Mental Healthcare Act 2010 – Needs revisions

The Population Health Improvement Alliance


Rajendra Pratap Gupta


Registered Speed Post / E-Mail

Dated: March 24th 2011

Shri. Ghulam Nabi Azad

Hon’ble Health Minister

Government of India

Nirman Bhavan,

New Delhi -110108

Reference: Revision of Mental Health Act 1987 & Mental Health Care Act 2010 ( draft )

Dear Shri Azad ji,

This needs your esteem, kind and personal attention.

I am writing this note on behalf of the Disease Management Association of India – ( DMAI)- The Population Health Improvement Alliance . DMAI works with all the stake holders in the entire continuum of care, for improving the population health of the nation . Over the last few years, we have worked with different stake holders to help define the right priorities in healthcare for the policy makers & the care providers .

Through this note , I am drawing your attention to the revision of the mental health act of 1987 and the proposed Mental Health Care act 2010 (Draft). The process of revision of the Mental Health Act 1987 was initiated about a year back, to make it compliant to the United Nations Convention on the ‘Rights of Persons with Disability’. Disability includes persons with long term mental illness. This convention advocates equal rights for all disabled persons.

Dr Saumitra Pathare ( a private psychiatrist) and Dr. Jaya Sagade (a lawyer) of Pune were in charge of conducting the regional consultations on behalf of the Ministry. Over the last one year, there have been 5 regional consultations with various stakeholders. The major stakeholders consulted have been users, care providers, professional bodies in mental health, mental health institutions and state government representatives. However, it is to be noted that, the Medical Council of India, other specialties of modern medicine, and professional organizations of general health field, have not been consulted. This is important, as the changes which are evident in the draft bill have far reaching consequences in terms of the way the modern medicine is taught and practiced currently.

DMAI- The Population Health Improvement Alliance, is surprised with the outcome of the consultations , and that there was hardly any discussion on the final outcome to patients due to the significant changes which are being brought in terms of the ‘mental health’ field of practice of medicine by way of promulgating this act. Proposed changes are likely to cost human lives , as persons who have not been trained to be physician (Clinical Psychologist, Psychiatric Social Worker, Psychiatric Nurse), will be entrusted with the role of independent examination, diagnosis and admission of patients in mental health facilities. Currently, this role rests with a Psychiatrist who is a medical doctor (MBBS) trained in Psychological Medicine. In modern system of medicine ,only a physician (M.B.B.S )can diagnose a patient, as only he has received training in all the specialties such as Medicine, Surgery, Eye, ENT, Obstetrics & Gynecology, Pediatrics, Orthopedics, Radiology, Dentistry, Dermatology, Anesthesiology, Pharmacology, Preventive and Social Medicine, Pathology, Microbiology, Physiology, Biochemistry, Anatomy etc. , which essentially means, covering all the systems of the body. Unfortunately, Human body cannot be compartmentalized and however we may wish, but we cannot have an Eye specialist who has studied only ‘Eye’ and not done MBBS ( as a basic general qualification and set of skills covering the entire human body system) to examine each and every system of human body. Similarly, we cannot have a Psychologist who has no training of the subjects studied at MBBS level, to diagnose mental disorders by only doing psychological examination!!!!

Only an MBBS trained doctor with the proper understanding of the entire human body system and its functioning, can do a detailed psychological evaluation and come to a diagnosis of whether the patient has a psychological illness or it is some physical illness, which is presenting itself as a psychological illness. In cases of latter, appropriate referral is required and any delay may even be fatal. S/he can also order various tests and imaging and interpret them for aiding in his diagnosis. After a diagnosis is arrived at, s/he can plan and provide physical treatment (ECT), pharmacological treatment or psychological treatment. The role of psychiatric nurse, clinical psychologist or a psychiatric social worker is to assist him by nursing the patient, helping him in psychological interventions, helping him in psycho-social interventions respectively. But the patient is under the overall care of a psychiatrist who is the leader of the mental health team. All the three categories of personnel work under the supervision of a psychiatrist .

 A clinical psychologist, PSW ( Psychiatric Social Worker ) or a psychiatric nurse is not trained to be a physician. They have not studied the human body as an MBBS doctor and cannot do detailed physical or systemic examination, investigations and imaging like a psychiatrist. They are in no position to independently examine, diagnose and advise admission of patient. A PSW and Clinical psychologist have not general training in other subjects of modern medicine. Just by talking to patient, how can a Clinical Psychologist or PSW diagnose a mental disorder? They will be severely restricted by their inability to do general and systemic examination and order and interpret investigations and imaging. A Psychiatry examinee will fail in his examination if he did not touch the patient for examination ; however bright drug treatment he may formulate for the patient ; as without a general and systemic examination, a person cannot make a diagnosis of mental disorder. In many cases special investigations and imaging also has to be ordered and interpreted. As per the diagnostic criteria for mental illness, a mental disorder can only be diagnosed after ruling out that the signs and symptoms are not better accounted for by a medical illness or use/abuse of a substance. In this scenario, without proper validation of the reason for the particular condition , what is the validity of diagnosis of mental disorder by a Clinical Psychologist, PSW or a Nurse ? Even the quacks believe that they can diagnose and treat independently. Each such claim needs to be examined objectively in line of their competence and current practice related to their vocation.

In modern system of medicine, which is regulated by MCI, there is no specialization known as Clinical Psychology, PSW or Psychiatric Nursing. The mandate of ‘Rehabilitation Council’ is limited to rehabilitation of persons with disability and practice of modern medicine under Rehabilitation Council is neither required nor allowed. If at all, new independent specialties such as Clinical Psychology, PSW and Mental Health Nursing without any supervisory role of a Psychiatrist is being planned for modern medicine system, then the whole modern medical system (MCI, Indian Medical Association, Other Medical Specialties) must be consulted .

If we go as per the draft, it means that Clinical Psychology, PSW and Mental Health Nursing personnel are as much a specialist as a psychiatrist and can independently examine , diagnose, admit and treat patients with mental disorders.

It is not understandable why a psychiatrist has to do MBBS (study the whole human body) and then specialize in Psychiatry while for the other persons they need to study only psychology or social work and yet be assumed to be qualified to examine the whole body, diagnose, admit and treat patients (albeit without medicines) . The demand to prescribe medicines by non psychiatrist is also going around (and may be later on this will be also be made possible.) There is no institution in the country where a Clinical Psychologist, PSW, Mental Health Nurse examines patients independently, diagnoses a mental disorders, admits patients and treats them. This amounts to practice of Psychiatry under the modern system of medicine and would invite penal provisions of MCI. The sole aim of drafters is to get the bill through and take credit for drafting the bill rather than have a healthy development of the sector. Nowhere in the country there is a Clinical Psychology ward, PSW ward or Psychiatric Nursing ward. The decision to admit is taken by the leader of the mental health team who is a Psychiatrist and it is the Psychiatrist who is overall responsible for treatment of a patient with mental disorder.

One of the reasons given by the people behind the draft of the Mental Healthcare Act 2010, for giving the role of independent examination, diagnosis and admission in bill, is the shortage of psychiatrist in the country. But if we go by the definition of psychiatrist in the bill which is the same as that in the previous Act, ‘an MBBS qualified person with experience and training in Psychiatry can be designated a psychiatrist’ for the purpose of the Act.

At present , there are about 8 lac medical practitioners in the country and these can potentially be designated as psychiatrist. So where is the shortage for the purpose of the Act ? The only purpose which could be served by giving an independent examination, diagnosis and admission to Clinical Psychologist, PSW, Mental Health Nurse in the bill is to later on claim that if they are capable of doing these jobs, then this means that they can practice their trades independently under the modern system of Medicine. This would mean they will be physicians of mental disorders just like a psychiatrist.

The inclusion of Clinical Psychologist, PSW, Mental Health Nurse for purpose of independent assessment, diagnosis, admission to a mental health facility should be deleted and replaced by ‘psychiatrist’ (an MBBS qualified doctor with some training/experience in psychiatry). After this, there will not be a need for defining mental health professional in the Act. If at all it has to be defined, then Clinical Psychologist and PSW shall be designated as Assistant Mental Health Professional as in the present legislation (Section 22 of State Mental Health Rule 1990) and their role clearly specified as being- to assist a psychiatrist.

Further, the supervision and review of the decision of a psychiatrist by a Clinical Psychologist, PSW, Mental Health Nurse in the mental health review commission is not feasible as review is to be done by practitioner of the same specialty i.e. Psychiatrist. Thus, the provision of Psychiatrist in the review commission should be made mandatory.

In a multidisciplinary team such as a mental health team, each team member has a specific role. If everyone will do the same role, which is to independently examine, diagnose and admit, then there could be no team functioning. Rather the role of each mental health person should be clarified in the Guidelines /Rules clearly, so that there is good team functioning and the public is well informed and is not misguided by manipulative persons. Can we imagine a similar provision for a Nurse specializing in Medical, Surgical, OBG, Cardio-thoracic nursing to independently examine, diagnose and admit patients in Medical, Surgical or OBG, Cardio-Thoracic ward respectively? Then why should we consider similar provision for Clinical Psychologist posted with Neurology department?

Psychiatry is a medical discipline as any other discipline. If Clinical Psychologist, PSW and Psychiatric Nurse want to independently examine , diagnose, admit and treat patients without even having the training and skills for the same and government wants to allow the same, then they should be allowed to start their own wards to do so and be responsible for their decisions. If we allow such changes to be brought, this would mean that a Psychiatrist too does not need to do MBBS. Then all the specialties of modern medicine should have direct specialization rather than first spend 5.5 years to be a General doctor. Human body cannot be divided in a compartments. All organs and systems are interrelated. A stroke can present itself as a depression in a mental health facility. What skill a psychologist or a PSW has to diagnose it without doing a full neurological examination or relevant investigations. They will treat for depression while the patient will die. In my view , compartmentalised knowledge is dangerous for the medical profession and defeats the basis of evidence based medicine

We are trying to make Clinical Psychologist, PSW and Mental Health Nurse into Physicians in mental health by giving the role of a Physician to them under the new draft bill on the pretext of shortage of Psychiatrist. However, there are less than a 1000 Clinical Psychologist and PSW both combined in the country. Further, there is no dearth of Psychiatrist under Mental Health Act, as Govt. can very well designate MBBS doctors with some experience in Psychiatry as Psychiatrist (as per the definition and provision in current legislation and the draft Bill). So even the assumptions for the shortage of psychiatrists is not a right justification for this act

The role given to Clinical Psychologist, PSW and Psychiatric Nurse in the draft bill is ; independent examination of patients, diagnosis , admission and then review of decisions taken by a Psychiatrist. Instead of this, in the draft bill, the role of a Clinical Psychologist and PSW- as a rehabilitation professional , and Psychiatric nurse – as a specialized nurse, should have been clarified and focused.

The position of a Psychiatrist as a mental health team leader should be reiterated and the decision of a psychiatrist should only be reviewed by a board having a psychiatrist. These rules could further be clarified In the draft bill psychiatric social worker and clinical psychologist has been mentioned as mental health professional just like a psychiatrist. However, In section 22 of the State Mental Health Rules’1990 (the existing legislation) the PSW and Clinical Psychologist are referred to as Assistant mental health professional. The change in the draft bill under consideration has been done with a view to make their role fit for independent examination, diagnosis, admission to a mental health facility by the drafters, without any regard to the impact of this on the patient care and safety. If they are full-fledged professionals (as they claim) who can diagnose, admit and treat patients, why do they need to be defined as such in the Act. At no place in the draft bill their role has been mentioned separately. At all places they are bunched as mental health professional with no individual roles. At no place it is mentioned that they will function under the supervision of a psychiatrist. If they independently examine, diagnose and admit patients they are then deemed to have an independent role. This will increase the role conflict which is already very high in the mental health team. So much so that at some places there is no team work. In Kerala High Court, there is a case going on, to allow clinical psychologist to independently practice in community to treat patients of mental disorders.

This is a serious issue and needs to be taken up strongly so that untrained people are not given the role of a physician i.e. to practice independently to treat patients.

DMAI insists that the Medical Council of India, Indian Medical Association & patient groups & DMAI needs to be taken in confidence and consulted, as independent examination, diagnosis and admission and also treatment by psychological or psycho-social means is practice of psychiatry under modern medicine and could not be allowed to be done by persons who do not even have a MBBS degree, in view of patient safety and care.

All health personnel shall work within the limits of their competence. In section 43 and 45 of the draft bill related to admission in a mental health facility: a mental health professional (i.e. Clinical Psychologist, PSW, Psychiatric nurse) has a role to examine a person suspected to be mentally ill independently, assess mental illness and its severity and advise admission. This is a role which goes beyond their competence. There are already instances of Clinical Psychologist practicing treatment of mental disorders independently as isolated examples. There is growing demand from clinical psychologist to allow them to practice independently the treatment of mental disorders. This change in the draft bill will allow them to be recognized as persons who can independently examine, diagnose, and admit patients, which will substantiate their claim to practice independently in community rather than under the supervision of a psychiatrist. It’s altogether different matter that they are not trained to examine and diagnose mental disorders as it requires ruling out other physical disorders as well and it requires a person to be a physician to do that. In section 22 of the draft bill : Constitution of district panels of mental health review commission , two members could be mental health professionals (i.e. Clinical Psychologist, PSW, Psychiatric nurse) which may not include a psychiatrist if he is not available, but then how the commission can judge the decision of a psychiatrist if no psychiatrist is in the commission? One needs to have knowledge of psychiatry to assess the correctness of the decision of a psychiatrist in a particular case. Provision of a psychiatrist in the review commission should be mandatory rather than being replaced by non-psychiatrist personnel Mental disorders are medical disorders and should not be treated by non-medicos .

I am quite sure that you will intervene and ensure that the corrective measures are taken to address the lacunae in the bill Also,

DMAI- The Population Health Improvement Alliance has initiated a ‘NCD Policy of India’ initiative, and would be glad to have the views of the ‘Ministry of Health’ involvement on the initiative

I am quite convinced that committed leadership will take cognizance of this note and take measures to implement the suggestions after a debate with all the stake holders in the continuum of care.

Should you need any assistance at my end, do let me know.

With best regards

Rajendra Pratap Gupta

CC. Dr.Manmohan Singh, Sonia Gandhi ,Rahul Gandhi , Dr.Syeda Hameed, Dr.Murli Mahohar Joshi , Montek Singh Ahluwalia ,Shri Dinesh Trivedi , Sitaram Yechury,  Members of Parliament , Sam Pitroda , Secy-Health & Family Welfare , GOI,  Dr.K.Srinath Reddy, Debasish Panda , Secretary (ME) Governors , MCI DGHS,MOHFW, Dr.Sudhir Gupta , CMO, NCD-MOHFW ,Dr. Suman Sinha, Psychiatrist,  IMA , Chief Minister’s of States

Include Homeopathy in National Health Schemes

DMAI wants the govt to give due weightage to homoeopathy in NRHM

Suja Nair Shirodkar, Mumbai Wednesday, March 30, 2011, 08:00 Hrs [IST]

The Disease Management Association of India (DMAI) has recommended the Public Accounts Committee (PAC) of the central government to increase the role of homoeopathy in the National Rural Health Mission (NRHM), especially for acute illness.

At present homoeopathy is not being leveraged properly under NRHM in spite of it being the cheapest way of treatment in the country. Rajendra Pratap Gupta, president and director DMAI pointed out that the homoeopathic medicines are cheaper and much more accessible to patients thus it is only natural that its potential should be utilised properly under NRHM.

Though the treatment used in homoeopathy is superficially similar to the medicines prescribed by a conventional doctor it differs in their source, preparation and dosage. He observed that in spite of having enough qualified homoeopathic physicians in the country the government is not giving them enough chance to play any role in the national health program. “Today there are  hospitals and colleges that cater to homoeopathy and encourage its use then why isn’t the government utilising these resources to increase the demand for homoeopathic medicines among the rural population.

The government should take step to ensure that the people in the rural India can also benefit from this system,” he pointed out. He said that the demand for homoeopathy has increased over the years as more and more people are adopting homoeopathic treatment due to its effectiveness compared to other available methods. Thus it should be put to use more effectively. He added, “Homoeopathic medicines are very cheap, in almost two rupees a patient can get a weeks worth of medicines which will be a great support to the rural population, it would provide them with cheapest alternative that assures best treatment.”

Homoeopathy is a system for the treatment of illness that is based both on the recognition of patterns within the symptoms of the illness and a wider consideration of how the individual is as a person. Although conventional medical assessment also takes these issues in to account, the homoeopathic approach integrates personality type, previous experiences, emotional state, the influence of the environment and other social factors to a greater degree than is usual with standard medical practice.

Rajendra Pratap Gupta

DMAI wants the government to extend the NRHM till 2017 with radical operational changes

The Population Health Improvement Alliance                                                                                                                                                                                                                  

The Disease Management Association of India (DMAI), a non-profit organisation propagating disease management concept and tools in the country, has urged the Public Accounts Committee (PAC) of the central government to reconsider its recommendations for scrapping of National Rural Health Mission (NRHM) as the NRHM has made an impact on the lives of the rural population in the country.

The DMAI suggestion in this regard was put forth by the DMAI president and director Rajendra Pratap Gupta in a letter addressed to PAC chairman Dr Murli Manohar Joshi recently.

The NRHM was launched in the country on April 12, 2005 for a period of seven years i.e. from 2005 to 2012 for providing integrated comprehensive primary health care services, specially to the poor and vulnerable sections of the society. It means that NRHM will get expired by 2012. However, seeing its impact on the rural population, the government is thinking of a possible extension for another five years. In this regard the government had asked PAC to review the NRHM. However, in its reports the PAC has recommended on scrapping the NRHM scheme.

However Gupta suggested, “NRHM is a very useful programme and has been successful in having its presence felt even in the remote parts of the country. However, there are many radical administrative and operational changes needed to be made in the present format of NRHM.”

He suggested that with proper administrative and operational tactic, this programme certainly will have the power to create desired impact in the rural health scene. In his recommendations to the planning commission on the changes needed in NRHM for the 12th five year plan, Gupta suggested that technology must be leveraged in NRHM for accountability, transparency and telehealth and that 12th five year plan must consider opportunities to digitise NRHM in all spheres of its implementation.

He said, “There are many important changes that needs to be undertaken in the NRHM, but of all changes the first and foremost change should be to improve the quality of medicines that is being supplied at the NRHM centres. Secondly, minor surgeries are not allowed in Primary Health Centres (PHCs) as of now. This should be changed and the government must allow minor surgeries in the PHCs as it would help reduce a lot for hassles for the villagers and bring revenue for the government as well.”

Other issue that he had highlighted in the letter was on the inadequate fund flow on time which could lead to corruption among the people working at the lowest level in PHC and sub centres.

“I have met people who were not paid salary for months, and also discovered the fact that the funds that were supposed to be sent for 2010 were received by the centres in mid January 2011. Such delays must be stopped with immediate effect as this clearly will encourage and lead to corruption as people drawing a monthly salary of Rs.5000-8000 won’t be able to sustain their family without salary for months. Either they will resort to bribing, selling the government supplies or starts absconding and working for employers in parallel. Thus I suggest that the fund meant for a sub centre or PHC must be transferred in advance for the quarter if not half yearly,” Gupta points out.

He put special stress on telehealth adoption goals for NRHM and other healthcare projects, as setting up and manning the physical infrastructure with qualified professionals at remote places is nonviable. To stress the importance of telehealth adoption in the country the Telemedicine Society of India (TSI) is organising a three-day conference Telemedicon’ 11 in Mumbai from November 11 to 13. TSI is completely dedicated to the promotion of telehealth in India and is being organised at a time when there is a big push from the government and private players in the field of telehealth in India.

Rajendra Pratap Gupta

Nuclear deal , FDI , Inflation & Black money – You did not change India , but changed India’s image Dr. Singh !

Dear Dr.Singh,

I read the top story in the current issue of the International Magazine ‘The Economist’ , and felt sad . Whenever , people like us visit outside of India , we are questioned or pointed towards corruption in India , and believe you me , it is painful to accept such criticism for our great country ! You put us to shame !

Nuclear deal & Jaitapur Plant : Recently , Wikileaks have exposed that Nuclear deal was not even acceptable to congress MP’s but money was paid to get votes !! It calls for a review and legal action against people making mockery of the most sacred institution of our country – Parliament ! Dr. Singh , please step down , we cannot bear more international assault due to your misdeeds ! Also, that India must immediately have a rethink on the location of all the nuclear installations from a public safety point of view . Jaitaput plant in Maharashtra is in Seismic risk zone and had 92 quakes in the past 20 years . The earth quake in 1992 was measuring 6.2 on Richter scale !! It calls for a fresh consideration of the approval granted in light of the developments in Japan post the Tsunami

FDI : Last week , I read that the government is considering granting FDI in retail for metros . Please desist from implementing your flawed policies again . Do not create hype and investment around metros , it leads to lopsided development and migration . If at all you want to grant FDI , please allow it in class 3 & 4 towns first , so that the local people get employment and we can see some reverse migration of populations and the burden on metros can reduce . Frame policies where foreign retailers cannot own more than 26 % in Indian companies across board . We do not want to lose our freedom Dr. Singh ! Also , as I have always mentioned change the definition of FDI from Foreign direct investment to Finance from domestic institutions ! Encourage retailer friendly policies for locals. Britishers financially exploited India , and took our wealth . Today MNC’s ( Multinational corporations ) are acquiring flourishing Indian companies and will take the profits away ! Are not getting back to pre-1947 days ? We will be exploited financially again and forever ! We are losing freedom with every investment & acquisition ! What is the use of such independence when the financial exploitation is similar to that under the British rule ? Please come up with rules that, in any sector , investments more than 26 -40 % cannot happen . Significant majority has to be with Indians ( Resident Indians). This is in the interest of national security & maintaining independence

Inflation : I have been watching your statements for the cause of inflation . Earlier , you attributed it to recession in 2008, poor rainfall in 2009 , and now you are attributing it to money from NAREGA !! Please do not blame the poor for every thing !! When you blamed poor rainfall as a cause of inflation , people were skeptical about it . When rainfall was good in 2010 , inflation still did not go down , now you had to find another reason , and quite cleverly , yourself & Pranab have been saying that because people are getting NAREGA money so they are buying more , thereby , leading to inflation . Please do not make lame excuses Mr. Prime Minister ! You & Montek have said that we must start to live with inflation as growth and inflation are intertwined . Sorry Dr. Singh , you need to study Economics again . History has shown that high growth and low inflation is possible and has happened in Germany & China and other parts of the world. So please do not give lame excuses . The real issue with inflation is that , because of your flawed policies for rural India , the migration has become perennial , and there is a tremendous loss in productivity ( multi-dimensional loss ) and that has caused inflation . Raising interest rates would not help ever , and time will tell us this hard fact . It is difficult to find a farmer less than 30 years in age .

NAREGA In its present form is causing irreparable damage to rural India , and I do hope that the educated economists in your team and the planning commission will attend to it as top most priority

I am scared that, if God forbid , India had a famine , how are we prepared ? We know such things can happen & without any notice like the recession ,and are not prepared for any such eventuality . Please let your cricket minister work on the worst case scenario’s as well.

Black Money : Last point is about the black money . We have seen all the estimates so far , and every number is an eye popping trillion dollar amount . Please challenge my number if you can !! India spends close to 30 % of its GDP in running the government and bureaucracy every year . it is a hard fact that, every employee who takes bribe gets almost double his salary in bribes ! Now another reality is, that senior bureaucrats and politicians get disproportionately high money in bribes when it comes to comparing bribes with their salaries . So clearly , the average B-GDP ( Black GDP ) is certainly 1.5 times the 30 % of GDP that the government spends on administrative costs of running the government . So If I average out the last five years GDP at half trillion dollars a year . India would have lost One trillion dollars in black money in just last five years , and trust me , these are the most pessimistic numbers ,and so are on the lower side . Your government & Mr.Khursheed talks about corporate governance ? When political governance of the nation is a sham and people have to take out thousands of cores off the balance sheet as bribes to your cabinet ministers , how can transparency and corporate governance work in this nation ? Take the case of telecom licenses ; every telecom company paid money other than the license fee . Where did the money come from , and where did it get accounted ? Not certainly in the legitimate account books , and so the corporate governance was severely compromised . Dr. Singh , The change should start at the top . if the political governance is good , corporate governance is good , if the political governance is shady , the corporate governance can never be imagined .

Dr.Singh , the nation recalls your letter to appear before the parliamentary accounts committee . I think that is not enough . You must be interrogated by CBI and charge sheeted for leading the most corrupt government in history of India ,and perhaps the world !

Read the article below from the Economist !

A Common Man

Rajendra Pratap Gupta

 Article from the latest issue of The Economist

Corruption in India

A rotten state

Graft is becoming a bigger problem—and the government should tackle it

Mar 10th 2011 | from the print edition

INDIANS’ anger over rising corruption has reached feverish levels. What people are calling a “season of scams” includes the alleged theft of billions by officials behind last year’s Commonwealth games in Delhi; $40 billion in revenues lost from the crooked sale of 2G telecoms licenses; and over $40 billion stolen in Uttar Pradesh alone from schemes subsidising food and fuel for the poor. Foreign businessmen, who have slashed investment over the past year, rank graft as their biggest headache behind appalling infrastructure. Now India’s anti-corruption chief has been forced out over, well, corruption (see article).

Graft is hardly new in India: the Bofors scandal brought down the government in 1989. But there seems to be more of it about than ever, if only because India is getting richer fast, and the faster the economy grows, the more chances arise for mind-boggling theft. The government says that in the next five-year plan period, which starts next year, $1 trillion will be spent on roads, railways, ports and so on, with billions more on re-equipping the armed forces and welfare. Add in an insatiable appetite for scarce land, water and minerals and a monsoon of bribes is forecast.

Some are inclined to shrug their shoulders. After all, corruption does not seem to be stopping India from growing. Yet imagine how much better the country would be doing without it. Corruption raises costs not just to Indians, but also to the foreigners whose capital India needs. Thanks in part to those scandals, India’s stockmarket was the worst-performing outside the Muslim world over the past year.

To its credit, the government has begun to take action against powerful individuals. Maharashtra state’s chief minister was forced out over a property scandal. Police have quizzed Suresh Kalmadi, the politician who ran the Commonwealth games. Most strikingly, Andimuthu Raja, the cabinet minister who oversaw the 2G telecom licences, was arrested.

A 2005 act giving the right to information is welcome, as are auctions for public goods, such as last year’s lucrative sale of the 3G telecom spectrum. Technology is helping. In some states, bids for state contracts are being run online, allowing anti-corruption bodies to monitor them. Gujarat does this for all contracts over 500,000 rupees ($11,000). It also puts land records and death certificates online, cutting down on one form of petty graft. Websites, led by, reveal the cost of graft by publicising the sums demanded for everything from registering a baby to fixing a broken water supply.

The central government should now implement a plan for a universal, computerised ID scheme. It would allow welfare payments to be paid into individuals’ bank accounts, hindering theft by state workers.

The licence Raj lives on Most of all, India must redouble its efforts to liberalise. The state could outsource official tasks, cut red tape and sell wasteful and corrupt state-owned firms (why does the government make watches?). For all that the “licence Raj” was supposedly scrapped two decades ago, it can still take nearly 200 days to get a construction permit and seven years to close a business. Regulations are not, by and large, deterrents to corruption, but a source of it.

Inaugural Speech delivered by Rajendra Pratap Gupta on March 14th 2011, at ‘Spardha’ – A national level event organized by VAMNICOM , Pune, for students of Management & Agricultural institutes across India

Good Morning friends !

I feel honoured to be here and am thankful to my friend, Dr.Yash Patil and the Director, Dr.Reddy, for giving me an opportunity to be a part of your National event, ‘Spardha’ .

Whenever I address students – the young , energetic and vibrant crowd , I am quite convinced that India will change . You are all full of great energy and ideas, but sadly , at present , India does not offer you a readymade & attractive platform due to our inefficient leaders at the helm of affairs and corrupt bureaucracy who are eating away the money and opportunities meant for the common man . But I see that the winds of change are on the horizon , and I believe that each one of you will push India ahead ; to set a new bench mark for the world in all spheres.

Today , India stands at a very critical juncture , and institutes like VAMNICOM hold the key for either India’s meteoric rise or a gradual fall !!

I was going through your chairman, Dr.Chandra Pal Singh Yadav’s message , and I was impressed with his views that we need to support farmers ,workers and weaker sections of the society for the development of this country. I believe that the education imparted via VAMINICOM aims to deliver that goal . This is exactly what India needs today .

It is an ironical fact that IIM’s and IIT’s have lost direction and failed to deliver the mission with which they had started with. Today, IIT’s & IIM’s are about fat packages from MNC’s . In fact , they have become subservient to MNC’s packages and are doing little for this country’s betterment . In these times , we want you all to pass out of VAMNICON and set goals that will re-define the future of this great nation.

Let me put things in a little perspective so that you do not have illusions in future when you move out of the campus. I believe that you will pass out this year or next year, depending if you are in 1st year or the final year. Some of you will get back to their family business , some will seek jobs and some will become entrepreneurs . No matter which path you take , the formula for success would remain the same . So let’s understand the realities of professional life :

Each one of you needs to have two goals in mind – Urgent ( short term ) & Important (Long term )goals . ‘Urgent’ is about the present i.e. your studies, to clear the exams with good marks . ‘Important’ is about future . What are you going to do after passing out from VAMNICON ? Don’t ever commit the mistake that President Obama did ! When President Obama started his election campaign, he talked about healthcare reforms & the Wall Street reforms. By the time he became the President , things had changed, but he still focused all his energies on the ‘Urgent’ & forgot the ‘Important’; that the market conditions had changed and there was a deep recession . People were losing the jobs every hour . President Obama still kept working on his ‘Urgent’ agenda,not realizing that the conditions had changed . He accomplished Healthcare reforms & Wall Street reforms !! Mid-term elections came in for the congress . President Obama had missed out addressing the Important , and so he lost to the Republicans in 2010, and finally , he is fighting to save the essence of the bills that he had passed on healthcare & Wall Street . The point is, never loose sight of the changed circumstances and keep focusing on both the urgent & the important . Else , you will have to compromise to survive . We are living in a very dynamic and an ultra -volatile world .

We live in a material world :. Don’t try to kill your desires. Reality in life is that people worship knowledge, position, influence & money. So you need to have each of them if you want to be successful. You must aim to be debt free by the age of 40 and, have a house , vehicle and savings good enough to last you without working for a year or two. It is extremely important to draw a line as to how much is much ? If you do not have those boundaries, you are bound to get into the mad rush for making money without realizing where to stop ! This is what our current politicians are doing . They lack moral boundaries, and they go for more and more and do not stop before nature pulls the carpet under their feet !!

Getting settled in life : How many of you want to get settled in life soon? Well let me quote you an interaction with one of my dear friends – Shiv Khera . He is the biggest motivational Guru in India . Sometime in 2009, we were coming out of The Grand Hyatt hotel , and he was discussing with me about the new path he had undertaken that required tough decisions . So I asked him ‘Shiv , can you leave your book writing and speeches and join politics full time ? To which , he immediately replied ‘ I am not yet settled’ . Imagine , if a person who is the highest paid speaker and the best motivational writer, is not settled , how will people like you and me be settled ? So it is wrong to assume that we ever get settled in life . Life is about facing constant challenges. Have you ever seen an ECG ? If ECG comes out as a straight line , the patient is dead !

You cannot have a long ride without a puncture : While all of you will do well in life , but you can never drive a vehicle always in the fifth gear . Long rides cannot be without a puncture . Some time , you will feel that you weren’t wrong but still you were punished . Never mind , even Gods were punished without fault ! Lord Ram & Lord Christ were punished for no fault of theirs . But do fight back for what is right !!

Keep reading books and newspapers to update yourself on the global and national scene & across sectors . If five friends came together , you could buy one book each and read five books . Form a habit to read at least two news papers a day . But learn to appreciate the difference between education , knowledge and wisdom . A highly educated person might not necessarily be a wise person .

Stay Fit : As you move up the corporate ladder , you will need to be mentally fit and physically active . Devote 5 % of your daily time for yoga , mediation and gym Working is important but so is networking . How many of you are on facebook , Orkut or twitter ? How many of you are on  a professional networking group ? Professional networking groups are a powerful professional tool for career progression . Please do not ignore them .

Always look for new ideas & not become copy cats : I was heading a large retail chain as a COO, and every time in the review meetings , I would solve the operational problems with a new approach . Once , my team member asked me , ‘Sir, every time you come out with something new , but one day you will run out of ideas , then what will you do ? I asked him “Since how many years river Ganges is coming out from Gangotri ? . He replied ‘ Since ages’. I asked him again ‘has it stopped ?’ . He replied ‘never’. He got the answer . That there is no limit to new ideas . While you are working in an organization , ensure that your work & experience profile changes every 2-3 years . Else , you would be like a truck driver with 20 years of experience. Remember that a truck driver faces the same road conditions every year . So his actual experience is just one year !!

You are amongst the five % Indians that are graduates . So you are also responsible for the remaining 95 %……… Let me ask you a question ? I know of a family where 56 % of the income goes in paying loans , 30 % of the income goes in running the household and another 10 % is miscellaneous expenditure , and only 4 % is invested to increase the income or to create assets . How would you rate such a family? Well to do, not good not bad or in a serious financial crisis ? So here are the facts about Indian economy : 55.9 % of the GDP goes into servicing the debt, approximately 30 % is the cost of running the government and bureaucracy, 2.5 % goes to subsidies , 2.6 % goes to defense . One fact is clear that only about 4 % of the GDP is going towards asset creation or wealth creation in this country . This is a very serious issue facing the nation.

How will the country be prosperous which spends about 96 % of its income with no wealth creation strategies & adds 17 million people to its population every year !!

If our country borrows Rs.80 lac a minute how will its citizens be prosperous ? Similarly, If the 99 % of the system is corrupt , you & your family members and even your next generation will certainly be harassed unless the system gets changed ?

Let me ask you another question. If you were earning handsomely after working hard, how many of you would share your monthly income with you neighbours or servants after paying your taxes ? We keep hearing that the fruits of growth has not reached the masses.

Common man will not reap the fruits of India’s prosperity unless he is the one driving it !! Why should someone share the earnings of his hard work with someone who hasn’t ? This is where each one of you can make a real difference . Agriculture continues to employ 65 % of its population and contributes just 17.2 % of the GDP. There is so much to be done but none at the policy maker level knows what to do ?

A few weeks back I was with the policy advisor of Rahul Gandhi , and we were discussing about how we could transform rural India . He informed me that he was advising Rahul to create 600 new districts at a cost of USD 1 billion each to transform India, but he could not convince me as to how 600 new districts transform the population’s standard of living ? After an hour of discussion , he admitted that the future of the villages was doomed ? Should we let this to happen ? We know the problem , lets take the challenge to change the fate of these ‘doomed’ villages . Each one of you can contribute effectively . We know that the government might not have the right answers but we must not just find solutions but also go ahead and implement them.

Rural India can transform if we understand that the basic requirement for such a transformation is having ‘transactions’ in rural India . The good thing about money is that whenever it changes hands , the hand becomes heavier ! I request you to think of creating business models that can utilize the local inputs and create products and services that leads to more transactions for rural India . Co-operatives & SHG’s ( Self Help Groups) are central to rural India’s transformation. Think about the 1.55 lac post offices , 2.38 lac gram panchayats and millions of kirana stores . Can we not create rural millionaires out of 700 million rural Indians ? We need micro-preneurs & agri-preneurs, if we want to change the rural landscape . Due to uncertainty of variable factors and no clear political vision for the prosperity for rural India , people do not want to remain in agriculture any more . If they get a job they keep moving and are selling their land. Because of the haphazard developmental policies , land and employment under agriculture is decreasing . In the western world, people are migrating to rural areas for better quality of life and in India , it is just the opposite, as Indians are migrating to urban areas. God forbid, if India ever faced a famine or severe draught , what will happen to a billion people ? Have we planned for it ? Can we guarantee it will never happen ?? We have not been able to tackle inflation even ??

A day before yesterday , I read that government wants to open the FDI in retail for metros and we have heard in the past that ‘Mumbai is being made Shanghai’ . So if we are creating hype and investing in metros , why should people not migrate ? We must create more ‘Mumbai’s in India rather than trying to create ‘Shanghai’ in Mumbai . Government has always said that opening up the FDI in retail will improve the supply chain. But we know that FDI in supply chain is already permitted . So we know that this is a wrong reason to justify FDI in retail.

Most of our growth is inspired due to the growth in China. India woke up for growth when China started growing at 10 + % per year with a much larger population . The current growth in India is about GDP and sensex . India’s growth is only applicable & benefits people who read The Economic Times . Such a growth has no strong fundamentals .

The government has allocated Rs,500 crore for skills development programme, and Rs. 40000.00 crore in NAREGA . This is, when we are facing acute shortage of trained man power in every sector at every level ! If a few thousand crore was invested in skills development for rural India , it would create a lasting value for the rural people and the economy

 Wastage of agriculture produce due to lack of proper infrastructure is to the tune of Rs.30000.00 per year . Can we address this issue ? Some of you go and start a daily transportation service that carries the farm produce to the nearest town for sale . Imagine the value addition it would bring to the farmers ? You charge them a fixed percentage of sale ?? All will make money in the process and Agriculture will be lucrative for farmers – something that is missing today .

Can some of you go and set up low cost rural cold chain facilities for rural India Can some of you set up international technical collaborations for enhancing the quality and quantity of farm produce India has the largest number of cattle but not milk products . Can some of you create more Amul’s & Warna’s in India ?

India is the largest producer of milk in the world but not the top most exporter !! India is endowed with livestock resources of vast genetic diversity and accounts for about 11 percent of the world livestock population. The country boasts of 55 per cent of the world buffalo population, 20 per cent of the goat population and 16 per cent of the cattle population in the world. India has the largest cattle and buffalo population in the world and holds the second rank with respect to goat and sheep world population. Some of you could take food processing techniques to rural India

Kiwi fruit is sold at Rs. 25 a piece and it is given to pigs in Manipur as the road infrastructure is so bad that the fruits are unfit for consumption by the time they reach the markets . Some of you develop technologies to save such a wastage

Healthcare reaches only 24 % of rural India . Some of you could create a viable rural healthcare delivery model .Some of you should go and set up telemedicine centres across rural India

Some of you could maybe set up veterinary care centres ?

Kirana stores in rural India are still lagging behind . Some of you can start a rural Kirana store chain

Can some of you go and set up SHG’s in different states in India and empower them to form a national level marketing channel for rural India Opportunities are countless , just go and execute .

Let me tell you that Indian system is very good but manned by wrong people , and so public has lost trust .

Despite all the odds , everywhere in India, I see so much opportunities to work on , and it is a great boon to be born in India . It is how you take it . I believe that each one of you will have a lot to accomplish in life , and am sure that this institution will equip you with the right tools to handle the opportunities that will come your way

I wish you all the best and hope to see you again


Elections in Tamil Nadu- AIIDMK Vs DMK

Yesterday I was in Chennai and discussed with some people about the scenario in the April elections for the state assembly

 I was informed that the 2 G money is already showing up , and last week only DMK distributed sarees and stainless steel jar to all the residents of kovilambakkam. Each vote is likely to cost Rs.2000 to 3000 only !!

 When I asked a few people ( professionals who work in different companies that , ‘ Why you all do not oppose such things ?  I was told that DMK has hooligans in their cadres, and opposing DMK means inviting the wrath of these cadres and creating problems for our families !! So it is better we take the freebies & cash and vote them back

 Further , these people said that DMK needs congress desperately , as if Congress is unhappy , DMK will invite action from congress for its illegal activities and black money. If congress is with DMK , State is already under its control and now centre will be blind to all the wrongs that DMK does – It is a win-win for both DMK –Congress . We know the kind of people congress works with and the thing congress supports !! DMK is widely referred as Daily Making Money for Karunanidhi – DMK

 Also, a few weeks ago, I was speaking with a grass root worker from Tamil Nadu , and he informed that DMK has approached a lot of AIIDMK leaders and offered them cash as high as 50 cores and got them to work in AIIDMK and transfer their votes to DMK !! Shrewd & crafty congress allies !!

 So , finally , we know what is going to be used in the state elections in Tamil Nadu & what will be the outcome on April 13. Only Almighty can intervene & swing things differently !!

 Rajendra Pratap Gupta

Tax till death ! Repeal tax on healthcare – Now Treatment would be worse than disease !!

The National Population Health Alliance

Shri Nitin Gadkari


Bharatiya Janata Party

 Dear Nitin ji,

 Namaskaar. Trust this finds you doing good.

 I am deeply pained by the latest slap by the congress government on the common man’s face . This government has not taxed the corporate world in this budget – on the contrary , there have been some reductions !! But the poor man has been taxed – “Now Treatment would be worse than disease”, as I call it

 This appeal is regarding the tax that the government has recently levied on the poor man’s pocket . If he earlier spent Rs.100 on healthcare , now he will be forced to spend between Rs.105 & 110 . Last week only , I returned from my visit to rural Varanasi . I also visited a CT scan centre , where people are provided CT Scan services at almost 50 % of the market rates , still , people cannot afford to pay and go back without treatment . I have a presentation that I made at the Institute of medical sciences , BHU, You can see that :

“ Any major medical intervention pushes a rural family back by 10 years and a death resulting due to such an illness pushes the family back by 30 years !! ”

  • 39 Million people go below the poverty line every year due to healthcare costs
  • In 2004 , 30 % of rural Indians did not go for treatment due to financial reasons, up from 15 % in 1995
  • 47 % of hospital admissions in rural & 31 % in urban India was financed by loans and sale of assets
  • Between 1986 and 2004,avg real expenditure per hospital admission increased 3 times

According to the Economic Survey 2009-10 

  • 13 % of rural population have access to PHC
  • 33 % of rural population have access to sub-center
  • 9.6 % of rural population have access to hospitals
  • 28.3 % of rural population have access to a dispensary or clinics
  • 34 % of rural population have access to diagnostic centers (According to CCF)
  • Only 24 % of rural areas have access to healthcare facilities

What a shameful act of our tax minister , Pranab Mukherjee !!  I am putting some of the slides from my  Keynote address at India health expansion Summit in 2010. I am also attaching a short version of the presentation ( and the complete one , if you have time to read it ). I am sure that healthcare needs more focus from our policy makers .

 Healthcare policy makers have to ensure that the changes are ‘Patient centric’ and  not just ‘industry centric’

Industry is organized but Patients are not , and so patients are never heard . This needs to change . Patient Care Collaborative Organization is non-existent . This is one major detriment for worthwhile changes in the Indian Healthcare

– Rajendra Pratap Gupta

“In a country where our  current PM had a triple bypass , former PM had a Joint replacement , Agriculture minister has cancer , Chairman- PSC on Health had a Kidney transplant ,Former Defense minister has Alzheimer’s  & one of our youngest M.P. has diabetes & Majority of our politician’s are senior citizens by all measures : still our finance minister decides to bring Preventive health checks under service tax !!’

-Rajendra Pratap Gupta

Biggest Challenge in healthcare is not technology, medical errors, compliance , prevention or disease management . They are all just opportunities coming out because of us failing to address the biggest challenge ; to convert ‘suffering populations’ into ‘active patients’

-Rajendra Pratap Gupta

 “ 700 million people live below 2 dollars a day , and for them getting two meals in a day is a daily priority .  Irony is that, for these people healthcare should be a necessity but it is luxury beyond thoughts”

-Rajendra Pratap Gupta

All the announcements on the taxes on pharmaceuticals and healthcare ( in any form ) must be reversed . This government is already spending meagre amount on healthcare.  People are taking loans to spend for treatment and  this rapacious government has no right to dissuade people from doing so by taxing the already expensive healthcare services.

 I expect BJP to take this up as seriously as the demand for JPC and get this taxes scrapped from the budget

 Thanks in advance for safe guarding the Common Man. This mail is marked to national leaders and media

 with best regards


 Rajendra Pratap Gupta

President & Director

Disease Management Association of India  ( )