Category: Uncategorized

UID & PDS – Will wipe out each other’s value proposition


I have been seeing that there is a lot of Hype & Hoopla around the fact that UID will weed out corruption , and that the poor will get their share of monthly grain & Kerosene quota

Let’s examine some hard facts :

PDS system runs on corruption , systemic loot and  injustice to the needy card holders. Else, why will a person take a ration shop and run it for distributing sub-standard grains to the poor with so low a margin!!

The margins are barely anything to even recover the rents & other incidental costs !! It is like the fuel stations around the country, the margin of  Rs.1.22 per litre of petrol and .64 Rupee on a litre of diesel is barely anything to cover the bribes to inspection authorities , rents and salaries ( few fuel pumps could be an exemption !! ). But most of the fuel stations run on ‘Adulteration’ & ‘Lesser quantities’ dispensed per every litre of fuel.

So UID has a value proposition which will make the business of PDS ( Ration shops ) business unviable for its licensees.  So while the poor will have UID card , but no shops to dispense the ration !! I am not mentioning about electricity in rural India etc.etc…for reading the UID card and other related issues w.r.t implementation

Also , UID on paper is very good. Believe me,  that about 300 million people in India still think that Indira Gandhi is the Prime Minister of the country !! The reason i write this is, because , parts of our country still live in 1847 ( grossly neglected ), parts live in 1947 ( plans on paper ) and about 300 Million live in 2000 ( have had an impact of ‘time bound’ growth ).

For people who don’t have shelter to sleep , clothes to wear , where will they keep the UID Card ? What will they understand of UID when they cannot even read and write , & when they know that ‘Government establishment’ is meant for either the people in government service or the corrupt !! One must study the ‘High tech’ ideas before taking it to the people who barely have 5-6 meals per week !! Remember , 7000 children die every day due to malnutrition in India

We must also understand that corruption never started because of lack of technology , but because of wrong leadership at the top,  absence of a feedback mechanism & corrupt machinery at all levels, that has never taken action . So i believe that, the powerful people in the rural India will mislead the poor and keep their UID cards or the poor will spoil them due to mishandling of the cards . Also , UID does not have the techniques to turn stock hoarders and swindlers into honest PDS contractors !! Either the rot will continue after the UID or will wipe out the PDS shops by making them non-lucrative businesses .

Time to address the real issues. UID is a good idea , whose time is yet to come !!

Rajendra Pratap Gupta

Email : office@rajendragupta.in

Wrong Economic priorities ,lop sided growth & flawed statistics


This is the follow up blog on my views dated 15th June 2010 & 27th June 2010 on the topic of “High GDP but low GDP per capita”.
Focussing on statistics , in April-May 2010, IIP witnessed a decent growth of 14 % but this did not cover some vital sectors . Only one sector , machinery and equipment , alone contributed 37 % to this high growth.  Transport equipment , metal products and mining contributed another 32 % to IIP growth. This implies that around 70 % growth of IIP was a result of high growth in just 4 out of a total of 19 sectors . Also , that these growth rates have an important factor ‘Low base effect’ . Like manufacturing sector achieved one of the highest growth rates of 19.4 % in April 2010 over a low base of 0.4 % in 2009. Similarly,  Capital goods sector’s high growth of 72.8% in April 2010 was over  a negative base of 6 % in 2009.
Time to balance out. Else , we will blame Greece, Italy , Europe , China , poor rainfall etc. Etc. for all our ills, forgetting that we never looked at “REAL India” for growth
Get the priorities right and actions STRAIGHT
BJP must be focussed more on right issues than routine struggles !!
Rajendra Pratap Gupta
Email : office@rajendragupta.in

National Council for Human Resources in Health -NCHRH


Date : June 30th , 2010.

Mr. Debasish Panda

Joint Secretary

Ministry of Health & Family Welfare

Government of India

Nirman Bhawan , New Delhi 110108

Ref: D.O. V.11025/10/2009-ME(P-1) dated 8th June 2010

Dear Mr.Panda,

Thanks for the invite for the regional consultation on NCHRH . Unfortunately,  I could not attend the meeting at Mumbai on 18th June due to a prior commitment at Bangalore for the India Innovation Summit on the same date.

I had sent you an email on the NCHRH with two recommendations. Since then, I have dwelled on the issue at length and wish to submit some recommendations for your kind consideration

Before I start on the specific recommendations, let us consider a few important points that need to be kept in mind for the National Council for Human Resources for Health – NCHRH

  • India has 1.2 Billion population out of which about 1/3rd is illiterate population
  • In the next 10 years, India will add 120 million people in the working age category
  • Currently, India has about 2/3rd of the population below 35 years in age
  • Currently , 2/3rd of India lives in rural India and probably, in that category, healthcare does not figure in the list of priorities
  • 2/3rd of India does not have adequate access to healthcare
  • Awareness and sensitization about healthcare is missing . People will go and splurge money on dining outside , but will not spend a fraction in wellness .
  • India believes more on religion , spirituality and charity than wellness
  • Healthcare professionals  available are not willing to work in the so called rural India . At max, they are willing to work in semi urban India
  • The incidence of diseases is not vastly different in rural India from that of urban India for most of the ailments
  • Status of urban poor is deplorable when it comes to healthcare
  • PPP’s in healthcare are not going to work in rural India
  • Those who study for healthcare in urban areas, majority of them are not willing to adjust to the rural lifestyle for professional or family reasons . Gives us a reason to think to start medical colleges in rural settings !!
  • The entire healthcare system is focused on medicine , doctors, clinics and hospitals etc. This has created a fear & suspicion amongst the healthcare users that healthcare means pills, surgery and hospitalization
  • New models of care are evolving for addressing the changing disease patterns and Indian healthcare system is ill prepared to handle the same
  • Time has come to take health ( not medical ! ) education from medical school to primary school. Basic healthcare education should be made compulsory at the school level.
  • 3G has now become a reality , so  mHealth will not just re-define the healthcare delivery but also healthcare education

In short , I would say that , the world over , no healthcare system has answers for our problems, as all the systems are already failed or heading towards a collapse . This provides a unique challenge and an

opportunity to build a robust healthcare system for India that is low cost,  agile ,  protocol driven, and evidence based and not eminence based system; one that avoids errors , trails and wastage . Then only we can have an outcome driven health system that cares !

Here is what I submit for your kind consideration :

NCHRH ( National Council for Human Resources for Health ) has been set up with the goals to overcome the acute shortage and uneven distribution of human resources in public health delivery system & aims at overhauling the current regulatory framework. Toward this end, it is proposed to set up a National Council

for Human Resources for Health as an overarching regulatory body to achieve the objective of enhancing the supply of skilled personnel in the health sector

What I can understand  from the above stated purpose for NCHRH  is that NCHRH will ;

  • Regulate the current set up
  • Identify the current need gap
  • Project the future requirement for the next 10, 20 & 30 years
  • Asses the population mix and the disease patterns and address the issues in a proactive manner
  • Create a resource pool & knowledge pool ( not just impart knowledge but create it as well )
  • Human resources for disaster management in healthcare is missing from the draft that I have gone through . It needs to be incorporated

Health in India has to be looked regionally and planned at the district level: It would be wrong to just limit it to five members headed by a chairman. I would suggest that you must create an “Indian Health & Wellness Service (IHWS )” for the entire nation on the lines of IAS . Today , if I have to complain against deficiency of healthcare services or standards or care at a hospital, there is no grievance redressal mechanism !! Because the system is ambiguous and there is no demarcation for people to look at health and wellness services. For erring police , I can go to SP City , DIG –Range or IGP or the DGP; for an erring postman , I can go to the Post master general etc., and the same for most of the services ; but if there is a deficiency in a hospital service provider where does a common man go ? Another hospital, I suppose !!

So when you are planning for NCHRH , You must consider having an all India service to tackle the multi headed monster called healthcare.

Have separate members in NCHRH, each having a clear role and responsibility for capacity building for the following :

  1. Urban Health
  2. Rural Health
  3. Tribal Health
  4. Health in hilly areas
  5. Health in Armed forces
  6. Health for retired government employees
  7. Health for private sector
  8. Work Place wellness
  9. Healthcare amongst Minorities
  10. Expatriates working in India
  11. Geriatric care in urban & rural health should be handled separately by different members
  12. Split ‘Mother and Child care’ under separate heads, each under a separate member . It is glaring to note that According to International Institute of Population Sciences , Mumbai , 56 % of the Indian women in the age group of 15-49 suffer from anemia
  13. Diabetes
  14. Hypertension
  15. Arthritis
  16. Cancer
  17. Epilepsy
  18. Mental Health
  19. Telehealth should be a strong focus area for Urban & rural health. It should also be a part of the Medical curriculum and a 3 month internship should be made mandatory for telehealth
  20. Medical Education
  21. Home health & care technicians
  22. Healthcare counselors and Physiotherapists
  23. Health administrators for clinics , hospitals other wellness providers
  24. Gyms & Wellness centers
  25. Diet and Nutrition
  26. Acute care
  27. Immunization
  28. Awareness & Education about wellness
  29. Awareness & Education about diseases
  30. NGO’s capacity building
  31. Disaster management in healthcare including outbreaks & epidemics
  32. Epidemiology & research on regional requirements . One example I will quote here. In north eastern part of India , in tea gardens , people take black ( known as red tea in NE ) with salt and so there is a very high incidence of Hypertension and stroke . Same applies to other belts in India which have very specific requirements that cannot be tackled with centralized planning and execution
  33. Technical up-gradation & training of the workforce on latest developments in equipments and technology
  34. CME for each level of workforce
  35. Nurses should be renamed as Physician’s Assistant (PA’s ) or Health & Wellness Officer (HWO’s ) . There should be a plan to create enough specialized resources under this head for rural health, geriatric care , telehealth , chronic diseases etc.  We need not make our healthcare system doctor & hospital centric . The number of PA’s / HWO’s should at least be double of that of the doctors in the next 10 years
  36. For medical education ( all streams ),  behavioral psychology should be added in the curriculum . This is one of the most important change that we need in the medical curriculum . Doctors have just been reduced to diagnosis & prescription machines . Whilst we might be imparting the best of medical knowledge, but  patient care and handling is missing totally from the curriculum . Writing prescriptions does not deliver care . Patient friendly care is a must . Because of the lack of understanding of the behavioral  psychology amongst doctors , the patients fear and suspect the doctors . Even the doctors do not go beyond prescriptions !! This needs an immediate change to ensure compliance and outcome from the treatment , most importantly, regain ‘Trust’ in the system by the users
  37. Put a separate head for innovation in healthcare education
  38. Separate head for guidelines, standards , treatment protocols , assessment & accreditation for each aspect of medical & health education and research

Further , each member should be responsible for research , planning &  execution for his department. It is clear that if we do not plan for human resources , it will not just lead to deficiency in healthcare services but also increase the cost of healthcare . Limited number of healthcare professionals would be available for jobs and that will definitely lead to unrealistic inflation of salaries amongst health professionals

Since this note is about the healthcare in the country , I would also like to add that, we must look at setting up a TAB ( Technology Adoption Board ). India must not import technologies simply because GE / Siemens have

produced it and it is the latest. Technology is one of the major cost drivers for healthcare . TAB must  ensure that the technologies that have demonstrated  positive impact on the treatment compared to its cost and accuracy of diagnosis should only be allowed in practice . In 2007  , a 64 slice CT Scan  was the most advanced , now it is 914 slide CT scan . The question is what is the difference in cost and accuracy of diagnosis compared to the earlier versions ?

Also, MOHFW should set up ICE – Insitute of Clinical Excellence to formulate and work on clinical pathways & protocol based treatment for all major illnesses , so that the doctors do not resort to expensive and arbitrary line of treatment at the cost & care of patient . A protocol based treatment would let all the stake holders in the continuum of care to work in close coordination

Also, the time has come to move to a greener healthcare system. I hope that we will learn from the MEA ( Ministry of External Affairs ). When you apply for a passport , the passport office gives you two or three receipts , one for the passport application fees, second for jumbo passport ( if you opt for ) and a third one for tatkal category ( if you fall under that category) . I fail to understand that, would it not be better to have one receipt with multiple options for ticking !!  It wastes paper , ink and generates three times the heat and noise printing three receipts . MOHFW needs to ensure that we move to a Mobile Health Record system (MHR ) that does not depend on paper . Mobile phones could carry all the records, and more so , when most of the people are likely to carry mobiles. Providers could sync all the medical records with SIM cards. But the success of this depends on the will of the policy makers, honesty and efficiency of implementers ( bureaucrats ) and literacy amongst users

Lastly, it is high time to check migration of our best brains & highly skilled manpower. We can build six AIIMS like buildings, but building institutions will be an onerous task in the current scheme of things, and this could well be the first test for NCHRH.

With some good leaders at the helm of affairs in healthcare , I am quite confident of the changes in healthcare for the benefit of the common man

I do hope that the recommendations are of some help. Incase, you need some clarifications or assistance , I remain at your disposal .

With best wishes

Rajendra Pratap Gupta

Email : President@dmai.org.in

C.C.-

Shri Ghulam Nabi Azad, Union Minister for Health  Family Welfare, Govt. of India

Dr.Syeda Hameed, Member , Planning Commission , Government of India

Shri Dinesh Trivedi, Minister of State for Health , Government of India

Sam Pitroda, Advisor , Prime Minister of India & Chairman, National Knowledge Commission .

Ms.K.Sujatha Rao, Health Secretary, MOHFW, Govt. of India

Dr.K.Srinath Reddy, President , PHFI, Government of India

Dr.Murli Manohar Joshi, MP.

Mrs.Sonia Gandhi , Chairperson ,NAC , UPA.

Rahul Gandhi

Dr.Sharat Chauhan, csharat@ias.nic.in / rshankar50@hotmail.com

Dr.Gautam Sen

Dr.Devi Shetty

Encl: note on healthcare reforms sent on 23rd November 2009.

Rich get richer and poor get poorer in India – GDP statistics


On 15th June , i wrote on my blog about the topic ‘ High GDP but low GDP per capita’ is like growth without progress and prosperity . Well, i did not know that 11 days after the blog a report would come out that would validate my analysis . Here is the report

According to the 2009 Asia Pacific wealth report , by Capegemini and Merrill Lynch wealth management , India’s high net worth Individuals ( HWNI’s ) are 120,000 ( 0.01 % ) but their combined net worth is close to one third of the India’s GDP

At the peak of recession ,in 2008, India had 84000 HNWI’s with a combined net worth of $310 billion . To put that figure in perspective , it was just under a third of India’s market capitalization , that is, the total value of all companies listed on the Bombay Stock Exchange – as of end March 2008. The average worth of each HNWI was Rs.16.6 crore .

According to the firm’s 2010 World Wealth Report , India now has 126,700 HNWI’s , an increase of over 50 % over the 2008 number . In 2009 alone , an estimated 13.6 million more people in India became poor or remained in poverty than would have been the case had the 2008 growth rates continued , according to the United Nations Department of Economic and Social Affairs ( UNDESA ). Also, an estimated 33.6 million more people in India became poor or remained in poverty over 2008 and 2009 than would have been poor has the pre-crisis (2004-7 ) growth rates been maintained .

I keep saying that recession or growth that we keep reading in the Times of India or The Economic Times , is only affecting people who read these newspapers. Rest all live under abject poverty .

Read the presentation that i made at the 6th India Innovation Summit on 18th June 2010 at Bangalore . You will see that our demographic dividend is fast becoming demographic disaster !! ( Download the presentation from http://www.rajendra.groupsite.com )

Rajendra Pratap Gupta

Email : office@rajendragupta.in

Dr.Bamboo – Tall & impressive but hollow – Dr.Manmohan Singh


I think , Dr. Manmohan Singh is like a Bamboo . Tall & Impressive in stature , but hollow .

See what he is doing  ? All across, the country is failing but his image continues to be a hit !

China has decided to do a nuclear deal with our Pakistan ! India has failed to check it

America is not as friendly with India , as it is with Pakistan

Inflation is going up and the government is clueless

Naxalites control 1/6th of India

This government is a failed government and BJP is not reining in the government ! I fail to understand why BJP is not addressing the important issues !!

Dr. Manmohan Singh is the Bamboo Prime Minister !! Time to raise voice and get the right issues addressed

Rajendra Pratap Gupta

Email : office@rajendragupta.in

Leading Effective Action Against Diabetes- LEAD


Join the fight against Diabetes. The campaign will focus on

1. Awareness

2. Education

3. Action

Lead will work at three levels A) Consumers  B) Communities C ) Doctors

Please visit http://www.dmai.org.in for more updates

The campaign will be driven under the leadership of Ms. Sangeeta Barde Email : sangeeta.barde@dmai.org.in or lead@dmai.org.in

India & China : New Super power and the next crisis state


India and China are headed for a new challenge . India has all the ingredients to qualify as the next super power . Unlike the US , Which has arrogated for itself the ‘Big brother’ status , and almost failed as a ‘Responsible super power’. China might have a big ‘Trade Surplus’ but has a huge  ‘Credibility deficit’. With no other credible alternative , it is for sure,  that India can work towards being the next ‘Responsible Super power’ by 2025

China is on the way to be become the victim of the ‘economic crisis’ that has already hit the USA & Europe, and for sure , now its China’s turn !!

Wait and watch

Rajendra Pratap Gupta

Email : office@rajendragupta.in

Pakistan , Pakistan Spy’s & Indian Fatwa’s


It is an established fact that,  Pakistan does not use funds that it seeks from US for the purpose that they are given. The funds are used for funding terror in India ,U.K. & the U.S.

It Is the right time that India asks for foreign observers ( Including and Indian representation ) to oversee and audit the use of any foreign fund in Pakistan

Also , we have seen two cases of Pakistan setting its strong hold in the Indian armed forces . We have just caught two of them ( Mrs. Gupta & Mr. Prasad ). I believe that there might be 100’s of such Pakistani moles within the Indian establishment and not just in forces and bureaucracy but also beyond . Time to act fast . Kargil , i believe , happened due to such a nexus !!

Also, over the last few weeks , i have see a lot of Fatwa’s issued by non-judicial entities . Why is our ‘Supreme’ court not taking a Suo moto action ?  It should be made a rule that no religious entity can issue any FATWA or order that goes against the fundamental rights enshrined in our constitution and the laws of the land . If anyone dares to do that , he or she must be tried for challenging the law of the land !!

Rajendra Pratap Gupta

Email : office@rajendragupta.in

Demystifying the Congress Report card


Clueless government

The 3G auction was expected to raise about Rs.32000.00 crore and it raised about Rs.69000.00 crore !! Normally , the statistical error is expected to be + or – 5 % , and that is the standard accepted level of error. If the government’s projections were left behind by a whopping 100 % , what do you call such a government ? Pranab da can rejoice , but not because of his colleagues or his planning !!

Same happens for inflation : Since the UPA government has taken over in May 2009, the inflation has touched double digits , Government talks like an astrologer that the inflation will come down in the next 6 months ( and this has been the talk for the last one year !! ). It does not tell why and how will the inflation come down ? Also, what is the government doing to bring the inflation down ? The government is heavily depending upon the divine intervention ( rain God’s ). When government launched the Maoist offensive , it was clueless that the entire battalion would be wiped off !! It just expressed its regrets !!

All this goof up when our PM is an Economist from Oxford, Home Minister from Harvard and Montek from World Bank  + we have a lot of professors from Cornell etc. ……………….All theory and no practicality !!

Education reforms : How many people in India actually use or even remember the knowledge of what they study from 10th class till their graduation ? I for sure , did not use my B.Sc degree ( except that for some weird reasons , since graduation was the basic requirement , i have done both the B.Sc and B.A. (Hon’s, Social Sciences ) and even M.A. Prev !! ). I talked to a good number of my ‘well placed’ friends, and they had the same response . That that qualifications did not matter or help them professionally . Majority of the Indian population study for the sake of getting degrees which finally , makes them either ‘highly qualified’ or ‘not with relevant experience’ category . We must look at mapping the ‘Knowledge gaps’ and ‘Skill gaps’ and then do the reforms in education . We are just manufacturing Degree holders and not creating any knowledge pool that has monetary value . Some degrees in graduation should be scrapped totally . We are wasting our time & killing our talent !! Time to understand what India needs ? In most of the company boards i sit , i find that my CEO / M.D. is not able to find the right ( competent ) talent at the lowest level for the job ? Because of this , all major companies lose out . On one side , we talk about unemployment and over a billion population , and on the other side , we are having acute shortage of skilled manpower ? Do we need educational reforms or ‘Skill development programs’ ? Countries like Finland , Israel etc with just a population between 5 to 7 million have more productivity per capita (PPC – sorry if you did not hear this word before !! I coined it in Indian  context ) than India . Unless , India addresses PPC in education reforms , churning out more degrees holders will just add to ‘Educated Naxalites’ in the next 5 years

Demystifying BPL or the Below Poverty line : According to Suresh Tendulkar committee report , poverty line for the rural areas is Rs. 15 and Rs. 19 in Urban areas. Whereas , according to Arjun Das Gupta , any one earning less than Rs. 20 per day falls below the poverty line ( Please correct me for my lack of knowledge ) What can you get in Rs. 20 per day per person ( Tea one cup Rs. 2 , Lunch Rs 10 , Tea evening Rs. 2 Dinner Rs. 10 ) This is the cheapest meal option ( Though ,i still have to find a stall that can serve you such cheap meals ).

Also , with this , i must highlight the following daily requirements:

1. Breakfast – 5 Rs.

2. Lunch – 10 Rs.

3. Evening tea and something to eat – 5 Rs.

4. Dinner – 10 Rs.

5. Clean water to drink , and taking care of the basic hygienic – 2 Rs.

6. Clothes to wear with washing Rs. 5 Per day ( atleast 1500 per year – two sets of an upper garment and an under garment and daily washing will need a minimum earning of Rs. 5 day )

7. Healthcare & Savings for unforeseen contingencies ( Rs. 5 per day )

8. Travel for going to take meals or get to work for earning the daily subsistence is not accounted for

9. Shelter to sleep, with bed sheet and seasonal clothing for winter and rain – 5 Rs / day

So, one needs atleast Rs. 37-50 per day to stay alive on the basics necessities of life On what basis the government calculates the PBL .

I think what C.K. Prahalad mentioned as the ‘Fortune at the bottom of pyramid ‘ , i will phrase it as ‘Unfortunate at the bottom of Pyramid’. The government’s basic responsibility is to create ‘Fortunate at the bottom of the pyramid, and than think of Fortunate and the fortune at the bottom of the Pyramid ‘

Our current Prime Minister is a typical case of good brand and poor performance !!

Time to think practically, and work more Dr.Singh  !!

Rajendra Pratap Gupta

Email: office@rajendragupta.in

Pakistan is a Schizophrenic Nation


Via Email with CC to Rahul Gandhi , Dr.Murli Manohar Joshi & Sonia Gandhi

Dr. Manmohan Singh

Prime Minister

Government of India

New Delhi 110001

Dear Dr.Singh,

This has reference to your initiative of the talks with Pakistan

It is a good thing that the talks will resume . The bigger question is , if this is good for something or good for nothing ?

Put three pre-conditions for the talks to start

  1. 1. Handover Dawood Ibrahim
  2. 2. Maulana Masood Azhar, Jaish-e-Mohammad leader
  3. 3. Hafiz Mohammad Saeed (LeT)

If Pakistan is sincere , it will hand over these three terrorists or else , it will continue its talk , shoot & blame the Taliban policy . And one fine day , we will be shocked to see that Pak nukes will be used against India and we might be wiped out of the map !! Pakistan will just blame the same on Taliban  and express regrets . Above mentioned three Pakistan agents cum terrorists are the key to end Taliban and its activities, and anything less than these three terrorists being handed over to India is a compromise with the security of Indians and underplaying the nuisance value of  Pakistan in future

Please do not take Pakistan on face value . You cannot expect a habitual offender to reform with just a dialogue . Pakistan is a schizophrenic nation

Diplomacy does not work with Pakistan . History has repeated and defeated itself when it comes to Pakistan

Take Pakistan seriously to avoid more troubles . I hope that you might not like to defend another 26/11 in the times ahead .

With best regards

Rajendra

Rajendra Pratap Gupta

President

Countryfirst

Email:  President@countryfirst.org