Category: Healthcare reform

Packaging sells and also kills !


We heard the famous marketing quote that , ‘ packaging sells’, but the story for most of the India’s middle class, who eat on roadside eateries is somewhat different , and the new message is ‘packaging kills’ , and more so, when food gets garnished with lead and other hazardous chemicals !

India is a foodie nation, and with the rising middle class, our eating habits are changing. There is an increasing tendency to eat food outside, and India, predominantly being a middle class nation, our preference is for road side eateries and small or mid size restaurants. But what goes unnoticed is; the newspapers used in packing food items, or the printed material on tea bags, and the potential dangers associated with them.

It is a fact, that the newspapers are printed with ink that is dissolved on it with the help of chemical solvents. Studies have shown that printing ink from newspapers can easily gets into foods wrapped or served in them and this is dangerous for health. The solvents used in ink are potentially carcinogenic.

Also, newspapers and cardboard boxes used for packaged foods are made of recycled paper, which may be contaminated with harmful chemicals like di-isobutyl phthalate and di-n-butyl phthalate that can cause digestive problems and also lead to severe toxicity.

It is a fact that the recycled paper used has printing ink residues. These un-cleaned residues have found to contain hormone disruptors like benzophenones and mineral oils which can interfere with reproductive cycle of women.

Through the print based packaging, there is an exposure to organic chemicals called aryl amines, such as benzidine, Naphthylamine and 4-Aminobiphenyl, which are associated with high risks of bladder and lung cancer. Apart from these, printing inks also contain colorants, pigments, binders, additives and photo-initiators, which have harmful effects.
It is also believed, that the mineral oil-based printing inks for newspapers contain mineral oils, which consists of various types of hydrocarbon molecules that can exist as Mineral Oil Saturated Hydrocarbons (MOSH) and Mineral Oil Aromatic Hydrocarbons (MOAH). These hydrocarbons usually convert into gases by evaporation that eventually penetrates food items.
Newspapers are usually produced by a system called offset-web printing, which requires a certain consistency of the ink (it needs to be very thick) and a particular means of drying. For the former, mineral oils (petroleum-based) and solvents such as methanol, benzene and toluene are used; and for the latter, heavy metal (Cobalt)-based drying agents are used. None of these should be used in food packaging, as they are also classified as harmful and can be dangerous for health if consumed.
According to the FAO / WHO, Joint Expert Committee on Food Additives, the safe upper limit for the MOSH in foodstuffs is 0.6mg/kg. Older people, teenagers, children and people with compromised vital organs and immune system are at a greater risk of acquiring cancer-related health complications.
Another problem lies in the plastic bags used in takeaways. These bags are made of polyethylene (polythene) and the principal potential ‘migrant’ agent is ethylene. There are a number of potential additives to polythene, such as anti-static agents, ultra-violet protection and flame-retardants. These additives can be very dangerous if they find way into the takeaway food, which usually happens.
According to an article in the British Medical Journal, ‘Food packaging and migration of food contact materials: will epidemiologists rise to the neotoxic challenge? J. Epidemiol’ by Muncke J, et al. (Feb 2014), scientists say that most food contact materials (FCMs) are not inert. Chemicals contained in the FCM, such as monomers, additives, processing aids or reaction by-products, can diffuse into foods and this chemical diffusion is accelerated by warm temperature, and in India, the temperatures can touch as high as 45 degrees Celsius.
The scientists believe that FCMs are a significant source of chemical food contamination. As a result, humans consuming packaged or processed foods are chronically exposed to synthetic chemicals throughout their lives.
Formaldehyde, another known carcinogen, is widely present at low levels in plastic bottles made of polyethylene terephthalate. Other chemicals known to disrupt hormone production and used in food and drink packaging include; Bisphenol A, tributyltin, triclosan and phthalates.
There is an increase in the use of tea bags, and while using teabags, sometimes people squeeze the teabag using the label at the end of the loop. This can leak the ink from the label. I would recommend that the guidelines be framed and implemented to warn people of the same and prevent this practice
I also suggest that based on the facts available, it might be worthwhile banning the use of plastics, recycled materials and newspapers for food packing.

The FSSAI must act immediately and frame guidelines to control wrapping of fried foods in newspapers, banning the use of plastic bags for takeaways, and other practices that are harmful.
Further, it must mandate the use of ‘food packaging grade’ butter paper or aluminum foil for packaging food. We need to act on this without losing any further time
DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com do not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly.

About Rajendra Pratap Gupta

Rajendra Pratap Gupta is a global healthcare leader and a revered public policy expert, and is the author of the Healthcare best selling book,  ‘ Healthcare Reforms in India – Making up for the lost decades’ . @rajendragupta

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Vehicle sales prove a depressing point about the Indian economy


Please see the data below .  If you carefully examine the data ,  a few things are apparent ;

1. Sales drop in tractors indicate poor state of affairs in agri- rural India ( decline in agricultural sector )

2. Sales drop in Medium and heavy ( M&H) segment indicate actual decline in industrial output

3. Sales drop in light commercial vehicles (LCV ) indicate that the ‘Public sentiment’ is negative .

In the tractor segment 3,44,911 units were produced as against 3,72,282 units in the same period of last FY, registering  7% decline according to the data of Tractor Manufacturers Association [TMA].

As per the  data of the Society of Indian Automobile Manufacturers [SIAM], total production in M& H segment was 2,11,530 vehicles against 2,72,400 in the same period of last financial year.

Source : http://www.business-standard.com/article/companies/steep-fall-in-commercial-vehicle-production-in-apr-dec-113012500139_1.html

VE Commercial Vehicle sales down 20% in December

By PTI Jan 01 2013 , New Delhi

Tags: News
Automaker VE Commercial Vehicles (VECV) today reported a 20.17 per cent fall in its total sales at 4,032 units in December, 2012.The company, which is a joint venture between the Volvo Group and Eicher Motors, had sold 5,051 units in the same month in 2011.Domestic sales decreased to 3,598 units in December 2012 from 4,512 units in the year-ago period, a decline of 20.26 per cent, VECV said in a statement.
Heavy commercial vehicle sales slipped by 27.80 per cent to 678 units from 939 units in December
Rajendra Pratap Gupta

India – from Emerging to a Submerging economy


India – from Emerging to a Submerging economy

On 22nd March 2012 , I wrote this on my blog and also sent the same to leading public figures .I had stated dwelling  in detail about how,  ‘ Have we oversold the India story’, and this was much before the bad news starting sinking in !

Link to the blog is  https://commonmansblog.com/2012/03/ .

This blog clearly mentioned that we must be prepared for bad news in April – May – June Quarter , and we know that,  India was downgraded as an economy by the international rating agencies ( S&P & Fitch ) and many Indian banks also faced the brunt , many retailers are gasping for breath ….

This time , I have decided to write about the story of how Indian economy would  enter a dark phase if immediate steps are not taken ,and this note is not against anyone but for everyone who wants to see India doing well !  I have tried my best to put data for every statement ( Besides Almighty , everyone should believe in data !).

So now , it is time to peep in the story of how an emerging economy can become a submerging economy .

Let us look at the following data :

Sector – Industry / company Financials ( Loans / NPAs) Source / Remarks
Telecom Sector Rs. 2.00 Lac Crore debt TOI, 26th September , 2012.
Banking Sector NPAs Rs.1.37 Lac crore as of June’12 Mint , 7th September, 2012
Banking Sector According to RBI’s assessment , a fifth of all re-structured loans go   bad . According to RBI, as on March 31, banks had Rs.2.18 Lac worth of   restructured loans on its books Mint, 7th September, 2012
Banking Sector State-run banks  NPA crosses   Rs.1.23 Lac crore Mint , 23/ August/ 2012
Credit card outstanding Rs. 22150.00 Crore As on July/ 21 Ref. ET 14/9/12
Indian Government Total planned borrowing is Rs.5.71 Lac crore for FY 13, of which   Rs.2.0 Lac crore would be in the second half of the fiscal by Dec’12 As per Mint dated September 28, 2012
Banking Sector Report by Credit Suisse group AG points that exposure to 10 large   Industrial groups constitute 13 % of the entire banking system Mint, August 21, 2012.
Banking Sector As of 27th July, Indian banks had loans outstanding of   Rs.36,600.00 Crore to the mining and quarrying sector, and Rs.93,170.00 Crore   to the Telecom sector Mint, 12th September, 2012.
Power Sector As of March, 2011, the accumulated losses of the State power distribution   companies are estimated to be alone Rs.1.90 lac crore which, by now,  would have crossed  Rs.2.0 lac crore IBN Live dated 23rd, September,  2012
Air India ( NACIL) Rs.67520.00 crores in loans & dues NDTV Profit, 8th Feb, 2012
Pantaloons ( Kishore Biyani’s ) Rs.3300.00 crore ET, 14th June 2012 . After selling a portion of its   apparel business to Aditya Birla Group. Before the sell-off , the debt of   Pantaloon was about a billion dollars
Reliance ADA Group Rs.86700.00 crore  FY’12 Business Line August 26th, 2012.
GMR Rs.33600.00 croreFY’12 Business Line August 26th, 2012.
JSW Rs.40,200.00 crore FY’12 Business Line August 26th, 2012.
Jaypee Rs.45,400.00 crore FY’12 Business Line August 26th, 2012.
Lanco Rs.29,300.00 crore FY’12 Business Line August 26th, 2012.
Essar Group Rs.93,800.00 crore FY’12 Business Line August 26th, 2012.
Vedanta Rs.93,500.00 crore FY’12 Business Line August 26th, 2012.
Adani Group Rs.69500.00 crore FY’12 Business Line August 26th, 2012.
Videocon Rs.27,300.00 crore FY’12 Business Line August 26th, 2012.
GVK Rs.21,000.00 crore F’12 Business Line August 26th, 2012.
Fortis Healthcare Rs.6237.00 crore Business Line August 15th, 2012
King Fisher Airlines Rs.7500.00 crore The Hindu, July 2nd , 2012
Losses of top three oil marketing companies Rs.40,500.00 crore in April-May-June’2012 Forbes India , Sept 03, 2012
Airtel Rs.60,018 Till Q1, 2012 Business Line , Aug 3, 2012

The total debt level of  ten companies alone (Adani, Essar, GMR, GVK, JSW, Jaypee Group, Lanco, Reliance ADA, Vedanta and Videocon) has jumped 5 times in the past five years to Rs 5,39,500 crore  ( Indian Express , September 06, 2012 )

Business Line dated August 26, 2012: Credit Suisse said that the aggregate debt of the ten groups accounts for about 13 per cent of total bank loans and a whopping 98 per cent of the entire banking system net worth.

“Therefore, surprisingly now in terms of concentration risk, Indian banks rank higher than most of their Asian and BRIC counterparts,” it added.

The report said a strong loan growth of Indian banking system in past five years is increasingly being driven by a select few corporate groups.

“Given the high leverage, poor profitability and pressure from lenders, most of these debt heavy groups have initiated plans to divest some of their assets. However, given that most domestic infrastructure developers are already over-geared, demand for these assets may be limited,” Credit Suisse said.

Each of these groups alone account for 1-2 per cent of total banking system loans, the report said, while noting that all banks appear to have high exposure to the same few groups.

“With the economic slowdown and a downturn in these sectors, multiple assets of each group appear stressed and financials of these groups are stretched,” the report said.

Bank’s exposure to real estate sector ( ET dated 22nd August , 2012)

Bank Exposure to real estate FY 2011-12 ( Rs. Crore )
State Bank of India 144668.38
ICICI Bank 81421.73
Axis Bank 52730.39
Punjab National Bank 48474.59
IDBI Bank 36784.47
Bank of Baroda 22157.40
StanChart 26027.78
HDFC Bank 25020.26
Total exposure Rs. 437285.00 Crore

Despite an exposure / investment of about Rs.4.37 lac crore from banks  ,still five lac houses remain unsold ( ET, 22/ 08/2012 & TOI dated 18/ 09/ 2012. ) . So land became costly as the builders brought them with loans , houses became expensive due to builder cartels and now that houses are not getting sold , all are a part of the downturn ……..no solution is in sight except for NPA’s and its cascading affect later .

Clearly, Indian economic story lacks ‘depth’ but has been built on ‘debt’ and this is a painful bubble waiting to burst …. So a common man must have enough savings to last a few years if without a job  !

July 26, 2012 in TOI, it was reported that at least eight cases of FDI in some obscure real estate companies – each worth more than USD 100 Million – from Singapore have come under scanner , with Income tax Overseas unit (ITOU) having investigated them for alleged round tripping . Suspicion was raised when authorities detected huge FDI inflows into some little known real estate firms in India in the form of equity participation . A senior finance ministry official said they suspect these real estate firms to be front entities of some corporate houses and their black money has been routed through Singapore to acquire real estate in the country . All these FDIs coming from Singapore pertain to 2011. India received Rs.1.74 Lac crore worth of FDIs in 2011-12, of which Singapore contributed third highest at Rs.24,700.00 , after Mauritius ( Rs. 46,700.00 crore ) and the U.K ( Rs. 45,000.00 Crore).  So , now we can understand why an Indian’s politician’s family have a flat in Singapore and why Indian Government along with a few ‘parties with vested interests’ are pushing  for FDI ! Does it also not answer the question why Government opened the real estate sector to FDI in 2005 ? So that money stashed abroad can be brought back in real estate sector, and further money could be made by investing in and increasing the prices by buying land !  Does Lavasa ring a bell in your ear !

In absolute terms, bank’s bad assets have doubled in three years between 2009 and 2012  – from Rs. 68216 crore to Rs.1.37 Lac crore ( Mint 21st August , 2012).  Bad assets in coal, iron and steel , mining , construction , textiles and aviation sector have been on the rise . Bankers see stress in telecom and power sector, too.  The biggest beneficiaries of loan restructurings are large industrial houses in the manufacturing sector – 8.24 % of loans given to industries have been recast. In the services sector , the comparable figure is 3.99 % , and in agriculture loans , 1.45 %.  It is clear that the small borrowers don’t get relief  from loan servicing but the large industrial houses have gotton one ( Mint , 21, August ,2012. ). According to the same article , public sector banks have 90 % of the restructured assets , and this in my view clearly states one fact – a strong political – bureaucratic and business houses nexus to make loans and buy private jets and show companies in losses to the investors !  What right do the business houses have to question the Government on profligacy and spending when these business houses have huge debts but have their CEO’s / promoters taking home 10’s of crore in salaries plus stakes in companies and still flying private jets on borrowed money ! We know of the large business house where the debts are more than revenue but the flamboyant chairman / promoter flies on private jets ! Such company’s ( any company that has over Rs. 50 crore external debt ), boards must be restructured by the MCA (Ministry of Corporate Affairs)  and independent directors with fixed term and remuneration should be appointed by the Government , so that the loans and shareholders money is not misappropriated by such promoters in the name of expenses and privileges  !

Three more developments to be noted to give you a sense of state of affairs in the Indian economy :

Remarks
India S&P rating is BBB (Minus) . Outlook  – NegativeFitch rating is BBB (Minus ). Outlook – Negative  ( TOI, 26th June, 2012 ).
Bharti Airtel Downgraded by Goldman Sachs and other banks. ET .  10th , August , 2012
Retail Sector Fitch has downgraded the ratings to negative

Agriculture / Food crises : The US is facing a severe drought , and India has witnessed a bad spell of monsoon this year with erratic and unpredictably low rainfall . When India imports pulses and oilseeds , & the prices of these commodities is set to rise. Stock piles of the biggest crops will decline for a third year as drought parches fields across three continents , raising the food-import costs already forecast by the United Nations to reach a near record $ 1.24 trillion . Combined inventories of corn, wheat, soya beans and rice will drop 1.8% to a four year low before harvests in 2013, the US department of Agriculture ( USDA) estimates . Crops in the US, the biggest exporter, are in the worst condition since 1988, heat waves are battering European crops . Wheat production in Russia , the fourth largest exporter , will fall 20 % this year , and in Australia , output will decline 19 % and, God forbid, another year of bad spell of rain in India will spell disaster for this country . This situation warrants an emergency action ! On 9th August , 2012 on page 7 of ET, I read an appeal to the GOI by All India Starch Manufacturer’s Association regarding the crises due to non-availability of maize in the domestic market.  Even if starch manufacturers were ready to buy maize at higher prices, it was not available and adding to it was the monsoon failure   !  We are all awaiting a miracle to happen with Wal-Mart et al. But the reality is that these players have not much to contribute. We must not forget that , the supply chain structures in these companies are leaner and they work on shortest inventory, so clearly , these people will not do much for supply chain management . Also, the biggest contribution is stated to be creation of 10 million jobs in India . I wish to ask that these companies have a ROI ( Return on investment ) for each employee and so , clearly , we must see what is the cost that we are going to pay to these MNC chains for them creating 10 million jobs & the Government must come out with a white paper on this ? After all , Wal-Mart is not here in India for charity !  For sure , it would mean we paid will pay them dearly for doing what we could have done 100 times cheaper ! All FDI investments to me appear to be taking the ‘economy in debt’ to ‘sell off’ ( divestment )… We are back to what East India Company did to India but this time , it is not one company, but multiple East India Companies !

Also , a time to look at the sectorial composition of GDP 1950-51 – 2011-12 from CSO data

Agriculture Industry Services
1950-51 53.1 % 16.6 % 30.3 %
2011-12 13.9 % 27 % 59 %

In 1950, India had a population of 350 million and now it is 1210 million. During independence,  the population dependent on agriculture was 72% and now it is  54 %. But except Madhya Pradesh, where agricultural growth has increased to dramatically  , not much is visible in other states .

Infrastructure – Construction firms sector ( Mint , September 11, 2012): for a set of 87 firms with a significant presence in infrastructure , sourced from Capitaline database , these numbers show an increasing difficulty to service debts

For these firms , the interest coverage ratio (ICR), for fiscal 2012, plunged  1.9 times , the lowest in at least five years. In other words , for every Rs. 100 of interest payments, the firms earnings before interest and tax ( EBIT ) stood at Rs.1.90 . The comparable number for 2007 was almost five.

In the fiscal 2012, at least 17 firms did not earn enough to pay the interest ! The list includes some of the bigger and better known firms such as Hindustan Construction Co. Ltd, Gammon Infrastructure Projects Ltd and GMR Infrastructure Ltd. This might give us a sense of where India is headed . First we oversold the India story, and now we are gonna pay heavily for it ….. !

Emerging Economy – really ? Let’s have a look at the following figures ;

  • According to the NSSO survey( July 2011 – June 2012 ), 10 % of India lives on less than Rs.17 a day . As per the survey , half of the population in rural India was living on a per day expenditure of Rs. 34.33 , and this is after two decades of reforms in India !
  • About 8.3 % of the population is unemployed
  • 54 % of Indian families live in houses that don’t have concrete or brick roof ( Census, 2011 )
  • 47 % of the total households live in houses with mud floors ( Census , 2011 )
  • More than 800 Mn don’t have toilets at home
  • Millions of tonnes of grains are stored in the open as we have no place to store !
  • Tata shut production of passenger vehicles for two days to avoid inventory pile up due to bad economic situation
  • 1/3rd of rural Indians and 1/5th of urban Indians forego treatment due to lack of money
  • 47 % of rural Indians and 31% of urban Indians finance treatment by loans or sale of assets
  • One child dies every 16 seconds due to malnutrition , diarrhoea or pneumonia
  • All major currencies have appreciated against dollar but rupee has weakened . Even Singapore dollar is up by about 50 % compared to rupee last year

GDP & Growth without fundamentals & eventual Collapse :  This is the India’s growth story’s fate . Let me give you two glaring examples and rest you can relate for your conclude;

I have travelled to the draught prone areas, and heartland of farmer’s suicides i.e. Vidharbha region of Maharashtra .  Lanco is setting up a power plant in Wardha and has purchased land for as high as Rs. 25 lac per hectare ( as per the farmers statement ). So  , let’s look at this example where Lanco purchased 7 acre land from a farmer for Rs.1.75 crore . A farmer who was drought and debt ridden for years becomes a millionaire overnight, and buys a SUV for himself along with a rifle , gold jewelry for his wife , builds a pucca house with the money he gets , and the money is spent soon as he did not know how to plan and how much to spend and the land is also gone to Lanco ! Also, money brought in a lot of vices ( please check the number of AIDS patients in the region ! ).   This company Lanco, runs a debt of Rs. 29300.00 crore and has gone for CDR ( Corporate debt restructuring ).  The banks that gave the loan should be ready for a NPA ( Non-performing asset )! So , the farmer , the company Lanco and the bank have become a non-performing asset ….. whereas , the farmer buying a SUV, Gold etc, would have boosted the sale of vehicles , gold, wines, apparel companies temporarily , and soared the rates & increased the GDP ! So this is growth in GDP but not a sustainable one or growth without prosperity !

Let me quote another example :  Country auctioned the airwaves (spectrum), a few years ago for which the companies paid tens of thousands of crore for airwaves. The companies took loans , passed on the cost to consumers ( Co’s were not wrong as they had to get an ROI for their investors ) and finally , like Airtel with over 200 million customers, run into a debt of about Rs. 60,018.00 crore ……….So , let me consider an alternative scenario . If companies were given spectrum for a nominal administrative fee of say Rs. 500.00 crore + 50 % revenue sharing . In that case, the companies would have invested more into infrastructure and services would have been better and much cheaper , also , the Government could have made a cool Rs.80,000.00 crore every year taking the current revenue of all telecom operators to be Rs.160,000,00 crore, with probably very little debt on telecom companies and no such scams !  Today, the telecom sector has a debt of Rs. 200,000.00 crore and government barely gets anything of the total revenue of Rs.160,000.00 crore as its revenue sharing is in lower single digits .  All have lost due to myopic policies of the Government . This is what I call GDP without prosperity ,  and this is what our entire Indian economy is passing through . It has no depth but debt ! What I call as lack of strong fundamentals, for which none of the parties have shown a concrete action plan . Companies have stock valuations and we are measuring our strength on the stock market indices which are not at all in relation to our ground realities ,  and only 2 % people in our country dabble in stock markets whereas 98 % suffer the hallucinations of this economic growth and GDP which is backed by loans , subsidies and political doll outs and have become a drain on our economy  & our economy is becoming a bottomless pit ! Here I will not fail to quote  the maiden address of our former finance minister and current President of India on 15th August , 2012  ‘It is indeed a wake-up call to Indian polity that even 65 years after independence and 74 years after Bose’s observation ( Subhash Chandra Bose in 1938 had flagged at the 51st session of Indian National Congress at Haripura that country’s primary challenges were poverty , illiteracy and hunger ) , the number of poor in the country today outstrip the population of the country in 1947’

All the sovereign wealth should be leased on 50-50 % revenue sharing between the Government & the private sector companies , and never be auctioned ! There is no other sustainable model for our meeting the financing needs and auctions only give a one-time income ! This must be made a policy so that every year , Government can make decent money and invest in the infrastructure,  growth and give good governance to all Indians

Indian population a mere statistics  ? Let us take the example of the recently concluded London Olympics . China with a larger population came 2nd with 38 gold , 27 silver and 23 bronze medals and India came on 55th position amongst 79 nations with zero gold , 2 silver and 4 bronze medals ….. this is what our leaders have led us to ! With committed leadership we must have made it the top by now …..

Let us do a rough sum of Indian economy which has a GDP of approximately Rs. 100 lac crore and we still borrow about Rs. 5.2 lac crore every year, and we already have  debts of about Rs. 45 lac crore . India’s  42 % of the net annual tax revenues of Rs.7.71 lac crore goes in servicing its debt ( Rs.3.20 lac crore ). Another 25 % goes in subsidies ( Rs.1.90 lac crore ) – an annual amount that would actually be Rs.78000.00 crore higher if off-balance sheet fuel subsidies to oil marketing companies were included.  The fiscal deficit of Rs.5.19 lac crore – 5.9 % of nominal GDP – is 67 % of the net central tax revenue . This was detailed in TOI dated 19th August 2012. I had read somewhere that , 54 % of Indian’s income goes in interest payments on debts taken for decades , 30 % is the cost of running the inefficient Government & bureaucracy and 16 % for subsidies ……so I keep wondering , does India have any money at all to invest in infrastructure or for future !!!! ( Hope I am wrong in remembering these numbers and India does better ). If not , time to take action !

According to Apparel Promotion Export Council ( APEC) , an estimated 4.5 million jobs have been lost over the past 3.5 years . Do our policy makers know how an ordinary Indian would survive without a salary for even a week and what pains his family and relatives pass through him being a jobless !

If all of you witnessed the discount sales season, it was advanced and even extended to make up for the shortfall , and this must show the desperation from the companies to meet the numbers . Unfortunately , If corrective steps are not taken immediately , we will have more companies getting into CDR or closure and millions of jobs might be lost till 2015……worst is yet to come !

Let me quote a facts about why India gained political independence and what was the average age of leadership . Maulana Azad became the President of INC at the age of 35 , Bose became the President of INC at the age of 41 and Nehru became the  President of INC at the age of 40… So now we know  why we got political freedom and why we have not been able to get economic freedom ??? For a nation with more than 65 % of the population below 35 years , it is important to take care of the representation of youth to lead this country with fresh innovative ideas for a double digit growth and that too  grounds up. Though our policy makers tell us that we cannot grow at about 8 % , but the fact is that, in 2011 calendar year , 12 countries clocked more than 8 % growth and some of them like Ghana , Iraq , China , Argentina and Turkey are not exactly small . We have been capped by the ‘old school of policy makers’ and their thinking , who believe that they know all and what they do is right ! This has to go now ! We need leaders with a nose on the ground , good governance and a strong political will and rest will fall in place . Government must earn from the rich and middle class, and help upgrade the lower income class to middle class on a ‘mission mode’ basis by empowering them by providing them training , education, healthcare  and technology  .

Our country’s finance ministers have taken to ‘Populonomics’ ( Economics of populism ) , and not ‘economics’, and this has clearly shown the results to the common man . India is heading towards an economic disaster and short cuts like FDI are short lived solutions !

I can bet you that if a party rises above caste , religion ,reservation, dynasty ,  and parochial regional politics, it is sure to win the youth and come to power without taking to populism !

It is the time for the finance minister to move from being an ‘efficient tax collector’ to ‘passionate creator of wealth through innovation & entrepreneurship ’. India is the only country in the world at this time that  has ample opportunities for each problem to be solved and is a fertile basin for innovation ! If you were born as a human- being , you must be lucky, but if you are born as a human -being and that too, in India , you must be the luckiest on earth, and this describes our India today and what it can offer to the world !

All ministries must have wealth creation strategies  ! Just imagine that for the year 2012-13, India will have gross tax receipts of 1,077612 crores and expenditure of Rs.1490925 crore…. Even if we do the sell-offs , we still cannot pay off the Rs.45 lac crores of debts that India has ! Which assets will be left to sell for our next generation ( oh boy that’s too far , I must say in the next 10 years ) ,to sustain our economy ? I think then , our Government will call upon the US President and ask his farmers & companies to come and invest in Indian land and make it more productive , and that will be the final sell off of this once a great nation i.e India

I am not an economist, though , I have studied economics during my graduation ( but I must confess that I do not remember anything I studied during graduation J , and I am glad that I don’t remember anything J) All that I have written here is a common man’s perspective from the data and facts available in the public domain.  I have researched the state of economy well over five months to help our dear policy makers to do a better job and making the life of a common man better and not bitter !

I am leaving to US for two weeks on 14th October evening , and on my return, I will launch www.indiawewant.org ,and would welcome your suggestions and participation

With best wishes

Rajendra Pratap Gupta

Economy I Healthcare I Retail I Innovation         

http://commonmansblog.com

 

Have we oversold the India story ?


Indian Economy From Aviation, Retail , Healthcare & SEZ Perspective

A lot of experts spoke about the robustness of the Indian economy when the global recession of 2008 did not entirely slow down India’s growth. Experts spoke at length about the pragmatism of India’s central bank leadership and its policies to have evaded the crisis. They even spoke about the sturdiness of the capital market and the role of the regulatory authority.  Today the global crisis is over in most of the nations. United States is back on track with the unemployment figures at a controllable rate and the retail spending picking up. Similarly Japan is expecting the return on investments it made after the Tsunami crisis last year. The amount spent on reconstruction has boosted the economy and it is expected to grow at respectable 2 percent this year. Only Europe seems to be lagging behind, however it must be taken into account that integrating economies of over 30 nations is a daunting task and credit has to be given to EU’s leadership for having dealt with the crisis in a respectable manner.

When compared to the growth rates of these developed nations India’s 7.6 percent growth rate seems to be enviable. So is everything great with the Indian economy? Is it really faring the way it is being projected? Every year fiscal consolidation is the buzzword yet the budget keeps running into deficit. The finance minister keeps promising to bring it under control yet deficit has increased from 4.6 percent last fiscal to 5.9 percent this fiscal year. Most of the deficit is on the account of food, fuel and fertilizer subsidies. The government keeps making provisions for the underprivileged but it is equally true that they are not getting the desired benefits. Most of the provisions are limited to mike & paper.

Let us evaluate the top most (so-called Sunrise )  sectors in India that are consumer driven and how they are faring – Retail , Healthcare , Aviation and also the ‘Oversold & over hyped SEZ story’.

We will have a moment of truth !

Aviation Industry

The India Aviation industry is in a tailspin. Every other day Air India, Kingfisher, Jet Airways etc are making the headlines for all the wrong reason.

Air India the state-owned company has been relying on frequent government bailouts for its existence. Air India alone was responsible for the 10 percent of the global aviation industry losses in the year 2008 while it handled dismal 0.35 percent of the global passenger traffic.  It is also over staffed with over 500 employees per aircraft whereas the industry average is around 120.

Kingfisher airlines owned by the flamboyant liquor baron Vijay Mallya is in troubles. Banks have finally decided to withdraw support in terms of providing further debt.  The only hope which the country’s third largest carrier can have right now is a government bailout. However there is a vehement opposition to such an action by the government. Experts and other industrial groups have strongly advised against such an action as it is a free market economy and it would amount to sheer wastage of taxpayers’ money.

Jet Airways has recently been in news when the tax authorities decided to freeze its account as it was about to default on its service tax payments. The Jet Airways spokesperson attributed the problem to rising crude oil prices and the high airport duties and lack of support from government in terms of policies. According to them the delay in service tax payment was a minor operational issue. However the mounting losses over past few years tell an entirely different story.  They were in news few years back for having laid off over 1200 employees and later taking them back next day after intervention from a local politician.

Other airlines in India like Spice jet, Go Air etc. have been on the fringe and have been moving back and forth from black to red.  An only Indigo airline is making profits. Several other have bowed down under pressure. They were either forced to shut down operations like Paramount Airlines or they managed to exit at the right time like Air Deccan and Sahara Airlines.

So what exactly is ailing the airlines in India?  Rising crude oil prices are often quoted as the culprit. In India fuel cost is almost 40 percent of the operational cost of running an airline whereas in other countries it remains around 15 percent. High fuels cost give little margin to maneuver in terms of other aspects like offering attractive tickets rates and other offers. However this is not the entire picture. Even though the crude prices reduced from $ 156 barrel to $70 barrel in 2008 to 2009, the Indian carriers continued to bleed and posted losses.

The real problem is of excess capacity due to overselling of India’s growth story . India’s daily domestic passenger traffic is approximately 1.51 lakh passengers whereas the capacity is around 2.16 lakh passengers. Imagine the revenue loss everyday on account of unused capacity. This has happened only due to the mindless unplanned expansion by the airlines hoping to cash on the Indian Incorporation growth story sold by the gang of politicians right from Sonia , Manmohan & inefficient Pranab and highly promoted Montek !  The airlines promoters were chasing numbers which was arrived on mere speculation & playing a ‘Valuation game to make quick buck’. They went on buying spree and expanded their fleet. Today the aircrafts remain underutilized.  India has the aircraft flying hours of 12 per day compared to 16 per day internationally.

Looking at the complete picture it is difficult fix the responsibility on the airline owners. They are capitalists who are driven by market forces. They anticipated growth in market based on market forecasts and other factors like projected rate of growth of GDP. They expected growth in industrial output and service industry output and subsequent increase in airline travel. However the reality was far removed from it. The India Incorporation failed to deliver and they were left in lurch. Today they are hoping for a miracle to save them from their predicament.

Losses Made by Major Domestic Carriers in India

Carrier Cumulative Loss 3 years (Cr)
Air India 13,000
Kingfisher Airlines 3900
Jet Airways 2400

Retail Industry

According to the experts the retail trade industry in India is having a bright future & is consumption driven due to the ‘reducing poverty due to social schemes and increasing middle class due to India’s growth story ‘. One of the studies by North bride capital expects it reach about USD 850 billion by 2012. Out of which organised retail will be having a share of over 20 percent. In numbers it over USD 175 billion. That is a huge market. According to others this figure will be achieved by 2015. Similarly other reports have painted rosy picture for the entire industry.  Currently it is increasing at a rate of 5% yearly.  A further increase of 7-8% is expected in the industry of retail in India by growth in consumerism in urban areas, rising incomes, and a steep rise in rural consumption.

As per consulting firm KPMG’s findings in a March 2009 report, the organised retail market in India has witnessed steady growth at 15 per cent in fiscal 2009. It will grow much faster, at the rate of 30-35 per cent annually, than the traditional one in the coming years. Fast moving consumer goods (FMCG) and apparel sectors are likely to drive this growth.

According to the 8th Annual Global Retail Development Index (GRDI) of AT Kearney, India retail industry is the most promising emerging market for investment. In 2007, the retail trade in India had a share of 8-10% in the GDP (Gross Domestic Product) of the country. In 2009, it rose to 12%. It is also expected to reach 22% by 2010.

A India’s Retail Market Report by Boston Consulting Group

Year

Total Size ($ Billions)

Organised Retail ($ Billions)

Percentage

2005

244

8

3

2006

276

11

4

2007

316

15

5

2008

362

19

5

2009

368

22

6

2010

425

28

7

2011

471

35

7

2012*

528

44

8

2013*

590

55

9

*Forecast

 

The true story of the retail industry: It has become a ‘Valuation game’ due to over selling the India story of the growing middle class 

Subhiksha, Vishal Mega Mart, Koutons , Wadhawan group’s Spinach etc; do these names sound familiar and have something in common. Yes these are players in the organised retail industry who have succumbed and failed to deliver at their promoters expectations. These chain stores were at one time case studies of India’s organised retail success. So what actually forced them lower their shutters.   

According to Jagannadham Thunuguntla, head of SMC Global all these cases are classic examples of the retailers getting carried away by the India’s fascinating growth story and the phenomenal rise of the middle class.

The phenomenon is not limited with these cases mentioned above but also with the so-called successful ones in the industry. Country’s largest department store Shoppers Stop for instance posted an overall loss of Rs.4 crore in the last five years, while its debt soared to Rs.390 crore. The Tata group’s retail arm, Trent decided to close down its loss making chain, Fashion Yatra. It was launched in Oct 2008 and it was aiming at low-income shoppers in Tier 2 – 4 towns. Similarly Reliance Retail decided to close its Reliance Wellness format and not only that it scaled its hypermarket format down in some cities. Hypercity closed down its catalogue selling venture and also got rid of its Gourmet City format.

For the modern retailers penetrating further into urban markets has become a challenge. They have no option but to continue to create, preserve and then destroy the store formats they have come up with. Having closed down and revived several formats, most retailers have realised they need to constantly experiment with them to stay afloat.

So we can clearly see that India’s organised retail industry, which has the coveted potential of nearly a billion plus customers with enough cash to spare, has so far claimed a number of players, small and large. These players expanded too soon based on mere speculations.

While these retail stores were expanding and accumulating debts they hoped that the middle class with disposable income would be ready in short time to support them.  Things did not turn out the way they had planned. India Incorporation failed to deliver and along with that came the global economic crisis. These firms ultimately paid the price by closing down their shutters. For instance Subhiksha had expanded to over 1600 stores country-wide entirely on debt. This was a blunder that it committed as it was counting on the rising customer demand which was only on papers.

Not only the growth stories are misleading, at the same time the country’s back-end is not developed and huge investments go into developing it.  The vital supply chain required for the retail networks are entirely missing. This leads to a huge inventory cost which the small retailers are unable to cope up with. Take for example, it is estimated that in the food retail business in India, the wastage due to lack of proper storage facility is staggering 40%. This entire situation is largely the result of the lack of proper policy framework from the government.

The Indian retailers like Future group , Reliance and others are backing FDI so that they can get investment and save themselves from the fate of Subhiksha , Koutons , Gini & Jony , Spkykar , Vishal Mega mart , Foodland super markets, Surya Group etc . We have more companies going into CDR – Corporate debt re-structuring post the closure of the financial year 2011 ( March 2012 ). Banks do not wish to announce the failures or NPA’s in this year.

Ideally , retail businesses should have been making money due to consumer demand but the fact remains that India’s income and growth story is limited only to 6-10 towns and impacts less than 10 % of India’s population

 SEZ’s in India

India adopted the concept of zones from as early as 1965. Kandla in Gujarat was the first Asian export processing zone till the advent of the modern SEZ’s as such zones are now known as. With the passing of the SEZ Act in 2005, it was hoped that the Chinese success story would be replicated in India. It was expected that investor’s confidence would be established in the Government’s commitment to a stable policy regime. The real aim was to generate greater economic activity and employment with the establishment of SEZ’s following the Chinese model of economic growth !

There were numerous applications from multiple sources with individuals, indigenous companies, foreign MNC’s all rushing to have a share in the pie. Sadly it was a short phenomenon. The initial excitement was over as the problems started cropping up. Today in the last two years, as many as 60 applications for SEZs have been withdrawn, while 35 developers have applied for de-notification, according to data by CB Richard Ellis (CBRE), the real estate consultants.

Till date, the government has approved 584 SEZs. There are 381 notified SEZs, of which 148 are operational. Of these 148, only 17 are multiproduct SEZs. The remaining ones are SEZs dealing in engineering, electronics, IT/ITeS, hardware, textiles, bio-technology and gems & jewellery.

So what exactly is wrong with the SEZ idea in India which paid its dividends in China, Poland and Philippines?

On the whole the SEZ idea in India seems to be very much the product of the irrational expectation which has been fueled by imagination.

Healthcare Companies :  Most of the healthcare companies are ‘managing profits’ and as i write , a major healthcare ( hospital ) chain and a pharmaceutical conglomerate is about to wind up in the next 3 months . Imagine a healthcare & hospital company winding up ?

So the Congress party has sold the India story purely on ‘Imaginative basis and on speculative data’ numbers , have no idea of what is fueling inflation and what will deliver growth ? With all sunrise sectors on a downslide , it is better to replace these ‘ignorant intellectuals’ and bring in people who can understand the economy and run it efficiently .

Based on the governments high-octane pitches for the India’s growth story , consulting companies have brought out reports supporting government announcements , and  business houses have approached investors or moved to stock market and raised money and have put up expansion plans . But the reality is that, India does not have a growth story with the current fundamentals being very weak and ‘Leaky’ social schemes are making the party rich and not the population !

Also,  that the current stand of the government to raise the tax issue with Vodafone is a clear proof of what i am writing . India is desperate for funds and behaving like a dictator reversing a five decade legislation for just 10,000 crore ( USD 2 billion ). Does it not show the lack of morality and desperation for funds ? Rest will become apparent in April – May-June Quarter !

Lastly , the financial deficit of the government proves the rest ; all is not well with the India ‘bubble’ story ! Tough times are ahead , if we don’t take immediate action !

Rajendra Pratap Gupta

Healthcare I Retail I Rural Economy I Public Policy

www.commonmansblog.com

12th Five Year Plan – DMAI


Image

Rajendra Pratap Gupta

President & Member

Board of Directors

March 09, 2012

Via e-mail / Speed-Post

Dr. Manmohan Singh,

Prime Minister

Government of India

Shri Ghulam Nabi Azad,

Union Minister for Health & Family Welfare

Government of India.

Subject: Strategic Considerations for Healthcare in the 12th five year plan

 

Dear Dr. Singh & Shri Ghulam Nabi Azad ji,

I am writing this note on behalf of DMAI – Disease Management Association of India.

Disease Management Association of India (DMAI – The Population Health Improvement Alliance) is formed by leaders from the Global Healthcare fraternity, to bring all the stake- holders of healthcare on one platform (Both the public & the Private sector). DMAI has been successful in establishing an intellectual pool of top healthcare leaders to become an enabler in building a robust healthcare system in India. India is on the verge of building its healthcare system, and it has a long way to go. DMAI is building the resource – knowledge pool to contribute & convert ‘Ideas’ into ‘Reality’ for healthcare in India. DMAI is the only not-for-profit organization focused on population health improvement in India.

Earlier in 2009, I have authored the comprehensive healthcare reforms agenda for India, and this has been appreciated by political and policy-making leadership at the highest level. Further, the healthcare reforms agenda  (detailed agenda is available at the DMAI website http://www.dmai.org.in/Healthcare_Reforms_Agenda.pdf) has been incorporated in the healthcare planning in the state of Chhattisgarh.

Further, DMAI has given inputs to various government bodies, as sought from time to time on:

Re-structuring of ICDS

NCD Policy

Re-structuring the 12th Five year plan for healthcare

Formation of NCHRH

Inputs in the high level UN summit for NCD’s (DMAI was an official invitee to the UN)

DMAI has raised important issues w.r.t. The Mental Health Act 2010, banning of Junk food in schools, reservations in airlines and railways for critically ill and in times of medical emergencies, radical changes in Jan Aushadhi scheme, healthcare reforms in J & K, Protocols and treatment guidelines for all major acute and chronic illnesses; besides other issues. Details available on www.dmai.org.in

12th five year plan is being talked of as the ‘Plan for Health’, and through this note, DMAI wishes to bring a few important issues before the policy makers for debate and appropriate action:

Quality of Healthcare: Last year, I was nominated to the five member Healthcare committee of the Quality Council of India. Since then, I have been discussing with all the stakeholders in healthcare, including the patient groups, about how to improve the quality of healthcare in India.

Action:  It must be made mandatory for all healthcare providers (Care Givers), to submit the Patient / treatment outcomes data e.g. for hospitals (including admissions, no. Of night stays, re-admissions, infection rates, deaths, referrals, etc.) to the government every year without fail. Also, getting similar data for doctors, clinicians etc. should also be looked at. This data could be maintained under the Quality Council of India (QCI) or an entity under QCI, funded jointly by the government and private players or, as an independent organization. This organization must analyze the data and post it on the website, so as to enable the patients to make an informed choice when it comes to choosing the doctors / hospitals or the caregivers. This will be the first step in bringing transparency in healthcare and a major boost to improving quality in healthcare. A hospital stay costs an average of $236 per day in India, $655 per day in France and an average of $3,949 per day in the US, according to a report — 2011 Comparative Price Report Medical and Hospital Fees by Country – released by the International Federation of Health Plans.  After paying USD 236 (Approximately Rs. 11328.00 / day (USD 1= INR 48), what does the patient get in return?  . We believe that by implementing this reporting by caregivers, the caregivers would work harder to improve their performance in terms of outcomes for treatment and, in a way, it will lead to ‘Pay for Performance’.  Patient would be able to make choices based on whosoever provides the best care!

Also, all the hospitals / care givers must ensure appropriate patient follow-up and feed back mechanism, and the government must devise an institutional mechanism to collect the data on success rate of treatments and examine the reasons for failure so that the quality of healthcare delivered can be improved.

This must be done by setting up the National Institute for Research in Healthcare Quality Improvement.

This institute must focus on coming out with annual reports on improving the quality of healthcare in all the states, as the healthcare issues vary from state to state. We have seen that recently, West Bengal has been home to dozens of child deaths in major government hospitals.

But as of now, there is no investigating body for healthcare to look into these issues, and the crime investigating agencies (Police) lack the necessary qualifications & skills to carry out any meaningful investigation and suggest remedial steps for such incidents. It is the time to correct this by setting a dedicated national body for such incidents.

USA has moved towards ACO’s (Accountable Care Organizations); and it is high time that India sets up the guidelines for all healthcare delivery organizations to become self-regulated ACO’s

Recently, DMAI was actively involved in doing the biggest Healthcare camp in Ajmer (the constituency of Shri Sachin Pilot), and examined over 50,000 (according to some media estimates, approximately 71,000 people). The people were given free diagnostic tests & medicines only due to active participation & support from the private sector. It is high time that the government acknowledges that the private sector has a pivotal role to play if the ‘Healthcare for all- Universal Healthcare’, has to move beyond ‘mike & paper’! Private sector has always shown commitment by providing resources for ‘pilots’ and ‘Free camps’, but we must not forget that, ‘Charity is as deep as the pocket’! It would be a win-win, if the government starts with launching the mass screening program with the private sector, re-launching the ‘Jan Aushadhi’ scheme with the private sector & implementing mass scale telemedicine / mHealth projects with the private sector

I was an invitee to the meeting called by the Hon’ble Health Minister /WHO on 23/ 24th August 2011 at Delhi, and was also involved in the writing of the document called ‘Delhi call to action’.  I recall, that the Hon’ble Minister made an announcement to screen 200 million people for diabetes and hypertension by March 2012. I have learned through reliable sources that this mass screening plan, that was to start with 100 districts was reduced to 10 districts and finally to slums of two districts, and the results were not encouraging! In a way, even 10 % of the target of 200 million (2 crores) has not been achieved. This reminds me of the Sir Joseph Bhore Committee report in 1946, which talked about Universal Healthcare.

Also of the National Health Policy (NHP) 1983, which talked about ‘Health for All’ by 2000 AD’.

Both these committees failed to deliver Universal Healthcare. So, essentially, even after 65 years, ‘Healthcare for all’ has just remained a ‘concept’ & a mere ‘talking point’.

In the current plan – 2012, we are again talking about the same thing ‘Healthcare for all’. This time, we have a high level committee and the wordings have changed to ‘Universal Healthcare’. Doubling of budgets for healthcare will not be able to address the healthcare problems facing the nation, till we ‘double our understanding’ of the real issues and the solutions and give up the parochial approach to remedy the ills in our system!

It is clear that the government lacks an execution plan, and also that; ‘execution’ has never been the forte of the government. It is high time that government puts “PPPr”- Private Public Performance based rewards partnership in place like the NHAI and then only releases the budget for the 12th five-year plan.

It is time to learn from what you did in UID! A person from the private sector has already issued 30 million Aadhaar cards, and this has already become the biggest biometric program in the world. Can we not learn from UID and implement in MOHFW ?

We need a ‘Professional’ CIIO (Chief Innovation & Information Officer) in the Ministry of Health, who will bring the necessary capabilities in the ministry to make a difference in the ‘Health for All’.

Free insurance & Free medicines: This scheme is a ‘Killer Combination’.  ‘Social healthcare’ has failed miserably in the western world, and we seem to have not picked up the lessons but are hell bent on ‘Importing failures’ of the west into the Indian healthcare system. As I mentioned in the 2009- ‘Healthcare reforms agenda’, I will re-iterate that we need a ‘Co-pay’ model for healthcare delivery.  Except the BPL families, all others must have’Co-Pay’ component in the healthcare services even if it is a token of 5-10 % of the total healthcare cost borne by the government. Co-Pay must go up with the income slabs!

Rajiv Aarogyashree scheme (highly publicized scheme of Andhra Pradesh), is now widely talked of as a ‘failure’, and the government is not in a position to pay the empanelled facilities for the ‘free treatment’ that has been a part of the popular scheme

It is time to re-look at ‘Free universal healthcare schemes’. If the government examines the free healthcare schemes currently offered all over the world, it would think twice about free healthcare!.

Free medicines scheme: During my visits to Rajasthan (medicines are given free in Rajasthan government hospitals), I was made to re-think about this scheme

This scheme has created a peculiar situation for doctors.  Doctors are told that the family member is suffering from cold, cough or backache, and s/he is asked to give the medicine!

When the doctors request to examine the patient as to check if it is dry cough, TB induced cough etc., the response that the family members give is, ‘ When the medicines are provided free by the government, then why do you ask so many questions?

If the doctor refuses to give medicines, political pressure is applied and the doctors are harassed! Doctors have been reduced to ‘compounders’, and are just dispensing medicines rather than treating patients, because of the ‘free medicine scheme’!  Even in the USA, we have seen scams where ‘dummy patients’ were created under Medicaid, and reimbursements taken from the government in the name of ‘diabetic patients’. India will witness large-scale organized frauds if such a scheme is rolled out without adequate checks and controls.

When it comes to medicines, I must request the government to monitor the pharma industry closely, as the customer is not getting the benefit of ‘low prices’ (read as- schemes that are offered by the industry to the distributors).  Just for the sake of information, I am quoting two examples:

Panegra is available at an MRP of Rs. 124.00 and the scheme offered by the manufacturing company is- seven strips free on purchase of one strip! Still the end consumer buys the medicine on MRP!  The manufacturer distributor – retailer nexus swallows the entire margin.

Another example is that of Cifran, priced at Rs.58.80 and the scheme offered by the manufacturing company is – one strip free on buying two strips. But, such benefits are never passed on to the ignorant end customer- patient. Similarly, 1000’s of products are available with such ‘deals’ but the patient does not get the benefit.

Government must take decisive action against such pharma companies. The two companies quoted here are just for reference and most of the companies are indulging in these practices

Also, the government must give a big push for mobile healthcare (mHealth & Telemedicine). CDAC Mohali (a government body) has developed a great application for telemedicine, and DMAI used that service during the mega healthcare camp at Ajmer, in collaboration with PGI, Chandigarh. It is time to promote such institutes and organizations.

May be, it would be worth having a joint working group between the ‘Ministry of Communications & IT’ and ‘Ministry of Health & Family Welfare’, to explore the commercially deployable models of telemedicine & mHealth

It is the right time to train all our nurses & pharmacists in healthcare counseling through online training modules and create a special cadre of healthcare counselors for chronic diseases.

It is the right time to set the Patient Charter for Healthcare, which includes the patient’s rights and responsibilities. DMAI is driving an initiative to come out with a ‘Patient Charter’ under the leadership of Dr.Aniruddha Malpani.

These changes are required if we wish to make an impact on the healthcare delivery system.

Currently, there is a big gap between ground realities, policy formulation & execution framework. We need radical changes in our thinking to create an ‘Inclusive Healthcare Ecosystem’. It is better that immediate steps are taken to correct the loopholes so that Healthcare for all can become a reality without compromising on the quality of care.

DMAI would be willing to volunteer with its knowledge pool and resources should the policy makers need the same

Yours in good health

 Rajendra Pratap Gupta

CC:

Mrs.Sonia Gandhi

Shri Nitin Gadkari

Dr.Manmohan Singh,

Dr.Murli Manohar Joshi, Chairman, Parliamentary Accounts Committee

Minister for Communication & IT, GOI

Montek Singh Ahluwalia

Dr.Syeda Hameed.

Shri L.K.Advani

Smt. Sushma Swaraj

Shri Sudip Bandyopadhyay

Sam Pitroda

Rahul Gandhi

Sitaram Yechury

Secy, Health & Family Welfare, GOI

DGHS, MOHFW,GOI.

Dr. K. Srinath Reddy

Dr.Girdhar Gyani, QCI.

Dr.V.K. Singh, QCI

Board of Directors – DMAI


Right to Primary & Preventive Care


August 10th , 2011

Dr.Manmohan Singh

Prime Minister

Government of India

7, Race Course , New Delhi 110001

Subject: Right to Primary & Preventive Care

Dear Dr.Singh,

 

Greetings from the Disease Management Association of India – DMAI, The Population Health Improvement Alliance .

 

DMAI – The Population Health Improvement Alliance is a not-for-profit organization formed by global healthcare leaders. It is the only civil society organization in India dedicated to chronic disease management in the country, with an objective of overall population health improvement .In the past three years , DMAI has worked at both International level and within India to address the issue of India’s healthcare challenges,  with the support of  patient groups , Industry & policy makers , and wishes to put on record the continuous support DMAI has received from policy makers and the industry .

 

Your government has been behind some key initiatives like

 

Right to information Act

Right to Education

Right to Work / Employment

Right to Food

 

I wish to draw your kind attention to consider enacting, the ‘Right to Primary & Preventive care’ for all citizens of this country, before it gets too late !

 

The nation is burdened by ‘a catastrophic disaster in slow motion’, moving towards it in the form of a huge population suffering from Life threatening diseases / disorders ( LTD’s ) or Debilitating Chronic Disorders- ( DCD’s ); what is today called the NCD’s ( Non communicable diseases ) .

 

We are already facing an acute shortage of both, hard infrastructure and soft infrastructure in healthcare delivery , and with our current ‘Baby Boomers’ becoming ‘Patient Boomers’ in the next 15-25 years , we could lose our competitiveness & productivity by over 50 % . India  in 2025 , with over 1.40 Billion population and with over 600 million LTD / DCD patients

would be a burden for the human race if we fail to adopt the Right to Primary & Preventive care, as the basic right for all citizens .

 

I must also state an electoral reason to accomplish this very important act . It is not just the US that fought the last elections on issue of Healthcare reform , but back home,  Andhra Pradesh and Assam are examples of how healthcare schemes can be a deciding factor for the public to choose who will run their government and so, lets get this ‘Right to Primary & Preventive care’ implemented at the earliest possible.  My detailed note on healthcare reforms agenda available at the DMAI website ( www.dmai.org.in ) , has the details of what could be potentially done in this area . It has to be multi-sectoral and inter ministerial effort & I am sure that this act with vast social & economic implications will be the best thing to do in healthcare !

 

Also, to keep you posted , I am working on the Chronic Care Bill & the Child Health bill . If all goes as per plan , the draft of these documents will be submitted to the policy makers by end of September 2011

 

Hoping for a positive response from a responsible government on the ‘Right to Primary & Preventive care !

 

We remain at your disposal for any help / assistance that you might need on this matter of great national interest

 

Yours Sincerely

Rajendra Pratap Gupta

president@dmai.org.in

 

H.E. Ban Ki Moon, Secretary General , United Nations

H.E. Joseph Diess , President of the UN General Assembly

Hon’ble Deputy Secretary General of the UN General Assembly

Ms. Margaret Chan, Director General, WHO

Shri Ghulam Nabi Azad , Hon’ble Ministry of Health & Family Welfare, GOI

Dr.K. Srinath Reddy , President , PHFI

Dr.Syeda Hameed, Planning Commission , GOI

Sri Sudip Bandopadhyay, MOS- H&FW

Shri K.Chandramouli, Secretary , H&FW , GOI.

K.Desiraju, Additional Secretary , Government of India.

Dr.Sudhir Gupta , CMO, NCD’s. MOHFW.

Board Of Directors , Disease Management Association of India – DMAI , The Population Health Improvement Alliance .

UN Summit on Chronic Diseases in September 2011


July 11 , 2011.

Dr.Manmohan Singh

Prime Minister

Government of India

7, Race Course , New Delhi 110001

Subject: UN High-Level Summit on Non-Communicable Diseases, September 2011

Dear Dr.Singh,

In the above quoted reference , and in continuation to the letter I wrote to you on 8th June 2011; I am connecting with you on my return from the UN session on NCD’s

On 16th June 2011  , on the invitation from the United Nations, I participated  in the informal interactive civil society hearing  & delivered an address at the UN General Assembly Hall . The session was presided by the President of the UN General Assembly , Mr.Joseph Diess

My view was also quoted in the closing remarks by Sir George Alleyne , UN Special Envoy to the Caribbean .

This September, you and your fellow political leaders will have a once-in-a-generation opportunity to halt a global epidemic that is killing and disabling millions of people, impoverishing families and undermining economic progress. The United Nations High-Level Summit on Non-Communicable Diseases (NCDs) is a chance for the Government of India to play a leading global role in confronting this major threat to health, prosperity and security of all of us and future generations.

I wish to assure you of the full support of our organization for the High-Level Summit in September 2011.  We campaigned for such a Summit because the NCD epidemic has reached such proportions that it now constitutes a major risk to global prosperity, development and political stability.

Together the four major NCDs – diabetes, cancer, heart disease and chronic respiratory disease – are the world’s number one killer. It is estimated that some 35 million people die from NCDs each year, and 14 million of these deaths could be averted or delayed.

Recently , Our Hon’ble Health Minister quoted; that every ten seconds two new cases of  diabetes are reported . Further , 14 % people in Bangalore were found to be diabetic , 21 percent had  high blood pressure and 13 % had both diabetes and hypertension. DMAI had conducted the first Health Risk Assessment study in 2009 , and our findings showed that  other NCD’s pose a threat of similar magnitude . We found that 44 % males & 42 % females were Obese , 18 % males and 8 % females were suffering from Hypertension ,  21 % males and 11 % females were suffering from Diabetes , 7% males and 6 % females were suffering from respiratory ailments .

Overall average occurrence across occupations was found to be thus :

Obesity 44 % , Diabetes  20 %, Hypertension 16 % & , alarmingly 7 % of the students suffered from Hypertension

India’s biggest enemy is taking the shape of a multiple headed monster i.e. Chronic diseases .We must be proactive in keeping India prepared for victory against our biggest enemy, Non- Communicable diseases. If we win the war against chronic diseases, rest of the enemies could be easily defeated, but if we lose the war against chronic diseases, we would certainly lose the war against all other enemies

The right word for NCD’s is ‘Irreversible diseases’ or ‘debilitating chronic disorders- DCD’s’ or ‘Life threatening disorders – LTD’s ’ . As a first step, let us address the diseases with the seriousness they need  ! Let’s change the name from NCD’s to LTD’s or DCD’s. Through the same note , I call upon the UN & WHO to redefine the terminology for addressing these disorders .

Dr.Singh , I must highlight you the points of discussions that we had at this special session at the UN on chronic diseases .

President of the General Assembly emphasized the need for a global response to the challenge of non-communicable diseases (NCDs). NCD prevention and control should not be seen as competing with other development and health priorities, and solutions must be integrated with existing initiatives

The Deputy Secretary-General noted that NCDs are a threat to societal well-being, taking

their greatest toll in developing countries. This is an issue that the United Nations is taking very seriously to ensure that there is a global response to the broader social and economic impact of NCDs. Praising the work and commitment of those present at the hearing, who are at the frontline of the fight against NCDs, she encouraged them to learn from and link with those working on other key health development issues – HIV/AIDS, and maternal and child health.

The World Health Organization’s Assistant Director-General for Non communicable Diseases and Mental Health cited key evidence on the scale, distribution and impact of the global NCD epidemic. Reviewing the key achievements of the past decade, he noted the important role that civil society had played in progress of management of chronic diseases to date

The Director-General of the King Hussein Cancer Foundation, Princess Dina Mired of Jordan,

emphasized the need for everybody to be unified in their efforts to get NCDs on the global

agenda and receive the attention they deserve

The first roundtable addressed the health, social and economic scale of the NCD challenge.

There is a fundamental right to good health that is being undermined by the globalization of

NCD risk factors and an insufficient action to date. Thus, a human rights-based approach to

NCD prevention and control is warranted. The global response to NCDs needs to address the

developmental and political aspects of the drivers of the main NCDs, and this will require

collective action – no individual country will be able to deal with the problem alone. Much greater progress can, and must be made in preventing and controlling the NCD epidemic to prevent unnecessary suffering and premature deaths.

Speakers emphasized the need for urgent national and global action as NCDs are increasingly frustrating social and economic development. Some countries already suffer the ‘double burden’ of communicable and non-communicable diseases as well as under- and over nutrition, sometimes in the same household. Health systems in all countries will not be able to cope with the projected burden of NCDs and governments need to be clear that the cost of intervening is much less than the cost of inaction. The economic burden of NCDs is already substantial and will become staggering over the next two decades. Economic policy makers need to better understand that NCDs pose a significant economic threat as they can be expensive to treat, require long-term management and undermine the labour contribution to production. There is also a substantial opportunity cost as the money spent on treating preventable diseases could be spent on other priorities.

Speakers stressed that the economic impact of NCDs is felt disproportionately among the poor and many individuals and families are already tipped into poverty by these diseases; thus NCDs are also a social justice issue. This will only worsen if NCDs are not prioritized in countries’ health and development plans. Health systems strengthening must address the need for social insurance to reduce the potential for ‘catastrophic’ expenditure by individuals who suffer from an NCD.

Given the complexity of the factors driving the NCD epidemic, speakers underscored the need for a response that is ‘whole-of-government’, multi sectoral and spans the life-course.

Both prevention and control are essential, and there is much that can be done by more systematically applying existing knowledge. There are highly cost-effective population and individual interventions for the four main NCD key risk factors – tobacco use, poor diet, inadequate physical activity and harmful use of alcohol – and these should be prioritized.

Focusing on the ‘best buys’ should not be at the expense of the broader range of approaches that is needed to effectively reduce the impact of these risk factors. Speakers noted that this includes the need to consider the broader social, environmental and economic determinants of health, which strongly shape health-related choices and decisions made by communities, families and individuals. Likewise, the cultural, religious and social context should be considered in implementing effective interventions.

Many speakers highlighted the need for a response that is integrated – not competing – with existing initiatives, improving health systems for all conditions regardless of their origin.

There is great potential for synergy with existing health development priorities, including those in the MDGs. The important role of health professionals in both prevention and control was highlighted by speakers. A holistic approach is required that addresses the needs of people and doesn’t treat diseases in isolation. In this sense, other non-communicable conditions such as mental health and substance abuse and oral health disorders should be considered in the health system response to NCDs.

The leadership role of governments was highlighted, which should include a commitment to developing and implementing a national NCD action plan and committing to ‘health in all policies’. It was repeatedly emphasized that all key stakeholders need to be involved in the response, but it was noted that clarity of roles is essential to ensure that potential conflicts of interest are appropriately managed and it was proposed that frameworks be developed to assist countries to do so. It was noted that there are some industrial influences that are in conflict with not just health and social goals but also the goals of other industry and private sector actors; all stakeholders have an interest in dealing with these negative influences.

Speakers agreed on the need for ongoing and improved surveillance of NCDs, their risk factors and outcomes. This will be needed to monitor progress, guide policy decisions and research priorities, and provide information on the effectiveness of different interventions.

There was strong endorsement of the need for a clear monitoring and accountability framework as part of the global response to NCDs, with measurable indicators that countries can report against.

Finally, it was noted that success is possible, and there are many examples of significant and rapid progress in addressing NCDs. Now is the time to scale up collective action on NCDs, and the opportunity must not be lost to avoid the growing negative social and economic consequences of the NCD epidemic.

The second roundtable examined effective ways to address the NCD epidemic. Much is known about effective interventions at both the population and individual levels to both prevent and control NCDs.

These include tobacco control as set out in the Framework Convention on Tobacco Control; reducing the sugar, salt, trans-fats and saturated fats content of processed food; improved diets; increased physical activity; effective policies and programmes to reduce the harmful use of alcohol; and providing low-cost high-quality essential medicines and technologies.

For example, chapters four and five of the WHO Global Status Report on non communicable diseases 2010 summarize the ‘best buys’ in NCD prevention and control http://www.who.int/nmh/publications/ncd_report2010/en/index.html

There is little contention about the evidence for the most cost-effective interventions, and the challenge is thus primarily one of ensuring their proper implementation. It was agreed that NCDs are a societal problem, so a range of government departments and societal actors need to be involved in the response. An effective mechanism to achieve this should be a priority for every country. There is an important role for civil society and civil society should be given a formal role in both the development and implementation of each country’s response.

Speakers highlighted that premature deaths from NCDs are largely preventable, and prevention is central to a more effective NCD response at both national and global levels.

Many primary and secondary preventive interventions are highly cost-effective and there are existing tools to support their implementation, including agreed international codes, strategies and Conventions.

Full implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) was cited by many speakers as being a top priority for action, due to the domination of tobacco-related premature deaths across the NCDs – currently six million per year. The FCTC is now widely ratified by both developing and developed countries, but more can and should be done to support its full implementation in developing countries.

NCD prevention and control should be grounded in a life-course approach, given the fatal and early childhood origins of some NCDs. Children are an important focus for interventions, with the growing impact of risk factors such as obesity on children and adolescents and the opportunity afforded to reach them through schools. Likewise, women are an important target for interventions as child bearers and, frequently, as the ‘gatekeepers’ for food, physical activity and health services for families. Speakers also emphasized the importance of prevention and effective treatment across the life-course, including into older age where much of the burden or diseases falls.

Speakers agreed on the need for an effective health system, which has benefits for all areas of health, not just NCDs. Primary care is the key healthcare setting for cost-effective NCD prevention and control. An important learning from HIV/AIDS is the need for better integration of prevention and treatment services across disease areas – so-called ‘horizontal’ and ‘diagonal’ approaches. In support of this, one participant proposed ’15 by 15′ – namely that by 2015, 15% of funding in all ‘vertical’ programs should be earmarked for strengthening ‘horizontal’ health systems activities. In low-income countries, such approaches should also address the endemic NCDs that affect the so-called ‘bottom billion’, for example sickle cell anemia and rheumatic heart disease, as well as palliative care.

Speakers referred to the roles that civil society organizations can play in NCD prevention and control. There is a significant opportunity to use information and communication technologies to promote health awareness and increase empowerment of individuals and communities to reduce their exposure to NCD risk factors and supporting self care.

Many speakers emphasized that access to essential medicines and technologies for prevention and treatment of NCDs is critical. The cost of the essential medicines is low, and these should be included in readily available ‘packages’ of essential care; this will require increasing manufacturing capacity of essential drugs to ensure quick access to high quality generic pharmaceuticals. The specific need for better access to adequate pain relief, especially morphine, as part of palliative care was raised by several speakers. It was noted that late presentation is all too common in developing countries, partly because of a lack of universal social insurance, as well as lack of awareness; both need to be addressed to avoid unnecessary suffering and premature deaths. Patient and ‘survivor’ groups should be engaged in policy and implementation and can play a significant role in influencing the public, politicians and the media with their stories.

Speakers noted that governments need to set the pace for change and utilize their power to ensure appropriate regulation to achieve public health goals. This may require regulation at both national and international levels to address significant health threats such as the obesity epidemic, for example to support the effective implementation of standards on marketing of unhealthy foods to children and agreed targets for salt reduction. Children and the public should be protected from commercial marketing that encourages unhealthy actions and, exposed to educational messages in schools and in their communities that encourage healthy action. The use of social media to deliver such messages needs to be greatly expanded. The role of physical activity was raised by a number of speakers. The benefits of physical activity are wider than NCD prevention and national and local policies should create an environment that encourages and supports people to be physically active.

Regarding the resources required to prevent and control NCDs, speakers noted that the majority of funding for health comes from within countries, and States need to mobilize their own resources. Health needs to be a higher priority for government spending, and NCDs a higher priority in health spending – this is the only way that funding will be sustainable in the long term. Likewise, current spending on NCD prevention and control needs to be carefully scrutinized to ensure the best possible value for money. NCD prevention and control should also be considered in decisions about ODA for health, in particular through integration with existing health development priorities. In addition, innovative funding mechanisms will need to be explored.

Many speakers emphasized that one important source of funding for NCD prevention and control is through increasing taxation of tobacco products. Tobacco taxation is also irrefutably one of the most effective ways to decrease tobacco consumption, particularly among young people, and is fundamental to an effective tobacco control programme.

Speakers endorsed the need to build capacity and capability to address NCDs among health professionals. This will require concerted efforts to revised training curricula, dealing with ‘brain drain’ of trained professionals from low income to higher income countries, and greatly strengthening research capacity in developing countries to monitor trends and evaluate interventions.

 The final roundtable examined ways to scale up action at the global level to collectively address NCD prevention and control. The full range of stakeholders, including all those present at the debate, was identified as been essential to a more effective response. It is vital to carefully examine previous international experiences to draw out the key lessons.

The value of international instruments such as the FCTC was emphasized, and it was noted that other such instruments may be needed in the future to support effective international action.

Speakers provided specific examples of enabling mechanisms to support global cooperation, including a ‘clearing house’ function to facilitate knowledge sharing, a global forum, and bilateral and multilateral partnerships to support technology and knowledge transfer.

The need for appropriate monitoring and accountability was reiterated, noting that accountability is a national responsibility that can be supported by appropriate international monitoring.

It was acknowledged that the funding environment is currently challenging, but there is much that can be done with existing funding. At the national level, there are opportunities to generate or ‘free up’ resources, for example through taxation of tobacco, alcohol and foods high in fat or sugar, and reprioritizing spending on ineffective and expensive health care interventions. Reducing donor ‘silos’ will help to ensure that health development occurs in a much more integrated way that will benefit NCDs as well as other priority areas. There is a need to expand the donor base, and opportunities to do so through linking with other related issues such as climate change.

International federations of NGOs, private sector and other organizations have a useful role to play in promoting global cooperation. Representatives of the research-based pharmaceutical industry and the food and non-alcoholic beverage industries outlined pledges they have made to contribute to NCD prevention and control. There is potential to expand new partnerships, for example with the sporting goods industries to promote physical activity. The private sector can bring a range of capabilities to support NCD prevention and control; for example, its global reach, and experience with global brands and global marketing campaigns. With respect to NGOs, speakers identified the value of greater collaboration, which has been realized over the past two years. This has greatly enhanced their ability to mobilize resources, advocate and generate social and political momentum. This collaboration will need to be further developed to support and monitor the implementation of the outcome document that is to be adopted in September.

 Sir George Alleyne, Director Emeritus of the Pan American Health Organization,summarized many of the key points canvassed during the day’s discussions. He noted a strong degree of coherence in the day’s discussion and agreement on the need to act urgently, while acknowledging the different views within and between the different stakeholder groups on some key issues. Underscoring the need to use proven tools and the value of strong partnerships within the UN and across broader society, Sir George urged all stakeholders to work together for the global public good of reduced suffering and early deaths from NCDs. He echoed the comments of many speakers on the need to integrate NCD prevention and control with action on other key health priorities, notably HIV/AIDS and maternal and child health.

In concluding, Sir George Alleyne exhorted participants to increase their efforts to stimulate political action on NCDs. Civil Society has the resources and passion to overcome the apparent inertia and it must use its unique ability to ‘agitate’ for change. The wider public needs to be informed of the size of the problem and of the consequences of inaction. He emphasized that the High-level Meeting is an important milestone but that sustained action will be needed beyond September.

In closing, the President of the General Assembly emphasized that, as with other key health and development issues, all stakeholders need to act collectively to address the global challenge of non-communicable diseases. He noted that the global community can act decisively and effectively on important global health issues, and we must learn from these prior experiences. It is in our common interest to act now.

Thanking all those who participated in the hearing, the President noted his optimism that the  High-level Meeting and the subsequent response will make a real difference to the global NCD epidemic. This optimism had been strengthened by quality of the discussion and range of ideas canvassed during the hearing and the obvious energy and sense of purpose from all stakeholder groups.

Principal conclusions

 The key conclusions of the hearing include the following:

Countries should move urgently to prevent and control NCDs to alleviate the significant social, economic and health impact these diseases are having, which is now compromising development gains. The last decade has seen some progress at the global level in NCD prevention and control and it is clear that concerted action and leadership by governments can result in significant and rapid progress. However, efforts need to be greatly scaled up to avert unsustainable increases in the costs of treating NCDs, which no country can afford.

There is a strong consensus that NCDs are a development issue and urgently need to be afforded greater priority in national health and development plans, and a higher priority in government funding decision. NCDs also need to be incorporated into the global development agenda in ways that complement rather than compete with existing health development priorities, and innovative funding mechanisms need to be rapidly identified and implemented.

The complex drivers of NCDs require multi-stakeholder action, and countries should put in place a mechanism to engage all the sectors needed for an effective response. Governments should ‘set the pace’ of the response and must show political courage and leadership.

Addressing the key risk factors for NCDs will require involvement of government, communities, civil society, non-government organizations, academia and the private sector. It is important that potential conflicts of interest are appropriately managed so that effective action is not compromised.

NCDs disproportionately affect the poor at global and, in many cases, national levels and lead to ‘catastrophic’ expenditure that forces people below the poverty line. Universal social insurance schemes are essential to avoid this and their implementation should be a priority, with attendant benefits for health care that go beyond just NCDs.

Countries should prioritize the implementation of the most cost-effective population and individual level interventions to prevent NCDs, some of which are in fact cost saving, to ensure they are getting the best value for money from existing expenditure. These interventions should be the priority for new spending on NCD prevention and control.

A renewed commitment to full implementation of the FCTC is essential to prevent a huge burden of suffering and many millions of premature deaths among working age people.

Countries should honour their commitment not just to full implementation nationally, but to international cooperation to support low-income countries to implement the FCTC.

Countries should continue to strengthen NCD surveillance and monitoring to inform and guide NCD policy and action at both national and international levels.

The health system response to NCDs must be fully integrated with programmes that address other key health issues, to ensure that services are delivered around the needs of the people who use them. Access to high-quality and affordable essential medicines is an essential component, and the implantation of programmes to deliver them effectively in low resource settings.

The outcome document for the High-level Meeting must have clear objectives and measurable indicators, supported by a monitoring and evaluation function, to support national accountability for scaling up NCD prevention and control. Civil society organizations should play a role in independently monitoring and reporting on progress.

It is essential the Heads of State and Government attend the High-level Meeting, to ensure that there is the high-level political commitment to scale up NCD prevention and control.

Countries should consider including NGOs on their delegations to the High-level Meeting, as they can bring technical expertise, can help to mobilize political support, and will be essential actors in implementing the agreed outcomes of the High-level Meeting.

Health workers are key to an effective national response to NCDS, but many are not trained to prevent, detect and manage NCDs. Training curricula should be reviewed to ensure that health workers receive relevant training in both NCD prevention and control.

Governments should look to tobacco taxation as a key way of raising revenue to prevent and control NCDs – in addition, this is a highly effective way to reduce smoking rates, particularly among young people.

DMAI – The Population Health Improvement Alliance asks you to attend the UN Summit and in person and make this a high priority for the Ministry of Health & Family Welfare . We are also calling for the establishment of a NCDs partnership to lead multi- sectoral and coordinated action, and a UN Decade of Action on NCDs to implement the commitments governments will make at the UN Summit in New York

DMAI – The Population Health Improvement Alliance would be pleased to provide your office with any further information in preparation for the UN Summit.

NCDs have the power to affect us all. Increasingly NCD’s strike people in younger age groups, including children, threatening international economic progress. But we are not powerless.

We have achievable cost-effective solutions. We need political leadership now to make them a reality. Please be a champion for NCDs by attending the UN Summit in September and safeguard the health and prosperity of future generations in India

We sincerely hope that the country will take leadership and set an example for the world on how to manage chronic diseases through early interventions

DMAI – The Population Health Improvement Alliance Recommends that:

Indian government establishes an NGO-Private Healthcare Players – Government  Alliance . An  India NCDs Alliance , linked to WHO, to coordinate follow up action with member states, other UN and multilateral agencies, foundations, NGOs and private sector

  • We must look at enacting a Chronic Care bill 2011 in the parliament in the winter session that addresses this biggest healthcare challenge (NCD’s) .
  • Create a high level committee for creating an actionable plan for identification , enrolment and treatment of chronically ill populations or move them under a primary prevention plan for people at the risk of chronic diseases . This plan should be implemented on ground before end of this year
  • As written in my comprehensive healthcare reforms document  in 2009, we must set up a CDR ( Central Disease Registry ). Details available at www.dmai.org.in .
  • Come out with protocols for the treatment of chronic diseases
  • Come out with mandatory guidelines for work force wellness
  • Enforce child health guidelines in all primary schools & dietary guidelines . Please refer DMAI’s note on Healthy Foods & An Appeal at www.dmai.org.in for details
  • Include general & basic information on nutrition and physical activity in school curriculum from class VI onwards . Have a compulsory paper on health & Wellness for  class 10th exam for all educational boards in India
  • Adopt an open minded and outcome driven approach of roping in private healthcare players to improve preventive care & treatment of identified populations
  • Include preventive checks and health clubs ( Gyms & Yoga ) under tax benefits
  • Levy additional premium on insurance policies for smokers to dissuade them from smoking
  • Launch a nationwide campaign for creating awareness on avoiding and managing chronic diseases
  • Encourage and implement the use of mHealth for timely access & affordability

 Post my return from UN session , I had discussions with leading pharmaceutical companies as to how to get their support and involvement in this major pan India efforts. All the

Companies  I have talked to are willing to work with the government on the way  to address the issue of chronic diseases . I believe that we must involve the companies in our outreach efforts and form a long term partnership with the pharmaceutical companies

Finally , I must state that success will depend on the development of strategic partnerships, ensuring there are explicit and measurable targets, and governments providing the necessary political leadership. I would be grateful for your consideration of the following in order to ensure a successful Summit in September:

  • Support the strong participation of civil society in the Summit. We request that civil society representatives be included in the official government delegation to the Summit.
  • Invest in the consultation process leading up to the Summit to ensure that the meeting produces an outcomes document with strong recommendations and a concrete plan of international action, as outlined in the NCD Alliance 10 Outcomes Document Priorities. This should include:
  • Language on the NCD Alliance’s 10 Priority Outcomes, based on previously agreed upon language.
  • Acknowledgement of the health, social and economic burden of NCDs in the world, particularly in low- and middle-income countries.
  • An increase in international development funds and technical assistance to NCD prevention and control, including support for international instruments such as the Framework Convention on Tobacco control.
  • Measures that address the availability and affordability of quality medicines and technologies to ensure that people living with NCDs can access life-saving treatments.
  • Agreement to global accountability monitoring, reporting, and follow-up mechanisms.

DMAI – The Population Health Improvement Alliance is a not-for-profit organization formed by global healthcare leaders , and the only civil society organization in India dedicated to the management of chronic disease management in India .  In the past three years , DMAI has worked at both International level and within India to address the issue of chronic diseases with the support of  patient groups , Industry & policy makers , and wishes to put on record the continuous support DMAI has received from policy makers and the industry . We wish to expand this association further to address the issue of NCD’s together in form of a ‘PPPP’ – Profitable Private public partnerships .  I personally believe , that if the first “P” – Profit is missing from PPP We would just be restricted to pilot stage. We should not shy from adding the additional  “P” – Profits , so that the industry is incentivized to align its goals to government, and work together in a sustainable and profitable manner with performance that is measurable and with positive outcomes 

I think without profit , government cannot demand performance ; and without performance, private players should not expect profit . So profit has a pivotal role in the success of PPPP

To show our support for this summit , we have put the sub-theme ‘Management of Chronic Diseases using technology’ at the International Telemedicine Congress (www.telemedicon11.com ) that I am chairing from 11-13 November 2011 at Mumbai, India.

We would very much appreciate the opportunity to share perspectives on the meeting with you or one of your colleagues. At your earliest convenience, please let me know your availability in the coming weeks.

We look forward to your personal participation with a team of civil society organizations at the High-Level UN Summit in September, & I am sure that your thoughts will be really helpful for the summit and will set an example for others to follow . We wish you and the UN a successful summit .

Yours sincerely,

Rajendra Pratap Gupta

President & Member of the Board

Disease Management Association of India

Member – Healthcare , QCI. Government of India

P.N. : Details of the work done by DMAI in managing chronic diseases is available at the website www.dmai.org.in

Encl: Message at the UN delivered on 16th June 2011.

CC:

H.E. Ban Ki Moon, Secretary General , United Nations

H.E. Joseph Diess , President of the UN General Assembly

Hon’ble Deputy Secretary General of the UN General Assembly

Ms. Margaret Chan, Director General, WHO

Shri Ghulam Nabi Azad , Hon’ble Ministry of Health & Family Welfare, GOI

Dr.K. Srinath Reddy , President , PHFI

Minister of State for Health & Family Welfare , GOI

Dr.Syeda Hameed, Planning Commission , GOI

Shri K.Chandramouli, Secretary , H&FW , GOI

Board Of Directors , Disease Management Association of India – DMAI , The Population Health Improvement Alliance .

Address of the President of DMAI – The Population Health Improvement Alliance at the UN on 16th June 2011

Venue : UN General Assembly Hall , United Nations , New York.

Chaired by Mr. Joseph Deiss , President of the UN General Assembly .

Dear Friends ,

I am honored to be here , &  have few key points  for the special high level, two-day session that UN will convene in September 2011 for addressing the issue of chronic diseases.

I appreciate the point that UN session talks about local issues across regions . I would further suggest the United Nations that , if we want the governments to act on its recommendations , we must go beyond local i.e. get micro . My experience in public policy makes me believe that governments do appreciate and act on recommendations that are local but also focus on micro issues .

We have mega goals but  our actions have to be micro and we must suggest inputs that are local and at  micro level,  for execution.

Also, let us  accept the fact that for this generation , we are late, and we have already missed the bus . What I would not like is, that our next generation sits in the same UN General Assembly hall after 40 years , and discusses the same issues related to chronic diseases , and says that ‘our earlier generation behaved irresponsibly and did nothing for us ! ’. So the time has come for us to distinguish the ‘Urgent’ & ‘Important’ . Urgent is that we must fix the issues related to the chronic diseases now , but it is more Important  that we plan to build a healthier next generation . So my expectation from the UN is,  that  there will be a dedicated session related to Child health at the UN General Assembly in September .

Also that,  the technology is becoming all-pervasive and we must use this UN session to promote the use of  mHealth to address the issue of chronic diseases . I am expecting that the UN general assembly will dedicate a session to mHealth, and how it can help in the delivery of care for chronic diseases.

Lastly , I would like to run a quick survey on ABCDE of  Chronic Diseases / Healthcare . Where,  A stands for – Asthma/ Arthritis , B stands for Blood Pressure , C stands for CVD / Cancer , D stands for Diabetes & E stands for Epilepsy / Elderly patients ( as 84 % of all the elderly patients are on one or more medications)

If anyone of you or your immediate family members have any of these ABCDE , please raise hands .

The response is unbelievable ! I have made a point . It is not about the 5 or 10 % prevalence rate of chronic diseases. We have just now had the visual proof of the prevalence of chronic diseases , and it is much higher than the figures that we read often .

It’s time to act now .

Thank you.

Rajendra Pratap Gupta

Recording of the speech is available at www.un.org/webcasts