PREVIOUS HOUR

GS-KSK/3A/3.00

֮֕ן ֤ (֟) : ӡ ֻ ִ ׻ֵ, ֕ ָ ӡ , ָ פ ֵ , ӡ օ ָ ֣ , ֟ ֵ, ֣ ֟ ֵ, ֻ ֟ ָ֕ ָ֮֯ ֻ ߴ׸ ֟ ӟ ״ֻ֟ ָ ֟ ֻ ֟ ָ ֤ ֮ ָ , ָ և ֛ ֟ ֲ ӡ , ס ֣ ֟ ֟֟ ֮ ָ֟ , ִ־ ? ֻ , כ և ֲ ָ , ֲ ֻו Ù , ֲ ָ ֟ ֻ ӡ ӡ ָ ׾ , ؓ֟ ִ֤ ָ֕ ׸ָ և, ִ և , ָ, ָ ָ, ӓ ָ ֵ ֯ Ӥ ֵ ֕ , , ӡ ֜ , ֜ ֌ ֮ Ӥ ֲ ӯ ֙ , ֌ ֮, ӡ ֜, ֵօ ֯ ֟և , ֟ ֟ ֲ 괲ָ ֱ ٻִֵ ֕ ֳ ֋, ָ ָ ֟ ָ ֕ - דֽ ׻֟ ׻֋ דֽ ׻֟ ֻ כ כ Ùߙ ֟ , ֟ ֯ ߮ ߮ ֤ ֮, ߮ ߮ ֤ ֮ ? ֳ֬ , ָ ֓ ֵ ֋ ֮ , פ ֵ ֣ ֲ ߻ ֛ ֋ ֮ ֆ, ֕ ֆ, ֣ ֻ֟ ֌ ߮ ߮ ֤ ֮օ ו פ ֣ ߻ ֋, ߻ ֛ , ߮ ߮ ֤ ֵ, ߮ ߮ ֤ ֵ ? ߮ ߮ ִ֯ ֵօ ֻ כ Ùߙ ֟ , ָ ï֙ ֟ ֿ ׾ ֣ ָ ֟ ֿ ׾ ֣ ָߕ ֟ , ו ָߕ ָ , ו ֙ ָ֮֯ , ָ ָ֮֯ , ָ ֵ, ֟ ߮ ߮ ֤ ֮, ߮ ֤ ֮օ ֲֻ֟ ? ֻ כ כ Ùߙ ֻ և , ָ , ֌ ׻֋ ֳ֬ , ֕ ߮-ָ ֻ כ כ Ùߙ ֙ ֮ ֟ ߅ ׻֋ ֟ ײָ ׳ֿ֯ ? ָ ָ , ִ , ֟ ָ ֻ ײָ , ׻֋ ֵ ֻ כ כ Ùߙ ֙ ֵ ׻֋ ֵ , ֕ ֵ ָ ִֻ ֻ֟ ִ ֟օ ָָ ï֙ ִֻ ֕ ֟-֚ ֻ ָ ֓ ߴָ ֛ և ߅ (3 ָ ָ)

-GS-KSK/SC-GSP/3.05/3B

֮֕ן ֤ (֟) : vomiting ߅ ִ ֮ , ֛ פ ïֻ֟ ֆ ߻ , ֓ ֛ ֟ פօ ָ ֲ ׮ֵָ ֋ ָߤ ׻֋ ֻ ֵօ ֲ ֻ ֵ ֓ ײ֮ ָ և ֋ ֲ ֯ ָ ֋ ? ֲ ָ ָ ֋߅ ָָ ïֻ֟ ָ ָָ ïֻ֟ ֋ ֋ͅ ֯ - ֵ ֓ ָָ ïֻ֟ ֮ ֟ ? ׻֋ ָ ֟ ֟ ָ ו֋ ָ-ߟ , ָ-ߟ , ָ-ߟ ָ ֕ ָ ָָ ïֻ֟ ָ ִ ָ ֮ ֵ ָ ֕ ׻֋ ӡ ׮־ , ֤ ׮־ , ֣ ׮־ ֯ ָ ֺ ד֋ ָָ ïֻ֟ -־ ָ ֺ ד֋ ָ ֯ Ԯ ߅ ֳ֬ , ֮֟ ִ ֮ , ו֮ ִ ָ ïֻ֟ ִ ֛ , ִ ׾ػݛ ïֻ֟ օ ݻ ׸ ִ ָ ֕ ֮ ӟ ָ ֋ ֕ , ל ֕ օ ֻ ִ ֮ ֟ , ֟ ִ ֤ ֤ؕ ߮ ֻ ֤ Ӿ ֋, ֋ ӓ ֋ ߮ ֟ , , ֮ ָ ָ ™ן ֮ ָ ָ߲ ֤ ֮ ָ ׻֋ ïֻ֟ -־ ׸ Ӿ ו Ӿ ? ָ ֮ ָ ֮֮ߵ ֤õ Ӥ ָ ֮ ֮֮ خ ֮ ו֮ Ӿ ֯׸ , Ӿ , ָ ָָ ֜ פ ֋օ ֯ ..(ִֵ ә) , ִֵ ִ֯ ֵ ?

ֳ֬ ( ϟ֯ ) : ֯ ֮ ִֵ

֮֕ן ֤ : ָ ߔ ֻ , ...

ֳ֬ : ֯ ֻ 6 ״֮֙ , ֯ ֚ ״֮֙ ֯ ֮ ִֵ ?

֮֕ן ֤ : ֯ ָ

ֳ֬ : ֯ ֌ ׸

֮֕ן ֤ : ָ, -߮ ״֮֙ ִ֯ ֯ ָ ׾ָ֓ ׸ Ӿ ָߕ , ו֮ ֮ ֕ ֮ , ו֮ ߴָ פ֮ , ו֮ þã , ? , ָ ִ ֵ ֟ ׾ֻ ֕Ԯ ױ ָ ִ ֆ, , ֟ ֕ ׻֋ ָ ֲֻ֟ ָ ִֵ ֮֯ , ָ ָָ ïֻ֟ , Ӿ þã ֤֕ ֲֻ֟ օ , ִֵ ֻ ֤ , ִֵ ֟ , ִֵ ֟ ׻֋ ִֵ ָ ֟ ֵ ֱ ֟ ֮ ֟ ִ֯ ֮־֤

(ִ֯) (3- ָ ֿ:)

SK/3C/3.10

DR. K. KASTURIRANGAN (NOMINATED): Thank you, Mr. Vice-Chairman, Sir, for this opportunity to share my own views on this very important Ministry of Health and Family Welfare. I shall focus in my few observations specifically on the research area in the medical theme and in particular on the Indian Council of Medical Research for two reasons. One is, of course, there is no need to emphasise the importance of the medical research in the overall context of the medical service in this country. Certainly with the type of poverty and the type of demands of the larger section of the population, we obviously have to undertake research programmes which could lead to affordable method of dealing with the type of diseases that the tropical region is known for. I was also seeing the Standing Committee Report on this particular Ministry. They have made some observations, particularly, with respect to the type of Budget that has been allocated for the Indian Council of Medical Research, which is of a certain concern. So, I will comment on both these areas in my small presentation.

I may not have to mention that the Indian Council of Medical Research consists of 21 institutions and 6 field stations spread across the country and they, of course, carry out research along with a number of institutions outside the ICMR system. The important thing about the ICMR is that it is one of the oldest institutions -- in some form, it took shape almost 90 years ago. So, it is probably one of the oldest research institutions in medicine across the world. Certainly, over the last nine decades, it has grown, it has evolved, it has got strength and it has performed in a variety of ways. But, the need for increased investment in medical research is something which is not only appreciated in this country but across the world also. In fact, if one looks at the 2000 WHO Commission on Micro Economics and Health and also the National Commission on Micro Economics and Research, one need not have any doubt with regard to the increased investments that the health research can take in and the type of impact that it can make. In fact, the statement goes that it is better health through research. Improving the people's health, in particular the poor and the most vulnerable populations, has its implications with respect to development in the Indian economy and subsequently, of course, in turn, has an increased likelihood of achieving the millennium development goals. If one looks at the performance of the Indian Council of Medical Research over the last few years, say 6 to 7 years, certainly, there has been an upswing in terms of its performance, in terms of carrying out research and output from the research which is directly applicable to the social domain and also the type of scope it has expanded. An important thing that has happened in recent times is that the Ministry established a Performance Appraisal Board, particularly to look at how the ICMR has functioned over the last one or two decades. In this context, one may mention that the ICMR today has several dimensions of activity. One, of course, is the research priorities which are related to the social context and the type of obligation that it has to the nation. It is in this context that the ICMR has a major role to play as a Government-funded research organisation because the type of research that it can undertake is more related to the tropical region, that addresses the poor and the most vulnerable part of the population. This is something which the commercial system in the country, or, anywhere in the world, do not easily undertake because they try to put money only where there are maximum returns. There is a difference between the goals that the ICMR has got within the country and the type of medical research that goes on in the private sector. (Contd. by ysr-3d)

-SK/YSR/3.15/3D

DR. K. KASTURIRANGAN (CONTD.): Then, of course, there are very, very interesting and important things that have come out with these kinds of research. I can mention only a few of them. Pulse polio control strategy, multi-drug therapy for leprosy, etc. Many of these kinds of things have really influenced the public health in the country. It also does the knowledge management, the intellectual property rights, and things of the kind. More recently, it has been very seriously involved in developing policies which are related to public-private partnership.

Now, in this connection, I would like to make three important points. One is on the type of governance, the type of structure that the ICMR presently has got and how one could improve the autonomy or the functioning of the ICMR to ensure that for a given input you get the maximal output.

One of the suggestions that has come out from the Appraisal Board has been to see whether we could have a full-fledged department on the lines of the Department of Health itself. We understand that the Government is seriously thinking of accepting this kind of a recommendation which has also come from the Scientific Advisory Committee of the Cabinet. I think it is a very important step in trying to create additional autonomy to the functioning of this medical research area. We hope and expect from the hon. Health Minister that we will have in the near future a department of research in health which would function under the Ministry of Health and Family Welfare.

One could also think of a little higher level of autonomy on the patterns of how the space and the atomic energy today are organised. In this connection, I may say that it will be even good to think of, at the higher level, a commission, a commission which would set the vision for the future, a commission which can set out the policies.

One could also look at the budget from the short-term, medium-term, and long-term budgetary requirements and also the related plans. Then, of course, you have the policies related to international cooperation, and public-private partnership. So, there is a whole host of things under the medical research which can be considered under that kind of a super structure. I hope, and again the hon. Minister would consider whether it is worthwhile at this time, timely, and appropriate, to set up a health commission.

On the third side, I would like to talk about the budget itself. The Standing Committee has reviewed the budgetary allocations with respect to 2007 and 2008. It has observed that in spite of the fact that full expenditure has been incurred with respect to allocations made at the B.E. level, the budget for 2007-08 is pegged at something like Rs.176 crore, which is much less than the revised budget of this year.

(THE VICE-CHAIRMAN (PROF. P.J. KURIEN) in the Chair)

So, obviously, in spite of fully utilising the money and also making sure that you have the output coming out of it, the Standing Committee has observed the inadequacy of the budget, and I think this needs to be reviewed. I would like to lay emphasis on this that we cannot underplay the importance of the medical research and the type of budgetary allocation currently provided for is grossly inadequate. In fact, a rule of thumb is that one spends something like two per cent anywhere to have a meaningful output out of the medical research of the overall health budget of a particular country which essentially means that we have to increase it by three to three-and-a-half times the current level of budgeting if we want to meet that kind of a goal. In fact, the Performance Appraisal Board has even suggested that in the 11th Plan we allocate something like Rs. 5,000 crore totally. But at the current level of budgeting, that is going on, I am not sure whether we will reach even one half of this by the end of the 11th Plan which is going to be really impacting the activities and outcome of this institution.

On the human resource development policy also, one has to really look at the addition of manpower, particularly in the area of research and development. One has to fulfil some of the more ambitious goals with respect to this institution. One needs to ask for something like 500 research workers in the next five years. The question is whether we have the necessary provisions for this. There is a sense of urgency in increasing and augmenting the manpower, especially the research and development manpower. On the other side, we also find that the institution does not have a policy with regard to retaining the field workers. The field workers are an important component of gathering data about a variety of diseases. There is a skill in this particular job and there is no permanency for these kinds of people within the institution. I think there are even threats that their whole system would be dismantled which can actually impact the total research programme of the ICMR. (Contd. By 3E)

-YSR/VKK/3e/3.20

DR. K. KASTURIRANGAN (CONTD.): So, I earnestly request the Minister to see whether we can have a clear-cut policy with regard to retaining the field workers who gather the vital data which becomes the premise for doing various types of research programmes. Infrastructure is another thing which is grossly inadequate in terms of the current needs of the institutions and one needs to invest, at least, between Rs.300 and Rs.500 crores in the next four to five years if one has to modernise the infrastructure and bring it to a level where you can do meaningful research at the international level.

Lastly, I would like to say something about the research methodology. Currently, the ICMR works within itself and also through some extramural programme. I think there is a need for coupling the medical colleges and hospitals and derive more information related the clinical data which is so critical to the research. Today, this coupling is extremely weak. Therefore, I suggest to the Minister to look seriously at institutional mechanisms by which the research component could be strengthened, by means of medical schools coming along with the hospital and having some kind of a synergy where the doctors work and encourage research as a part of the medical research programme. These and many others which form part of the recommendations of the Performance Appraisal Board, I think, are very critical to see that the ICMR of tomorrow would stand on its own to meet the challenges of the health requirements of this country in the 21st century. I know that the hon. Minister has got a very good vision with regard to even converting ICMR into the National Institute of Health kind of a model, but, then, one is talking about billions of dollars every year in terms of investment into medical research. The question is not, whether we can afford it. The question is, whether we can afford to ignore it. Thank you.

(Ends)

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Thank you Dr. Kasturirangan. Now, Dr. E.M. Sudarsana Natchiappan.


DR. E.M. SUDARSANA NATCHIAPPAN (TAMIL NADU): Thank you, Sir. First of all, I would like to congratulate the UPA Government and the hon. Minister for Health for implementing the National Rural Health Mission which was started on 12th April, 2005. More or less, we have completed two years. In the same way, we have completed the Tenth Five Year Plan. We have already started the Eleventh Plan. At this juncture, Sir, the focus upon the rural health is very much on the cards and the Ministry is doing the work very excellently. But, at the same time, we have got the infrastructure which was created by earlier Five Year Plans, for example, the primary health centres. These are very important nerve centres of the programme implementation at the rural level. This programme was very well planned and it had a comprehensive healthcare in that particular primary health centre programme. Any person who comes to the primary health centre, he will have the specialists. He will have all the facilities. He will have the medicines there itself. Even beds are provided to them and healthcare is given to them. This programme can be strengthened further. If it is strengthened properly with the help of the State Government, we can achieve the target which was already fixed for us. But pathetically, the State Governments are not concentrating on these programmes because of their financial constraints. Therefore, we have to give more blood and flesh for this particular programme of public, that is, the primary health centres. There are no doctors; there are no nurses. The primary health centres are saying that they are not getting medicines to supply. The same thing happens in Government dispensaries and Government hospitals at the State level and also at the national level.

Sir, we have to find out as to how much we have done for the past ten Five Year Plans, how much human resource we have developed through various mechanisms, for example, medical colleges, nursing colleges and pharmaceutical colleges. We have to find out as to how many people have specialised in the school of excellence or at AIIMS and other places. (Contd. by RSS/3f)

RSS/3f/3.25/

DR. E.M. SUDARSANA NATCHIAPPAN (CONTD.): How many people have been educated in the past 60 years through the Government budgeting and also through the Government money? How many such people are serving this country? Are we making the whole of India a special economic zone to export all our intellectuals to foreign countries, and thus, allowing foreign countries to enjoy the services of our people, without leaving any intellectuals to serve our poor people over here? This is the pathetic situation which we are facing today. Many management institutions like I.I.Ms and I.I.Ts are coming up in this country. We are going to start 3 more institutions in India. But, for whom? After completing their MS or MD, where are they going to be employed? They are not going to serve the rural people. They are going to foreign countries where they are having enough opportunities. They are earning huge money. Besides that, they are settling down with their families in foreign countries. But, what about the poor tax-payers' money which the Government spend on their education? This is high time that we have to think about it. We have to revise the policy of education in its entirety. We have to see to it that education is given to the people who are patriotic, who want to serve the people, and who want to be in the villages to serve them.

THE VICE-CHAIRMAN (PROF. P.J. KURIAN): At least, they should pay back the money spent for their education.

DR. E.M. SUDARSANA NATCHIAPPAN: I am coming to that point. At least, they should give an undertaking that when they go there, whichever university or hospital or institution is hiring them, they should pay back the money spent on their education to the country so that, at least, that money can be ploughed back for educating the other poor people. We cannot go on spending money for their education for sending them to foreign countries. There is a limit to that. We cannot tolerate this situation any further. At the same time, we are encouraging commercialisation in medical education. The hon. lady Member, who spoke before me, has mentioned that about Rs. 35 to 40 lakhs are being paid for an M.B.B.S. seat. For an MS seat, they are paying more than one crore rupees. Even blank cheques are also given. Let the people who have got the money pay and earn in their own way. But what about the wards of the poor people who are ready to learn and who are ready to serve this country? We have to give opportunities to them also. We are giving a Health Mission Plan, which we want to achieve in 2020 or so. Before that, we have already signed a Millennium programme. It is an international programme. We have committed ourselves to it. For that, have we got any calculation as to how many medical personnel or resources are needed in 2020? How much population is going to get the health care through our system? Have we got any calculation? Have we made any calculation on that basis? For that purpose, have we started any medical colleges in India so that the poor people, having aptitude to become the medical officers and work for the country, can avail of the opportunity for that purpose? That type of programme we expect. Then only, we can serve the people. It is not for serving the commercial people who are starting the hospitals with bank loans. They are getting the NRIs money also. The FDI is also flowing in their institutions and they are making the medical profession a department of tourism. How pathetic our situation is! We want to show our culture; we want to show our environment, but everything is gone. But we are bringing the patients here, making them spread their diseases, and getting them cured and then go back without paying the money. This is what is happening. It is high time we have to revise our policy and programme and say that here are the people who need the healthcare. Sir, if we go to the Ram Manohar Lohia Hospital, which is next to the Parliament House, you will be surprised to see the situation prevailing over there. I was there for two days due to some emergency. I could see many poor people with their families sleeping on the road. (Contd. By 3g)

MKS/AKG/3.30/3g

DR. E.M. SUDARSANA NATCHIAPPAN (CONTD.): For what purpose? I enquired of them, "Why are you lying on the road like this?" They said, "We have come from Bihar. We have come from Uttar Pradesh. We have been waiting as outdoor patients for five days, for six days." Sir, this is the pathetic situation prevailing in a hospital near the Parliament House. Sir, I tell you the treatment that the ordinary people get. When we go there as Members of Parliament, they give us preference in getting x-rays and other tests done. But umpteen number of people have to wait for days together despite having cards in their hands. Persons who are taking x-rays and other things are working like machines. They do not even look at the poor people; they do not even look at the ordinary human beings. They just press some particular button, push the instrument to their stomach or to their heart and push the man out! This is the mechanical thing happening over there. How are we planning it? Sir, this is high time to see that when we want to modernise hospitals in our villages, we should plan it in a systemic way. If such a pathetic situation is prevailing in Dr. Ram Manohar Lohia Hospital, what can we expect from them in villages? Sir, this is high time to see that our funds go straight to the common man.

Sir, I want to mention one thing more. As Members of Parliament, we want to be happy in rendering service to the poor people. When we send a letter to the Ministry of Health, through the Prime Minister's Fund, they are sending about Rs.50,000/- for heart operations. We are thankful to the Ministry, especially Dr. Anbumani Ramdoss, who, after assuming charge of his Ministry, has increased the amount Rs.30,000/- to Rs.50,000/-. For open heart surgery, the minimum cost they are charging is Rs.1,25,000/-. In some cases, they are charging Rs.1,50,000/-. From where will the poor people get this money? We are just writing letters to the MLAs. We are just writing letters to the Lions Club, to the Rotary Club, but none of them is ready to respond. But, Sir, a person who is dying because of some deadly disease thinks that he has got life in this world and hopes that the Government is going to help him. Why can't we give the entire money to him for his treatment? You give such persons some healthcare and make their health insurance. Sir, I feel that it should not be given for Health Mission. We have already made, we have unnecessarily made life insurance open to private sector companies. They are minting money because we have already made the average age of all the people more than 75 years or 80 years. When we started it at the time of independence, we were having 25 years as the minimum age. But we pumped in money for public health. We have succeeded in that way. The average age of an ordinary man is coming to be 80 years. Therefore, it is very easy for these private sector companies to ensure them for 30 years. None of the amounts is going to be paid back to the concerned person. He is not going to die. Therefore, they are going to spend the premium for some other purposes. But what we were doing through the LIC was, we were utilising the amount for the purpose of laying roads and for the purpose of providing water supply to the rural people, to the dalits. We were giving back that money. But, nowadays, the persons who come from foreign countries are taking away all the money from them. Are we compelling them or are we making it compulsory for them to spend at least 50 per cent of that amount on the health of the poor ordinary fellow? He has to be insured for that. Have we given any statutory mandate for that? Sir, this is high time that we made it compulsory. We have already provided the infrastructure to the people to enjoy life insurance through the private sector and get the money back. Why don't they pay back to them? We are giving a lot of exemptions to them. Sir, we have to ask them to pay them Medicap. To whom they are giving it? For corporates, they are making it Rs.2,000/-. They are ensured for Rs.2 lakhs. Sir, earlier, there was a scheme. If a person paid Rs.15/-, the non-LIC people, i.e. insurance companies used to pay Rs.15,000/-. Through private hospitals, they could take the Medicap. That we have taken away now. Now, for Rs.30,000, if you pay one rupee per day, out of Rs.365/-, Rs.200/- is to be paid by the Government of India and the rest, about Rs.136, is to be paid by the person who is ensured. (Contd. By 3h)

-MKS-TMV-HMS/3.35/3h

DR. E. M. SUDARSANA NATCHIAPPAN (CONTD.): They will be getting about Rs.30,000 of medicare. How many companies have got these people insured? They would get minimum commission. Sometimes, they would not get any commission. None of these people are happy to go and insure the people. Though there is a scheme, it is not being implemented. I would request the hon. Health Minister to kindly spend, at least, Rs.1,000 crores from his fund for this purpose. He should ask for more funds. He should spend Rs.1,000 crores for this purpose and every person below the poverty line should be insured totally. He should be provided with the necessary medical care, whether it is open-heart surgery or any other surgery. He should also be treated in the same way as a rich person is treated because he is human resource. If he has good health, he can contribute more for the welfare of the country. His physical force and mental force can be used for the development of the country. How are we going to develop the country? It is only by human resource, by the health of the ordinary people. Therefore, we should look after their health and see to it that their lives are insured. They should have the feeling that even if they die tomorrow, their family will not be on the streets. They should be protected. Their families should be protected. So, insurance should be made compulsory for every citizen. Every citizen below the poverty line should be insured fully by the Government of India. It should be implemented. That is the main thing. It may be there in the books, but it is not being implemented in many places.

Finally, I would like to bring to the notice of the hon. Minister that the AIIMS type of an institution is not there in the south. There is already a promise that such institutions would be established in three or four places. But in South India there is no AIIMS type of an institution. There are already problems in the AIIMS here. The Thorat Committee has given a lot of good recommendations. I hope the hon. Health Minister will look into it and implement the Thorat Committee recommendations so that the discrimination being practised against the SC, ST and OBC is stopped. The health of the administration should also be looked into and see to it that there is no discrimination among the doctors and the students. They are all master degree holders. They are ready to serve the AIIMS and that is why they have come. But they are discriminated. When one goes for promotion, they look for his caste and they put minus marks on the basis of his caste. Are we born in a particular caste because of our prayer that we want to be born in a particular caste? It is only man who created the caste. Why should they discriminate against the people, when they got efficiency? They are up to the standard, whether they are born in SC or ST or OBC. They have got the marks. That is why they have become an MS or MD. That is why they have got the employment. They have not come with 20 or 30 marks. They have got 90 marks and in some cases they have got centum. But because they are born in a particular caste, they have been isolated. They want to come to the AIIMS. They come to the AIIMS to get jobs. When they get jobs, they are discriminated. It has been revealed by the Thorat Committee. I request the hon. Health Minister to implement every paragraph, every sentence, of the Thorat Committee and to see to it that there is no discrimination against different communities of India. Thank you. (Ends)

DR. GYAN PRAKASH PILANIA (RAJASTHAN): Mr. Vice-Chairman, Sir, thank you very much for your kind indulgence in giving me an opportunity to participate in the discussion. I have no pretension of teaching medicine to our hon. Health Minister, Dr. Anbumani Ramdoss, who is a visionary and a doyen of doctors. I have no temerity also to sit in judgement on the performance of the Ministry. As an ordinary citizen of the country, I want to share certain health concerns and bring them to his notice.

(Contd. by VK/3j)

VK/3j/3.40

DR. GYAN PRAKASH PILANIA (CONTD): He is a well-intentioned person. But they say that the way to health is, at times, paved with best intentions. I have certain statistics which are alarming and which raise an issue regarding certain concern areas in the field of health. Prior to touching them, I will share my concern on a general view which has come up from various distinguished speakers here and that is, Sir, the first claim on health services of any country should be the poorest and the lowest, the daridranarayan. That should be the focus for overall health services in the country that how we are catering to the lowest, the poorest, the BPL, a villager in remote helmet and how proper health care he is getting. The first concern of health should be for the man who is the lowest, who is at the end of the tunnel or who is at the end of the queue and that is the poorest man. But that does not happen. A rich man will be able to get his health care either in the best Government hospital or in the best private hospital. He does not bother about it and that should not be the first concern of a democratic country also where nearly 30 crore people are Below the Poverty Line. The first principle to be adopted and to be accepted by the Government should be that the first claim on medical health care is that of the poorest, the lowest and the man at the end of the queue. That should be the attitude of doctors also. This attitude is not there. That is why the perception about a Government hospital is poor; the perception about a Government hospital is not the right one. That is what was said very pointedly by Shri Rajniti Prasad that when a man goes to a Government hospital, he goes there only when there is no better option available and he cannot afford to go anywhere else. He goes there out of his total dismay. He does not go there willingly. He does not go there happily. He does not go there by choice. A person would not like to send his child to a primary school run by the Municipal Committee; he would like to send him to a private school. Similarly, a patient would not like to go to a hospital run by the Government because the Government-run hospital signifies, as was very pointedly said, death, signifies lack of care and signifies total indifference. That attitude has to be changed. Another point is, hospitals must provide medicine also. Hospitals should not provide only prescriptions. Then the poor man would have to borrow money from someone and then purchase the medicine from a shop. He would also not be sure whether the medicine is spurious. If a patient comes to a hospital, the hospital should be the place where he is treated and he is given prescription as well as medicines. If that happens, that will be the real and right combination of health care.

Another point is, as I was submitting about statistics, I would like to point out two scenarios. One is about children who are the hope of the nation and who are the leaders of the nation and second is about motherhood of the nation. I have statistics with me of which, I hope, the hon. Minister is well aware. But these statistics are alarming. According to the National Family Health Survey-3, which is the latest one, India's Maternal Mortality Rate, is the highest in South Asia - 301 per cent deaths per one lakhs live births. India has an estimated 1,36,000 women who die every year due to pregnancy related setbacks.

(Contd. by 3k)

RG/3.45/3k

DR. GYAN PRAKASH PILANIA (contd.): This is a horrendous scenario. A moment, which is a moment of happiness for a woman to deliver a child, to be a mother, is a moment of her death. One-seventh of the world's mortality deaths occur in our great country, great India, unique India. When we compare it with the Asian countries and the Western countries, we are at the lowest bottom. Twenty per cent of infant mortality happens because of anaemic pregnant women. And, how is the scenario of pregnant women in our country? As far as anaemia in pregnant women is concerned, 57.8 per cent are anaemic. One would say that it is a very high figure. So, firstly, something must be done to save the Indian women. The number of maternity-related deaths, which occur in a week in India, -- it is an alarming figure -- is equivalent to what occurs in the whole year in Europe. In the U.S., the MMR has dropped by 99 per cent in recent years largely because of improvements in sanitation and post-natal care rather than new medicines. That care is missing here. If we are not taking care of Indian women, who are we really caring for? Safe maternity is a birthright of an Indian woman. It is a vital social indicator. What is at stake is the life of Mother India. A smiling Lakshmi ought to be the face of modern India, and not a dying mother. I am saying this with utmost urgency and humility.

The other concern is about children. If mother was not cared for, how would a child be cared for? About the child scenario, I would again quote statistics because they are more reliable. The data from the National Family Health Survey - 3, -- this is the latest one which was released on 21st February, 2007 -- indicated that 45.9 per cent of its children are underweight. Malnourishment in India is much higher than sub-Saharan Africa, where malnutrition averages 35 per cent. Four out of five children, or, to say, 79.1 per cent of children, in India are anaemic, which is almost five per cent more than the last count of 74.2 per cent. Malnourishment causes 50 per cent of all child deaths. Anaemia in women has also gone up from 51.8 per cent in 1998-99 to 56.2 per cent in 2005-06. Five per cent of all infants between six and 35 months of age are anaemic; over a third of children, up to the age of three, are stunted and a sixth of them too thin for their age. The survey data also shows that routine immunization of children, which are very essential for their sound health, declined in 11 States. Maharashtra registered an almost 20 per cent decline between 1998-99 and 2005-06, and Punjab fell by 12 per cent. If this is the scenario, the hon. Minister would well realise that something specific has to be done for the Indian children.

Sir, I have talked about two segments of our society, the child and the mother. To tell you the overall concern about India's poor health card, I should again cite from the study conducted by ASSOCHAM and Price Waterhouse Coopers on "Working towards Wellness: An Indian Perspective". This study must have attracted the attention of the hon. Minister. (Continued by ks/3l)

3l/3.50/-rg/ks

DR. GYAN PRAKASH PILANIA (CONTD.): The percentage of cardiovascular patients who succumb to death in India is currently estimated at 30 per cent within the age group of 35-64 as compared to 12 per cent in the USA, 22 per cent in China and 25 per cent in Russia. Of almost 66 per cent of the deaths in 2020 are likely to be from chronic diseases and, apart from this, we do not talk of diseases like tuberculosis, malaria, pneumonia, HIV/AIDS, diabetes. Around 57.2 million people will be affected by diabetes by the year 2025. Diabetic nephropathy is expected to develop in 6.6 millions of the 30 million patients suffering from diabetes.

Finally, I come to India's per capita expenditure on health which is estimated at 23 dollars and its total health expenditure is only 0.9 per cent of the GDP. The study recommends that until and unless we increase public expenditure on health, things will be horrendous. India is way behind countries like the USA where the per capita expenditure is pegged at 4,4499 dollars, as compared to India which is 23 dollars; in Germany, it is 2,442 dollars; in Canada, it is 3,058 dollars; and at the tail is India. So, something has to be done. How it has to be done, what can be done, it is for the Ministry to find out. The hon. Minister is the person where the buck stops. I would like to point out, Sir, that there must be some Sarva Swasthya Abhiyan, total health for every one, because health is the concern of the poorest as well as the richest; and there cannot be any right to live without the right to health. Our hon. Minister is there to ensure this right to health. I am sure he is doing his best. But much more has to be done. There are two points that deserve his attention. One is that all prescriptions prescribed in Government hospitals, including the AIIMS, must have prescriptions of generic salts; they should not be of branded medicines. Let medicines be common for every one, the poorest and the richest. It should be generic salts and it will be very cheaper. It will end exploitation and it will save us from many troubles. Sir, it is a very simple formula. We have experimented it in Rajasthan and it is paying dividends. I think certain other States have also tried it. Let it be tried at the all-India level. There should be no prescription of a branded medicine. It should only be of generic drugs and salts. Another is that there must be a kind of a compulsory condition for all those who do their MBBS to go and serve in a village for a year or two before they are granted the degree. Then, people would not say that doctors are not willing to go to villages, that they are not willing to serve the poor and the rural masses.

I think, Sir, I will close by saying just one thing that there must be some way to curb unnecessary prescriptions, over prescriptions, costly drugs, and unnecessary tests and labs. When a poor patient visits the hospital, the doctor asks him to get scans done and to undergo all kinds of tests, which is a very costly thing. Let us take care of the poor and if the poor are taken care of, three-fourths of India is taken care of. And if that happens, then Dr. Anbumani Ramadoss will be called the dhanavantari of this country; I wish it comes true.

Thank you very much, Sir, for allowing me the opportunity to speak for such a long time. (Ends) (Followed by 3m/tdb)

SCH/3.55/3M

ϟ֯ (ָ Ϥ): ֳ֬ , ֯ - ֮־֤ ֮֯ þã ӡֵֻ ִ ֮ ן

ֲ ֕ , ִ ߴ֟ Ӥ ָ ָ , ֤ ׬ ֮ ֮, ֮ ָ, ßן, ֲ , ׻֋ ֮ ׻֋ , ֺ ֟ ֯ ִ֮ օ

֟ ו ֯ ֟ , ֈ ָ ׻֋ ֮ ֮ ֻ ׮ֵ ֲ ֛ ã֮ ׮ֵ ֮ ֈ ָ ָ , ו֮֟ ֯ וֻ , ָ ֯ ִ ־ ָ-ָ ֟ ֮ ֮ ָָ ָ ӓ , ֟ ׌ ֈ ָ ו , 㴲և ָ , ָ߲ ֤ , ֟ ֕ ֋ ֋ ֲ ָ ߴָ ֮ ָ֟ ָ ֮ ֣ ֛ ֯ ֯ ִ ָ ֲӤ ֋, ֯ ִ , ִ

ָ ֟ , ֮֮ߵ ֤õ ָ ֟ - ׾ֳ ә ָ ֛֛ ֟ ֮ ־ ߴ׸ , , ֆևԾ ָ , þã ӡ ָ ֮֟ ֆ ָ ָ ִ ׻ ֆ ָ ִ ׻ , ֆ ָ ָ ׻ ָߤ ֟ , ֟ , ߴָ , ו ָ ִו ׮֮ ָ ִ ֟ ֲ ֓ ֟ ָ֮ ֤ ֻ ֟ ו ֤ , , ו , ָ ֋օ ֮֟ ֯ ӡֵֻ Ӳ׬֟ , þã ָ ָ ֛ , ׻֋ ִ ֺ

֮ ֟ ֻ ײ֮ ֟։, օ ֟ "" ߴָ - ִֻ ָ ӓ ו ױ׿֋ ߴָ , ֋ ֲֻ , ׯ֛״ , ߅ ׻֋ ֵ ֺ

ߴ֟ Ӥ ָ: ߴָ ?

ϟ֯ : , ו ݾև ֟

֟ , . ϳ ֟ ָ ָ ߴ ֻ֮ ִ ״ֵ, և׸, ֻ׸ ָ ׻֋ ֻ ߅ ֳ֬ , ִ ߴ׸ ߕֻ̮ ֻ ߴ׸ ָ֟ ֋, ד׮ֵ, ֻ׸, ָ ׻֋ ӟִ֕ ֲ ֕ , ֲ ָ֬ ָ֟ ָ , ֲ ֤ ָ ֓ , ֤ ֟ ֟ , ֮ פ ֟ , Ӥß ֻ ָ֟ ֋, ֓ , ־ã֋ , ו֮ ֮ ? þã ӡ ֲ ־ã , ֲ ߴָ כ ִִ ָߕ ֯ ֌ ֟ ֮ ֮ ֣

֯ ִֻ ӳ߸ ָ ֲ-ֲ ïֻ֟ և , ӓ ֮֬ , ֲ ֵ֤ ֟ ׬ָ ֳ ־ ֯ ־ ָ - ò , ִ ״Ù , ״Ù , ֤ ֟ , ו֋ ֮ ָ MCM/3N ָ ָ

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