Development
!
2. List out THREE important signs of the following
dimensions,,of Good Health
a) Physical Health i)
ii)
iii)
b) Mental Health
i).
Il)
■7 ill)
c) Social Health
i)
11)
ill)
i
L
2
3. List out the important a)Parts b)Functions c)Signs and
symptoms related to Ill health of any FOUR of the following
systems
a)Respiratory b)Circulatory c)Digestive d)Musculo-skeletal
e)Nervous f)Urinary g)Reproductive h)lmmune system
Functions
Parts
.. . 'V
Signs and
symptoms of Ill
health
1.
2.
3.
>
.
■
4.
!
4. List out the important a)Parts b)Functions and c)Signs and
symptoms related to Ill health of any TWO of the following,
special senses.
a. Eyes
b. Ears
Parts
1.
c. Nose
d. Skin
Functions
e# Tongue
Signs and
symptoms of Ill
health
3
s. Answer any six of the following pairs of questions
3. What is fever?
What are the common causes/types of fever?
b. How do you recognisesMalaria?
t-4or-Cs_)
re
iV
H~<~ JI
Typhoid?
c. What is Diarrhoea?
How will you manage a case of Diarrhoea?
d. What is Jaundice? How is it caused?
What precautions will you take in a
case of Jaundice to
prevent spread?
e. What causes peptic ulcer disease?
What preventive measures will you take?
4
f. What are the common skin diseases you know?
How do you tackle scabies?
g. What is Ringworm?
How do you tackle it?
h. What is the cause of Hypertension or Diabetes?
What advise (other than medical) would you give?
ia What are the common respiratory illnesses you know?
What action (other than medical) will you take to give
relief to Respiratory illness?
6. It is said that working with leprosy patients there is
more risk of getting the disease
What do you feel about this statement?
5
the
7. Write a few important points on
a. Diagnosis of Leprosy
b. Classification of Leprosy
c. Treatment of Leprosy
a. Causes of plantar ulcers
VIKAS
Centre for Development
Dalal House/ Panchvati Marg, Ellisbridge/ Ahmedabad 380 006/
India
An Introduction:
1.0 The Organisation: VIKAS Centre for Development is a regis
tered Public Charitable Trust/ a no-orofitno-loss voluntary agency established with
the purpose of educating urban and rural
masses for their development. Vikas mainly
works in the fields of healthcare, sanitation/
community development/ education etc. Vikas
wishes to solve the problems of the people
from the weaker section of the society,
acting as a link between various agencies
and the people. Vikas wishes to apply
itself to more meaningful work using its
professional skills to serve and satisfy
the needs of masses with small means and
limited resources. Rather than adopting a
sectoral approach to solve various problems
of the society/ Vikas aims at evolving a
comprehensive development methodology/
thereby effectively upgrading the standard
of living of the oppressed masses. Vikas
aims at becoming an influential changeagent
strengthening its ideals of serving the
masses-the urban poor in the cities and the
oppressed in the villages.
2.0 Areas of Interest:
2.1 Education
2.2 Health-care
2.3 Sanitation Maintenance and Environmental
Improvement
2.4 Rural Development
2.5 Community Development
2.6 Transfer of Appropriate Technology
2.7 Housing Improvement
2.8 Slum Improvement and Restructuring
- 2
3.0 Aims and Objectives:
3.1 To study and solve the problems of
urban and rural areas to improve the
quality of life of people.
3.2 To influence the public at large and
the Government, semi-Government,
voluntary, development, educational
and other institutions in studying,
understanding and solving the problems
of urban and rural areas.
3.3 To provide a forum to intellectual
resource groups for persons motivated
to work in the fields of urban and
rural development.
3.4 To undertake, promote and assist
activities related to healthcare, sanitation, education and housing improve
ment in urban as well as rural areas.
3.5 To promote, undertake and support
activities leading to the promotion
of human development ahd welfare among
the general public and awareness among
the poor and backward class of the
society.
3.6 To develop methods and techniques in
order to help people identify their
own problems and solve them.
AUGUST: 1982.
Phone : 67150
El/208 ARERA COLONY
BHOPAL
462 016
EKLAVYA
CHA K M A K
If your initial reaction is - •Yet another children's
magazine?!' - we understand. With so many of them
floating around, there is need to explain - why Chakmak.
A cursory examination of all the available children
magazines and similar children literature shall reveal,
amongst other things, the following :
By this
we mean the contents, the illustrations, the
pricing, the lay-out - everything.
1) They are targetted for urban children.
il) By and large, their contents suggest that all
that children like, or ought to like, are fairy
tales, tales of kings and queens or religious
stories.
111) There is no attempt to involve children in creative
activities or thinking, infact the reverse is likely to dull them.
Chakmak has particularly been thought to side-step these
absurdities. It is specifically meant for distribution
amongst the rural children; hence its contents, illustra
tions, lay-out and pricing are being worked out with such
an objective in mind. Through it, the aim is to make
children perceive their physical and social world with
an Increasing sense of criticality — to question and seek
answers. For this purpose, attempts shall be made to en
thuse them to use games, puzzles and activities directed
towards an awareness and understanding of their environ
ment. All this
is - - intended through interesting
contents, so that their curiosity is arousedand they feel
'participants' rather than a 'target' of a magazine.
Gradually, a large portion of the content shall be derived
from their writings and activities.
Chakmak shall ensure to eradicate in its content feudal,
religious, sex and caste biases - hence no eulogies for
kings and queens.
Though a large portion of the content will be directed
towards the demystification of science and technology,
it is not going to be a science magazine of the tradi
tional type, because it shall include good literature,
history and social sciences in an analytical manner,
drawing and painting etc. In essence its main objective
is to make children perceive all aspects of life inter
estingly, creatively, critically and scientifically, and
not merely talk of science.
IHoj ?r
(■
E K L A V Y A
Eklavya is an autonomous voluntary group registered
under the Societies Registration Act of 1860.
The founding group of Eklavya had been a participant
in the Hoshangabad Science Teaching Programme (HSTP)
in some way or the other. This group got together
with the aim of consolidating and furthering the exper
iences gained from the HSTP. In a very general sense,,
the main objective that Eklavya has set for itself is
to strive for inculcating a critical awareness amongst
the rural masses in both the physical and social dom
ains. To carry out this objective, Eklavya works both
in the formal school structure and outside it. In the
formal sector, Eklavya is expanding the HSTP to other
regions of Madhya Pradesh; it has already seeded the
programme in six more districts of Madhya Pradesh in
the last one year - Dhar, Dewas, Ujjain, Shajapur,
Rati am and PJandsaur.
In addition, Eklavya is engaged in bringing in similar
curriculum changes in social science and Hindi teaching.
In the non-formal sector, Eklavya has undertaken mass
propagation of ideas aimed at demystifying science,
looking at history, culture, environment, planning and
development more critically and in an integrated manner.
For this purpose, booklets are published and distributed,
a bulletin called ’Hoshangabad Vigyan' is regularly pub
lished, and regular articles are writeen in newspapers
and periodicals; however, the aim is to reach rural
masses, and this determines the choice of media. For
example, ’Rozgar and Nirman’, which reaches every vill
age panchayat of Madhya Pradesh (18000), carried for
months together a full page by Eklavya on popular science.
Now, a children’s magazine, named Chakmak, shall be pub
lished (monthly) and a copy shall reach all middle and
higher secondary schools (15000) of Madhya Pradesho
Eklavya staff stays in field centres at Pipariya, Hosh
angabad, Harda, Dewas, Ujjain and Dhar, in close touch
with schools and villages, and works in collaboration
with the local communities. A strong work-force is that
of about a 1000 school teachers, who have been trained
by Eklavya. With the help of some of these teachers,
science clubs, .environment clubs and discussion forums
are being opened"in remote areas.
In recent months, Eklavya has, naturally, been involved
with the Bhopal Gas Tragedy and has produced the follow
ing documents on it:
Bhopal - a people’s view of death, their right to
know and live (English, copies available).
{■
Bhopal Gas Trasdi - Jan Vigyan ka Sawal (Hindi,
copies available)
Bhopal’s environment after the gas tragedy
(English, limited copies).
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will” exercised by modem entrepreneurs—their responsible
decisions regardinghiring, expansion, etc.—may in fact arise
A biblical view
of the best personal judgments available to them.
of Roman and American economics outTheir
individual “free will” decisions, however, are being
duplicated by hundreds of thousands of other managers, and
by Walter Wink
“arbitrary” deviations (choices dissimilar to those of
ot only the uneducated, but large
'
'
0
I%
numbers of the best educated,
I
including government finanI %
J
cial experts, find money mat|>
|
ters the final mystification.
B
j \
The current “stagflation” criLmiw J
sis has forced confessions from
the economists themselves. According to former Secretary of
tne Treasury George Schultz, “We are in a very unusual
period, where we more or less cast loose from [economic]
beliefs that we once held to be unarguable. We have cast off
from a large number of these old moorings, and we have not
yet found new ones.”
Economics has always had this unpredictable quality, as of
a
power operating independently of its human
1
a transcendent
agents. This is not simply a “primitive” impression. The “free
A^t^l^opiSivS
competitors) are usually quickly abandoned, as if invisible
forces were at work to compel uniformity. The return to the
pattern predicted by earlier growth suggests, according to M.
Haire, “the operation of inexorable forces operating on the
social organism.” Perhaps Adam Smith’s “invisible hand” no
longer operates through competitive enterprises on an open
market, but it seems to operate nonetheless.
Our language for these phenomena is no less mythological
than that of Scripture. Perhaps it would be worthwhile to
contrast our perception of these “invisible powers” with the
biblical authors. What we call “economics,” “politics,”
“systems,” and “social structures,” they designated by a more
inclusive category: “the principalities and powers.” Unlike
our more neutral, antiseptic terms, however, the biblical
language
_ _ has the virtue of addressing the fact that these
powers are ordained by God.
It is God’s will that we live corporately, sustained,
nourished, and served by these suprapersonal structures. Yet
at the same time, these powers are also demonic, seeking their
own advantage as the highest good, regardless of the long
term, best interests of humanity. In examining economics,
then, we will be analyzing but one of the many powers that
encompass us, serving and exploiting, benefiting and
burdening us.
Sojourners Reprints. P.O. Box 29272. Washington DC 20017. Single copies 50<: quantity discounts available.
The Roman Economy at the Time of Christ
J
;
t might be a misnomer to speak of a “Roman
economic system,” for the Roman state, on the
whole, avoided direct involvement in comI
mercial enterprises. Where it had to become
J
J involved, it practiced a kind of stateI capitalism of a slipshod sort. Not until the
Iwkk J fourth century did it direct its immense
resources toward state-owned businesses in any significant
way.
Otherwise its policy was to make the world safe for
merchants and to extract from them the stiffest tolerable
return. Grain production was concentrated in Egypt, Syria,
and the Caucasus; and some products such as Tyrian purple,
Aquileian amber, and Pergamene parchment, were the
monopoly of locales. Generally, however, transportation costs
were too high to make a consolidated economic system
possible.
There were no real “companies” in the modern sense. Some
individual magnates amassed fortunes in business and
commerce, but wealthy merchant families never succeeded in
hanging on to their newfound wealth long enough to build
dynasties of the Rockefeller or Rothschild sort. Rome was too
quick to swallow these upstarts and expropriate their
fortunes for its wars.
Since land was not so easily converted into the emperor’s
coin, liquid assets were quickly converted into large estates.
The rich of the gospels were thus landowners, usually
absentee (Matthew 20:lff., 21:33ff., 22:5,25:14-30). Since land
was ancestrally owned, the wealthy had to find powerful
means by which to pry tracts loose from their owners. One
way was cash; the more frequent was foreclosure for debt.
The tenant farmers of the gospels lost their land through
debt (Matthew 13:44, 18:23-35, 21:33-46; Mark 12:1-12; Luke
16:1-13). The pattern is known all too well by the modern
sharecropper: goods undersold in the market by the large
plantations, inability to meet bills, deepening indebtedness,
sale of one’s land to avoid imprisonment, or becoming an
indentured servant.
Jesus spoke quite seriously and literally when he referred to
§
E our forgiving one another’s debts (Matthew 6:12), and he
o depicted a king doing just that for his indentured servant
g (Matthew 18:23ff.). There was little hope for the poor without
some such wiping clean of the slate in accordance with the
s ancient Israelite injunctions of the Sabbatical year and
a- Jubilee. No wonder the first act of the Zealots at the outbreak
© of the Great Jewish War in A.D. 66 was to burn the temple
o treasury, where the records of indebtedness were stored.
- There was no free trade within the Empire. Products that
g were transported over great distances had to contend with the
high costs of transportation as well as a gauntlet of customs
| districts and their avaricious toll-collectors. It was cheaper to
■g make
mnVn poor nnnioc
(rnnJs Innallv
copies nf
to imnnrf
them,
of mmlitv
quality goods
than tn
import fhnm
locally than
and consumer demand made shoddy work profitable. The
second century saw a sharp rise in decentralizationand mass
£ production of low-quality goods, with a resultant loss in
E artistic ability and innovation.
£
With the decline in the quality of the arts and crafts within
& the Empire, demand for luxury items from Africa and the
* East soared. One of the earliest “radical” economic treatises,
Revelation 18, pictured with remorseless satisfaction the
•£ anguish of the “merchants of the earth” who will weep over
® Rome’s burning:
Q.
1
...since no one buys their cargo any more, cargo of gold, silver,
jewels and pearls, fine linen, purple, silk and scarlet, all kinds
of scented wood, all articles of ivory, all articles of costly wood,
bronze, iron and marble, cinnamon, spice, incense, myrrh,
frankincense, wine, oil, fine flour and wheat, cattle and sheep,
horses and chariots, and slaves, that is, human souls.
(18:11-13)
A great deal about Roman economics can be learned from
an analysis of this passage alone. Even a partial listing of the
origin of the various luxury items gives an idea of the breadth
of the trade:
Gold—Africa, Spain, Gaul, the Caucasus; silver—Spain, the
Caucasus, Gaul; jewels—India, Arabia, Egypt (amethysts,
beryls, emeralds, topazes), Ethiopia (emeralds); pearls—
India, Ceylon; fine linen—a Roman monopoly within Egypt;
also produced in the Caucasus, Spain, Anatolia, Palestine,
Syria; purple—a Tyrian monopoly with a new rival in
Mauritania under Augustus; silk—China, India; scarlet—
Tyre; scented and costly woods—Pontus, Somalia, India,
Africa, Mauritania; ivory—India, Africa; cinnamon —India;
spices—India, Ceylon, Africa, Arabia; incense—Africa,
Arabia, India; wine—Italy, Asia Minor, the Greek Islands,
Spain, Gaul; oil—North Africa, Palestine, Italy \fineflour and
wheat —Egypt, Syria, the Caucasus, North Africa; cattle and
sheep—Northern Italy; and slaves—all conquered territories
especially Syria, Bithynia, Africa and, after the Great War in
A.D. 70, Judea.
Freedom to travel made it possible for merchants from
every nation to engage in this traffic. Syria, Egypt, and
Ephesus were the chief depots for the luxury trade wending
its way toward Rome. Trade with the Far East, which had
flourished under Alexander and later under the Egyptian
Ptolemies, had languished during the early Roman period.
Gradually it was revived, creating a balance of trade with the
East that was unfavorable to Rome, which lacked desirable
exports.
Since it was cheaper to ship wheat to Rome from Egypt than
to move it overland within Italy, Italian farmers switched to
growing feed-grains for livestock, which could then be driven
on hoof to Rome. The result was an even deeper shortage of
wheat in Italy, greater dependency on Egypt and Syria, and
greater vulnerability to famine in the event of natural
disaster: exactly the pattern into which our own world
economy has fallen.
The same held for the province of Asia: wine rendered five
times more profit than wheat off the same acreage, so its
production undercut local grain cultivation. Frequent
famines were the result. Domitian sought to provide relief in
A.D. 92 by decreeing that the vines should be uprooted in
favor of grains, but the landed interests forced him to
withdraw his edict and to impose sanctions on those who
allowed their old vineyards to go out of cultivation. Hence the
dry outrage of Revelation 6:6:
. .
.
And I heard what seemed to be a vowe m the nudst of the Jour
civing creatures saying, “A quart of wheat for a denarius, and
three quarts of barley for a denarius; but do not harm oil and
wine!”
Whereas in Cicero’s time (to A.D. 43) a denarius, the day’s
wage, bought 12 quarts of wheat and 24 of barley, now
inflation had so eaten up the denarius that the family could no
longer buy enough to eat. The fact that it is God who speaks
here on behalf of the poor, and speaks virtually nowhere else
in the book of Revelation until 21:5, is evidence of the depth of
God’s anguish on behalf of the poor.
One can scarcely avoid comparison with today, when grains
are grown for alcoholic beverages and for cattle feed, while
other farmers are paid to allow their fields to go out of
cultivation, despite massive starvation and unmistakable
evidence that it will worsen in the decade ahead.
It was into this Empire that the gospel spread. The New
Testament abounds with reflections of the general distress the
poor suffered at the hands of landowners, bankers, and
creditors.
Jesus wasted no time in declaring for the poor (Mark 10:1730; Luke 6:20-26, 12:13-14,15, 16-20, 22-31, 32-34, 16:19ff.),
and his disciples were those who would voluntarily join their
ranks (Mark 10:17-30; Luke 1:53, 12:21). He identified the
world’s great idol as Mammon (Matthew 6:24), by which he
meant money, or property in general, as a power no longer
under human control and no longer in the service of human
needs. The chief manifestation of the god Mammon is
accumulated wealth.
tne way
Thus, when aricn
way to eternal Me,
Jesus the
a rich man asKeu
asked jesus
told him to
gjve jt the poor, and follow
all he
him" (Mark ld?17-22). Jesus’ ruthlessness’ here is over
whelming; he refused even to use the occasion of the man s
conversion as a way to fund his own band. Nor did he plead
with the man to change his attitude toward his wealth and
practice better stewardship of the “largess bestowed upon
him by God,” as our preachers like to put it Instead, he
demanded complete divestiture of the rich man’s wealth.
In the discussion which this exchange provokes, Jesus
makes it clear—against almost the whole history of the
interpretation of this passage, which has been nothing less
than a history of rationalization and dilution —that no rich
person can enter the kingdom of heaven. The “eye of the
needle” is not “city gate” in Jerusalem; that is a figment of
medieval exegesis. It is the eye of a sewing needle, and it is
easier for a camel to squeeze through this tiny hole than for the
rich to enter the kingdom of heaven (Mark 10:25). In short, it is
impossible. The rich must cease to be rich (Mark 10:23-31;
Luke 1:53, 3:10, 12:32-34, 14:33, 19:8-10).
The parable of the rich man and Lazarus indicates tiie
reason. The rich man “feasted sumptuously every day,” as
most of us do, while poor Lazarus was lucky to beat the dogs to
the garbage. When Lazarus dies we discover him safe in the
bosom of Abraham, whereas the rich man cries out in torment
from hell (Luke 16:19-31). This account, at every stage of its
development, is not the original pie-in-the-sky argument
whereby the poor are lulled into acquiescence with the hope of
a heavenly reversal. On the contrary, it demonstrates the
impossibility of salvation for those who promote a situation
which causes inequities and those who gorge themselves on
.
the illicit fruits of their injustice.
Jesus permitted no one to be his disciple while clinging to
accumulated wealth. His retinue shared what they had in
common (Luke 8:1-3), a practice which the early church
continued in a most dramatic way (Acts 2:45, 3:6,4:32-5.11, 2
Corinthians 6:10; 8:2; Revelation 1:9, 7:16-17).
Because Jesus’ followers expected the world to end
immediately, they developed no economic strategies. Since
they expected the kingdom any moment, they merely
liquidated assets and lived off the proceeds until the
Jerusalem church was destitute.
Paul, too, anticipated a speedy end. Apart from raising
st support for the Jerusalem church, his main advice was for
/ those who buy to live “as though they had no goods, and those
| who deal with the world as though they had no dealings with
i it. For the form of this world is passing away” (1 Corinthians
'7:30ff.).
Once the imminent end faded, this advice degenerated into
mere Stoicism, a kind of bourgeois disinterestedness which
made toleration of inequities all too easy, a result Paul would
have deplored. By the time 1 Timothy 6:17-19 was written, the
wealthy were being courted, coddled, and coaxed to be
generous with a wealth they were no longer required to
renounce.
The Epistle of James, by contrast, clearly teaches that the
rich inquirer is to receive absolutely no special treatment, for
it is the poor of the world who are heirs of the kingdom (James
2:1-7; also 1:10, 4:13).
And naw, you plutocrats, is the time for you to weep and moan
because of the miseries in store for you! Your richest goods are
ruined; your hoard ofclothes is moth-eaten; your gold and silver
are tarnished. Yes, their very tarnish will be the evidence of
your wicked hoarding and you will shrink from them as if they
were red-hot. You have made a fine pile in these last days,
haven't you ? But look, here is the pay ofthe reaper you hired and
whom you cheated, and it is shouting out against you! And the
cries of the other laborers you swindled are heard by the Lord of
Hosts himself. Yes, you have had a magnificent time on this
earth, and have indulged yourselves to the full. You have picked
out just what you wanted like soldiers looting after battle. You
have condemned and ruined innocent men in your career, and
they have been powerless to stop you.
(James 5:1-6, Phillips)
Here, at the navel of society’s underbelly, there is no
mystification of economics at all. James calls it straight, just
like the Seer of the Apocalypse. These biblical authors saw
what some of us are only now beginning to grasp: a total
aggregation of power in a system inimical to life. Never mind
that they lacked analytical tools for diagnosing it—ours have
not proven all that good either.
They called it Mammon. They saw it concentrated in Rome.
By A.D. 95 the author of Revelation was able to describe the
emperor-cult with clairvoyant precision as a consolidation of
power with religious trappings to legitimize it and economic
sanctions to enforce it. Among the characteristics of the
Roman civil religion and its priesthood was this:
It causes all, both small and great, both rich and poor, both free
and slave, to be marked on the right hand or the forehead, so that
no one can buy or sell unless he has the mark, that is, the name of
the beast or the number of its name.
(Revelation 13:16ff.)
Today we are familiar with some of the same forms of
economic strangulation: the blacklist, refusal of seller’s or
builder’s permits, requirementof asocial security number for
every conceivable non-social-security purpose, and un
employability because of political, religious, or economic
views.
The Multinationals
0
ur economic system, of course, is
scarcely comparable to that of the
first centuries of our era. Whether
it be the state capitalism of Russia
or the monopoly capitalism of the
U.S., the decisive difference be
tween then and now lies in the
importance placed on economics today. Economics is an
abstraction which dominates us beyond the farthest reaches
of awareness.
Our entire social system is a giant machine of production.
People are “units of production,” and the public, “consumers. ”
We have made economic growth the primary social good. We
pass off the problem of poverty as an outstanding debt to be
paid off by further economic growth, though by now we
should have learned that increased productivity does not in
fact resolve inequities in the distribution of wealth.
Consumerism, as the political philosopher Charles Taylor
puts it, has become the only universally available mode of
participation in the cult of modern society. When poor blacks
buy fancy cars, or destitute Mexican children shine shoes in
order to buy Coca Cola at twice the cost of local colas, they are
not just being “materialists.” They are saying, according to
the only rules society has laid down, “Damn it, I belong!”
We, too, have an economic system bearing the marks of a
priestly religion, though it appears to be a wholly secular
economy with no religious pretensions whatever. Modern
monopoly capitalism is manned (there are almost no women in
top management) by a new breed of idealists who see the
By now we should have
learned that increased
productivity does not
resolve inequities in the
distribution of wealth.
global corporation as “the most powerful agent for the
internationalization of human society,” in the words of
Aurelio Peccei, a director of Fiat.
According to Richard Barnet and Ronald J. Muller (in
Global Reach—The Power of the Multinational Corporations},
many of these corporations have sales greater than the gross
national product of entire nations. GM is bigger than
Switzerland, Pakistan and South Africa; Royal Dutch Shell is
larger than Iran, Venezuela, and Turkey. These world
corporations thus have the leverage to counter the virulence of
nationalism.
The world managers believe that, by managing the world as
an integrated system, they can solve the economic and social
problems of the planet, including poverty, housing, un
employment, and the environment; and that by shifting
personnel all over the globe they can inculcate an a-national
consciousness, helping to “detribalize” humanity. People w*11
become citizens, not of their country of origin, but of th
corporation. (The director of Nestle Alimentana S.A., Dr.
Max Gloor, says that the company’s executives must develop
what he calls “special Nestle Citizenship.”)
Here we are faced with the problem of one power setting
itself against the unquestionable evil of another. For behind
the salutary idealism of these world managers one perceives
another deification slouching toward the Holy Place, to set
itself “where it ought not to be” (Mark 13:14). The “one world”
these theorists long for is not the world of which Christ is the
universal principle of cohesion. It is, instead, the world of a
hierarchical pyramid presided over by the world managers
themselves.
“The nation-state has succeeded in attracting from
organized religion the basic religious impulses of man,”
according to a 1971 working paper of the Chief Executives
Roundtable. These same religious impulses must be
harnessed by global corporations, the document continues, if
they are to secure the legitimation necessary to gain people ’s
faith that what they are doing “is in the interest of every
human being” and “will eliminate hunger and increase the
goods and services available to everybody.” Barnet and
Muller correctly grasp the drift: “If the global corporation is
to survive it must, in effect, establish its own religion. ”
Chilling. It makes Revelation 13 read like a clipping from
the Wall Street Journal. John could see the “beast from the
land” (13:11) for what it was: a pseudo-religion whipped up by
the emperors and fanned by fawning sycophants; a religion
which “makes the earth and all its inhabitants worship the
first beast,” Rome (13:12).
U
The process is the same today, only the beast is different.
The world managers are, like the Roman Empire,
manufacturing a new world-religion capable of legitimizing
the world corporate system; motivating its devotees, the
“consumers;” and gaining acquiescence. Its values are clear:
profit, growth, survival; its priesthood: the top managers,
keepers of the mysteries (not even the U.S. Senate can obtain
copies of their profit statements); its god: the corporation
itself; its acolytes: the advertising industry, with its capacity
to create new needs and to legitimize the corporations. It even
has a new ethic: the Consumption Ethic, which has virtually
replaced the old Work Ethic.
One does not often find sociologists speaking biblically, but
sociologist Robert Bellah does just that when he says, “The
pressures to maximize the power and wealth of large
government structures pull us along. It’s like being possessed
by demons, if you want to use the biblical metaphor, because I
^on’t feel human beings are in control of it. And I feel that, if
? don’t get in control of it, these huge structures which know
nothing about love and care and concern for human beings,
but only about maximizing power, income, and wealth, will
take us to destruction.... We have to bring these structures
under control, or everything we value will be destroyed. ”
It is probably true that corporate managers are obsessed
with power; but it is probably not true that they are just
personally greedy. Greed, the oil of capitalism, inheres in the
system itself.
According to traditional capitalist theory, private greed
was supposed to lead to public good, since competition would
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restrain the selfishness of each to the benefit of all. Now,
however, monopoly capitalism has destroyed the open
market, a possibility which already troubled Adam Smith.
“We are not contending against flesh and blood, but against
the principalities, against the powers, against the world
rulers of this present darkness” (Ephesians 6:12). We are
contending against the greed, including our own, reified into
systemic solidity by a host of persons over a long span of time.
The economic system is greedy on our behalf. We as
individuals are thus free to have clear consciences, treat
people politely, raise lovely families, live in nice homes, and
care about humanity in general. It is precisely this
institutionalization of greed that Jesus called “Mammon.”
Because institutionalized greed is a power, the quest for a
private solution is futile, whether it be individualistic
conversion, personal insight through depth therapy, or
increased awareness through meditation or encounter
groups. It is hardly reassuring to learn that approximately
half of Fortune’s 500 top businessmen have been “sensitized”
through sensitivity training. One wonders if perhaps an even
higher percentage is nominally Christian. I have an axiom
that runs, “Every good, by itself, is evil.” The unquestionable
personal enrichment that accrues from these “solutions”
cannot affect the premises of the system itself; and it is the
premises which are evil.
The great developmental push of the 1960s simply widened
the gap between rich and poor. American consumer wants
have been imposed on people too poor to attain their
satisfaction. Local food patterns have* been undermined in
Our economic system
appears to be wholly
secular, but it bears the
marks of a priestly
religion.
favor of American “junk” foods and infant formulas, resulting
in a new kind of “commerciogenic malnutrition.”
Finance capital, raw materials, and brain power have been
drained from the poorer nations instead of utilized on their
behalf. The idealist dream of the world managers has, under
the scrutiny of analysis, proven a nightmare for the world’s
impoverished, now even poorer than before the corporations
stepped into their lives.
One mark of a power run amok is the sense of powerlessness
not only of its victims, but of its operators as well. The
pressure of the annual profit sheet prevents overseas
managers from supporting income redistribution which
might create wider markets in poorer countries in the future,
even though this would be in the company’s long-range
interest. These overseas managers are systemically inhibited
from acting for the good of the whole.
Eight local managers in poorer nations who were
interviewed by Barnet and Muller felt a degree of moral
distaste and frustration with practices which are bleeding
their nations of much needed capital and resources. But
necessity prevents their doing otherwise: “If we don’t engage
in these practices, our competitors will, and where does that
leave us two, three, or five years down the road?” queried one
executive.
The world managers are being managed! They themselves
are captives of values and commitments which set them at
odds with their own deepest feelings of justice and humanity,
and which render them powerless to change. It is not then
surprising that job alienation has spread to as much as twothirds of lower and middle management. The entire corporate
enterprise appears to be losing legitimacy for many sensitive
people in the system.
We should be aware of the danger of unmasking the powers
without offering a vision of life’s true cohesive source. The
most telling consequence of this de-legitimation, salutary as it
is. is a high incidence of alcoholism, depression, drug
addiction, and divorce among executives and their wives.
The Church's Response
hose who care must then ponder what is
“the manifold wisdom of God” which the
church might now make known to the
^^“principality and power” (Ephesians
|
|3:10). In words of utter simplicity, 1
I John 3:17 lays this matter before us: “If
|
La^H^^^^Jany one has the world’s goods and sees
his brother in need, yet closes his heart against him. how does
God’s love abide in him?”
Today that
confronts not
not only
only individuals,
individuals,
question confronts
that question
Today
whole
nations.
....____
individually,
The first step, of course, is for each of us to take individually,
Our personal transformation will not change the system, but
it is the indispensible prerequisite to systemic change. We can
alter our own patterns of consumption: less fuel, less junk
food, less litter,less
litter, less detergent, less beef: more recycling, more
conservation, longer use of clothes and products, rejection of
style fads and the mania for newness. Our very values can
change: we can slough off the spell of bigness, the love of
luxury, the bogus security of owning things.
The values needed for justice and survival are the familiar
1* j
democratic values preached by prophets and sages since the
;pect for human dignity, justice,
beginning of history: respect
frugality, honesty, moderation, and equality. “These values,”
____ 1__ “urill
Barnet and Muller, “will not come tn
conclude
to mnlano
the
replace flip
temporary outmoded values—competitive individualism,
contemporary
wciote, infinite growth, and security through
comfort,, waste,
uuiiuuil
accumulation—because human beings suddenly learn alal
truism. They will come to be the dominant values in the
>ming century, if at all, only if enough people are awakened
coming
to their necessity for the survival of the species.”
Change unquestionably begins here, in our own econo-' >
practices and beliefs, where the entire edifice of legitimat
j
rests. We have been systemically “trained in greed” (2 Peter
2:14) from birth, and we can neither indulge in the pseudo
righteousness of those who deny their complicity nor assume
that our hands are cleansed by mere recognition of the evil.
We will be involved for the rest of our lives in pulling out the
“flaming darts of the Evil One” (Ephesians 6:16) which this
system has driven into our flesh.
We
cannot stop- there, however, or our good becomes an evil: a
---------------personal solution to systemic distress which leaves the systei
intact. Short of a total world revolution, I see no immediate
prospect of displacing the global corporations. Revolutionary
Vietnam and Angola were already negotiating with the oil
companies even before the smoke had cleared. National
ization of Western enterprises by Third World countries can
have only limited usefulness, since the corporations have now
prepared contingency plans for switching production
elsewhere and absorbing the losses.
While we wait for better, more encompassing strategies to
emerge, those suggested by Barnet and Muller can provide a
start. We can find ways to hold the global corporations
responsible to the general public, such as new worldwide laws
requiring complete financial disclosure; the break-up of
holding corporations; repeal of laws favoring investment by
U.S.-based corporations overseas; and defeat of pro
corporation legislators working against the public interest.
For several decades the United States has been moving
toward ever greater income disparity, not only between rich
and poor, but between rich and middle class as well. It is time
we seriously considered ways to redistribute income.
Banks should be required by law to get out of nonbanking
businesses, and bankers to get off the boards of corporations.
Local communities could take an aggressive role in requiring
corporations in their area to operate with public ac
countability, worker involvement in decision-making, and
less hierarchical plant procedures.
Regulatory commissions might be elective rather than
industry-dominated through appointments. Ways could be
found to encourage more decentralized cooperatives that
handle not only food, but clothing and other necessities as
well.
We already have “socialism for the rich, laissez faire for the
poor.” Since the rich always get the best, why not let the poor
and the increasingly exploited middle class have a taste of
socialism, too? When will we demand adequate health care for
all our people, for example? Why not see to it that the super
rich pay taxes for a change?
But this is only a start. The basic contradiction of capitalism
: he most fundamental issue of all. We can no longer sanctify
* stem premised on greed. The alternative we offer to the
present evil order is not anarchy, but the yet unrealized
possibility of a more just world. It will emerge, not from the
brain of a single thinker, or even from the concerted efforts
of many, but from the polar interplay of all the existing
powers. It will thus be a compromise: human, fragile,
relatively unjust.
But we cannot leave the world to the world managers. Our
involvement may mean just the thin margin that edges the
order toward greater equity. Short of the kingdom, we may
not hope for more. We cannot, in good conscience, hope for
less.
The church’s involvement in this struggle is crucial. No one
expects the corporations and the government to break up
their long love affair just for a clean conscience. The massive
lobbying powers of the multinationals alone can prevent most
of the needed changes. And the churches are implicated in the
system right up to their steeples, both as legitimators of the
satanic values which make exploitation so easily tolerable to
Christians, and as dependents on the financial overflow of its
wealthier contributors.
The larger issue is the moral legitimacy of the corporations
nselves. Once the churches seriously begin to question
tneir own docile acquiescence in the values of a system
premised on exploitation and greed, as the churches of South
America and black Africa are already starting to do, then the
economic system is under notice that its own collapse is
imminent unless it finds a way to re-establish its moral
legitimacy.
The church has seldom had a clearer mandate to act. If the
churches are willing to suffer loss of status and members for
the sake of obedience to the gospel, they can make the
manifold wisdom of God known to the principalities and
powers in the heavenly places (Ephesians 3:10). Their simple
message, “Christ is Lord,” is the death-knell of every sub
system’s pretentions to absoluteness, and the gl immer of hope
to those who are being exploited.
Finally, it is time to overhaul our national theology of
wealth: the blasphemy about God having blessed America. God
has done nothing of the kind. This is the source of the heresy
that we are rich because we are righteous and righteous
because we are rich. God did not “give” this land to the white
race. We took it from Indians who were wise enough to know
that God had not given it to them either—it was God’s. They
were simply his guests—“stewards ” as the Bible describes it.
No one really knows how to construct a perfect economic
system in the United States which greedy people will not
subvert to their own gain. But we are free to risk moving
toward a way that is more equitable and just, knowing that we
are grounded in an inextinguishable love whose banner is the
cross. Such love makes one feel wonderfully small, and finite,
and human.
Enveloped by such love, which trembles at the suffering of
the world’s impoverished, how can we do less than everything
we can to change ourselves and our system toward the justice
which God desires for all his children?
Greed has been
institutionalized: the
economic system is greedy
on our behalf.
Walter Wink is Auburn Professor of Biblical Interpretation at
Auburn Theological Seminary in Neie York City and Staff
Associate at the Hartford Seminary Foundation in Hartford,
Connecticut.
IMF
MAK1NG MEDICAL EDUCATION RELEVANT-A STUDENT’S
POINT OF VIEW
RAVI NARAYAN*
Introduction
The history of Indian Medical Education
reaching down over the decades—for over
100 years, has seen no major changes in its
pattern, structure or adoptation to the chang
ing needs of Indian Society. Even after
over two decades of Independence and
National planning the problem of uneven
distribution of medical personnel i. e. 20%
of doctors in areas where 80% of the popu
lation resides, still continues. This is irres
pective of the increase in number of medical
colleges from 25 in 1947 to 97 in 1971 and
the annual admissions from 2000 to 12000.
Since our Medical Colleges continue to be
located in the urban areas the needs of the
rural population has been sadly neglected
and in addition the concept of community
health even in our urban areas has not been
adequately stressed by these colleges. There
fore the greatest need in India today is—
1.
To make Medical Education more
community oriented.
2.
To reorient
clinical training to
prepare our young doctors for work
in rural areas.
Shortcomings in the Present System
The present system of medical education
makes the young medical graduate ‘professio
nally incompetent’ and ‘emotionally unpre-
pared’ to face his new role in the community
because of the following shortcomings :
1.
Education is not community oriented
Medical Education in India is hospital
oriented and not community oriented. The
doctor does not learn to treat his patient
within the context of his life in society but
on the basis of brief encounters in the wards.
He looses sight of the fact that the stress and
strain of everyday life affects the patient both
in health and disease and if this is not taken
into consideration the treatment becomes one
sided.
Academic Environment of Institutions
The environment in nearly all the teach
ing institutions is highly academic where each
person endeavours to work in as narrow a
field as possible. This stress on specialization
leads to the fragmentation of a patient
making medicine more organ-centred. The
student therefore prefers to specialise rather
2.
than take up general practice.
3. Stress on Curative Medicine
Too much stress is laid in our teaching
hospitals on curative medicine and little or
no stress on the preventive and social aspects.
A student studies these aspects through a
course of didactic lectures but no attempt is
made to make these concepts a practical
reality with reference to the cases in the
ward,
* Registar, St. John’s Medical College, Bangalore. At present at London School of Tropical Medicine and
Hygiene.
t Paper read at XI Annual Conference of Ind. Ass. Advancement of Med. Edn., held at Poona, 1972.
70 IND. JOUR. PREV.
4.
SOC. MED.
Foreign Bias in Medical Education
The textbooks we study are all written by
foreign authors whose experience is based on
casesand facilities present in their hospitals.
The student thus develops a foreign bias and
is not able to reorientate his knowledge to
suit the special needs in our rural areas or
even in our smaller urban communities.
Community Oriented Medical Education
To make our system relevent to the needs
of our society certain changes have to be
introduced in our present patterns of training.
All these suggestions have been discussed
with students and all of them have been
found to be acceptable to them.
For Medical Education to be more
community oriented the earliest change must
be:
(a) Pre-professional Student Counselling
All high school and pre-university students
planning to take up medicine as a profession
must be counselled to make them aware of
their responsibility to society.
(b) Pre-professional Course
The student should be prepared for his
role in society through lectures in certain
aspects of sociology, anthropology, elements
of economics, statistics and biomathematics
even at this stage.
(c) Preclinical Course
The introduction of Preventive and Social
Medicine at this stage is very welcome. The
student must be taught about Nutrition,
Industrial and Personal
Environmental,
Hygiene, Population Dynamics and National
Health problems and programmes. A
systematic course in the social sciences i.e. in
Sociology and Psychology at this period of
training will make the student aware of
vol
. 4, June . 1973
certain duties towards the community which
are overlooked during the hospital training.
(d) Clinical Course
It is during this period of training that
medical students
can be made most
‘community’ and ‘rural’ conscious. Though
the hospital is the centre of his training an
attempt should be made with the help of a
well organised community health department
to shift the emphasis of training and research
from the hospital to the whole community.
This can be done by:
(1) Clinical bed-side teaching must take
into account the preventive and social as
pects of diseases encountered in the wards and
the student should be encouraged to study
these aspects in each case. e. g.: In a case of
T. B. (i) a follow up of the patient’s contacts
must be made, (ii) At the time of discharge
the patient and his family must be educated
on the public health measures to be taken to
prevent spread of the disease, (iii) A study
of the socio-economic circumstances in which
the patient developed T. B. should be made.
This will help students to understand and
appreciate all aspects of a disease and its
treatment.
(2) Throughout the course, in addition to
the ward training, the students in batches
must be made responsible for the primary
health of organised groups in society like
school and college students, children in
orphanages, inmates of destitute homes,
rehabilitation centres, prisons and in the big
cities even of localised slums. The stress
should be on primary health care and mass
screening. One of the criticisms of hospital
training is that the students are not given
enough responsibility in the treatment of the
The above scheme would help
patients.
them to shoulder this resposibility and make
them more conscious of their usefulness in
MAKING MEDICAL EDUCATION RELEVANT ----A STUDENTS POINT OF VIEW
society. Recently the Bangladesh Refugee
problem gave many of our interns and
students an opportunity to voluntarily accept
the responsibility of a large number of people
for a certain time and this has been a very
rewarding experience.
L
(3) The Rural Orientation : In order to
prepare a student for work in the rural
1
I
J
1
areas he must be familiarised during his
course with rural conditions, rural culture and
traditions and the psychology of villages.
This can be done by: (i) a study of an Indian
Textbook which should be prepared on the
lines of the book ‘Medical care in Developing
countries—a symposium from Makerere—
Nairobi which is based on African rural
conditions, (ii) Practical traning in rural areas
for upto 6 months during the clinical years
and 3—6 months during the period of
internship.
(4) The PSM Department which would
also be Public Health or Community Health
department has a very important role during
clinical years. In addition to the cS-ordinated
activities suggested above student should be
helped to conduct surveys and studies in the
field work areas in nutrition, infant care,
I-'
J
I
I
71
which will give him a background for possibe
village work after internship. Each Medical
College could take over a few primary health
centres or start its own rural health centres
where such training could be imparted.
This programme could be planned out with
the Government District Health Officer so as
to prevent too much overlapping in the
health care of particular villages. In this
connection the government scheme of sup
plying 50 bedded mobile hospitals to medical
colleges to provide opportunity for rural
work is very welcome
( f) Postgraduation
According to latest estimates at least 50%
of medical graduates go in for higher studies
either in the country or abroad. One of
the main reasons is that young doctors
who qualify have to compete with their
seniors who are already well established in
the urban areas. Therefore to enter this
highly competitive field they feel the need
of specialization. If at this stage however
the government offers certain incentives like
“good living and working conditions, vehicle
for field work, visits to specialised institutions
maternal welfare and in diseases like TB,
Cancer, Malnutrition and Diabetes. The
students could also be posted in this depart
ment for 1-2 months for partcipating in the
above schemes.
in the country and abroad and opportunities
for professional
advancement by way of
admission to postgraduate
courses after
(e) Internship
orientation during the medical course the
majority of our young doctors will opt for the
rural areas.
Finally it is during the period of internship
that the young medical graduate will be able
to determine how well oriented he is for work
in the rural areas—if he is posted in a
Primary Health Centre for 3-6 months. In
the company of a senior doctor and his
colleagues he will get a first hand impression
of the type of work in Rural Medical Centres,
completion of 2-3 years in rural areas” I
am sure with the added background of rura{
In conclusion it can be said that the
crying need of the moment in the field of
medical education is to widen the horizon of
the student from a severely clinical patient
oriented outlook to a wider, socially cons
cious community outlook.
EDITORIAL
MEDICAL SERVICES IN INDIA
In the colonial period in India the State Health Services for the general public
consisted of medical centres in Taluka and District Head Quarters and Small Pox vaccina
tions and control of epidemics when they broke out. In the last days of this period, the seeds
of modern health service was implanted by setting up the Bhore Committee. Since 1952
the health orgnisation began to take shape on a compromise out of the one recommended
by this committee. One can see today vast improvement over the health services of the
colonial days. But from the very begining the foundation of this health service has been
weak. One would expect that any scheme should be based on earlier determination of the
volume and nature of the problems so that the services best fitted to tackle them can be
identified. To a certain extent such attempts have been made for mass diseases especially
for Malaria but in the case of medical aid, it has been one of unabashed neglect.
Studies of the medical services is needed as regards its quality, quantity, availabi
lity and efficiency. These will be affected largely by the health status of the population.
Many studies on morbidity are available but two defects are commonly seen in them. Most
of them do not conclude inductively for the population because of the initial neglects in the
samples. Morbidity has been surveyed by questionnaire, data from hospitals, examinations
by senior students and junior doctors, interview by medical social workers, by telephone
and postal enquiries etc. and by special methods as use of X-Ray, biochemical and
microbiological laboratories without caring to note and check the correctness of the
procedures. Definitions of parameters and morbidity are hardly mentioned and sometimes
In all these, unreliable results, which are not
not even the programme of work.
repeatable have been constant features.
Without sufficient heed to one’s capabilities and
facilities, there have been efforts to bite more than what one can chew. It is not surprising
that the aim appeared more to produce a ‘paper* rather than to find out what the real
experience of the population is.
This situation is mainly due to the fact that sufficient
thoughts have not been directed to the method of morbidity survey as yet and that they are
difficult. The easiest way therefore has been to neglect them.
As regards the actual medical services, the immediate objectives and the final
goal of the different medical Institution like Primary Health Centres and their subcentres,
the referral Hospitals, the District and the teaching Hospitals have not been defined and
they continue to remain vague. Are they to be merely curative centres ? Are they to take
part in comprehensive medical care ? If so, to what extent and in which situations can
they work ? What are the resposibilities of the general medical practitioners and the
specialists, working on their own, in the total health care programme ? Similarly, the parts
played by the private and big trust hospitals have to be related to the health services.
ii
vol
IND. JOUR. prev . soc . med .
. 4, June , 1973
Physical facilities for medical establishment like buildings for different purposes, their
sanitation, drugs, instruments and other equipment etc. have to be investigated. Technical
problems on one side and human relation on the other make medical services a science
more than an art. Where does one fit into the other for the benefit of the public—the tax
payer and the voter ? Number and qualities of different type of staff needed for attainment
of the final aim and immediate objective are not at all determined on scientific basis.
A budget limit is bound to be always there and efforts to provide the best of services under
the conditions have to be made on a basis supported by scientific enquiries. But we have
no information and no scientific thought on them. The medical services, born of im
pressions and ignorance, are empirical. It is a makeshift orgnisation with an outmoded
programme yielding to pressure from whatever sources they come.
The above shows a gloomy and negative picture.
Yet, there are possibilities and
hope too. The need is, at the first instance, collection of scientific data and then to go on
for planning reorganisation of the present medical services or introducing new types.
Reseasch in the health service will have to be continuous. With the establishment of one
type of health service, it becomes stereotvped with the passage of time and resists
further development. Interests get vested in the system and they fight any effort to change.
On the other hand social ideas progress and scientific discoveries come on thereby making
a particular type of service of little use to the public. The situation here is dynamic and the
services and orgnisation should have continuous evolution. The Health Service departments
have not been either inclined to such research or have found them unrewarding in the
course of their day to day service programme. Thus, this national responsibility should be
taken up by the departments of Preventive and Social Medicine and other institutions like
the All India Institute of Hygiene and Public Health and National Institute of Health
Administration and Education.
With 100 departments of P. & S. M.
today, it should not
be difficult in the country to accept this responsibility.
Inspite of the unfortunately misleading name (which has brought in so much
difficulties for the P. & S. M. Department and their activities) the 100 departments are
bound to go for seeking informations on determinats of health and disease and identifying
the most suitable health services through their 100 Health Training centres. It may be said
that a department of P. S. M. would earn the claim to its existence when it satisfies the
three responsibilities of teaching, research in Epidemiology and research in planning-evalua
tion of health services. The Governments which own the medical colleges and employ
the staff have hardly made any demand of service or research on the P. S. M. Departments,
the only exception being undergraduate teaching. There is no doubt that the governments
by this neglect, are losing excellent opportunities of getting their health problems investi
gated by these P. S. M. Departments. This is mainly due to the ignorance about the fun
ctions of these departments. On the other hand so far as the medical services are concerned
it is equally true that except rare exceptions these departments have not shown their worth
through voluntary research work aud publication about this type of service.
EDITORIAL
iii
It is earnestly hoped that those departments of P & S. M. doing post-graduate
teaching, about 40 in number in India, would try to wipe out this omission in recent and
not too distant years. In the course of these research work, occasions will arise when the
need for a face to face discussion with other workers on these problems will be felt.
Through its aims and objectives the Indian Association of P.S.M. can provide such a forum.
But joining such a discussion group unprepared and without previous experience and
thought will not be of much use. Publication ahead will provide, to the readers, points of
initial contact for understanding different aspects of these problems, so that the later discus
sion will be more fruitful. The Indian Journal of P S.M. can offer co-operation in this field
by providing space for such articles.
I
—A K. NIYOGI
w
Voluntary Health Association of India E -31Telegrams': VOLHEALTH
C-14, Community Centre
Safdarjung Development Area
New Delhi-110016
ri <
V I2
New Delhi-110016
\4.\
I'nl
Telephones : 668072
> $'
al
%
,
.
668071
B-4fll9.
IW7071982
LIST OF COMMUNITY HEAL'D! PROJECTS
IN THE VOLUNTARY SECTOR IN IWIA
ACTIVITIES
NAI-1E OF THE INSTITUTE
!•
Victoria Hospital
Dichpalli, Nlzaciabad Dt
503 175, A P
Contact person:
Mr Narasimhaiah
2.
Indo-Dutch Project for
Child Welfare "
Chevalla Block, Hyderabad
A' P
Contact Person:
Dr H W Butt
3.
Nutrition Education Unit
& Conniunity Health Project
CSI Campbell Hospital
Jamalamadugu 516 434
Cuddapha Dt, A P
4> Swallows;in India'Rajupeta
Project,- Rajupeta, Post
via V Kota 517 424
Chittoor Dt A P
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramongrla
Bangalore-560034
India
a. Under Fives Clinics
b. Family planning and maternal H S
c. Health Education
d. Leprosy care
e. VHW Training
a.
b.
c.
d.
e
f.
h.
a*
b.
c.
Health services
Creches
Mahila Mandals (Hyd Mix)
Youth clubs
Individual dairy fanning scheme
Individual backyard poultry unit
Agriculture
Training of ANMs and Dais
Developing and monitoring of MFR E
workers scheme ■
Training of village health agenta
Nutrition programm for -under fives
Village clinic
Immunziation
a. General hospital
b< Community health & training pf VH?.<
c. Non formal education school for be
d. Outreach curative care programm
e. Balwadi
f. Maternal and child health & tinder
g*
h.
c Hnic/iramunization
Farmers training programm
Adult education / Maliila Sanagam
Tree planting/Entrijronment^ sanita-
Is/g/7071982
J
:2:
£
5.
j
Arogyavaram Community
Development Project
Arogyavziram Development
Society, Madanapalli
A P
He
be
C<
de
e.
fe
g*
6.
Jevandan Projects (Health
Center) 9 lingampet PO,
Ye Liareddy T*luq
Nizambad Dt, A P
Soil mamgement and conservation
Irrigation
Farm mechanisation and workshop
Agriculture credits/inputs
Advisory demonstration programm like
irrigation, animal husbandry
Village road reconstruction
Drinking
1 water and sanitation
h4'!
Public Health (MCH, health education, ■
control of communicable diseases)
a#
Health center
Community Health programm
Training of VHWs
Integrated development programm
be
c,
d.
Contact person:
Fr Remigi Nadackal
7.
Health Center Tallampallem
Kavali Taluq, Nellore Dt
A P '
Kalankari Center
Asaniketan Training Center
Vengalarao Nagar, Kavali
524 202
AP
a.
be
c.
d.
e.
Kalankari Training cum production centoT'
for women economically backward
Leprosy control programm
General .^health center
Village visits
Balwadi
Contact person:
Sr Madeline
3.
Brothers to all Men (BAM)
Gaya Bihar
d.
Community health project
Leprosy control
Training of VHWs
General development
a.
b.
c.
d.
Small Health centers
Village work for Health
Training cf VHWs
Maternal and child health—
a<
b.
Ce
IL
9.
%
Community Health Project
Palamau Dt, Bihar
(
7
]>4*119 . . . u
:3:
5s7iv7071982
He %yr. Sadan Davakfernna
Zankhvav^PO via Kosajriba
Surat Dtj G-ujarat
Contact person:
Sr Angela (MBBS)
a.
b.
c.
d#
Health care
Vi‘Hage community health project
Training of dais and VHVfe
General developnent wor&
I
*
12. Kaira District Mothers &
' Infants Health prograarf
Trj.bhuvandas Foundation
&nul Daypy
Anand., Gujarat
.'3 ^>V^
*<
Gomj^ehc^pgive rural Health
Sex^vicep ¥roj oct
Ballahgarh, Haryana
a.
b#
Cw
S-.
bG>
d»
Contact perse-n:
j> R^diah
x»
Pnder fives clinic
Health & welfare of mothers & infants
Medical caro / food / wat^r
Medi cal eare OPD (Antenatal postnatal
child 0^)
School health services
Family planning programm r
Teaching and training - ANM, ioidvd.TOS?
junior residents in rural medicine •
Research - We an£ motion study of basic
health worlceri and stjidies o .q Qlinical^
^ciplines
■■■w
14. ABPANA. Trust
M^dhuban, Kqrnal, Haryana
a.
K
c.
dispensary
Public health project
E^re camp
Goulet person:
DrW < y^h^a
V
W;
15^ Lady Williiigtpsi'Hospital
ManaH, Kulu Dt, H P
175 131
b,
G.
Health education
z
Nutrition
Control of ipfectio^ disease®-\TH
Malaria )
IixiirnizaMUi®.
Family planning
Sanitation
Training of VKWs
.n
Sb
T}A,
7
F* * “?/•?
16. John Bishop Memorial
f.
g>
*
.j
Italia.» .,,VHW Training
<
:4:
Wg/7071982
17.
Comprehensive Health &
Rural Development Project
Good News Society Hospital
Bidar Dt
Karnataka
a.
b.
c.
d.
c.
Health education with visual aids
Immunization programm
Antenatal and postnatal care
School health programm
Clinics
a.
b.
c.
d.
e.
f.
Health education
Under five clinics
Nutrition program
Juvenile guide
Family counselling and maternity Care
Socioeconomic development(agri, cottage)
Environment & Sanitation
Leprosy/TB/Cholera control program
Rehabilitation of the disabled
Contact person:
Dr A C Salins
13.
Health for a Million
Project
St John’s Hospital
Pirappencode PO
Trivandrum Dt, Kerala
h.
19.
Marianad Community Development
Proj ect
b.
Puthencurichy 695 303
c.
Trivandrum Dt
d.
Kerala..
f.
gh.
20.
Conimunity Health Project
Christian Hospital
Chhatarpur, 1-IP
a. Socioeconanic development of the
fishing community
Catamarams
Marketing
Fishermen’s cooperative
House building
Vj 11 age level ’workers/leadership
training
Health programm
Youth clubs & creche
Saving scheme
Mahila'sangain. - courses to women on
social, family, home
a.
b.
c.
d.
School Health program
Urban area program
Rural area program
'Training VHWs
a.
Tye Camps
Village Health Workers
Contact person:
D W Mategaonker
I
21.
Community Health
♦
:5:
22.
Raigarh Ambikapur Health
Association (RAHA)
c/o BfhSop’s House PO
Kunkuri, Raigarh Dt
MP 496 225
a.
b.
c*
dt
e.
Under fives clinics
Village Health promoters Training Program
School Health
Cheap medicine fund
Medical Insurance scheme/Samaritan Fund
Contact person:
Sr Basil
23.
Community Health Project
bat' Christian Hospital
Jobat, Dt Jhabua, MP
a.
b.
c.
d.
e.
f.
g.
h.
J.
Chinchipada Christian
Hospital,'Chinehipada
Dt Ehulia, MS 425 427
25.
Comprehensive Rural Health
Project (CRHP) Jamkhed
Ahmednagar lit, MS 413201
Contact person:
Drs Mr & Mrs Arole
26.
Integrated Community
Health
Family Welfare
Unit, W F Pierce "Memo.
Hospital, Wai Dt, Satara
MS 412 803
b*
c.
d.
a.
b.
c.
d.
e.
f.
a.
b.
c.
d.
e.
f.
Health cai^/education and Tran ru ng Prog
Family planning & MGH
Under five clinic & immunization
Educational program
VHWs education
Nutrition and feeding programm
Control of tuberculosis
Home visits
Training of lab technician
r
f
Children developnent
Village health workers training
Clinic Medicines provided on cost basis
Eradication of diseases like TB, Leprosy
Sanitation/Nut ri
Family Welfare Planning
Under Five clinics
Control of chronic illnessPrevention of blindness
Curative Sc HLagnostic services
t
Training programmes on - VHW/founglhrmors
club/yiahila Mandals/workshops on Cnwnm ’t'
Health
Training of VHWs
Immunization
Safe drinking water
Family
w welfare planning
Leprosy/TB SET
lift irrigation scheme
l
f
I
i
ls/g/7071982
27<
: 6:
Integrated Mother Sc
Child Health Nutrition
Project9 J J Group of
Hospital & Grant Medical
College, Bombay 400 008
cle
b.
c.
d.
e.
f.
28.
Rural Health Research
Project, 3R Society '
Mandwa, Post Sasavane,
Ta Iuka Alibag, lolatm
Bombay
a.
b.
c.
d.
e.
f.
g.
2?.
30.
Dcfticiliary Treatment of .
Protein Calorie Male
nutrition, Institute of
Child Health, JJ Group of
Government hospitals &
Grant Medical College
Bombay
a.
b.
c.
d.
Integrated Health Service . •
Project,. Miraj Medical
Center, Miraj, Sangli Dt
MS
a.
b.
c.
d.
e.
e.
fr.
g.; e
Coordinated services of ongoing
nutritional programs
Feeding program
Procurement of locally available
foods for use as supplement
Demonstration of the role of diet
Maximum encouragement of community
involenient based on education
Training of VHWs
Under five care
Antenatal care
Control of TB and leprosy
Medical survey
Health education and Family Planning
motivation
Animal husbandry/sani +. a+d nnA cri n nl
Training of VHWs
Nutrition
Immunization
Maternal surveillance
Detection of ’AT RISK1 children and
mothers
Parttime social workers (PTSW)
ongoing training
Family Planning
Health education/school health
MCH services
Nutrition
Dais/auxiliary nurse midwi w s A’illage
health assistants
Enviro nment a 1 s arltati on
Immuniz atio n/Sm^ilZpoxA^-larn a
I.
31.
Comprehensive Health Care .
& Development Project
a.
b.
C.
Under fz’.ves clinics
Anbenaiul & postr/t^il clinic
Family
J-' cUiU--J-J planning clinic
—
4
B~4«119
IS/g/7071982
32.
33.
:7:
Nawarngpur Christian
Hospital, Koraput Dt
Orissa 764 059
a.
b.
c.
Contact person:
Dr M Suna
d.
Post Partum. Programs
Dept of Obstetrics &
Gynaecology, CMC Hospital
Ludhina, Punjab 141 008
a.
b.
Dr B Howie
34.
Ccrnmunity Health Dept t
Christian Medical
College & Brown Memorial
Hospital, Ludhiana Punjab
141 008
c.
d<
e.
f.
a.
b.
c.
d*
Regular Hospital services
Training village health workers
Teachiiug courses for wives of Evangel
ists & Pastors
Boarding children
Antenatal clinic
Mother and baby clinic
Gynaecological clinic
Family planning clinic
Field survey (Gulnhaman Gali center)
Schools survey
Rural and urban outreach programm
i
Early detection of pregnancy
Immunization
Health education
Training - interns and student nurses'
Research TB survey Chronic Bronchitis,
Adult nutrition study (Narangwal)&Child
nutrition study (Lalton Kalan)
1I
I
i
-I
35.
Community Health Project Mac Robert Hospital
Dhariwal, Gurdaspur Dt
Punjab
Contact person;
Maj Arnold F Bennett
36.
Deenabandhu Medical Mis
sion, Integrated
Community Health Project ■
RK Pet Ghingleput N
Arcot TN 631 303
Contact person:
DRS Mr & Mrs Prem
a,
b.
c
d.
e.
■4
MCH & family planning clinic
Mobile Family health workers team
Immunization
Antenatal care
Nutrition
I
I
-I
1
1
a,
b.
c<
d.
Q^
f.
g.
h.
i.
Leprosy control
Family planning
Primary care (MCH)
Orphanage
Cooperative far^
Housing
Printing press
Carpentary shop
Auto Shop
:8:
M..119
IS/g/7071982
37.
■
Tirunelveli Social
Service Society
Palayamkottai 627 0p2
TN
a.
b.
c.
d.
e.
Adult education
Grihini training
Balwadis
farmers training
MCH education programm (MCHE)
Contact person:
Fr Thomas Malayumpuram s
3^
39.
Kbttar Social Service
Society, Bishop’s House
PB No 17 Nagercoil
Kanyakumari, TN 629 SOI
a.
b.
c.
4.
e,
Contact person:
Fr Jam.es
fe
Nutrition Rehabilitation
Center Govt Erskine
Hospital, Maduari
625 020,
TN
a*
bo
Contact person:
Dr S A Kabir
40.
Christian Fellowship
Community Health Center
& Christian Education
Health & Development
Society, Santipuram
Ambilikai 624 612 Maduari
Dt, TN, Hospital:
Oddanehatram 624 619
Maduari Dt, TN
d.
e.
a.
b.
c.
d.
e.
f.
41.
Voluntary Health Services
Mini Health Project
Adyar Madras 600 020 TN
Selection of malnourished children
Admission - feeding/treatment
Teaching mothers (selection of food/
followup)
Training Balsevikas and VHWs
Educational aids, books slides
Films, charts
Leprosy hospital
TB Hospital
Cancer center
Training of Health guides
(M P B H VU ANM)
Prinint press
Harijan & hill tribes welfare
society/Soc econanic development prog
involving cottage industries & teach,
training
School and Bimiaaual home
Contact person:
Hr K Cherian
f
Training voluntary village Extqjj.Worker
Agriculture
Fisheries
Housing & drinking water supply
Community health & adult education
Health guide training course
a*
b.
c«
d.
e.
Maintenance of health records
Maternity & child welfare
Family planning
Medical care
Cooperative community ca«^?
I
**
B-4 ai9 _ _
Wg/7071W
:9:
Contact person:
Dr Daleep S Mukerji
g*
h.
J.
k.
l.
■A
43.
• '*
Schi off cling leprosy
Research'& Training Center
Karigiri, N A Dt, via
Katpadi 632 106 TN
Contact person:
Dr Ernest F Frits chi
Rural comniunity Health
Developnent Project (Soya
Production & Research'
Association) Faridpur^ Dt
Bareilly, UP 243 503
a.
b.
c.
a.
b.
c.
d.
e.
f.
Agriculture/Animal husbandy
VWs training
Male rural ccmmunity organiser trg
Under fives clinic
Health & nutrition education/low cost
curative care
TB control
Farmers clubs/Scd economic
Varieties of training programm eg
adult education, cctnmunity'orga. & dev
Drip irrigation techniques, post graduate
certificate course in integrated rural
dcvelopnent (CIRD) etc
Control management & rehabilitation of
leprosy patients
Training of medical/paramedical
personnel in leprosy
Research in leprosy
Simple inexpensive health services
Early diagnosis/treatment of TB & Leprosy
VHWs Training
Adult education
Nutrition education
Agricultural extension
♦
F
It5.
46.
MCH
Family planning
Nutrition
Comniunity Health Project
of Creighton Freemen
Hospital, Vrindaban
UP
a,
b.
c»
d.
Contact person:
Dr David Thmos
e.
Campaigns for e- adicating prevalent
diseases
School health/Training of VHWs
Community health Project
Harriet Benson Memorial
a.
b.
Health education
Training of VHWs
>
B-4.U9
is/g/7o71982
47e
:0O:
Saharanpur Rural Health
a#
Project, Center for Develop—
"i
_
.1 .
t
•
*
*.
z
Indwtris.1 Technology (CEND b*
IT) C—11 C(Maunity Center b»
SDA, Hew Delhi- 110 016
d<
e.
Contact person:
f.
Mr K N Tiviari
Child ±n Need Institute
(CINI), Village Daulatpur
PO Amgachi, via Joka^ 24
Parganas, West Bengal
contact person:
Dr S N Chau^huri
a
b
c
d
e
f
g
h
k.
Ccmmunication process - family life
planning
Primary health center
Nutrition
Eradication of TB/fe.laria etc
Training of para-medical & VHWs
Apprenticeship schemes for the youth
handwork for women etc
Pre and postnatal Care/Clinics
Nutrition oxtension/education/supplement
Functional literacy
Prepare lav; cost nutritioris easy to make
■Po-xJ Pr.-r
Irlren
gaining MCH wc7xi^n/one;r.uiwaci^
Tuberculosis control prograTina ■
Community/action cell
Maternal 4 child health proyraEEi
Self Bnployment scheme
Technical training for village youth
craft training for mothers
Dairy/jfisheries
/
/ •
49.
Bam India, J/221/A
Paharpur Road, Calcutta
700 022;, West Bengal
'demmunity
lib . »a?ogranim, Calcutta
contact person:
Dr Mitra
a.
b.
c.
d.
j
. i '■
■( i
>■
V
Leprosy control X
JB Control
Under five clinics
Social Bcontmc qevelopnsit
Sanitation
e
'*•
I
?
a
s
s
I
ft
T
*
Voluntary Health Association of India
■
Telegrams : VOLHEALTH
C-14, Community Centre
Safdarjung Development Area.
New Delhi-110016
VHA>
w
\
1
\
/
/
Cv K
0
/'')/
New Delhi-! 10016
T . .
668071
Telephones : 668072
Management Of Common Snake-Bite Poisoning
COMMUNITY HEALTH CELT
326 v Mein, I Block
Koremtrigalg
Dr J Jacob, M.B. ,M.R.C.P.(Lond)
lt>;
^angalGrQ-5G0Q34
India
Tiruvalla Medical Mission has long experience in managing snake
bite poisoning. This hospital is the only one around about 20 km.
radius that is accepting and treating snake bite patients. We have
accumulated a wealth of experience in this line because we could
not rightly evade this great problem of fatal snake bite poisoning
in our neighbourhood.
''*j>'‘
A
I
. ’7,
& • *A
'■
l7
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f.
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;•
Most of the cases we come across in our hospital are caused by
snakes belonging to the Viper family. We have been able to develop
an effective system by trial and error for treating patients who
are admitted with snake bite poisoning. In 1968 and before, we
used to give two ampules of antivenom irrespective of the condition
of the patient. We never gave any anti-histamine or heparin or
Cortisone. Our retrospective study then, showed a mortality of
25 per cent out of which 83 per cent was caused by acute renal
shut down. We did a prospective study at that time and increased
the number of antivenom to an average of 10 vials per patient.
At the end of the study, we found that we are able to reduce the
mortality from 25 per cent to 6.7 per cent. We were convinced
then that adequate antivenom was the basis of treatment.
At that time the major problem appeared to be occasional peripheral
circulatory failure, CNS damage and rare secondary haemorrhage.
We still have not understood the problem of shock and CNS damage.
The problem of secondary bleeding is now well known to be caused
by disseminated intravascular coagulation (DIG). Subsequently,
for a time, we instituted heparin in every patient who, we felt,
had significant envenomation.
Our recent retrospective study showed that our method of giving
large amount, of antivenom as bolus injection intravenously is not
as efficacious as giving smaller amount of antivenom in a
slightly longer period of time. We understood that the tendency
for bleeding was definitely due to an anticoagulant and/or the effect
of a procoagulant. Animal study as well as studies on victims of
bite have clearly -shown that there is an on-going DIG which in
most cases is controlled by antivenom. In the light of this finding,
we have for the last one year stopped the routine use of the heparin.
I
»
-2-
lt is found that for any significant bite bleeding and. clotting time
will be prolonged. However, some patients who were brought
with an efficient tourniquet could have normal clotting- time
initially but developed prolonged clotting time and proteinuria
after releasing the tourniquet.
So far our understanding of the adverse effect of venom are
1. Cerebral damage
2. Excessive bleeding tendency
3. Renal shut down
4. Peripheral circulatory^failure.
CNSdapjage still stands as an enigma. There has been no clear
cut description of the pathophysiology to account for it. While it
P??8lble
the central nervous system damage may be due to
the direct efiect of the venom the most likely cause is either
generalised or localised haemorrhage or thrombosis due to DIG.
1. Excessive bleeding tendency is now clearly proved to be due
to consumption coagulopathy. The treatment for all patients
is adequate antivenom. The proteinuria and the acute renal
shut down have always been felt to be doe to the direct toxic
effect (nedrotising) of the venom. Whether or not there is
also additional,da mage to the kidney by blood clots by the
ongoing DIG is not clear. Many patients have haematuria
along with proteinuria but the haematuria, in our experience has always come 12 to 16 hours after the bite. But the protein
uria manifests itself even as early as the first half hour after
t e bite depending on the extent of the envenomation.
2* nS? periPhera,11 circulatory failure which happens in pdtients
quite unexpectedly, has not been successfully explained by
any one so far, ft could be mediated through the effect of the
venom at the brainstem level. The mechanism of action should
be the same as septic shock.
Mode of treatment
fl
haeyoSlobin’ clotting time and urine tests, we start af\ve Per cent dextrose water IV drip and give an injection of antiSw6’ f^ien there 1S n° obvious signs of envenomation such
fr°m Slte’ SwelhnS or shock, we wait for the lab
result before starting any special treatment. If the result is abnormal
we start four ampules of antivenom in a 100 c.c. of 5 per cent
-33. Two hours after completion of the second four ampules of
antivenom, clotting time is repeated. If normal, no more
specific treatment is given. If prolonged, another four
ampules are given in three hours time. Three hours after
completion of that clotting time is repeated. In case where
the clotting time is still prolonged, we would consider
treatment of DIG and start heparin 5000 units over four-six
hours and then do a platelet count. If platelet count is very
low, we give 250 ml of fresh blood in si liconised bottle. When
the blood results return to normal, we stop giving antivenom.
V/e do not advocate giving more than 16 ampules of antivenom
to any patient. Ordinarily we give a maximum dose of twelve
ampules only. In exceptional cases we give another four
ampules. We have found that in the case of most patients
(90 per cent) the clotting time comes back to normal by 12
ampules of antivenom.
There would be some patients who have a normal clotting time and
no proteinuria initially. For them the lab test is repeated after one
hour. If the clotting time is still normal, the test is repeated again
after another two hours. If it is still unchanged, then we repeat the
test three hours after that to be absolutely certain. There will be
a rate patient who develop prolonged clotting time five to eight hours
after bite and many develop renal failure.
For the patients who have a tight tourniquet our policy now is to
give two ampules in 100 c.c. even if the initial clotting time is
normal. After that the tourniquet is released and we wait for an
hour to do a clotting time. If that is prolonged, then we give them
four ampules and continue the regime as for any poisonous bite. If
the clotting time is normal, then we wait for two hours and repeat
it and then three hours after that. By giving patients two ampules
of antivenom as a routine we certainly do give it to a few patients
who do not require any antivenom at all but the danger of the CNS
damage that can occur can be devastating on the release of
tourniquet without proper coverage, with antivenom. We therefore,
feel justif ied in giving antivenom to an occasional patient who
does not tequire it.
Patients who are brought within the first four hours after the bite
have the maximum chance of survival without complication such as
peripheral circulatory feilure (shock) or acute renal shut down.
Even to patients who are brought later, we still give the antivenom
if the clotting time is prolonged. If they have only heavy albuminuria,
they-are treated with monitol 150 c.c. twice daily and lasix
80 - 200 mg. IV to avoid renal shut down.
We have found the best way to handle the patients in a state of
*
-4-
?■ .I--
i
■
of whole blood is safer than giving salt solution which is otherwise
the method of treatment. Whenever we ha/e used small amount
of fresh blood taken in siliconised bottle, the blood pressure came
• to normal gradually. We have also used in such patients fatly heavy
doses of cortisone. Patients who are adequately treated with
antivenom in the hospital seem to improve with blood and cortisone
in this situation. Our greatest mortality is in shock patients and
most of those are the patients who are brought late to the hospital
after native treatment or who were treated inadequately with
antivenom elsewhere.
The percentage of patients with complication such as shock and
renal shut down varies according to the degree of envenomation.
But our statistics show that moderate to severe bite causes
shock if not treated adequately to have 70 to 80 per cent of the
patients with inadequate treatment will require some mode of
treatment for acute renal shut down either conservatively or by
dialysis. 15 t o 20 per cent will reouire treatment for shock
or treatment for CNS damage. The mortality is over 80 per cent.
Even if these survive, they usually have some mode of deficit which
in time tends to clear up to some extend.
We have found peritonial dialysis to be more useful than haemo
dialysis/ This has been the experience of other people in the
field of dialysis.
,1
I have not mentioned anything about Cobra bite. Patients with
severe Cobra bite never reach the hospital. Moderate bites will
require antivenom till they are out of their neurological deficit,
which is quite obvious. In these patients blood and urinary
findings are all normal but we can easily make out a Cobra poisonous
bite by such findings as drooping of the eye lids, dysphonia and dysarthia
etc. If not adequately treated immediately, they develop respiratory
paralysis.
Summary
The routine management of snake bite poisoning is explained in
detail in this paper. This work is the result of our experience
at this hospital for the past 15 years or more. So:mediscussion
of the major complication of the snake bite poisoning has also
been included.
Excerpt from
’The Journal Of The Christian
i
c 6^//
VOLUNTARY HEALTH ASSOCIATION OF INDIA
C-14, COMMUNITY CENTRE, S.D.A., NEW DELHI 110016
Phones : 668071,668072
Grams : VOLHEALTH
New Delhi-110016
i
if
>
052
From "HEALTH CARE AND HUMAN DIGNITY"
-David B. Werner
' I,
I would like to summarize a few of the steps that economy being
taken, or might be taken, to implement a regional or country
wide approach to rural (or periurban) health care which is more
genuinely community supportive.
1. Decentra Ii zat i on. This means relative autonomy at every
level. Advice and coordination from the top. Planning and
seIf-direction from the bottom.
2. Greater self-sufficiency at the community level. This is,
of course implicit in decentralization. The more a community
itself can carry the weight of its own health activities, both
in cost and personnel, the less paralysed it will be by break
downs in supply and communications from the parent agency.
3. Open-ended planning. For all the talk about "primarydeci s ion-maki ng by the community", too often a program’s
objectives and plans have been meticulously formulated long
before the recipient communities have been consulted. If
the people’s felt needs are truly to be taken into account,
program plans must be open-ended and flexible.
It is essential
that field workers and representatives from the communities not just top officials - attend and actively participate in
policy planning and policy changing sessions.
4. Allowance for variation and growth. If a program is to
evolve, alternatives must be tried and compared. Substantial
arrangements for conceiving and testing new approaches, methods
and points of view should be built into the ongoing program.
Also, private or non-government projects should be observed
and learned from not forced to conform or stamped out.
GoH H- G2-
: 2 :
5. Planned obsolescence of outside i nput. If selfsufficiency at the community level is indeed to be considered
'
a goal, it is advisable that a ccut-off
date fqr external help
be set from the first. All input of funds, the earliest
needed. Thus
possible date when such assistance
longerneeded.
--- -- .3isnono longer
the outsider’s or agent-of-change’s first job, whether he be
a medico or an agronomist, should be to teach local persons to
take his place and, in so doing, make himself dispensible.
Outside funding, likewise, should not underwrite ongoing
activity, but should be in the form of ’seed’ money or loans
to help launch undertakings which wiI I subsequently carry
their own ongoing costs.
6- Deprofessionalization and deinstitutionalisation. We have
got to get away from the idea that health care is something
to be delivered. Primarily, it should not be delivered, but
encouraged. Obviously, there are some aspects of medicine
which will always require professional help - but these could
be far fewer than is usually supposed. Most of the common
health problems could be handled earlier and often better by
informed people in their own homes. Health care will only
become truly equitable to the extent that there is less
dependency on professional or institutionalized help and more
mutual self-care. This means more training, involvement and
responsibility for and by the people themselves. It should
include continuing education opportunities for villagers
which reinforce their staying in and serving their communities.
7. More curative medicine. For a long time, health care
experts have been pushing for more preventive medicine at
the village level - and with good reason. But too often
this has been used as a convenient excuse to keep curative
medicine completely - or almost completely - in professional
hands. Clearly, preventive measures are basic. However,
the villagers’ felt needs have consistently been for
curative measures (to heal the sick child, for instance).
If primary health workers are to gain the respect and
confidence of their people, they must be trained and
permitted to diagnose and treat more of the common problems,
especially those when referral without initial treatment
increases the danger to the sick.
I should point out that when I say ’’more curative
medicine,’’ I don’t mean "more use of medicines.” Over
medication, by both physicians and villagers, is already
COMMUNITY H 'ITH CELL
326, V Mp:
.uck
Koramenc.
: 3 :
Bangalore-obJ034
India
I mean more informed use, which in many cases
flagrant.
will mean far more limited use, of medications, But this
will require a major grass roots demystification of Western
medicine which can only happen when the people themselves
learn more about how to prevent and manage their own ilInesses.
To promote such a change, the village health worker must have
a solid grasp of sensible medicine and, in turn, help
reeducate his people.
It is, of course, doubtful whether such a metamorphic
awakening to sensible medicine can ever happen outside the
medical institution until there has been some radical
rethinking within it.
8. More feedback between doctors and health workers. When
health workers refer patients to a doctor, the doctor should
always provide feed-back to the.health worker, explaining in
full clear detail and simple language about the case. This
can and should be an important part of the health worker’s
and the doctor’s continuing education.
9. Earlier
EarIier orientation of medical students. From the very
beginning of their training, medical students, should be
involved in community health, and be encouraged to learn from
experienced village health workers and paramedics.
10. Greater appreciation and respect for villagers^ their
traditions, their skills, their intelligence, and their
potential. Villagers, and especially village health
workers, are often treated like children or ignoramuses
oy their more highly educated trainers and supervisors.
This is a great mistake. People with very little formal
education often have their own special wisdom, skills and
powers of observation which academicians have never acquired
and therefore fail to perceive. If this native knowledge
and skill is appreciated, and integrated into the health care
process, this will not only make it more truly community
oriented and viable, but will help preserve the individual
strengths and dignity of the health worker and his people.
I cannot emphasize enough how important it is that health
program planners, instructors and supervisors be ’’tuned in”
to the capabilities and special strengths of the people they
work with.
: 4 :
11. That• the
••
directors and key personnel in a program be peopIe
uman
who
h
are
.
This is the last, rmost subjective and perhaps
---- - ---most important point I want to make, Let me illustrate it with
an example:
In Costa Rica there is a regional
r
program of rural
health care under the auspices of the Health^r*
‘ ‘
---- .1 Ministry
which
differs in important ways from the rural health system
i n the
country as a whole. It has enthusiastic community participation
and a remarkable impact on overall health. It may well have
e lowest incidence of child and maternal mortality in rural
Latin America. Its director is a pediatrician and a poet, as
well as one of the warmest and hardest-working people I have
met
The day I accompanied him on his trip to a half-dozen
village health posts we didn't even stop for lunch, because
he was so eager to get to the last post before night fell
He assumed I was just as eager. And I was his enthusiasm was
that contagious !
I will never forget our arrival at one of the posts.
It was the day of an "under-fives" clinic. Mothers and
patients were gathered on the porch of the modest building
As we.approached, the doctor began to introduce me,
explaining that I worked with rural health in Mexico and
was the author of Donde No Hay Doctor. Frantically, I looked
this way and that for the health worker or nurse to whom I
was being introduced. As persons began to move forward to
greet me, I suddenly realized he was introducing me to
a. I I the peop I e, as he would to his own family. Obviously
he cared for the villagers, respected them, and felt on the
same level with them.
This, I must confess, was a new experience for me.
I was used to being marched past the waiting lines of
patients and being introduced
■ - the
health worker, who was
----- to
...o l._
instructed to show me around and answer imy questions,
while the patient, whose consultation we■ had interrupted.
s iI ent Iy waited.
’’This man is an exception!” II thought
In
thought to
to myself.
myself.
In
our >visits throughout Latin America, we found almost invariably
that the truly outstanding programs
— ■ — at
one or two
i
--have
— • least
. v*keypeople^who are exceptional human beings. These people
attract others like themselves.
------ —,. And the genuine concern of
c
: 5 :
people for people, of joy in doing a job well, of a sense
of service, and the sharing of knowledge permeates the
entire program clear down to the viI I age worker and members
of the community itself.
People are what make health care work.
: 6 :
RECENT TRENDS OF RURAL HEALTH CARE PROGRAMS
from this
TREND
J
+o this
Who are served?
i
few most
pri v ileged
Who provides the
key services?
majority in
■^accessible areas
profess ionaIs
(a few out
siders at high
cost with long
i nappropriate
tra i n i ng)
sub-professionaIs
a I I the
■> peop I e
local persons,
trad itionaI
healers (many
insiders at
low cost with
short,
practicaI
tra in i ng)
'health ’’team”
Where are training
and services
provided?
large
hospitaIs
modest
health centre
> smaI I post
or dispensary
home
Primary concern:
sickness (of
i nd i v iduaIs)
health (of
ind ividua Is7
tiealth, well-being
and future of the
community
Focus of action:
Curat i ve
-— ■$>1 ntegrate
■^Preventive
(water sanitation
Development
hygiene, vaccina (health education,—
tion, nutrition
leadership, agricul
mother/child care
ture communications)
famiIy p lann i ng
pl ntermed i ate
early Dx-Rx)
I technology
(conscient iza+'ion
I_ ^land reform sociaI
reform)
[*
*
COMMUNITY
: 7 :
HEW.™ cell
«b >ock
Koramonga’a
4 . /
Bangalore-5600
India
Geographic coverage
of ou+reach programs:
small, arbitrari ly defined
areas of great need (or beauty)
entire regions
or countries
Sponsoring agencies:
many
sma I I
pilot
projects
C private!
< foreigny
I re I igiousl
z?i nternat iona I
1 i zed
|^-^centra
>na+iona
\idecentraIi zed
: 8 :
RURAL HEALTH PROGRAMS IN LATIN AMER ICA
TWO APPROACHES
1
----------COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPLING)
Initial
object i ves
Open-ended. Flexible
Consider community’s
felt needs. Include
non-measurabIe
(human) factors.
Closed, Pre-defined
before community is
consulted. Designed
for hard-data evaluaion only
Size of
progress
SmaII, or if large,
effectively decentraI i zed so that sub
programs in each area
have the authority to
run their own affairs,
make major decisions,
and adjust to local
needs.
Large. Often of state
or national dimension.
Top-heavy with bureau
cracy, red tape, fill
ing out forms. Super
structure overpowers
infrestructure. Fre
quent breakdown in
commun ication.
PIann i ng,
priorities, and
deci sionmaki ng
Strong community
participation. Outs i de agents-ofchange inspire,
advise, demonstrate
but do not make
unilateral decisions
Theoretically, community
participation is great.
In fact, activities
and decisions are
dominated or manipula
ted extensively by
outsiders, often ex
patriate ’’consultants”
F inanc ing
and
suppIi es
Largely from the
community. Self
help is encouraged.
Outside input is
minimal or on the
basis of "seed
funds," matching
funds or loans.
Many giveaways and
handouts: free food
supplements, free
medicines, villagers
paid working on
’’community projects"
Village health worker
(VHW) salaried from
r
: 9 :
,1
COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPLING)
Agricultural ex
tension and other
activities which
lead to financial
self sufficiency
are promoted.
Low cost sources
of medicine are
arranged.
outside. Indefinite
dependency on
external sources.
Way in which
common i ty
parti ci pat ion
is achieved
With money and giveaways.
With time patience
Agents-of-change visit
and genuine concern.
briefly and intermittently,
Agent-of-change lives
and later on discover that,
with the people at
in spite of their idealis
their level, gets to
tic plans, they have to
know them, and esta
blishes close relation ’’buy” community partici
pation .
ships, mutual confi
dence and trust.
Many programs start with
free medicines and hand
Care is taken not to
outs to ’’get off to a
start with free ser
good start", and later
vices or giveaways
begi n to charge. This
that cannot be concauses great resentment
t i nued.
on the part of the people.
Da+a and
evaIua+ ion
Underemphasized. Data
gathering kept simple
and minimal, collected
by members of the com
munity. Includes
questions about the
people’s felt needs
and concerns.
Simple scheme for
self-evaluation of
workers and programs
at a I I I eve Is.
Overemphasized. Data
gathered by outsiders.
Members of the community
may resent the inquisi
tion, or feel they are
guinea pigs or
’’stat i st i cs”.
Evaluation based mainly
on ’’hard data” in
reference to initial
object i ves.
: 10 :
COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPUNG)
Evaluation includes
subjective human
factors as well as
’’hard data”.
Experience and
background of
outside agentsof-change
Much practical field
experience. Often not
highly ’’qua I if ied”
(degrees).
Much desk and conference
room experience. Often
highly ’’qua I if ied"
(degrees).
Income,
Modest. Often volun
standard of
teers who live and
Iiving, and
dress simply, at the
character of
level of the people.
outside agentsObviously they work
of-change. (MDTs, through dedication,
nurses, social
and inspire viIlage
workers,
workers to do like
consuItants,
wise.
etc.)
Often high, at least in
comparison with the
villagers and VHWCwho,
observing this, often
finds ways to ’’Pad” his
income, and may become
corrupt). The health
professionals have
often been drafted into
’’social service” and
are resentful.
Sharing of
know I edge
and ski I Is
At each level of the
preordained medical
hierarchy (health team)
a body of specific
knowledge is jealously
guarded and is consi
dered dangerous for
those at ’’lower” levels.
At each level from
doctor to VHW to
mother, a person’s
first responsibility
is to teach - to
share as much of his
knowledge as he can
with those who
know less and want
to learn more.
: 11
COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPLING)
Regard for the
peopIeT s
customs and
trad itionaI
folk healing,
use of folk
healers
Respect for local
tradition. Attempt
to integrate
traditional and
Western healing.
Folk healers incorporated i nto the
program.
Much talk of integra
ting traditional and
Western healing, but
little attempt. Lack
of respect for local
tradition. Folk healers
not used or respected.
Scope of
cli n i caI
activities
(Dx.Rx)
performed
by VHW
Determined realisti
cally, in response
to community needs,
distance from
health center, etc.
Delimited by outsiders
who reduce the curative
role of the VHW to a
bare minimum, and permit
his use of only a small
number of "harmless"
(and often useless)
medici nes.
Selection of
VHW and
heaI th
committee
VHW is from and is
chosen by community.
Care is taken that
the entire community
is not only consulted,
but is informed
sufficiently so as
to select wisely.
Educational prerequisities are
flexible.
VHW ostensibly chosen
by the community. In
fact, often chosen by a
viIlage power group,
preacher, or outsider.
Often the primary health
worker is himself an
outsider. EducationaI
prerequisites fixed
and often unrealisti
cally high.
Training
of VHW
Includes the scienti
fic approach to prob
lem solving. Initia—
t i ve and th i nki ng
are encouraged.
VHW taught to mechani
cally follow inflexible,
restrictive "norms" and
instruction. Encouraged
not to think and not to
question the "system"
: 12 :
COMMUNITY SUPPORTIVE
Does the
program
i nclude
"conscienti zation”
(consciousness
raising) wi+h
respect to
human rights,
land and
sociaI
reform?
Manual or
guidebook
for VHW
Yes (if i+ dares).
COMMUNITY OPPRESSIVE
(CRIPPLING)
Issues of soc i a I
inequities, and
especially land
reform are often
avoided or glossed
over.
Simple and informative
i n language, iI Iustrations, and content,
geared to the user’s
interest. Clear index
and vocabulary inclu
ded. All common prob
lems covered. Folk
be Iiefs and common use
and misuse of medi
cines discussed.
Abundant illustrat
ions incorporated into
the text. The same
time and care was
taken in preparing
i I Iustrations and
Iayout as viI lagers
take in their artwork
and handicraft.
Cookbook-style, unattrac
tive. Pure instructions.
No index or vocabulary.
Language either unnessarily complex or chil
dish, or both. I I Iustration are few, inappropri
ate (cartoons), or care
lessly done. Not integ
rated with the text.
Useful information is
very limited, and some
of it inaccurate. Many
common problems not
deal th with. May use
misleading and/or
i ncomprehens i bIe
flow charts.
Manual contains a
balance of curative,
preventive, and pro
motive information.
Manual often strong on
preventive and weak on
curative information;
overloaded with how to
fill out endless forms.
: t3 :
COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPLING)
Limits
def i n i ng
what a
VHW can do
Intri nsic. Determined
by the demonstrable
know I edge and ski I Is
of each VHW, and
mod i f i ed to allow
for new knowledge
and skill which is
continually fostered
and encouraged.
Extri nsi c. Rigidly and
immutably delimited by
outside authorities.
Often these imposed
Iimits falI far short
of the VHW’s interest
and potential. Little
opportunity for growth.
Superv i sion
Supportive. Depend
able. Includes fur
ther training. Super
visor stays in the
background and never
’’takes over”. Rein
forces community’s
confidence in its
local workers.
Restrictive, nitpicking,
authoritarian, or pater
nalistic. Often undepen
dable. If supervisor is
a doctor or rvurse he/she
often ’’take over”, sees
patients, and lowers
community’s confidence
in its local worker.
Encouragement
of selfI earn i ng
outsi de of
norms
Yes. VHWs are pro
vided with information
and books to increase
knowledge on their
own.
No ! VHWs are not
permitted to have books
providing information
outside their ’’norms”.
Feedback on
referred
pat ients
(counterref erence)
When patients are re
ferred by the VHW or
auxiliary, the M.D.
or other staff at the
referral center gives
ample feedback to
further the health
worker’s training.
Doctor at the referral
center gives no feed
back other than ins
tructions for injec
ting a medicine he
has prescribed.
Flow of
suppIi es
Dependab Ie
UndependabIe.
'4
: 14 :
COMMUNITY SUPPORTIVE
Profit from
med ic i nes
(in programs
that charge)
COMMUNITY OPPRESSIVE
(CRIPPLING)
VHW sells medicines at VHW makes a modest
his cost which is pos (or not so modest)
ted i n pub lie. (He
prof it on sale of
may charge a smaI I fee medicines. This
for services rendered). may be his only
Use of medicines is
income for services,
kept at a minimum.
inviting gross
overprescribing of
med icines.
Evo Iut ion
toward
greater
community
i nvoIvement
As VHWs and community
members gain experi
ence and receive addi
tional training, they
move into roles ini
tially filled by out
siders - training,
supervision, manage
ment, conducting of
under-fives clinics,
etc. More and more of
the skill pyramid is
progressively filled
b*y members of the
commun ity.
Little allowance is
made for growth of
individual members
of the community to
fill more and more
responsible posi
tions (unless they
graduate to jobs
outs i de the commu
nity). Outsiders
perpetually perform
activities that
v iI Iagers couId
I earn.
Openness to
growth and
change in
program
structure
New approaches and
possible improvements
are sought and encour
aged. Allowance, is
made for trying out
alternatives in a part
of the program area,
with the prospects of
w i der appIi cat ion if
it works.
Entire program is
standardized with
little allowance for
growth or triaI of
ways for possibly
doing things better.
Hence there is no
bui11-in way to
evolve toward better
meeting the community’s
needs. If is static.
k
15 :
COMMUNITY SUPPORTIVE
RESULTS:
COMMUNITY OPPRESSIVE
(CRIPPLING)
Health worker plods
Health worker conti
along obediently nues to learn and to
or
quits. He/she
grow. Takes pride in
fu
I
f iI Is few of the
his work. Has initia
community’s felt
tive. Serves the
needs. Is subser
community’s felt
needs. Shows villagers vient and perhaps
mercenary. Rein
what one of their own
forces the role of
can learn and do,
dependency and
stimulating initia
unquest ion i ng
tive and responsibi
serviIity.
lity in others.
Community becomes
more self-sufficient
and self-confident.
Community becomes
more dependent on
paternaIi st i c out
side charity and
controI.
Human dignity and
responsibility grow.
Human dignity fades.
Traditions are lost.
Values and responsi
bility degenerate.
If outside
support
fails or is
d i scont i nued..
Health program conti
nues because it has
become the
communi ty1s.
Health program flops.
TACIT
OBJECTIVE
Social reform heaI th and equaI
opportunity for
all.
’’Don’t rock the boat. n
Put a patch on the
underlying social
problems - don’t
resolve them ’.
_____________________
: 16 :
SPONSORING
AGENCIES
(There are
notab Ie
exceptions)
COMMUNITY SUPPORTIVE
COMMUNITY OPPRESSIVE
(CRIPPLING)
Often small private,
religious, or volun
teer groups. Some
times sponsored by
foreign non-government organizations.
Often large regional
or national programs
co-sponsored by
foreign national or
multi-nat i onaI
corporate or govern
ment organizations.
H -
GROUP TECHNIQUES
FOR
PROGRAM PLANNING
d £> tn
A guide to nominal group
and delphi processes
From GROUP TECHiJIQUES FOR PROGRAM PIANNING
by Andre Delbecq* Andrew Van de Van and
David Gustafson^ Copyright 1975 Scott,
Foresman and Company, Reprinted by permission.
Scott, Foresman and Company "Glenview, Illionis Dallas Tex. Oakland
N.J. Palo Alio, Cal. " Tucker Ca Brighteen, England.
The final chapter discusses in the detail the one of NGT in planning
exploratary research involving citizen identifying multidispllnary exprts
and rsMdteN reiewing project proposals.
NGT IN HEALTH CARE ADMINISTRATION
Perhaps I was given the honor of writing this introduction because I
happen to be one of a rapidly eiarging group of professional practitioners
who have used NGT for a variety of purposes and in diverse settings. I feel
comfortable in accepting this assignment even though I am not a theorist of
or organizations or of group process, because as a practitioner and teacher
of health care administration I have been deeply impressed with what NGT
can accomplish and with the case and utility of its use, I have used it, or
portions of it, in common administrative problem solving situations. I have
also used it to plan for a continuing education program for staff mem
bers and consumer boards of health centers, I have used it in graduate
seminars ina school of publich health and in consumer training program.
, *, With Andre Delbecg, I used it to define problems facing comprehensive
health planning boards in Hasvati, Guam, and six governmental districts
of Micamesia (in the last setting the participants spoke many different
languages and had employed NGT in a research project to develop consumer X
and professional definitions of the uniquely important rules and qualities
of primary health care organizations. I can therefore, fully attest on
its advantages in planning administration, continuing education, academic
teaching and research. My evaluation of its effectivenes is based on
four types of evidencet (1) the greater flow of ideas I have seen
generated when compared with traditional meetings! (2) the fuller parti
cipation of all those involved in contrast to other settings (3) the
increased evidence of the task being brought to closure, and (4) the
evident senses of satisfaction on the part of participants about these
three accomplishment.
Over time I have also beer able to asswer in large part the
'principal reservation I have had about its use. will there be difference
in participation between persons coming from different cultures or
different socioeconomic backgrounds? Can
...2.
2
diverse groups participate effectively together? De participants
feel manipulated creeded and resentful because of the
of
the proces. Is charsmatic leader necessary to make it work? Can
use be article or minimized? In answer to these questionss
I should like to share some of my observations.
In my experience this technique seems to work in groups made
“
i We have used
up of members from any socioeconomic level of culture.
—
it successfully with members of poverty communities and also with
wsome of the nation1s leading exports on health care. We have used
it with professon and persons with grade-school educations. We
have used it with English-speaking participants and those needing
translators. It has also proven to be effective and acceptable
in groups where backgrounds are mixed and# as the authors pointout
it allows what in other settings might be conflictual or potentially
offending statements to be brought out# clarified# and ranked with
out strife or discord. It creates situations where those who might
not participate for reasons inherent in ideology or in the social
situation hisrwsn» become full partners. In Guam for example# the
KGT groups contained cha/monan women
jbUBtagKBftK
from the villages who spoke little English alongside
women from the capital city who were active in civic affairs. It
became quite clear after the first few hours of the day that both
groups took deep satisfaction in the work they acommplished. One
of the Chomonan women told me afterward that she had great fear
o fhaving to speak in what she coniserad here inadequate English.
Soon to her great surprise# she felt very comfortable in presenting
the items on her list and in assisting in their clarification
Recently we went through a somewhat similar experience in a Southern
city of the Unitied states# The Participants while all Southerners
represented a particularly wide range in age sex# race# and social
status. The person most obviously under anticlpatary tension in
this group was a white woman of upper-class background. Her hands
were clenched at the beginning. As the day were cn she relaxed;
soon her partiepation wa enthUBisaetlc.
Questions about the rididity of the process and whether or
not it will be perec.ived as manipulation or coercion must be given
serious consideration. In my experience# no matter the background
(and we have used it with groups whose members were particularly
sensitive to being manipulated)# participants have not resented the
structure. But and I feel that this is a critical pcint-we have
always a had skilled leaders to explain the rationale and guide
the process. In clumsy or insensitive hands# or in the cluths of
someone who wished to exploit rigidity for purposes of control#
the results might well be otherwise.
This cautionary note raises the issue of the quality of leader
ship and its Importance in the success or failure of the NGT
process. The quality of leadership is of great importance. It
requires not only someone who feels comfortable with all phases
of the proces but one who can also provide understandable and
reasonable explanations and who posesses sensitivity to unasked
questions. It requires someone who has the ability to impose structure
3
in a nonthreatening manner and, during the clarification period,
someone who is able to move the discussion along briskly, keen it
from becoming bogged down in detailed ancedotes of "position papers’
and at the same time avoid hunting anyone’s feelings* These tasks
obviously cannot be accomplished by everyong*
This brigs me to its appropriate use* NGT can be and has
been used in a variety of setting* For example, in the next section,
Angelo Foruna of AEA Services INc*, discusses its applications
In a business setting* The authors stress, however, that NGT is
net a panacea to overcome all problems of small group process; It
must be used with discrimination. Because of the necessity for
preplanning, for adherence to a predetermined procedual structure,
and for an adequate amount of time. It cannot be used In the
average meeting* Additionally, the effort required on the part of
the participants goes for beyond posslve attendance. *or these
reasons, it dould not be considered for routine decision making.
Its use is for Issues adjudged especially important, where it is
essential/ to have wide and representative input, and where diffi
culties in ranking and rating problems or* solutions as a basis
for group decisions are such that the traditional meeting is of
relatively little use.
Alberts Wt Parker9 M.D*
Clinical Professor of
Community Health
School of Public Health
University of California
Berkeley
GROUP DECISION
MODERN
MAKING IN
ORGANIZATIONS
Increasingly, practicing administrators of professionals
are seeking useful new techniques to increase rationality, creativity,
snd participation in problom solving inoetings associated with program
planning* As the number of occasions requiring pooled jugments
in planning increase, so does the need for increased skill in con
ducting such meetings*
In this volume we shall focus on two specific techniques the
Delbeeq and Van de Van hominal Group Technique (NGT), and the Delphi
Technique. At the completion of the book, the practicing administrator
or professional planner should thoroughly understand the theory,
research and practical protfems surrounding both methodologies, for
increasing a group’s creative capacity to generate critical Ideas
and understand problems and the component parts of their solutions;
thus participants can aggregate (pool) individual jugements and
arrive at desirable group decisions•
4
5
THE
NATOR E
OF
PROGRAM
PLANNING
activiJlZ aJhShW«n!f?^5,ln^the terTO lniPlles a prearranged set of
fifs®
i. fonwty i„ ors.; to ptoiS:
specifies technieZ?tlV^S* <°r example, a crisis intervention program
1
professional activities aimed at ameliorating
ErSonal
l^div dials fJc&X!XriinVUCid*S' and Priding comfort to
and indSSivf i
1 cri®es« Ir‘ th« private sector (business
H’S7 ro£®r to a 8et of technological roanlDulatians1^™^^ 29
is JS
man«f«cture a products. In svmmar?. a pw^am
prodSct^r mSrfloA^ Ce*neC*S8ary to Provide a oeclflc service or
°r moortlcatlon of programs. Administrators and professional
tisk^o?CerQriupseor teihn^i?9i-aSked tO
» Scial committees
new p;?™? or eh^no^ 2 ? LteaniE conc«rned with recommending
proar^s
easting programs
Where the changes in
el2£T*B?t o£
cirSJtan£eih
programs occur under complex
V
circumstances, the participants face real challenges.
lncludrS^f?li2Ji«hJta^«lO ^J®*1** in program planning would
®^®ry Program administrator
or professlonal^lSnnei^St 0*
processional planner (Brief, belbeeg and Fuiey, 1974 Dclbecq 1974)»
1'>K
proqr™.
«=am..s to adopt th. w
b-
!l?ii^?rOgran,a* or lack of codified and agree-uppn
™via®neo• c °r technics models and lack of experimental
£ 12rge nwT,b®r of individuals or groups (e.g., providers
decision Std:hirfiPw<if?Sh1OnaiS* and administrators) ^conatlute the
vhich Will have to approve the program and which will
review the proposal under conditions wherei
a. the groups have different value and conceptual orientations
b* in1?heCd^«?^itnrs^e WO^S ba’ed on Joint Participation
development of earlier successful programs do not
exxs*•
These two papers are concerned with detailed teortical
and
elaborations of the
oro.n?Lt?!^»?r?K'”<i
The proposed program will h»v.
have a groat Impact on proaent
rganisatlonal arrangements and allocation of resources due toi
a, limited slack resources,
b. absence of major outside funding.
Program-planning processes must be adopted to cone
with
with thes complex planning situations fortunately/there le Moh P
agreement concerning the general aequenc. of
6
must follow in such cases. The authors have developed a model of seq
uential planning steps called PPM (Program planning Model) which
suggests that critical features of program planning under conditions
of complexity should Include (Delbecq and Van de Van, 1971; Van de van
and Delbecq, 1972)I
Obtaining early review of the planning Intent, and a clear
mandate from top-level decision makers concerning the general
approach followed in //developing the program.
Involving clients or consumers in problem exploration meetings
to document unmet needs.
Involving outside resource people (both scientific and technical
to help explore components of an appropriate program to solve
those needs.
Involv ng administrators, funding sources, clients, and
professionals in an early review of program plans.
Involving appropriate personnel in developing designs for
implementation and evaluation.
Involv ng other pe sonnel, from orgaisation who will be
later adopters of the new program, as participant observers
in a demonstration program, to prepare the way for technological
transfer or diffusion of Innovative programs.
GROUP TECHNIQUES AND PROGRAM PLANNING
In this book, we will focus upon group techniques useful in program
planning and administration obviously many other elements enter into
program planning beyond group meetings. Nonetheless s nee they processes
include (1) problem explorating; (2) knowlege exploration: (3) pre
liminary review (4) design and implementation tean.s: and t5) evaluation
and review meetings; then group processes which facillatate the sharing
of jugements at each of these critical junctures are importort.
Since NGT and the Delphi Technique are but two specific types
of group processes. It is important to defferentlatc them from
other group processes such as bargaining confrontation, hearings etc • *
which also have their places in program administration and planning.
The nature of NGT and the Delphi Technique
Like other group techniques (e.g,, force-field analysis and
parliamentary procedure), NGT and the Delphi Techniques are not a
panacea for all group meetings. They are special-purpose techniques
useful for situations where individual jug^toents must be tapped abd
combined to arrive at decisions which cannot be calculated by one
persons. They are problem solving or idea-generating strategies, not
techniques for routine meetings, coordination, bargaining, or negotiations,
r.7
8
Since the distinction between jugmental versus other types of
meeting situations is an important distinction, a word of elaboration
is worthwhile so the reader clearly understands the type of meeting
we are concerned with in this book*
We are not concerned with routine meetings. Generally speaking
we can define a routine meeting as a situation where members of the
group agree upon the desired goal, and technologies exist to achieve
this goalz In such a meeting the focus is on coordination and in
formation exchange, and the meeting the focus is on coordination
and information exchange, and the meeting is “leader centered”
(Delbeeq, 1967). In a program-planning situation, this task would
be delegated to a trained technical export or team of experts to
handle based on established formulas.
Likewise, we are not comrned with negotiation or bargaining,
we can define this situation as one in which opposing factions defferIng in norms, values, or vested interests stand in opposition to
each other concerning either ends, means or both. The management of
conflict and the formulation of representative groups is also out
side our focus (Delbeeq 1967). In a program-planning context this
situation occurs when opposing factions have assumed hardened posi
tions based on strong value differences.
We are concerned with judgemental decision making
Colloquially,
we are talking about creative decision making. The central clement
of this situation is the lack of agreement ox* incomplete stats of
knowledge concerning either the nature of the problem or the components
which must be included in a successful solution. As a result hetero
geneous group members must pool their jugements to invent or discover
a satisfactory course of action. Obviously, jugemental problem
and solution exploration is but a subset of meeting important to
administrators and planners in program planning. Nonetheless, the
need for creative or jugeinental problem solving occurs frequently.
NGT and the Delphi Techniques along with other meting formats,
are important components in the repertoire of professional $nd mana
gerial group skills which planners will find useful.
The increased need for pooled Judgments
With growing frequency, then, contemporary program administrators
or professional planners face situa ions where they must elicit and
combine jugments in group meetings. Not only do ndministretors or
planners need to involve their own professional staffs in program
planning, but they are also often urged to find viable methods for
tapping the jugments of various outside groups (e.g., resource exports
customers, clients etc.) from different backgrounds, positions and
perspectives.
2. In simon’s terminology this is the •'Programmed* decision
(simon, 1960) In thampeon ’s terminology this is the
decision situation (Thompson, 1959)
3. Here we are talking about the situation which in Simon1©
and in Thampson's terminology is
terminology is
*Judgmental*.
• •9
9
Unfortunately, organizational life for many administrators and
professional planners has become an endless stream of cwnmittee meet
ings absorbing countless precious working hours. Indeed, a recurring
complaint among administrators and planners is that they lack the
Tu f and °PPortunity to work alone and uninterrupted* It has been found
that as much as 80 percent of a program administrator^ working
time is spent in committee meetings (Van de Ven, 1973)* Simply on the
basis of costs per working hour, it behooves the administrator or
professional planners to explore more expedient efficient processes for
group aecision making*
“°5® important, however, is the fact that judgmental decisions are
often obtained by utilizing the same group processes that dominate
routine coordination and information exchange (Delbeeq, 1963). It is
a critical regainment of effective leadership, therefore, in redefine
group roles and processes so that judgmental decisions are faciliated
by Judgmental techniques. This book will help the planners or admini
strator structure such judgmental situations away from the leader
centered coordination format of routine meetings.
This is an age of "maximum feasible participation" wherein clients)
US<5fl ?r con®un,er groups in public and private organizations wish to
participate in program planning and administration. In the public
sector, citizen or client participation is often legally required in
the programs funded by federal agencies in health, education, welfare,
2nd “rban
Such participation, however, is not rtstticted
to the public sector, and the appropriateness of having administrators
or professionals unilaterally plan or make decisions for customers has
been questioned.
Yet the involvemert of user groups presents a diletma for the organic
zation striving to achieve naximura feasible pcx*ticlpatione When both
professional and client nwnbers are present within problem-solving
group, destructive dominance or confrontation is not unusual• Adminlis'| f?7orf wh? ^f^itionelly have been exposed only tc do not possess the
slc*“ls
ar?d constructively involve by personnel in meetings
professional members* It has been claimed by D.P* Moynihan
k 19t>9J that client involvement using conventional group techniques has
resulted in maxixnuro feasible misunderstanding*" As a result NGT in
pe-rticular han been widely adopted as a method for client involvement
in problem identification*
4 ^tizeri participation is not the only reason for increased aroup
decision making* Another important force is the need, to share expertise
ot ,en, a particular professional does not command sufficient techncloaical
expertise to unilaterally develop solutions to complex problems* As
tne accumulation and specialisation of knowledge increuses, viable
solutions to complex problems require the involvement of r source experts
from heterogenous disciplines or functions* This
Thin fact partly explains
tne proliferation of adhoc problem solving groups as opposed to standing
committees in complex organisations.
• •10
10
Contemporary administrators repeatedly complain how difficult
4,7° develoP effective dialogue among multifunctional or multidiciplinary resource personnel so that a new and creative frame of
an^fsis can be brought to bear on a particular problem (Delbeeq.
^972)e As a «®ult , at the end of problem
solving meeting the administrator frequently leaves a conference
feeling reduced by the "mind set" or fframwork of one or two assertive
group members. Such meetings do not provide for adequate consideration
of all facts of the problem or alternative solutions, because the
cost of long meetings and the further availability of resource personnel
makes further interaction impossible. Indeed, methods to quickly
phase in outside personnel without becoming trapped in an exorbitant
number of meeting are in short supply. The techniques treated in
this book are specifically designed for such situations.
In summary, this volume is written for the program administrators
or professional planner who must facilitate jucjnental group meetings
in setting such as those just discussed. It is directed toward answer
ing the following specific questions:
1) How can I use NGT and the Delphi Technique to obtain qroun
Judgments?
technique should be used for what types of problems?
3)
skills and prerequistAs are needed to implement each
technique
4) tVhen real world constraints for calling group meetings
(©•g«f time, cost, and travel) become important considerations
how does one weigh the costs and benefits of choosing one
technique over another ?
THE
NOMINAL GROUP
TECHNIQUE
4
was devel°Ped bY Andre L. Delbeeq and Addrew H. Van de Ven
4
in 1968• It was derived from social * psychological studies of
decision conferences^ managenent science studies of aggregating group
Judgments^ and social-work studies of problems sorrounding citizen
participation in program planning^ Since that time NGT has gained
extensive recognition and has been widely apr^lled in health, social
service education, industry, and governmental organization.
4. The term Mnominal ° was adopted by earlier researchers to
refer to processes which bring Individuals together but do
not allow the individuals to communicate verbally. Thus, the
collection of individuals is a group"in name only" since verbal
exchange, a sine qua non for group behavious is excluded, NGT
combines both non verbal and verbal stages, as will be elaborated
in the text. Thus NGT is more than a “nominal group. Along
researchers use a nominal process in differing forrnnts, particulary
emphasizing the generations of ideas as opposed in the generation,
discussion, and mathematical evaluation format which is the
normative process set forth by Delbeeq and Van and Van. For a
review of other literature on nominal formats refer to van de
Ven and Delbeeq. 1971.
• .lie
11.
one idea from his or* her
a” rou”^“robin fashion,
presents
nroDoSt<MliUi^fJJ1! noo,lna} Phase of the meeting is a list of
d^Mlon finw^TrSaUth- iL?Unterlng/lghteen t° twenty-five
TZ
™AOW8 auring the next phase of the meetinrr hnwmmr u
7
mathematically pooled outcome of the idivldual votes.
To sunnarlze, the process of decision making in NGT is as follows,
1) Silent generation of ideas in writing
2) Round-robin feedback from group members to record each idea
in a terse phrase on a fiirchartT
W
each ldea
3) Discussion of each recorded idea for clarification and evaluation
a> ^nrSe^Scii0;
JofiX
"*' hOWeWr *
of the process cS S
1) To assure different processes for each phase of creativity.
2) To balance participation among members.
3) To incorporate mathematical votina
techniques In the agrejatlon
of group judgment.
A brief word about
ph-.. of e«.^or» “
..12.
12
and an evaluation phase. The fast-finding phase deals with problem
search and the generation of data about the problem or* alternatively
about different proposed solutions. The evaluation phase is concerned
with information synthesis, screening, and choosing among strategic
elements of a problem or comptonent elements of alternative solutions.
There appears to be a consensus in research findings that these phase
of problem solving are two distinct decision-making activities and
require different roles and processes (Bales and Strodtbeck. 1969:
Simon and Newell 1958). In fact, to avoid group ambiguity about
differences in decision making phases. Maier and Hoffman (1964) suggest
that one that one type of group process should be used to generate
information and another type used to reach a solution.
The program administrator or planner should be concerned about
which group decision making process is appropriate in each phase of
problem solving. For example, while a number of small-group theorists
and practitioners question of viability of group interaction for the
problem identification or fact findin. phase, this does not inply
that interaction is not appropriate for clarification and evaluation.
Indeed, research by Vroom and his associates (1969) suggests that
discussion is useful for evaluating screening, and synthesizing
phases of problem solving. A major advantage of the two techniques
discussed in thSt book is that both NOT and the Delphi Technique
involve different group processes for the phases of independent idea
generation structured feedback, and independent mathematical Judgment
(Gustafson. Shukla. Delbeeq. and Waister. 1973).
A second advantage of the NGT format is the increased attention
to each idea and increased opportunity for each individual to assure
that his or her ideas are part of the group’s frame of reference
The nominal (silent and independent) generation of ideas, the round
robin listing and serial discussion, and the independent voting all
increase individual particpation. By contrast, the conventional
inter
group discussion generally
influence
of a few individuals due to status, personality, and other for ces
which we will through/ly explore in Chapter 2.
Finally, the voting procedures in both techniques Incorporate
insights from mathematics and management sciences. Studies in
these traditions have shown that the addition of simple mathematical
voting procedures can greatly reduce errors in aggregating indivi
dual Judgments into group decisions (Huber and Delbeeq. 1972).
THE DELPHI
TECHNIQUE
Unlike the typical Interacting meeting or NGT where close physical
proximity of group members is required for decision making the Delphi
Technique does not require that participants meet face to face. The
Delphi Technique is a method for the systematic solicitation and
collation of Judgments on a particular topic through a set of care
fully designed sequential questionnaires interespersed with summarized
information and feedback of opinions derived from earlier responses
13
4
13
To conduct the Delphi process. Turof (1970) suggests at least
three separate groups of individuals that perform tliree different
rolesi
Decision maker(s) The individual or individuals expecting sone
sort of product from the exercise which is used for their purposes
A staff group. The group which designs the initial questionnaire
summarizes the returns, and redesigns the follow up questionnaires.
A respondent gro ip. The group whose judgments are being sought
and who are asked to respond to the questionaires.
The Delphi process was developed by Dalkey and his associates
at the Rand Corporation. It has gained considerable recognition and
is used in planning setting to achieve a number of objectives!
1) To determine
natives.
or devalop a range of possible prograir alter-
2) To explore or expose underlying assumotions or information
leading to different judgments.
3) To seak out information which may generate a consensus on
the part of the superdent group.
4) To correlate informed judgments ona topic spanning a wide
range of diciplInes.
5) To educate the respondent group as to the diverse and
interrelated aspects of the topic.
Although there appears to be agreement among practitioners on
the above description of Delphi objectives, considerable variance
is possible in Delphi formats relative to design and implementation.
In particular, variations among practitioners in the administration
of the Delphi Technique revolve around the following issuest
1) Whether the respondent group is anonymous
2) Whether open-ended or structured questions ere used to obtain
Information from the respondent group.
3) How many interations of questionnaires and feedback reports
are needed.
4) What decision rules are used to aggregate the judgments of
the respondent group.
As we shall discuss in chapter 4. which reviews the delphu
5. The derivation of the label "Delphi " relates to the
"Delphic oracle * Delphi was /originally used to forcast
technological developments that like the
It was
used to look into the future.
14.
14
Technique in detail, the specific form of a Delphi is generally
determined by the nature of the problem being investigated and
constrained by the amount of human and physical resources available.
The basic approach used to conduct a Delphi can be exemplified
however, by a simplified Delphi situation wheieLn only two interatlons of questionnaires and feedback are used, first, the staff
team in dxi coilbaration with decision makers develops an initial
questionnaire and distributes it by mail to the respondent group.
The responents independently generate their ideas in answer to the
first questionnaire and return it. The staff tram then summarizes
the responses to the first questionnaire and develops a feedback
report along with the second set of questionnaires for the respondent
group. Having received the feedback report, the respondents inde
pendently evaluate earlier responses. Respondents are asked in
independently vote on priority ideas included in the second question
naire and mail their responses back to the staff team. The staff
team then develops a final summary and feedback report to the respondent
group decision makers.
CHOOSING A DECISION MAKING BBOCESS
.
Of course^ the program manager1s or planner’s choice of a
decision-making precess will reflect real-world constraints such as
the number of workign bourse required for group decision making
the cost of utilizing committees, and the proximity of group parti
cipants. The Delphu process requires the least amount of time for
participants. However, the claendar time required to obtain judgments
from respondents may take significantly longer than NGT meetings. In
addition, the staff-tdine and cost to design and monitor the Delphi
process may be more than the time and cost required to conduct an
NGT or interacting meeting.
Physical proximity may also be a real world constraint affecting
the practitioner’s choice of a decision making process. The Delphi
Technique doos not require participants to meet face to face, while
NGT and interacting processes require physical proximity. However
if disagreements or conflicting perspectives need to be resolved
the practitoner may question the viability of the Delphi Technique
which uses a simple pooling of individual judgments without verbal
clarification or discussion to resolve the differences.
In summary, concomitant with the advantages of a particular
method for group dedision making there is also a need to know the
cost associated with each process. In the final analysis, a compara
tive evaluation of the benefits and costs of NGT and the Delphi
Technique may force the administrator to adopt a less than optimal
technique for a give decision making situation, These trade-offs
will be discussed in some details in Chapter 2.
LOOKING AHEAD
t This book, then is concerned with acquainting program admini
strators and planners with two relatively new group techniques for
creative or judgmental probloa solvingi NGT and the Delphi Technique.
Both techniques are capable of avaoiding many difficulties on countered
in the usual interacting group discussions so often used for judgmental
problem solving.
• •15
15
In Chapter 2, we will examine in detail the theoretical and
empitical studies supporting the value of NGT and the Delphi Tech
nique as opposed to interacting committee meetings. Those readers
who are only interested in a detailed description of Delphi and NGT
processes and benefits of both techniques, rather than the theoretical
basis for the group processes, amy wish to skip Chapter 2, which is
somewhat complex, and turn directly to Chapter 3 and 4.
Chapter 3 is a training guide to utilizing NGT as a program
planning tool. Chapter 3, is a training guide to utilizing the Delphi
Technique. Chapter 5 discusses applications of NGT to typical
program-planning situationsi exploratory research, citizen partipa tion, utilization of multidisciplinary experts and proposal review.
1though Chapter 5 focuses upon NGT, readers of Chapter 2 and 4
will easily see the apportunitles to substitute the Delphi Technique
for NOT and will understand ths conditions under which it is advant
ageous to do so.
REFERENCES
Bales, R.F., and F.L Strodtbeck, "phases in Group problem solving"
In Organisational Decision Making. M. Alexis and C.z. Wilson,
eds* pp 122-33 Prentice Hall, 1969.
Brief. Arthur Paul, A. L Delbeeq, and A.C.Filley. "An Empirical
Analysis of Adoption Behavior", Paper presented at the Academy
of Management Annual Meeting, Seattle, Waehingtion 1974.
DellMeqy-Avbv-ax^adwawMp-An-Rweiiteoe-Deelslea-Meklng-W&tMa-the
Aeud—y ed-Menagemena Jeiumal 10, 4 (Deewmbee 1967)
Delbeeq, a.l. "Leadership in Business Decision Conferences" Doctoral
dissertation, Indianna university Graduate school of Business 1963.
Delbeeq A.L. The Management of Decision Making Within the Firm* Three
Strategies for three Types of Decision Making". Academy of
Management Journal 10, 4 (December 1967)t 329-39.
Delbeeq A.L."Contextual variable affecting Decision Making
Planning." Decision Sciences (October 1974).
in Program
and a.h. Van de Ven. "A Group Process Model for problem
Delbeeq
identification and Program Planning" Journal of Anpllod
Behavital Science (July-August 1971).
Delbeeq A.L. A.H.Van de Ven, and R Wallace "Critical problema in
Health Planning, Potential Managment Contrllxitions".
Paper presented at 32nd Annual Meeting of Academy of Management
August 13-16, 1972.
Gustafsun. David H. Rartiesh K. Shukal. a.l. Delbaeci, and G.Wllliaro
Walstar. "A comparative Study of Deifferencea in Subjective
Likelihood Estimates Made by Individuals, Interacting Groups,
Delphi Groups, and Nominal Groups "Organizational Behavior and
Human performance 9 (1973)i 280-91.
16.
16
Huber, George, and A.L. Delbecq. Guidelines for Combining the Judgrent
of Individual Members in Decision Conferences"! Academy of
Management Journal 15, 2 (June 1972)i 161-74
Maier, N.R.f., and L.R. Hof Irian "Quality of First and Second solution
in Group Problem Solving "Journal of Applied Psychology, 41
(1964): 320—23.
Moynihan, D.P. Maximum Feaible Misunderstanding Community Action
in the War on Poverty, Free Press, 1969.
Simon, Herbert A. The new Science of Management Decisions, Chapters
2 and 3. Harper Brother I960.
Simon, Herbert A, and Allen Newell, "Heuristic Problem Solving:
The Next Advance in Operations Research" Operations Research
Journal (January-February 1958)• Thompson and luden cit.
Thompson,
Thompson. J.,
J.. and Arthur Tuden. "Strategies, Structures, and Processes
of Organisational Decisions." In Comparative Studies in
Administration. Thompson et al, eds, pp. 198-99 University of
Pittsburgh press, 1959.
Turoff, M. "The Design of a policy Delphi". Technological Forecasting
and Social Change, 2 (1970)
Van de Ven, A.H. An Applied Experimental Text of Alternative Decision
Making processes Center for Business and Economic Research
Fraas. *ent State University, 1973.
Van de Ven, a,h. and A.L.
A,L Delbeeq. "Nominal Versus Interacting
Group Processes for Committee Decision—Making Effectiveness
Academy of Management Journal (June 1971).
Van de Ven.
and <A.L. Delbecq "A Planning Process for Deve
.H., and
___ a,jet
lopment of Complex Regional Programs". Proceedings of the
American Socialogical Association Annual Meeting August 1972.
^room V.H. L.D Gomt, and T.J. Cotton. "The Consequences of Social
Internetion in Group Problem Solving "Journal of Applied
Psychology 5#t4 (August 1969)i 338-41t
Delphi Technique is superior to NOT and interacting groups. If
on the other hand, participants have the time and no large travel
costa are entailed in brigning people together, NGT and interacting
processes require less administrative cost and effort, and the
inform ation can be collected in far less calendar time.
..17
17
TABLE 2-1.
Time Cost, and Effort in Conducting 20 NOT Groups 20 Interacting
Groups, and 20 Delphi Groups with a Two
Delphi Survey.
Sourcet Adopted from Group Decisionmaking Effectiveness by
Andrew Van de Ven, published by Center for Business and
Economic Research Press, Kent State University, 1974. Used by
Permission.
Administrative Time and Efforts
NGT
Intsxactinc
Physical Preparation Time
Administrative Time in
Training Leaders
20 hrs
20 hrs
8 hrs.
4 brae
30 hrs.
30 hrs.
30 hrs.
30 hrs.
Time Requirements for 20 Leaders
in Conducting Meetings @lh Hours
Post-Meeting Summary Reports
Administrative Time in follow
up Reminders for Questionnnir
# 1
Preparation and Bistrlbution of
Feedback Reports and
Questionnaire #2
Delphi
20
hrs
29»4
hrs.
30
hrs.
Administrative Time in follow
up Reminders for Questionnair ^2
hrs.
Administrative Time in Preparing
post-Delphi Swmary Reports
Total Administrative Working
Hours
88 hrs.
84 hrs.
20
hrs.
141^
hrs.
Administrative Costs
Cotai Administrative Salar (2.50/
hr.)
Total Cost of Supplies and Mlsc.
Total Administrative Cost
Calendar Time to Conduct Meetings/belphi
Participant Timet
Actual Number of Participants
in All Groups
Average Time Requirement per
participants
Total Participant working Hours
$220
10
$230
4 evenings
$210
10
$220
$353.12
86.80
$439.92
4 evenings 5 months
130
138
120
IJj hrs
162.5 hrs
1^ Jr
hr
60 hrs.
160 hrs
.18
18
TABLE2-2
Comparison of Qualitative Differences Among Interacting NGT,
and Delphi Groups. Sourcesi Adapted from Group DecisionMaking Effectiveness by Andrew Vande Ven, Published by Center
for Business and Economic Research Press, Kent State University,
1974. Used by permission.
DIMENSION
INTERACTING
NOT
DELPHI
OVERALL
METHODOLOGY
Unstructured meeting structure meet- Structured
High Variability bet ing Low varia- series of quebility between stionnalres and
ween decison -making
decision-making feedback reports
groups
groups
Low variability
between decision
panels
ROLE ORIENTATION
OF GROUPS
Social-emotional
focus
Balneed socialTask-instrumen
emotional and
tal focus
task-instrumental
focus
RELATIVE QUANTITY
OF IDEAS
Lows focused
"rut" effect
High independent High Isolated
thinking
thinking
RELATIVE QUAjOEIIY
AND SPECIFICITY
OF IDEAS
Low quality
Generalizations
High quality
High quality
High specificity High specificity
NORMATIVE BEHAVIOR
Inherent confoxmity
pressures
Tolerance for
nonconformity
SEARCH BEHAVIOR
Practive
Extended problem
focus
Take avoidance
High task
centeredness
tendency
New Social knowledge New social and
task knowledge
EQUALITY OF
PARTICIPATION
Member dominance
Member equality Respondents equ
ality in pooling
of independent
judgments
METHODS OF CONFLICT
RESOLUTION
Person-Centered
Smoothing over and
withdrawal
Problem centered Problem centered
Confrontation and Majority rule of
problem solving pooled indepent
Judgments
CLOSURE TO DECISION
PROCES
Lack of closure
Low felt accomplish
ment
Medium
Hlgh closure
High felt accom
plishment
High
TASK MOTIVATION
Ractive
Short Problem focus
Freedom not to
conform
Practive
Controlled pro
blem focus
High task
centeredness
New task
knowledge
High closure
Medium felt
accomplishment
Medium
It
SUMMARY PROFILE
Based upon the proceeding review of research findings. Table
2-2 presents a recapitulation of the qualitttive differences among
interacting* q not and Delphi groups. The research suggests that
different phases of problem solving require different group-process
strategies. A profile of the comparative merits of the three deci
sion making techniques for generating information and group Ideas on
problem or issue can now be summarized.
Interacting groups
For fact-finding problems* interacting groups contain a
number of process characteristics which inhibit decision-snaking
performance«
1) Because interacting group meetings are unstructured high
variability in member gnd leader behavior occurs from
group to group.
2) Discussion tends to fall into a nut* with group members
focusing on a single train of thought for extended periods*
and with relatively few ideas generated.
3) The absence of an opportunity to think through independent
ideas results in a tendency for ideas to be expressed as
generalizations.
4) Search behavior is reactive and characterized by short
periods of focus on the problem* tendencies for task
avoidance* tangential discussions* and high efforts in
establishing social relationships and generating social
knowledge.
5) High-status* expreslve* or strong personality type in
dividuals tend to dominate in search* evaluation* and
choice of group product.
6) Meetings tend to conclude with a high peroSLval lack.
GROUP TECHNIQUES
FOR
PROGRAM PLANNING
A guide to nominal group
and delphi processes
From GROUP TECHNIQUES FOR PROGRAM PLANNING
by Andre Delbecq, Andrew Van de Van and
David Gustafson, Copyright 1975 Scott,
Foresman and Company, Reprinted by permission.
Scott, Foresman and Company "Glenview, Illionis Dallas Tex. Oakland
N.J. Palo Alio, Cal. " Tucker Ca Brighteen, England.
The final chapter discusses in the detail the one of NGT in planning
exploratary research involving citizen identifying multidisplinary exprts
and rssfltow reiewing project proposals.
NGT IN HEALTH CARE ADMINISTRATION
Perhaps I was given the honor of writing this introduction because I
happen to be one of a rapidly elarging group of professional practitioners
who have used NGT for a variety of purposes and in diverse settings. I feel
comfortable in accepting this assignment even though I am not a theorist of
or organizations or of group process, because as a practitioner and teacher
of health care administration I have been deeply impressed with what NGT
can accomplish and with the case and utility of its use, I have used it, or
portions of it, in common administrative problem solving situations. I have
also used it to plan for a continuing education program for staff mem
bers and consumer boards of health centers, I have used it in graduate
seminars ina school of publich health and in consumer training program.
With Andre Delbecq, I used it to define problems facing comprehensive
health planning boards in Hasvati, Guam, and six governmental districts
of Micamesia (in the last setting the participants spoke many different
languages and had employed NGT in a research project to develop consumer X
and professional definitions of the uniquely important rules and qualities
of primary health care organizations. I can therefore, fully attest on
its advantages in planning administration, continuing education, academic
teaching and research. My evaluation of its effectivenes is based on
four types of evidencei (1) the greater flow of ideas I have seen
generated when compared with traditional meetings! (2) the fuller parti
cipation of all those involved in contrast to other settings (3) the
increased evidence of the task being brought to closure, and (4) the
evident senses of satisfaction on the part of participants about these
three accomplishment.
Over time I have also been able to answer in large part the
principal reservation I have had about its use. Will there be difference
in participation between persons coming from different cultures or
different socioeconomic backgrounds? Can
...2.
t
2
diverse groups participate effectively together? De participants
of
feel manipulated creeded and resentful because of the
the proces. Is charsmatic leader necessary to make it work? Can
use be article or minimized? In answer to these questionss
I should like to share some of my observations.
In my experience this technique seeir.s ito v;ork in groups made
up cf members from any socioeconomic level of culture,» We have used
it successfully with members cf poverty comiuunities and also with
wsome of the nation's leading experts on health care. We have used
it with professon and persons with grade-school educations. We
have used it with English-speaking participants and those needing
translators. It has also proven to be effective and acceptable
in groups where backgrounds are mixed and# as the authors pointout
it allows what in ether settings might be conflictual or potentially
offending stateneiits to be brought out# clarified# and ranked with
out strife or discord. It creates situations where those who might
not participate for reasons inherent in ideology or in the social
situation Ipswaixie become full partners. In Guam for example# the
NGT groups contained ch^ftncnan women
had ■
from the villages who spoke little English alongside
women from the capital city who were active in civc affairs. It
became quite clear after the first few hours of the day that both
groups took deep satisfaction in the work they acommplished. One
of the Chomonan women told me afterward that she had great fear
o fhaving to speak in what she conisered here inadequate English.
Soon to her great surprise# she felt very comfortable in presenting
the items on her list and in assisting in their clarification
Recently we went through a somewhat similar experience in a Southern
city of the Unitied states# The Participants while all Southerners
represented a particularly wide range in age sex# race# and social
status. The person most obviously under anticipatary tension in
this group was a white woman of upper-class background. Her hands
were clenched at the beginning. As the day were on she relaxed?
soon her partiqpation wa enthusisastic.
Questions about the rididity of the process and whether or
not it will be pererlved as manipulation or coercion must be given
serious consideration* In my experience# no matter the background
(and we have used it with groups whose members were particularly
sensltix'e to being manipulated) # participants nave not resented the
structure. But and T feel that this is a critical point-we have
always a bad skilled leaders to explain the rationale and guide
the process. In clumsy or insensitive hands# or in the civ,ths of
someone who wished to exploit rigidity for purposes of control#
the results might well be otherwise.
Tbia cautionary note raises the .Issue of the quality of leader
ship and its iinportancc in the success or failure of the NGT
process.> The quality of leadership is of great importance* It
requires not only someone who feels comfortable with all phases
of the proces but one who can also provide understandable and
reasonable explanations and who possesses sensitivity to unasked
questions* It requires someone who has the ability to impose structure
3
in a nonthreatening manner and, during the clarification period,
setneone who is able to move the discussion along briskly, keep it
from becoming bogged down in detailed ancedotes of "position papers"
and at the same time avoid hunting anyone's feelings. These tasks
obviously cannot be accomplished by everyong.
This brigs me to its appropriate use, NGT can be and has
been used in a variety of setting. For example, in the next section,
Angelo Foruna of ARA Services INc,, discusses its applications
in a business setting. The authors stress, however, that NGT is
not a panacea to overcome all problems of small group process; it
must be used with discrimination. Because of the necessity for
preplanning, for adherence to a predetermined procedual structure,
and for an adequate amount of time, it cannot be used in the
average meeting. Additionally, the effort required on the part of
the participants goes for beyond possive attendance, ^or these
reasons, it dould not be considered for routine decision making.
Its use is for issues adjudged especially important, where it is
essential/ to have wide and representative input, and where diffi
culties in ranking and rating problems or solutions as a basis
for group decisions are such that the traditional meeting is of
relatively little use.
Alberta W. Parker, M.D.
Clinical Professor of
Conrounity Health
School of Public Health
University of California
Berkeley
GROUP DECISION MAKING IN
MODERN
ORGANIZATIONS
Increasingly, practicing administrators of professionals
are seeking useful new techniques to increase rationality, creativity,
and participation in problem solving meetings associated with program
planning. As the number of occasions requiring pooled jugroents
in planning increase, so does the need for increased skill in con
ducting such meetings*
In this volume we shall focus on two specific techniques the
Delbeeq and Van de Van Nominal Group Technique (NGT), and the Delphi
Technique* At the completion of the book, the practicing administrator
or professional planner should thoroughly understand the theory,
research and practical proHsms surrounding both methodologies, for
increasing a group's creative capacity to generate critical ideas
and understand problems and the component parts of their solutions;
thus participants can aggregate (pool) individual jugements and
arrive at desirable group decisions*
....4
5
THE
NATUR E
OF
PROGRAM
PLANNING
activitles^hich^ne^T'F?*1”^^6 term implies a prearranged set of
public sector
mean8 to achieve a goal, in the
is formulated in order toUprovide services
®overn,ne"t), a program
human service objectives
services which accomplish defined
specifies technical aJS nro^essloS^actlvltJ’Z1’8 fnt®rwntlon program
actlvities aimed at ameliorating
i>ersonal suf ferine oreventin^ a, '
indiv duals facino*oersonalnaclde*' a"d Providing comfort to
and induatry), a J^graTSy SXr'to a s«
pulations required tn
ZO a ®et of technological roaniis the means^end sequence neces”™
a Program
a *eclflc service or
product or modification of procS
planners are increasingly bSSt Sk^d
Prof«ssi^al
task-force grouns or
to Pa:ticiPate in s-eci al committees
new prograns or chaLJna 2X11? S concerned wlth recommending
or®anl2<'tlo"’l readiness to adopt the now
progranie
a*
Of th® lmP°rtance of client problems
which the program proposal addresses.
b‘
m^f?tan^ng O,f availabl<s solutions due to either
e?rller organizations who have adopted
simila^ ^«iln9
rograms, or lack of codified and agree-uppn
e?ideJcetC
technlcal models and lack of experimental
2}
2) A ;largo number of individuals or groups (e.g., providers
clients, funders, professionals,
. J and administrators) constlute the
I.
decision set which will .__
!>ro9"”an<i whlch u111
- ™
review the proposal under
a. the groups have different value
and conceptual orientations
b. prior communication networks based on joint participation
in the development of earlier
-- successful prSgrams do not
exist.
y. Th«®e two papers are concerned with detailed
elaborations of the
aetaixea teor-tlcal and
3) <The P^anoeSZX^nX^J/^d3 great lmPact on Present
organisational arrangements and allocation of resources due to:
a. limited slack resources.
b. absence of major outside funding.
with thesy°complexPplanninq13ituatlPrOC!FSSeS niUSt be adoPted to cope
a9reement concerning1 the^general^e^ence^^deps^whioh^planners11
6
rnUS^j^?^^?w
®uc^ cases* The authors have developed a model of seq
uential planning steps called PPM (Program planning Model) which
suggests that critical features of program planning under conditions
Ofs complexity should include (Delbecq and Van de Van, 1971; Van de Van
and Delbecq. 1972):
Obtaining early review of the planning intent, and a clear
mandate from top-level decision makers concerning the general
approach followed in //developing the program.
Involving clients or <--consumers in problem exploration meetings
to document unmet needs.
Involving outside resource people (both scientific and technical
to help explore components of an appropriate program to solve
those needs.
Involv ng administrators, funding sources, clients
clients, and
professionals in an early review of program plans.
Involving appropriate personnel in devoloprbiag designs xor
implementation and evaluation.
Involving other pe sonnel, from orgaization who will be
later adopters of the new program, as participant observers
in a demonstration program, to prepare the way for technological
transfer or diffusion of innovative programs.
GROUP TECHNIQUES AND PROGRAM PLANNING
In this book, we will focus upon group techniques useful in program
planning and administration obviously many other elements enter into
program planning beyond group meetings. Nonetheless s nee they processes
include (1; problem explorating; (2) knowlege exploration: (3) pre
liminary review (4) design and implementation teams: and $5) evaluation
and review meetings; then group processes which facilietate the sharing
of jugements at each of these critical junctures are importat.
Since NOT and the Delphi Technique are but two specific types
of group processes* It is important to defferentiatc them from
other group processes such as bargaining confrontation, hearings etc.,
which also have their places in program administration and planning.
The nature of NOT and the Delphi Technique
Like other group techniques (e.g., force-field analysis and
parliamentary procedure), NGT and the Delphi Techniques are not a
panacea for all group meetings* They are special-purpose techniques
useful for situations where individual jug^rnents must be tapped ahd
combined to arrive at decisions which cannot be calculated by one
persons. They are problem solving or idea-generating strategies, not
techniques for routine meetings, coordination, bargaining, or negotiations.
• •7
8
Since the distinction between jugmental versus other types of
meeting situations is an important distinction, a word of elaboration
is worthwhile so the reader clearly understands the type of meeting
we are concerned with in this book.
We are not concerned with routine meetings. Generally speaking
we can define a routine meeting as a situation where members of the
group agree upon the desired goal, and technologies exist to achieve
this goal in such a meeting the focus is on coordination and in
formation exchange, and the meeting the focus is on coordination
and information exchange, and the meeting is "leader centered"
(Delbeeq, 1967). In a program-planning situation, this task would
be delegated to a trained technical export or team of experts to
handle based on established formulas.
Likewise, we are not conemed with negotiation or bargaining.
We can define this situation as one in which opposing factions deffering in norms, values, or vested interests stand in opposition to
each other concerning either ends, means or both. The management of
conflict and the formulation of representative groups is also out
side our focus (Delbeeq 1967). In a program-planning context this
situation occurs when opposing factions have assumed hardened posi
tions based on strong value differences.
3
Colloquially,
We are concerned with judgemental decision making
we are talking about creative decision making. The central clement
of this situation is the lack of agreement or incomplete state of
knowledge concerning either the nature of the problem or the components
which must be included in a successful solution. As a result hetero
geneous group members must pool their jugements to invent or discover
a satisfactory course of action. Obviously, jugemental problem
and solution exploration is but a subset of meeting important to
administrators and planners in program planning, Nonetheleos, the
need for creative or jugemental problem solving occurs frequently.
NOT and the Delphi Techniques along with other meeting formats,
are important components in the repertoire of professional and mana
gerial group skills which planners will find useful.
The increased need for pooled judgments
with growing frequency, then, contemporary program administrators
or professional planners face situa ions where they must elicit and
combine jugments in group meetings. Not only do administrators or
planners need to involve their own professional staffs in program
planning, but they are also often urged to find viable methode for
tapping the jugments of various outside groups (e.c., resource exports
customers, clients etc.) from different backgrounds, positions end
perspectives.
2. In simon’s terminology this is the •‘Programmed" decision
(simon, 1960) In thampeon's terminology this is the
decision situation (Thampeon, 1959)
3. Here we are talking about the situation which in Simon's
and in Thampson's terminology is
terminology is
" judgmental •*.
.-9
9
Unfortunately, organizational life for many administrators and
IWsSWSWisL
that as much as 80 percent of a program administrator’s working
8p!n5 ln comrol,t^ee meetings (Van de Ven, 1973). Simply on the
basis of costs per working hour, it behooves the administrator or
’xp,,,lent
proc.... tor
is the £act that Judgmental decisions are
saro® group Presses that dominate
routine coordination and information exchange (Delbeeq. 1963). it is
re<^1,3Dent of effective leadership, therefore, in redefine
^roup roles and processes so that judgmental decisions are facillated
^toi^es. This book will help the planners or admini
strator structure such judgmental situations away from the leadercenterea coordination format of routine meetings.
ThiS 18 an age of ‘,I(!ax ^raurn feasible participation*1 wherein clientm
US®fl ?X consumer groups in public and private organizations wish to
participate in program planning and administration, in the public
sector, citizen or client participation is often legally required in
by federal agencies in health, aducation, welfare,
and urban affairs. Such participation, however, is not restricted
to the public sector, and the appropriateness of having administrators
or professionals unilaterally plan or make decisions for customers has
been questioned.
Yet une involvenient of user groups presents a dilemma for the organi
zation striving to achieve tnaxlmum feasible participation. When both
professional and client members are present within problera-solving
group, destructive dominance or confrontation is not unusual. Adminitraditionally have teen exposed only to do not possess the
vitally and constructively involve by personnel in meetings
raember8« It has been claimed by D.P. Moynihan
11969) that client involvement using conventional group techniques has
resulted in maximum feasible misunderstanding." As a result NGT in
particular has been widely adopted as a method for client involvement
in problem identification.
, . Citizen participation is not the only reason for increased group
decision making. Another important force is the need to share expertise
often, a particular professional does not command sufficient technological
expertise to unilaterally develop solutions to complex problems. As
the accumulation and specialization of knowledge increases< viable
solutions to complex problems require the involvement of resource experts
from heterogenous disciplines er functions. This fact oertlv explains
XlSiMn^p^’oraanfSlS:.: 01''1"5 9rO"P’ "
•“'>"■>9
..10
10
<.C^tTnpOf’ary ®*T’lnistrat°rs repeatedly complain how difficult
n,ee?n9?ije administrator frequently leaves a conference1
5educedcb\the ,,n,ind set" or ffcamwork of one or two assertive
S^ll
SCh me®tings do not provide for adequate consideration
f H1® Problero or alternative solutions, because the
makJ. furthe/TSiS^?"
availabnity of resource personnel
further Interaction impossible. Indeed, methods to quickly
Personnel without becoming trapped in an exorbitant
K f ri,eetlng ®re in short supply. The techniques treated in
this book are specifically designed for such situations.
In summary, this volume is written for the program administrators
or professional planner who must facilitate jugmental group meetings
fUC1? as h5108® Just discussed. It is directed
toward
’*-- --2 ---J answering the following specific questions:
1) How can I use NOT and the Delphi Technique to obtain group
Judgments?
2)
technique should be used for what types of problems?
3) WhajJ< skills and prerequistAs are needed to implement each
technique
4) When real world constraints for calling group meetings
(e.g., time, cost, and travel) become important considerations
how does one weigh the costs and benefits of choosing one
technique over another ?
THE
4
in 1^8,
NOMINAL GROUP
TECHNIQUE
dev®loPed bY Andre L. Delbeeq and Afldrew H. Van de Ven
It was derived from social - psychological studies of
participation in program planning. Since that time NGT has gained
extensive recognition and has been widely applied in health, social
service education, industry, and governmental organization.
4. The term 11 nominal w was adopted by earlier researchers to
refer to processes which bring individuals together but do
not allow the individuals to communicate verbally. Thus, the
collection of individuals is a group”in name only” since verbal
exchange, a sine qua non for group behavious is excluded, NGT
combines both non verbal and verbal stages, as will be elaborated
in the text. Thus NGT is more than a ’’nominal group. Along
researchers use a nominal process in differing formnts, particulary
emphasizing the generations of ideas as opposed in the generation*
discussion, and mathematical evaluation format which is the
normative process set forth by Delbeeq and Van and Van. For a
review of other literature on nominal formats refer to van de
Ven and Delbeeq. 1971.
..lie
11.
folloSlL1^™!?^
? 9rOUp roeetin9 whi c h proceeds along the
divi^i?2
imagine a meeting room in which seven to ten inar?und a table in full view of each other; howbeginning of the meeting they do not speak to each other
4.n?r*
en^
^Ve to ten minutest a structured sharina
one^dea
Each individual, in round-robin fashion, presents
?r private ii’t. A recorder writes that idea on
a flln
Ch
1 £U11 View of other members. There is still nof discussion
la.2!
°i privately narrate d
U“tU 811 nien’bers indicate they
hSve no furSe^deas to share?
ni-r>r>«3<lT<^Ut?U\O£
nominal phase of the meeting is a list of
discussion
u’“ally numbering eighteen to twenty-five
is strutted
neXt ?h®8e of the ma«ting however, it
iL?“ut
ea^ idea receives attention befofe independent
°°
Thi 18 accorr,P1i8hed by asking for clarification, or stetina
T?pp ™ °r nonsupport of each idea listed on the flip chart. IndepnpJlJrltiw ’bt’JSnk^Jderino*? EacJ member privately, in writing selets
ring (or rating). The group decision is the
1
mathematically pooled outcome of the idivldual votes.
To summarize, the process of decision making in NOT is as follows i
1) Silent generation of ideas in writing
2) Round-robin feedback from group members
'
to record each idea
in a terse phrase on a flip chart.
3) Discussion of each recorded idea for clarification and evaluation
•) Individual voting on priority ideas with the group
group decision
decision
being mathematically derived through rank-ordering or rating.
NGT overco“«a a number of critical problems typical of
1 9 groups. (These problems will be discussed in Chapter 2)
fnfiSo mornent' however, objectives of the process can be stated as
XwXXQwBB
1) To assure different processes for each phase of creativity.
2) To balance participation among members.
3) To incorporate mathematical voting techniques in the agregation
of group judgment.
A brief word about each objective might be useful in this introdO8c*lptl°n* Ab will be discussed in Chapter 2 when we review
it is possible to Identify two JniSe
phases of creative or judgmental problem solving; a fact-finding phase
..12.
12
and an evaluation phase. The fast-finding phase deals with problem
search and the generation of data about the problem or, alternatively
about different proposed solutions. The evaluation phase is concerned
with information synthesist screening^ and choosing among strategic
elements of a problem or component elements of alternative solutions.
There appears to be a consensus in research findings that these phase
of problem solving are two distinct decision-making activities and
require different roles and processes (Bales and Strodtbeck, 1969:
Simon and Newell 1958). In fact# to avoid group ambiguity about
differences in decision making phases, Maier and Hoffman (1964) suggest
that one that one type of group process should be used to generate
information and another type used to reach a solution.
The program administrator or planner should be concerned about
which group decision making process is appropriate in each phase of
problem solving. For example, while a number of small—group theorists
and practitioners question of viability of group interaction for the
problem identification or fact finding phase, this does not imply
that interaction is not appropriate for clarification and evaluation.
Indeed, research by Vroom and his associates (1969) suggests that
discussion is useful for evaluating screening, and synthesizing
phases of problem solving. A major advantage of the two techniques
discussed in thM book is that both NGT and the Delphi Technique
involve different group processes for the phases of independent idea
generation structured feedback, and independent mathematical judgment
(Gustafson. Shukla, Delbeeq. and Waister, 1973).
A second advantage of the NGT format is the increased attention
to each idea and increased opportunity for each individual to assure
that his or her ideas are part of the group’s frame of reference
The nominal (silent and independent) generation of ideas, the round
robin listing and serial discussion, and the independent voting all
increase individual partiepation. By contrast, the conventional
inter
influence
group discussion generally
of a few individuals due to status, personality, and other for ces
which we will through/ly explore in Chapter 2.
Finally, the voting procedures in both techniques incorporate
insights from mathematics and management sciences. Studies in
these traditions have shown that the addition of simple mathematical
voting procedures can greatly reduce errors in aggregating indivi
dual judgments into group decisions (Huber and Delbeeq. 1972).
THE DELPHI
TECHNIQUE
Unlike the typical interacting meeting or NGT where close physical
proximity of group members is required for decision making C
the Delphi
Technique does not require that participants meet face to face. The
Delphi Technique is a method for the systematic solicitation and
collation of judgments on a particular topic through a set of care
fully designed sequential questionnaires interespersed with summarized
information and feedback of opinions derived from earlier responses
13
13
To conduct the Delphi process, Turof (1970) suggests at least
three separate groups of individuals that perform three different
rolest
Decision maker(s) The individual or individuals expecting some
sort of product from the exercise which is used for their purposes
A staff group. The group which designs the initial questionnaire
summarises the returns* and redesigns the follow up questionnaires*
A respondent group. The group whose judgments are being sought
and who are asked to respond to the questionaires*
The Delphi process was developed by Dalkey and his associates
at the Rand Corporation. It has gained considerable recognition and
Is used in planning setting to achieve a number of objectIvest
1) To determine
natives.
or develoo a range of possible program al ter—
2) To explore or expose underlying assurootions or Information
leading to different judgments.
3) To seak out information which may generate a consensus on
the part of the superdent group.
4) To correlate informed judgments one topic spanning a wide
range of diciplInes*
5) To educate the respondent group as to the diverse and
interrelated aspects of the topic*
Although there appears to be agreement among practitioners on
objectives considerable variance
the above description of Delphi objectives*
is possible in Delphi formats relative to design and implementation.
In particular* variations among practitioners in the administration
of the Delphi Technique revolve around the following issuess
1) Whether the respondent group is anonymous
2) Whether open-ended or structured questions are used to obtain
information from the respondent group.
3) How many interations of questionnaires and feedback reports
are needed*
4) What decision rules are used to aggregate the judgments of
the respondent group*
As we shall discuss in chapter 4, which reviews the delphu
5, The derivation of the label “Delphi " relates to the
"Delphle oracle " Delphi was /originally used to forcast
technological developments that like the
it was
used to look into the future.
14.
14
Technique In detail/ the specific form of a Delphi is generally
determined by the nature of the problem being investigated and
constrained by the amount of human and physical resources available.
The basic approach used to conduct a Delphi can be exemplified
however/ by a simplified Delphi situation wheain only two interations of questionnaires and feedback are used/ first/ the staff
team in k±k± coilbaration with decision makers develops an initial
questionnaire and distributes it by mail to the respondent group.
The responents independently generate their ideas in answer to the
first questionnaire and return it. The staff tram then summarizes
the responses to the first questionnaire and develops a feedback
report along with the second set of questionnaires for the respondent
group. Having received the feedback report/ the respondents inde
pendently evaluate earlier responses. Respondents are asked in
independently vote on priority ideas included in the second question
naire and mail their responses back to the staff team. The staff
team then develops a final summary and feedback report to the respondent
group decision makers.
CHOOSING A DECISION MAKING SBOCESS
.
Of course/ the program manageres or planner's choice of a
decision-making process will reflect real-world constraints such as
the number of workign bourse required for group decision making
the cost of utilizing committees/ and the proximity of group parti
cipants. The Delphu process requires the least amount of time for
participants. However/ the claendar time required to obtain judgments
from respondents may take significantly longer than NGT meetings, In
addition/ the staff-time and cost to design and monitor the Delphi
process may be more than the time and cost required to conduct an
NGT or interacting meeting.
Physical proximity may also be a real world constraint affecting
the practitioner's choice of a decision making process. The Delphi
Technique does not require participants to meet face to face, while
NGT and interacting processes require physical proximity. However
if disagreements or conflicting perspectives need to be resolved
the practitoner may question the viability of the Delphi Technique
which uses a simple pooling of individual judgments without verbal
clarification or discussion to resolve the differences.
In summary, concomitant with the advantages of a particular
method for group dedision Snaking there is also a need to know the
cost associated with each process. In the final analysis, a compara
tive evaluation of the benefits and costs of NGT and the Delphi
Technique may force the administrator to adopt a less than optimal
technique for a give decision making situation, These trade-offs
will be discussed in some details in Chapter 2.
LOOKING AHEAD
, This book/ then is concerned with acquainting program admini
strators and planners with two relatively new group techniques for
creative or judgmental problem solving: NGT and the Delphi Technique•
Both techniques are capable of avaoiding many difficulties on countered
in the usual interacting group discussions so often used for Judgmental
problem solving.
• •15
15
somewhat complex, and turn directly to Chapter 3 and 4.
n! »nnT«apr^fi3
tra±"in9 9Mid® to utilising NOT as a programlichSiaue
Chantir PJea<3* 18 8
9uide *o utilizing the Delphi
lechnique. Chapter 5 discusses applications of not to typical
program-planning situations* exploratory research, citizen parti^l^oSahUChai^Si?n*°f multidisclPlinary experts and proposal review.
1 enough Chapter 5 focuses upon NOT, readers of Chapter 2 and 4
3®®th® opportunities to substitute the Delphi Technique
for NGT and will understand the conditions under which it is advantageous to ao so*
REFERENCES
I:
i
Bales, Re*.,
R.F., and F.L SUrodtbeck,
Strodtbeck, Kphases in Group problem solving”
sales.
in Organisational Decision Making, M* Alexis and C,2. Wilsoneds. pp 122-33 Prentice Hall, 1969.
Brief. Arthur Paul, A. L Delbeeq, and A.C.Filley. "An Empirical
Analysis of Adoption Behavior", Paper presented at the Academy
of Management Annual Meeting, Seattle, Washingtion 1974.
Dekbeeqr-A<fev-Mxteade»eh4p-4n-Bu®iHeee-Dee4s4eii-.Mak4»g-W44h4»-4he
Aeeeemy-e#^eMgemene-^wm^-4^r M4-4DeeeMber-M6^)>
Delbeeq, A.L. ’’Leadership in Business Decision Conferences” Doctoral
dissertation, Indianna University Graduate School of Business 1963.
Delbeeq A.L. The Management of Decision Making Within the Firmi Three
Strategies for three Types of Decision Making”. Academy of
Management Journal 10, 4 (December 1967)t 329-39.
Delbeeq A.L.”Contextual variable affecting Decision Making
Planning." Decision Sciences (October 1974).
in Program
Delbeeq
and A.h. Van de Ven. **A Group Process Model for problem
identification and Program Planning" Journal of Applied
Behavital Science (July-August 1971).
Delbeeq A.L. A.H.Van de Ven, and R Wallace "Critical problems in
Health Planning: Potential Managment Contributions".
Paper presented at 32nd Annual Meeting of Academy of Management
August 13-16, 1972.
Gustafsun, David H. Ramesh K. Shukal. A.L. Delbeeq, and G.William
^Ister. "A comparative Study of Deifferences in Subjective
Likelihood Estimates Made by Individuals, Interacting Groups,
Delphi Groups, and Nominal Groups "Organizational Behavior and
Human performance 9 (1973): 280-91.
16.
4
16
Huber, George, and A.L. Delbecq. Guidelines for Combining the Judgnmt
of Individual Members in Decision Conferences"^ Academy of
Management Journal 15, 2 (June 1972): 161-74
Maier, N.R.F., and L.R. Hoffman "Quality of First and Second Solution
in Group Problem Solving "Journal of Applied Psychology, 41
(1964): 320-23.
Moynihan, D.P. Maximum Feaible Misunderstanding Community Action
in the War on Poverty. Free Press, 1969.
Simon, Herbert A. The new Science of Management Decisions, Chapters
2 and 3. Harper Brother 1960.
Simon, Herbert A, and Allen Newell, "Heuristic Problem Solving:
The Next Advance in Operations Research" Operations Research
Journal (January-February 1958). Thompson and Tuden cit.
Thompson, J., and Arthur Tuden, "Strategies, Structures, and Processes
of Organizational Decisions." In Comparative Studies in
Administration. Thompson et al, eds, pp. 198-99 University of
Pittsburgh press, 1959.
Turoff, M. “The Design of a policy Delphi". Technological Forecasting
and Social Change, 2 £1970}
Van de Ven, A.H. An Applied Experimental Text of Alternative DecisionMakingg processes Center for Business and Economic Research
Press,, ^nt State University, 1973.
Van de Ven, a.h. and A,l. Delbeeq. "Nominal Versus Interacting
Group Processes for Committee Decision-Making Effectiveness
Academy of Management Journal (June 1971).
Van de Vsn. A,h., and A.L. Delbecq "A Planning Process for Deve
lopment of Complex Regional Programs". Proceedings of the
American Socialogical Association Annual Meeting August 1972.
^room V.H. L.D Gomt. and T.J. Cotton. "The Consequences of Social
Intemation in Group Problem Solving "Journal of Applied
Psychology 5®,4 (August 1969): 338-41.
Delphi Technique is superior to NGT and interacting groups. If
on the other hand, participants have the time and no large travel
costs are entailed in brigning people together, NGT and interacting
processes require less administrative cost and effort, and the
inform ation can be collected in far less calendar time.
..17
17
TABLE 2—1.
Time Cost, and Effort in Conducting 20 NOT Groups 20 Interacting
Delphi Survey.
Groups, and 20 Delphi Groups with a Two
Source* Adopted from Group Decisionmaking Effectiveness by
Andrew Van de Ven, published by Center for Business and
Economic Research Press, Kent State University, 1974. Used by
Permission.
Administrative Time and Effort*
NGT
Physical Preparation Time
Administrative Time in
Training Leaders
20 hrs
20 hrs
8 hrs.
4 hrs.
30 hrs.
30 hrs.
30 hrs.
30 hrs.
Interacting Delphi
20
hrs
29k
hrs.
30
hrs.
Administrative Time in follow
up Reminders for Qvestlonnair if 2
41^
hrs.
Administrative Time in Preparing
post-Delphi Summary Reports
20
hrs.
141*4
hrs.
Time Requirements for 20 Leaders
in Conducting Meetings @l*j Hours
Post-Meeting Summary Reports
Administrative Time in follow
up Reminders for Questionnair
# 1
Preparation and Bistribution of
Feedback Reports and
Questionnaire #2
Total Administrative Working
Hours
88 hrs.
84 hrs.
Administrative Cost*
Botal Administrative Salar (2.50/
hr.)
Total Cost of Supplies and Misc.
Total Administrative Cost
Calendar Time to Conduct Meetings/Delphi
Participant Timet
Actual Number of Participants
in All Groups
Average Time Requirement per
participants
Total Participant Working Hours
$220
10
$230
4 evenings
$210
10
^220
$353.12
86.80
$439.9i
4 evenings 5 months
130
138
120
1*5 hrs
162.5 hrs
1*4 jr
160 hrs
h hr
60 hrs.
.18
1
18
4 TABLE2-2
Comparison of Qualitative Differences Among Interacting NGT»
and Delphi Groups. Sources* Adapted from Group DecisionMaking Effectiveness by Andrew Vande Ven, Published by Center
for Business and Economic Research Press, Kent State University,
1974. Used by permission.
DIMENSION
INTERACTING
NOT
DELPHI
OVERALL
METHODOLOGY
Unstructured meeting
Structure meet- Structured
High Variability bet ing Low varia- series of queween decison -making
bility between stionnaires and
groups
decision-making feedback reports
groups
Low variability
between decision
panels
ROLE ORIENTATION
OF GROUPS
Social-emotional
focus
Balnced socialTask-instrumen
emotional and
tal focus
task-instrumental
focus
RELATIVE QUANTITY
OF IDEAS
Low« focused
"rut* effect
High Independent High Isolated
thinking
thinking
RELATIVE QUALITY
AND SPECIFICITY
OF IDEAS
Low quality
Generalizations
High quality
High quality
High specificity High specificity
NORMATIVE BEHAVIOR
Inherent conformity
pressures
Tolerance for
nonconformity
Freedom not to
conform
SEARCH BEHAVIOR
Ractive
Practive
Extended problem
focus
High task
centeredness
New social and
task knowledge
Practive
Controlled pro
blem focus
High task
centeredness
New task
knowledge
Short Problem focus
Take avoidance
tendency
New Social knowledge
EQUALITY OF
PARTICIPATION
Member dcoiinance
Member equality Respondents equ
ality in pooling
of independnt
judgments
METHODS OF CONFLICT
RESOLUTION
Person-centered
Smoothing over and
withdrawal
Problem centered Problem centered
Confrontation and Majority rule of
problem solving
pooled indepent
judgments
CLOSURE TO DECISION
PROCES
Lack of closure
Low felt accomplish
ment
Medium
High closure
High felt accom
plishment
High
TASK MOTIVATION
High closure
Medium felt
accomplishment
Medium
It
SUMMARY PROFILE
2-t
t’m'
qualitative differences among
interacting, h ngt and Delnhi
strateclAA a
eoAvxng require different groupwprocess
interacting groups
1) Because interacting
j--- 9rouP meetings are unstructured hiah
i,eder behavior occurs frorn
group to group. mo,nber
2) Discussion tends to fall into a nut, with group members
end JiS
Wlof.
” ldLf?SS*if<JB.’Pwi?1MtI <;o thl"k ««®“9h Independent
X?.nstSni? •tendTOcy f”
«««**« u
4) Search behavior is reactive and characterised bv shortfocus on the problem, tendencies for task
eltibliSln*"1®*”?1?1 d^®cu*»lon8» and high efforts in
knowledge^ 9 8Ocial ^atlonships and generating social
5)
•xPr®«lve, or strong personality tyne intend tO d?"inat* in aaarch, evaluatlon^ and
choice of group product.
6) Meetings tend to conclude with a high perMwal lack.
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