ֵ ֿ Ͼֻ (֟): ֮ ׯ֔ ֻ ֮ ״ֵ ֮և , ֕ ָ ֛ ֮ - ֵ ָ ָ ֮ ָ ֟ ֻ և ֋ ֟ ֵ֤ ֋ ...(־֮֬)

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Mr. Jai Prakash Aggarwal, one second please. You will get time. Now, it is 5 o' clock. I would like to take the sense of the House. With regard to this discussion, Mr. Jai Prakash Aggarwal said that he would take only 5 minutes and then the Minister will reply, and this discussion will be over....(Interruptions) But, I would like to take the sense of the House. Should I now start the Half-an-Hour discussion or continue with this discussion?...(Interruptions)... SOME HON. MEMBERS: Please continue with the discussion and finish this debate.

THE VICE-CHAIRMAN: All right. Mr. Minister, how much time will you take?

THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. ANBUMANI RAMDOSS): Sir, I will take half an hour to forty-five minutes.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): All right. Mr. Aggarwal, please continue your speech and keep your promise.

ֵ ֿ Ͼֻ: ָ, ָ ֲ , ֱ -߮ ָ ֮ ֟ ֿ ӡ ֻ ֲ ֈ ױ כ , ו֮ ֮

֕ ï֙ ֻ֟ , ו ָ ָ ֵ , ֯ ֱ ֟ , ֯ ֋ ֋, ֯ All India Medical Institute ֻ ֋ ו֮ ߿֮ Ӥ ָߕ ָ և, , և ß ߮ ָ ӟָ֕ , ָ ֻ֟ ֯ ָߕ , ֬ ָߕ ֬ ָ ֻ ֯ ï֙ ֿ ֯ ָ ꅠ

ָ, և ï֙ , ï֙ ָ ֯ ָ , ָ ָ ָ֮ , ָ և ֮ ֻ ߓ ß , ֲ ָ֮ ֟ ? ֯ ָ ֟ ֻ ? և ï֙ ָ ֤ ֻ ֟ , ֲ ֛ ײ ֟ , ï֙ ֻ ׻֋ ָ ֻ ֯ ֣ ֮ - ָ ָ-ָ ̸֕ ֟ - ָ ֵ ײֻ ָ ָ ï֙ ֻ ֋ ײֻ ָ ֋ ֋ ֮ Ù ֟ ׻֟ , և ָߤ ֟ ױ ֯ և Ӥ ײ ׻֋ ֟ , , ֛

֯ ֻ ֯ 500 600 ֵ ׮֙ ֲ , և ï֙ ֻ 3500 ֵ ׮֙ ֲ ֟ ֟ ? ֿ ִ ֤ ָ׮ֵ , ֯ ֮ ֺ ֋ ֯ ߕ ָ ܟ ָ߲ ֤ ָ֮ ꅠ ָָ ָ߲ ֤ ׻֋ , ֻ 껱ָ Ù , 50% ֤ ָ߲ ߓ ֟ ï֙ ֮ ֕ ֋, ׻֋ ִ ? ֱ ֛ ֤״ֵ, ֛ ï֙ ֛ ׻֋ ִ ? ָ ָ ֮ , ָ߲ , ו֮ , և ? ־֋ ָ ָ ß ֛-֛ ָ

֯ ָ ݕִֻ , ֯ All India Medical Institute ֋ ָ ֻ ֟ , ָ ָ , ߮ , ߮ ߮ , ߮ ߮ ָ ֬ ָ ֋օ ֕ ָ ? ָ ֤ , , ï֙ ֻ , ֲ פ ֮ ? Ù ־֮Դ , ֯ ֯ , ֿ ָ ֮ ׮ ֤, ֮ ß ֤, ֮, ו֮ ׻֋ ֮ ֮ ֛-֛ כ֙ ״׮Ùߕ , ֳ ֵ֮ ß ָ ֋, ָ ֟ , ֟ ָ-ָ ֮ ֵ֤

֕ ֟ ֵ ֮ ֮ , ָ ֋ ײ ? ֟ ֯ כ֙ ֟ ֟ , ֋ ֕ ײ , ָ ָ ٙ MCM/4B ָ ָ


ֵ ֿ Ͼֻ (֟) : ֿ ֯ ֋ꅠ ָ, , և ï֙ ִ ָ ׻ֱև , ֯ ָ , ֯ ָ , ׻֋ ָ֮ ֱ ֮ ָ ә ָ ߕ ֯ ָ, 00 ״ֻ֟ , כ ֮ 00 , ָ, ָ, ֓ ָ ִ օ ֿ ֯ ׮ ֋߅ (ִ֯)





* Pp 566 Onwards will be issued as Supplement.




THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Thank you, Mr. Aggarwal, for keeping your promise. Now, Mr. Minister

׻֟ ֟ : ֮֮ߵ ֳ֬ , ׮ִֵ ָ ֱ--ָ........(־֮֬)

THE VICE-CHAIRMAN: No; I have taken the sense of the House. ...(Interruptions)...

SHRI LALIT KISHORE CHATURVEDI: According to that, Half-an-Hour Discussion should be taken up at 5 o'clock.

THE VICE-CHAIRMAN: That is over. I have taken the sense of the House first and, then, decided. ...(Interruptions)... It was the sense of the House. ...(Interruptions)...

SHRI SURENDRA LATH: Sir, it is to be taken up at 5 o'clock.

THE VICE-CHAIRMAN: I have taken the sense of the House. You were there.

SHRI LALIT KISHORE CHATURVEDI: I have not told you that first, it should be taken up.

THE VICE-CHAIRMAN: When I took the sense of the House, nobody had objected. Now, that decision is taken. ...(Interruptions)... Already, I have decided. Now, you can't raise it.

DR. ANBUMANI RAMDOSS: Sir, firstly, I would like to thank all the hon. Members of this august House for bringing in the discussion on the working of the Health Ministry and I would like to especially thank Smt. Brinda Karat for initiating the discussion, which again is giving me an opportunity to share with the Members the ongoing programmes started by the Health Ministry in our country.

Sir, three years ago, after I took over as Health Minister, my leader Dr. Ramdoss, called me aside the same day and gave me a suggestion saying, "In the next five years, during your tenure, the healthcare that the President of India is getting, the common man, the last person living in the last village, should get the same, and all your concentration should be focussed on this issue." My Prime Minister called me the next day, Sir, and said to me, "I want almost all your focuses on the rural areas." And that is how this National Rural Health Mission has come into force.

Sir, I come from a rural background. I have practised as a doctor for more than one-and-a-half years in a very remote village and I know the feelings of the people living over there. There is a vast difference between the rural infrastructure and the urban infrastructure. I have seen that 73 per cent or 75 per cent people living in the rural areas have about 25 per cent health access and vice versa on the other side. Sir, if you ask me, "What is your main priority being a Health Minister of this country?", without thinking, I will say "To save the mothers of this country, to reduce the maternal mortality rate, to save the women of this country." That is my main focus, and the other focuses are linked to that. If the mother is being saved, then, automatically, the child is saved, and to reduce the maternal mortality rate, which, again, all the Members have said that on the one side we are developing, we have a healthy percentage of growth, but, we have the UNDP figure saying....

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): In Kerala, we have reduced it.

DR. ANBUMANI RAMDOSS: Sir, we have the UNDP figure saying that India is 126th in the world. Again, as part of the Government, being an Indian, both in national and international forums, we are sometimes put to shame because of this figure when India is being compared with other lesser developed countries like Afghanistan or Africa saying that India is on a par with on maternal mortality or infant mortality of that country. And this is why a conscientious decision was taken for bringing the National Rural Health Mission. Sir, the National Rural Health Mission is the priority programme of the UPA Government and I would go one step further saying that in Indian history, this National Rural Health Mission is the biggest programme ever started in the health sector.

(Contd. by TMV/4C)


DR. ANMBUMANI RAMDOSS (CONTD.): This wholly and solely concentrates--in fact, I can't say wholly and solely because part of it is linked with the urban which will be coming up in future--but mostly, on the rural areas and how the infrastructure and health-care facilities can be upgraded. A lot of issues have been raised about the intention of the Government, the spending percentage of the GDP, etc. It is just three years since I have taken over and, in fact, way back, in the early nineties, the total public spending in the health sector was about 1.3 per cent of the GDP at that point of time. Subsequently, in the later part of the nineties, it came down to 0.9 per cent and it was the same 0.9 per cent till we took over. In our CMP, Common Minimum Programme manifesto, the UPA Government said that definitely, in the next five years, we would try to reach, at least, two to three per cent from 0.9 per cent. The public health spending is not only the spending by the Government of India, but it relates to the State Governments also. Taking into account the State Governments, earlier the total spending in the health sector was about 7.5 per cent of the total Budget of the States. Then there has been a steady decline and today it is 5.5 per cent. Some of the States spend only about 1.5-2 per cent of their total Budget in the health sector. We are trying to rectify this through the Planning Commission. I have had discussions with the Prime Minister and the Planning Commission and they have been asking the States to definitely increase their spending in the health sector. If you take the previous years, the outlay for health in 2003-04 was about Rs.6,625 crores. Today, it is about Rs.14,363 crores. So, from Rs.6,000 crores to Rs.14,000 crores, there is nearly 117 per cent increase. This shows the intention of the Government and the priority areas are health, education, agriculture, drinking water and other social sectors. In fact, for the Indian System of Medicines, there has been literally an increase of 236 per cent after we took over. But this intention is not reflected by the response of the States. That is why we are trying to work out, along with the States, how we can increase it.

Sir, there are a number of programmes which I just rush through because there is lack of time and I will take up all the Members' queries and explain what our intention is and what we are going to do.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): We have to take up the Half-an-Hour Discussion.

DR. ANBUMANI RAMDOSS: I understand it, Sir. But this is such a very important issue and all the Members have contributed a lot to this, and I am also looking forward to this because I would like to share my experience in the last three years. More than my experience, I want to incorporate the suggestions and experiences of all the Members in the future programmes for the health sector.

Sir, as I said, the National Rural Health Mission is a holistic programme of health, drinking water, sanitation and nutrition put together at the village level. This programme is two years old. It was started on 12th April, 2005 and it took nearly one-and-a-half years for us just to put in place a mechanism. This is a seven-year mission programme, two years in the Tenth Plan and five years in the Eleventh Plan, and it is just going to go further. Initially we have got it thrusted. I have also challenged my Prime Minister and told him that what has not been achieved for 30 years, I will definitely try to do in three years. I said that it was not an empty challenge. That is why we have taken up the National Rural Health Mission. The basic unit of the National Rural Health Mission is ASHA, Accredited Social Health Activist. A lot of Members have asked what the functions of ASHA are and whether it will clash with the functioning of ANM. Let me, before explaining the basic parameters of the National Rural Health Mission, say that ASHA is a linking worker in each village. An ASHA must be she. She has to be minimum eighth standard. It is a little flexible in underserved areas. She has to live in the village and work in that village. That is the criteria. She will not get any salary. Initially she will get a remuneration and then according to the work she does such as taking a child for immunisation. She is not going to do any work herself. She is not trained to do any work herself. She is going to facilitate the woman or senior person, taking the children to the sub-centres or primary health centres for immunisation or women for delivery to the community health centres. All the money is incorporated in that. I will not be going deep into this because I need more than one hour just to explain what the National Rural Health Mission is. I would love to do it in due course of time and I would request the hon. Members, through you, to accept this. You could give me time only for discussing the National Rural Health Mission in this august House so that I could explain each and every point as this programme is actually the biggest programme.

(Contd. by KLS/4D)


DR. ANBUMANI RAMDOSS (CONTD): This year we are spending nearly Rs.10,000 crores on this National Rural Health Mission. This is a programme where almost all the State Governments have cooperated. All the State Governments have signed MoUs with the Central Government. Nowadays, rather than the Health Ministers of North-East, the Chief Ministers have talked to me very frequently saying that the first time ever money in the health sector has come to the North-East and programmes are being implemented in the North-East. Same thing is happening in other parts of the country also where there has been a lot of cooperation in the National Rural Health Mission. The basic unit of the National Rural Health Mission is district, Sir. We have nearly 600 districts and 600 District Health Societies. These are registered societies. With regard to the Chairman of a District Health Society, we give flexibility to the States and it can be either the District Collector or the Zila Parishad Chairman, District Chairman, Panchayat Chairman, Either of them. Chairman or Vice-Chairman, they can interrelate depending upon different States. Money from the Centre goes directly to the District. So, this is one of the unique programmes where the money goes directly to the district, the districts are accountable, the District Health Societies are accountable to that and they have their own

parameters. We have given them the parameters. We have appointed the Chartered Accountants, MBA graduates, Information Technology people at the district level to monitor our programme, day-to-day monitoring and give it to the State Government and information to the State Government. So, this is something unique, a programme which we have planned out to implement it and all the facilities, Sub-centres, Primary Health Centres, Community Health Centres, District Headquarters Hospitals all are being modernised and improved. This is one of the bases of this programme. About Sub-Centres and PHCs, hon. Members have said that earlier they were population based. Now my Prime Minister has asked me, Sir, no more population based. You make it need based because you cannot make it population in Rajasthan where we have deserts or the North-East. You say for 3000 or 5000 people you have a Sub-centre. But then we cover the entire area. So, according to our needs we are changing our policies and priorities and according to need we are giving Sub-centres. My priority now is to improve the existing infrastructure because it is easy to build new infrastructure but getting manpower is difficult. The first priority is to improve the existing infrastructure, Sub-centres, Primary Health Centres, Community Health Centres. Literally, Sir, the first instalment of Rs.20 lakh rupees for all Community Health Centres has gone. With regard to District Headquarters Hospitals, there is no limit for improvement. If they give us a plan, how much money they want, definitely, they will be given the money to improve the infrastructure. It can be operation theatre or labour room or any of the facilities they want. Under the National Rural Health Mission, there is so much of flexibility. In fact, the Mission Steering Group, the Cabinet has given the flexibility under the programme where the Empowered Steering Group under the chairmanship of the Health Minister. The Deputy Chairman of the Planning Commission is a member of that, the Rural Development Minister is member of that, the HRD Minister is member of that, the Panchayati Raj Minister is a member of that. All the Ministers are members and almost all the Secretaries are members of this Steering Group where we have flexibilities to decide how we could implement our programmes and priorities. Sir, under the National Rural Health Mission, we are giving mobile medical unit for each district initially and we are giving united funds. Sir, there is a concept called "Village and Health Sanitation Committee''. All the villages are going to have this Committee literally and till date about 17,000 Committees have been formed. They have to have a bank account. That is why it is taking little more time for them to do it. Then the Chairman of the Village Health Sanitation is going to be the Panchayat head and the members are going to be the ANMs, Anganwadi workers, self-help group women, and local community people. They are going to decide what priorities they want. We are going to give them an untied fund of Rs.10,000. They can improve the transportation, they can improve the services of drinking water, nutrition and all that. It is an incorporate programme. Sir, this ASHA, she will report to the ANM in the Sub-Centre but she will be working under the Anganwadi worker in the village. She will be sitting with the Anganwadi worker, nutrition worker in the village and she will be reporting to the ANM in the Sub-Centre. Mr. Chandra Sekar Reddy was asking what is the necessity of ASHA when you have an ANM. ANM caters to the population of about 3000 to 5000 and sometime she has to take care of even five villages also. But ASHA is only in one village. She has to concentrate on that. ASHA will take the patients; ASHA will take the women, the children to the sub-centres for immunisation, for de-worming and all the other purposes like that. So, the work of the ANM will be reduced but overall she will in-charge of entire thing. Sir, I wanted to explain more about the NHRM but due to paucity of time I am not able to do it today. In some of the other programmes, which we have now after the UPA Government has taken over, one of them is National Drug Authority, a Central drug authority. (Contd by 4e/sss)


DR. ANBUMANI RAMDOSS (CONTD.): We are trying to give more autonomy. There were lot of issues raised that autonomy is being usurped in some institutes. I am a professional trying to become a politician. I am one professional who wants to give more autonomy to different sectors. I am a doctor and I know how they are trying to do. This Drug Authority is going to be an independent body which is going to be professional. Today it is being manned under the Health Ministry. I said, as a try put it into separate groups, professionals, let them man it, we are not going to interfere on the policies. There is a Food Authority, which is again coming. Within this year, the Food Authority will be appointed. But for the Drug Authority, Sir, in fact if there is time in this Session, I will be happy to introduce the Bill for amending the Drug and Cosmetic Act where we are trying to bring it. A building is being readied and there have been a lot of queries. Members have been speaking about spurious drugs and sub-standard drugs. Today we are trying our best. But, Sir, there is no coordination between the State and the Centre. And there have been some issues raised whether the autonomy of the State is taken over by the Central Licensing Pattern. Worldwide, most of the countries have this pattern. In fact, US FDA also has the same pattern. That is why it will be easier to implement. So, today the State Governments have their own drug authorities. They give licences. Central Government give licences for new products; and then for blood, vaccine, and those products the Central Government gives. If someone is denied a licence for example, from Tamil Nadu, the same person can go to Pondicherry and get the licence and manufacture there and supply it back. Nothing prevents him. So, this is something, which is causing a huge problem, and the Mashelkar Committee Report has recommended that there should be a Central Licensing Pattern. It is not as if we are trying to take away the powers. But it is going to be a gradual phenomenon in the next five years and in consultation and cooperation with the State Government we are trying to do it. We are having capacity buildings. All the drugs and food labs in this country, the Central Government and State Government labs, are being modernised. Nearly fifty per cent of the work has been done. It is a World Bank funded project. The manpower has been trained. We have in fact, asked the Finance Ministry and the DOPT for more personnel also to man such a huge issue and in fact, Mr. Ahluwalia was repeatedly telling that at least 35 per cent of the drugs are spurious which I strongly, vehemently deny. This august House Member should not say that 35 per cent of the Indian drugs are fake. It does not augur well for the country, for the reputation of the country. That is definitely not the fact.

SHRIMATI BRINDA KARAT: There were some Press reports.

DR. ANBUMANI RAMDOSS: The Press keep on sensationalising these things. (Interruptions) Please, let me finish.

ֵ ֿ Ͼֻ : ״׮Ù , ֟ ֯ , ֟ ֯ ֲָ ֜ ֮ և ß֮ ֮ ...(־֮֬)...

THE VICE-CHAIRMAN (PROF. P. J. KURIEN): After the Minister finishes I will allow you to put a question. ך....ך.... (־֮֬)....

ֵ ֿ Ͼֻ : ֮֯ ֛ ִָ ֮ פ ...(־֮֬)... և ָ ֯ ֟ ֓ ....(־֮֬)...

ֳ֬: ֯ ך

DR. ANBUMANI RAMDOSS: Sir, coming to the research part, Dr. Kasturirangan has rightly pointed out that ICMR, Indian Council of Medical Research is the premier research institute in the country and it needs lot of focuses and we have not been doing this for the last few years. We are trying to make ICMR again an autonomous body. We are trying to make ICMR a separate Department in the Health Ministry. Today, they go through all the procedures and then it comes to the Section Officer. Now, ICMR have strongly recommended and once that is being made then there will be more budgetary allocation and there is going to be more individualised flexibility and there is going to be lot more research activities taking care of this. Another programme is the Integrated Disease Surveillance Project. It is again a World Bank funded project where today, unfortunately, Sir, if there are any disease outbreaks in any part of the country, we only know it late and if we come to know it earlier, it is through the media. It is an unfortunate situation. This should have been much earlier. But, then we are going through this programme, this is one of my very important focussed programmes where if there is any outbreak of Cholera anywhere in the country, after this programme is implemented in the next one and half to two years, after this entire country is networked and implemented, within six to eight hours the State Government and the Central Government will be notified of the outbreak and we will take immediate action, whether it is cholera or bird flu or any issue. That is why this programme is very, very important for us and, in fact, an Additional Secretary is being entrusted to do this job and he will be going into this. Of course, the other concept is trauma and emergencies. (Contd. by NBR/4f)


DR. ANBUMANI RAMDOSS (CONTD.): Yes, Sir. In fact, in all these years, there has not been much focus on trauma. Only due to road accidents, nearly, 100,000 people die and nearly 500,000 people are injured. That is why we have decided to take up a programme. The Ministry of Road Transport and Highways and the Health Ministry have come together and trying to take up a new programme. One concept is to have trauma centres all along the National Highways. We are even trying to discuss of having a holistic concept of emergency. Emergency includes road accidents, trauma, suicides, snake bites, burns, maternal delivery, theft, etc. In America you have a number 911 for emergency. So, we are trying to work out for a common number throughout the country. If anybody calls up and tells about any emergency, immediately they will be responded to. We are working on this programme. In the next few months we will be letting out the ways and means of how we could move forward.

A lot of hon. Members have given their views on the medical education. They not only gave their views, but also expressed their concerns how this medical education could be spread and improved. They have also mentioned about the commercialization of medical education and how we could, as Mr. Narayanasamy has said, streamline this mechanism. As far as medical education is concerned, Sir, there are 262 medical colleges in this country. Out of which, 135 are in the Government sector and the rest are in the private sector. Out of these 262 medical colleges, about 60 to 70 per cent are in six States -- Tamil Nadu, Andhra Pradesh, Kerala, Gujarat, Karnataka and Maharashtra. And the rest of the country has the remaining 30 per cent colleges. So, this is something which is causing a lot of concern, because there will be very unequal distribution when we plan about the health human resources for future. In Bihar, I think, there are only about 8 medical colleges. In M.P. there are only about 8 or 10 colleges. Whereas, in A.P. there are about, I think, 38 to 40 colleges. In Maharashtra it is something the same. So, we need to plan out and that is why we are trying to work out. Smt. Brindaji said that I should not shy away from my responsibility by saying that this was the problem of the States. Definitely, I will not shy away from my responsibility ever. Definitely, I am responsible and I will be responsible whatever happens in this country. Even though it is the work of the States, we work in tandem. We will try to coordinate with the States. We are trying to work out programmes and priorities as to how to induce the States to have more programmes. One such programme is the PMSSY - Pradhan Mantri Swasthiya Suraksha Yojana. A lot of hon. Members have raised queries that it is a long-pending programme. Sir, I have a good predecessor. Smt. Sushma Swaraj was one of the best Health Ministers. She was my predecessor. She had initiated a lot of programmes which I am continuing today. In fact, this PMSSY was her brainchild. But, when this programme was conceptualized there was no financial backing. This programme was not planned in the Tenth Plan. This PMSSY envisages six new AIIMS-like institutions requiring literally about Rs. 4,400 crores. This was not planned in the Tenth Plan. This was conceptualized in the middle of the Tenth Plan. It took me nearly one-and-a-half years to request the hon. Prime Minister and the hon. Finance Minister to get resources. Last year, the CCEA has approved this. In the last few months, we are going through the process of appointing a consultant, going through the environmental impact study, etc. That is the process which is going on. In about 3 years these 6 new hospitals will come up and we are upgrading 13 existing institutes literally from all the States. To each State we are giving Rs. 100 crores and the State concern has to give Rs. 20 crores and the work is definitely going on. In fact, one Additional Secretary is put inc-charge specially for this programme. We are trying to work out this programme. I assure the hon. Members of this House that this is one of the priority programmes of this Government. We are keenly concentrating on this programme and trying to finish this programme without much delay. I now come to the rural posting of doctors. Mr. Pilania has also said, 'why cannot we have a rural posting for doctors?' Yes, Sir. We envisage that. Maybe, in the next year, after he or she finishes his or her House Surgeonship he or she will be posted in rural area for one year. (CONTD. BY PK "4g")


DR. ANBUMANI RAMDOSS (CONTD.): It could be mandatory and the doctor would be posted under the supervision of a Medical Officer; he just won't be posted anywhere. The District Medical Officer will post his doctor in a PHC, in a CHC on rotation. So, it is not going to be a fixed posting. The doctors will be getting stipend, not salary. The State Governments and the Central Government are trying to work it out. Literally, Sir, about 29,800 MBBS graduates are coming out every year from all these 262 Medical Colleges. So, we need to use those resources; and, from the next year onwards, it will be mandatory.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Mr. Minister, what Mr. Pilania said was that the degree should be given only after this compulsory service.

DR. ANBUMANI RAMDOSS: Sir, during the house surgeoncy, there is a three months' rural posting of this doctor. We will be giving a temporary registration after the house surgeoncy. After the doctor finishes one year mandatory rural posting, then only, the doctor would be allowed to write the PG and all those things. We are trying to work out the logistics on that, Sir.

Coming to the existing doctors in this country, we are trying to work out a system of mandatory continuing medical education to update and upskill their knowledge because some of the doctors....(Interruptions)..


Ӥ 껻 : ӡ ׸ Ӥ ֻ ׻֋ ?

DR. ANBUMANI RAMDOSS: I have listened patiently to you...(Interruptions).. I just request you to patiently listen to me. ..(Interruptions)..

THE VICE-CHAIRMAN: Already those points have been...(Interruptions).. He is replying to that...(Interruptions)..

DR. ANBUMANI RAMDOSS: I will, definitely, answer your queries. You note it down...(Interruptions)...

THE VICE-CHAIRMAN: The hon. Minister is replying to that.

DR. ANBUMANI RAMDOSS: Sir, continuing medical education, we are trying to make it mandatory that all existing doctors in this country will have to re-register themselves every five years, after undergoing sixty hours of mandatory continuing medical education to update their skills and knowledge. After five years, after they re-register saying that they have undergone sixty hours of CMVs, then, for the next five years, they can do practice. I have had a discussion with all the professional bodies, the associations like FOGSI, they are all into this; they say, "definitely, we are supporting this." So, these are some of the changes we are trying to bring in. Then, we are also bringing in Clinical Establishment Regulation and Registration Act, 2006. We are trying to work it out this year and I will also be introducing it this year itself. Under that Act, all the hospitals in this country, the private hospitals and the public hospitals, will be regulated. Today, Sir, it is concerning that we don't know exactly -- it is really wrongful for me to say that -- how many hospitals in the private sector are there in this country. Who is practising where? In fact, today, all that they need is just a licence on the municipalities in some States. Some States have a system of registration like Maharashtra, West Bengal, etc., but most of the States don't have, because anybody can start a hospital anywhere. All that they need is the Municipality or Corporation permission and they can start it. As you know, so many issues are there. So, we want to streamline the entire procedure. That is why, we are trying to work out by way of new Act where all the hospitals and clinics, whether it is a one-man clinic or a 5,000-bed hospital, including the diagnostic labs, all the labs, will have to be registered with its District Authority. We are going to put it up -- who is the authority, what are the powers of authority and all that? There is going to be a State Authority and the Central Authority which are going to regulate this. After giving the establishment time, maybe a year or two, we will be putting up Indian Public Health Standards; so that a 500-bed hospital should have these standards; a 5,000-bed hospital should have these standards. If they don't, then, we would ask them to rectify these. After giving them sufficient time, we will try to make some modifications. So, it will be mandatory that all hospitals in due course of time in diagnostics will have to pertain to the Indian Public Health Standards. This is to streamline the private sector. Not only the private sector, the Government sector will also have to have in due course of time these Public Health Standards. There is no difference between the private and the public. Of course, there were a lot of concerns about the declining sex ratio. Shrimati Brindaji also mentioned about that. We are now constantly going through sitting with the PNDT body and we are trying to work out how we can improve further. In fact, there were a lot of suggestions put up in the last meeting. We are now trying to work out those. I think that this is not only a health issue, but also a social issue. It needs the support of all the hon. Members here and also the common public, civil society, religious CBOs, FBOs, etc.

Coming to the Organ Transplant Act, Sir, there have been a lot of issues about transplantation of kidneys, livers, etc. being done scrupulously. We are now trying to have an amendment to the Act to make it more stringent. We have the Authorisation Committee. Sir, there are two categories. I don't want to take much time, Sir. (Contd. by 4H)


DR. ANBUMANI RAMDOSS (CONTD.): One is, the blood relation where they could do it. The blood relations like the mother, father, brother, sister and all that can give organ. And, then there is the other category of 'love and affection' where if you know that person for a long time, then the person could give organ. So, we are trying to work it out. We are trying to strengthen the authorisation committee in each State, and we are even trying to expand the cadaveric transplants. That is the main programme which was needed. We are also having a National Organ Transplant Programme. In fact, an initial amount of Rs. 1 crore has been envisaged in this year's Budget where all the hospitals have been linked and the concept called ORBO, i.e., Organ Retrieval Banking Organisation, like the one in AIIMS, should be there all over the country. Initially, in four Metros, we will be spending about Rs. 8-10 crores for each centre and there will be networking with each. As Mr. Narayanasamy has said, someone who donates should be given some incentive. We are trying to give incentives not in cash but in kind like someone in the family of the cadaver, who brings a dead person, could be given free rail pass and he can have a recommendation certificate. We are trying to work out on that.

Sir, in the Indian system of medicines where a lot of issues have been raised, I would like to say that this is our own system and definitely it is the duty of the Government to propagate our own system. We have been following the system. Our food habits, the way we behave, our culture, everything shows that we have been following the Indian system. We have been definitely trying to propagate this system. In fact, my predecessor, Sushmaji, had done a wonderful job in propagating the Indian system, and we are trying to propagate it not only in our country but all over the world. We have been strengthening the institutions which are trying to propagate that. We are also trying to integrate the modern as well as the Indian system. This is a world-wide phenomenon which is happening. There is the Golden Triangle Concept where an amount of Rs. 120 crores has been envisaged for research on Indian system. The ICMR, the CSIR and the AYUSH Department are coming together and trying to do that job. Of course, then there is TKDL, Traditional Knowledge Digital Library. Some patents have been misused by our own institutions. We are trying to look into that. We have also envisaged money for the Medicinal Plant Board. So, these are some of the initiatives which we have taken.

Now, due to lack of time, I will straightway take up some of the queries which the hon. Members have raised. The first one is of Mrs. Brinda Karat. She was saying that nearly 80 per cent of the people are having out of pocket expenditure and, in fact, because of the health spending, there has been a tremendous increase in rural indebtedness. Sir, it is correct. In fact, health is the second highest reason for rural indebtedness. Agriculture is number one. We are now trying to take steps on that. Our focus is on health insurance. I think, Sir, the health insurance is the only way by which we can avoid it. Today, we have a health insurance scheme which has, unfortunately, not taken off much. So, we are trying to have some changes. My Prime Minister took two presentations only on health insurance and he had asked us to devise ways and means how we could have wider consultations, have a lot of workshops which we have in due course of time. Sir, at the end of this year or in the beginning of next year, we will be announcing a new programme for health insurance which is going to go a long, long way. That is one of the best solutions to this indebtedness.

Sir, she was again right in saying that 80 per cent of the health infrastructure in this country is in the private sector. In fact, I had inherited a system where a little over 80 per cent of the infrastructure in the health sector was in the private sector. We are now trying to increase the public health spending. That shows the intention of this Government. As I have said that, there has been 117 per cent increase in the last three years, at least, in my Budget, the health Budget. In fact, last year, we had 22 per cent increase. This shows the intention of the Government of India. But the State Governments have to respond to that. Of course, the hon. Member was asking how the Government could regulate the private sector. This is an important concept especially in these days of medical tourism. Sir, today, the cost of treatment in India is the lowest in the world. In fact, the Indian pharmaceutical price is also the lowest in the world. The Government's intention definitely is to keep it that way. We don't want to increase the rates due to foreign tourists coming to India for treatment. Time and again, I have been telling these organisations like CII, FICCI, ASSOCHAM, etc. -- whenever I go, I tell them -- about it. The Government is very, very conscious of this phenomenon of foreign patients coming to this country. (Contd. by 4j/SKC)


DR. ANBUMANI RAMDOSS (CONTD.): Today, heart surgery costs about Rs. 1 lakh 20 thousand or 1 lakh 15 thousand. Some experts in the field say that in future it may even go up to Rs. two lakhs. But then, we say that the Government is very conscious and we want it to be reduced. We want the burden from the private sector to be given to the BPL. We are trying to work it out. Today, the situation is fluid, Sir, frankly speaking; we do not have a solution to that. But, we are very much aware of that and I would like to assure the Members that if a situation comes where due to the foreign patients coming here the cost of treatment of the Indian patients increases, we would definitely take a lot of steps to rectify it. We are not waiting for it to happen; we would be taking steps before that. Initially, we will be having discussions with the associations; as such, they are responding positively. This is just for the information of the august House.

The hon. Member was asking whether there would be privatisation of CGHS. Definitely not, Sir. We have about 24 cities in India which are CGHS centres. We do not have hospitals to cater to the CGHS patients. Literally, we have about 50 lakh beneficiaries, 5 lakh pensioners in CGHS. Even though we have our own dispensaries and polyclinics in most of the cities, in-patient treatment, surgery and all that, of the 24 cities, some of them do not have facilities in the government sector to cater to these. That is why we take the help of the private sector. And the rate at which the private sector is giving it is that of the AIIMS. So, it is not like we are throwing away money just like that. We are definitely co-ordinating and checking this mechanism, and in fact, we are trying to open out the entire system. If anybody wants to register, they can do so at any point of time within the prescribed parameters of quality, the eligibility of diagnosis and rates, etc. So, we are definitely not in favour of privatisation of CGHS.

Of course, I should talk a little about the AIIMS issue. Coming to the AIIMS issue, Sir, there has been a lot of talk; a lot of articles were written in the media saying that there was some fight between Ramdoss and Venugopal. Sir, it is very disheartening. We all respect Dr. Venugopal. He is one of the best doctors in this country; he has done a lot of pioneering work there. I am also a medical doctor and I respect him. There is absolutely no ego whatsoever between us. I would just like to clarify even though this would be going slightly beyond the issue, but, I just wanted to clarify. Sir, I am a professional trying to become a politician. I think and work that way. I am a youngster and I want to change the system for the better.

Sir, under the Health Ministry, there are about 40 to 50 institutes which have Directors. Why should I point out just one Director? There are so many Directors, Director of PGI, JIPMER. What do I have personally? Absolutely nothing. I want the institutions to improve. The All India Institute of Medical Sciences is one of the most premier institutes in this country without any doubt and it has greater expanding powers. I have been travelling world-wide and seeing what kinds of hospitals they have and I have been wanting a tie-up with them and for every institute to move up. Sir, we are literally spending approximately 500 crores of rupees on All India Institute of Medical Sciences; Imagine spending Rs. 500 crores on one institute! And, what is the net result? No doubt, it is one of the most premier institutes. We want it to function; it is an autonomous institute. But autonomy doesn't mean no accountability. I am accountable to the Parliament; everybody is accountable to the Parliament. We need results. And this is the whole idea. The media just wants to create some confusion. It is a media-driven concept of ego, personality clash. There is absolutely nothing personally between myself and him. We wanted the Institute to move forward and I would do everything in my capacity to push the Institute forward to make it not only the best in the country but the best in the whole world.

SHRI PENUMALLI MADHU: Then what is it? That can be explained.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): He is having his say. Please listen. You may agree or disagree with him; that is a different thing. (Interruption) Please continue, Mr. Minister; there is shortage of time. (Contd. by 4k/ksk)


THE VICE-CHAIRMAN: How many minutes will you take? There is half-an-hour discussion.

DR. ANBUMANI RAMDOSS: Of course the finances, about which Brindaji was asking whether I had any struggle to do to get increased allocations for my Department, I would like to say, "Definitely, not, Sir." The Prime Minister is giving me all the money that I want. The only problem is the absorption capacity of the States. Since it is a new phenomenon, during the last three years, Budget of the health sector has increased by nearly 117 per cent. So, there are lot of funds, but the problem is the State Governments' absorption capacity; how they are responding to that. Sir, I depend on the States for my spending, and the State Governments respond by not giving the utilisation certificates. Every quarter, every amount of money they spend, they have to respond by giving the utilisation certificates. Some of the bigger States in North India did not respond favourably. That is why, that capacity is not there. Therefore, we need little more time to establish that absorption capacity. So, regarding finances, my Prime Minister has given me all the money that I want. So, money is not a criterion at all. There is no struggle to get more money for the health sector. In fact, his intention is to give even more. But, absorption capacity is a problem. That is why, there is difference in actual expenditure and outlays. We are trying to work out that. In National Rural Health Mission, the money goes directly to the Health Society. Going through this process is eliminated and accountability is with the District Health Society. We have Chartered Accountants and MBA graduates appointed there. So, the monitoring of the programme will be easier. So, there will be more absorption. We have done the same thing in the North-East also. We have the Regional Resource Centres (RRC). We have lot of consultants there in the Centres. It is set up in Guwahati. And, these centres are planned for the entire North-East. Almost all the State Governments are responding very positively. They are coming to the Resource Centre and they are having the programmes, not only the programmes, even implementing and monitoring has been done by Regional Resource Centres.

Now, coming to promoting health, nutrition, tackling anaemia, drinking water schemes, reducing maternal mortality, and, of course infant mortality, I would like to say that my number one focus in health sector is to reduce maternal morality. To save the mothers is to save the children. That is why, Sir, one of the main focuses of this entire National Rural Health Mission is to reduce MMR and IMR. That is the main intention because most of the MMRs are in the rural areas where they have inaccessibility of health facilities and most of the maternal mortality is due to mothers who are previously anaemic. During delivery, there is lot of blood loss, post-natal haemorrhage and coupled with that, diabetes also. About 40 to 45 per cent of the maternal deaths take place due to this reason. To set that right, these Community Health Centres are being equipped. We will be giving between Rs. 20 lakhs to Rs. 2 crores for all Community Health Centres. There are about 3,446 CHCs, that is, the taluk headquarter hospital, and we are modernising all of them. We are having blood storage capacity. We are modernising all the delivery rooms and operation theatres. We are putting Indian health standards where there have to be a Physician, a Gynaecologist, and Anaesthetist. And, if there is no such doctor, then these people can be taken on contract basis. Money is given under NRHM. For example, if they need an Anaesthetist, then the Committee could appoint an Anaesthetist. So, this is a very flexible scheme. The Janani Suraksha Yojana, regarding which she raised some very important questions, I would like to say that under this scheme, we are giving about Rs. 1,400 to the mothers in a low performing State. This money will go directly to the mothers. Total amount is Rs.2,000, out of which Rs.1,400 will go to the mothers, Rs.600 to the ASHAs, to the Anganwadi worker, and to the AMM for transportation charges, for food charges. Because, every morning ASHA gets up, she has to see her diary that today she has to check that so many children are to be immunised. The dates are there. So, she will take the children to the immunisation sub-centre. And, today, she wakes up, she will see that she has to take so many mothers for ante-natal check-up; so many mothers have delivery date today. So, she has to take them for delivery. So, that is the main concept of ASHA, but her main focus is on delivery. Sir, ASHA has been equipped for that. It is not like that ASHA is just a set-up, or, like endless ASHAs are there. ASHA is going to be trained for a 28-day period over a period of one year, initial year, seven days each. First seven days will be orientation training. (continued by 4l - gsp)


dr. anbumani ramdoss (contd.): We have had a module of training for this. ASHA is not going to be loaded with work. It is going to be made simpler for them to work. She will be working under the aegis of Anganwadi worker. She will work with the Anganwadi worker but she will be reporting to the ANM -- that is the mechanism -- and, ASHA will be selected through the Panchayat mechanism.

Coming to Janani Suraksha Yojana, she has raised very valid points about the age of 19 years, and, about why only two children. Sir, we have had a lot of deliberations, and, I would like to assure this House, through you, that this issue would be taken care of. This issue will be taken care of and we will definitely try to rectify these issues, including the age limit of 19. Even though it is illegal but most of the maternal deaths are happening to these young girls. In most of the States, like Madhya Pradesh, Chhattisgarh, or, Jharkhand, girl child is married at the age of 12-13 years, and, after some time, when they go there for delivery, they cannot be turned away from the hospital. It is there in most of the tribal areas, and, we cannot turn them away. We will definitely work on these two points and we will take conscious and positive decision on that. As far as Rogi Kalyan Samiti is concerned, about which she said it is a user fee or the privatisation....

SHRIMATI BRINDA KARAT: I said it is being reduced. I said it is a good concept.

DR. ANBUMANI RAMDOSS: Definitely, under the National Rural Health Mission, we have not asked anybody to have any user charges. Rogi Kalyan Samiti is a hospital management committee formed in the hospital locally with prominent members there. We are supporting these Rogi Kalyan Samitis.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): She welcomed it very much. She was welcoming it.

DR. ANBUMANI RAMDOSS: The Government of India is giving money to this Committee. In a PHC, in a CHC, in a District headquarter, we are giving money from Rs. 20,000 - 50,000 - 1,00,000 for them to spend money themselves. And, in fact, in due course of time, in some of our programmes, like for delivery, if the hospital takes up delivery, amount of Rs. 100 - 200 will be going to the Rogi Kalyan Samiti. That is how this Rogi Kalyan Samiti will work. They will put all the money, which they are getting through this, and, expand their services.

Today, if a PHC does not have a tubelight, we have to write to the authorities, and, it takes six months to get a tubelight. But we are giving the money to the PHC; we are giving them contingency money. We are giving them Rs. 25,000, they can buy a tubelight overnight and put there. Similar is the case with ambulance tyre puncture or oil etc. So, lot of flexibility is there in the programmes, and, we are trying to do that. As far as Nursing Schools are concerned, it is a very important concept. Today, where doctors are not going to the rural areas or villages, we are trying to make a mechanism of mandatory posting of doctors in the rural areas.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): I have a time-constraint also. How many more minutes will you take?

DR. ANBUMANI RAMDOSS: Sir, this is something which is very important to be answered. I just want a little more time. I am sure my colleagues will have no problem. (Interruptions)

SHRIMATI BRINDA KARAT: Sir, he is replying to the important questions. This is very important. (Interruptions) Please let him answer. (Interruptions)

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DR. ANBUMANI RAMDOSS: Sir, the Member has no problem. (Interruptions)

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THE VICE CHAIRMAN: No, I tell you why I said that. At 5.00 p.m., we had to take up the Half-an-Hour discussion. (Interruptions) No, no. Let me say. (Interruptions) You were not here. That is the problem. Mr. Jaipal Reddy also said that he would like to take it up. I asked the hon. Minister, "How much time will you take." He said, "Half-an-Hour". (Interruptions) That is in my mind. I am ready to sit here upto any length of time. Only thing is that your own party members were raising this issue. You were not here. What can I do? They raised this issue. I have to see both the sides. Now that you agree, hon. Minister can take as much time as he wants. I said only because of the commitment. Otherwise, I don't want to control a Minister. You are correct. But, at the same time, if there is a commitment, I have to honour that. That is the point. (Interruptions)

DR. ANBUMANI RAMDOSS: Thank you very much, Sir. (Interruptions)

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Now, it is clear. Now, he can take as much time as he wants.

DR. ANBUMANI RAMDOSS: Thank you very much, Sir. (Interruptions)

THE VICE CHAIRMAN: But when I am on the Chair, I have to keep up the commitment. (Followed by sk-4m)


DR. ANBUMANI RAMDOSS: Thank you, Sir. Coming to the issue of nursing, if there are no doctors, we need paramedics to serve in the rural areas. And, due to lack of them, there are so-called quacks coming out. Then, they are killing the patients and then there are a lot of issues that are happening. That is why, Sir, this nursing concept is a very, very important concept. The Government of India is giving a lot of funds to the State Governments to start nursing colleges and to upgrade the nursing schools into colleges. In fact, anywhere between 1.5 to 3 crore rupees we are giving for existing infrastructure. In the North-East, we are giving them hundred per cent money to start as many nursing colleges as they want. The only problem is of manpower. That is again, if they plan out that, we are willing to give them any amount of money. This is something which we are concentrating very, very intensively. In fact, we are trying to start centres of excellence in nursing initially in the four metros. So, every centre is going to cater to the curriculum, the monitoring of all the other nursing colleges and schools in this country. More quality is also associated in this, Sir.

Of course, the Malaria Programme is again a priority Programme for us because we have been having a lot of issues with regard to malaria. I would again say that there are two programmes on which I am not satisfied with my Ministry itself. I am frankly admitting this. One is the Vector Borne Disease Control Programme and second is the Mental Health Disease Programme. These are the two programmes which I am not satisfied with. We are trying to change the programme continuously. We are trying to have newer concepts. For Malaria and other Vector Borne diseases, I have personally attended a lot of workshops. We have called national and international experts. They sat for two whole days and they have given a lot of recommendations which we are trying to implement. We are trying to do that, Sir.

In fact, the Chikungunya is the issue which is not included in the IDSP. In the IDSP Programme, we have 11 basic parameters and these are not fix parameters. In some States, we have different parameters. In fact, Kala Azar is included, as one of the parameters, in Bihar or West Bengal or Jharkhand or Uttar Pradesh. And, that Kala Azar is not there in Maharashtra because the disease is not prevalent in this side. So, it depends on these things. Chikungunya came after 32 years to India. And, this is just an outbreak. So, in future we are going to add Chikungunya. So, not only communicable diseases, even diabetes, cardio vascular problem, road-traffic accidents, environmental pollution and all that will also be a part of the IDSP survey.

THE VICE-CHAIRMAN (PROF. P.J. KURIEN): Have you got a medicine for Chikungunya?

DR. ANBUMANI RAMDOSS: Unfortunately, no, Sir. It is just palliative care that we are trying to do. There is no medicine.

And, regarding immunisation programme, she said that it is 47 per cent and whether because of repeated Pulse Polio programme, regular immunisation programme has been jeopardised. Definitely that is not to be, Sir. But, there has been, in the National Annual Survey-III, a concerning fact that in some 5 to 7 States, in Maharashtra and Punjab also, there has been declining immunisation coverage. I am now personally overseeing the functioning and sent letters to the Chief Ministers and Health Ministers. I asked my officers to again discuss with the Health Secretary and Principal Secretaries of Health of the States. We are considering on how to improve that. That is one part of it. Secondly, with respect to supply of vaccines, we are making e-logistics supply of vaccines. Earlier, we were planning it out on a bulk and then vaccines taking from the manufacturers to the user, to the sub-centre. There was the problem of cold chain. Now, through the e-mode logistics, electronic logistics, we are trying to work out the transportation, purchasing according to requirement because vaccines should not be stagnated there. Otherwise, life shelf is going to be over and quality is not going to be there. In some centres, shelf life and cold chain problems are there. We are trying to rectify that. And other part is that we are using auto-disable syringes because of the injection safety. We had a lot of issues about injections given are unsafe because some of them are re-used and not properly sterilised. So, we took a decision about a year-and-a-half ago saying that all the immunisation in this country will be done only by auto-disable syringes. And, today, Sir, all the immunisation in this country is being done only by auto-disable syringes. They are used only once and they cannot be re-used. They have to be discarded. How they will be discarded, all that procedure we are giving them. And then, in due course of time, we are going to have a policy saying that it will be mandatory for all the Government hospitals, Central Government or State Government, to use only auto-disable syringes. (Contd. by ysr-4n)