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 8^th June 2011; I am connecting with you on my return from the UN session on NCD’s

On 16^th 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 10^th 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 16^th 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 16^th 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

Post Pone FDI in retail for another five years

Prime Minister Dr. Singh,

Yesterday , I attended the meeting of CAIT ( Confederation of all India Traders ), I felt really bad seeing the plight of the traders, and the hell they would be subjected to , should FDI be allowed in India at this point .

Over the last few months, you have rallied all associated departments and ministries to build a case for FDI in retail. I feel sad that you & your government have ignored the fact , that FDI in retail at this juncture will put a big question mark on the means of livelihoods of over a Crore traders in the country .

I have seen that you / your government has been saying that inflation will come down as Wal-Mart , Carrefour , Tesco’s of the world come to India ( Wal-Mart has already come in few years ago ! ).

Prime Minister , remember, that Inflation has not come down despite Wal-Mart being in India . Your government’s logic that supply chain will get strengthened and prices will fall is fallacious . FDI in retail is a wrong justification for strengthening the supply chain , as FDI in supply chain is already allowed, and a lot of wholesalers are already around and more can come in without needing FDI – Why are you fooling around Manmohan ji ? How low will you stoop now to push to agenda of foreigners !!

Even those who are operating Cash & Carry business , are issuing cards to individuals to buy from them, thereby , stabbing the small retailers . Shut down Cash & Carry immediately after a proper investigation . I go to Sam’s Club in the US ( For your information , Sam’s Club is Wal-Mart’s Cash & Carry Venture in the US). Anyone can buy a card for USD 40 and start buying from Sam’s Club. I have gone twice with my friends to Sam’s club and brought goods from the store , my friends are not retailers , but Indian professionals working in the US . So when these retailers do the same in India , what will we do ???

Your government has failed to understand the cause of inflation , and firstly , you said that recession caused inflation ; then recession got over but inflation did not come down. Then you said that irregular and deficient rainfalls are the cause of inflation. Last year , we had good rains and inflation still did not come down. Realizing that there was no answer with your US educated ( read brain washed ) consultants ( Rajan ,Montek, Kaushik & Sam ) , your government said that inflation was due to high growth and it would continue . Study our next door neighbor – China . They have had high growth with less than 5 % inflation !! All your predictions have failed !!

Also remember dear economist, that ‘inflation is reversible but FDI is not’ . What I mean to say is that , when BJP comes to power, it will bring down inflation , but if you permit FDI ( As your government is hell bent on it ) , we will not be able to reverse FDI . So think before -hand !! Don’t jump like the nuclear deal & do another fiasco !!

Sonia Ji is shouting aloud on NAC podium for poor people on one side, and on the other side , both of you have already done a deal with major international retailers , and are hell bent on cracking the back bone of small retailers by allowing FDI

Government has a flawed policy with regards to FDI, as you are saying that you will allow FDI in top 35 towns to start with. This goes contrary to strengthening the supply chain. If you really want to strengthen the supply chain then please ask this big giants to start retail in ‘C’ class towns and then come to B & A class towns !!

Your statement that farmers will get better value because of FDI in retail : Wal-Mart’s of the world are known for extracting even the ‘blood’ of suppliers !! Their labor policy record needs to be closely examined , and how many times they have been fined !

Also, Wal-Mart is failure in Japan ( social dumping & doubts about its quality ) , Korea ( Wal– Mart failed to understand local customers) , Brazil ( Lack of understanding about local culture ) & Germany ( due to cultural insensitivity ) .

I am producing an excerpt from a report

‘Walmartization does not travel well’ Clearly, neither Wal-Mart’s business concept nor its social dumping – the so-called Walmartization – work in developed economies with a social dimension. Many consumers shun the Bentonville giant and prefer to do their shopping in stores where they know that workers are treated correctly and with dignity. There is also more and more uneasiness and suspicion about many of the products sold. Squeezing the last drop from suppliers can hardly promote safety and quality. There is also a growing aversion against buying, consuming and using products which could well have been made under inhuman conditions. That the tide is fast turning against Wal-Mart at home has not gone unnoticed abroad. Consumers start to know that the retail giant denies its American workers their fundamental rights, and many of them vote with their legs, going to other stores if they have a choice. The poor business results in Germany, Korea and Japan should be taken seriously in Bentonville

Another report : This article appears in the November 21, 2003 issue of Executive Intelligence Review. Wal-Mart Collapses U.S. Cities and Towns by Richard Freeman

During the last 20 years, Wal-Mart has moved into communities and destroyed them, wiping out stores, slashing the tax base, and turning downtown areas into ghost-towns. This is accomplished through Wal-Mart’s policy of paying workers below subsistence wages, and importing goods that have been produced under slave-labor conditions overseas. Often, communities will even give Wal-Mart tax incentives, for the right to be destroyed. Wal-Mart both reflects, and is, a major driving force for America’s deadly implementation of the Imperial Rome model. Unable to produce physical goods to sustain its own existence, the United States, like Rome, sucks in imported goods from around the world, using, in this case, a dollar that is over-valued by 50-60%. America has been transformed from a producer to a consumer society.

I believe that Wal-Mart destroyed American Economy and now it is here to kill ours !! Also, since we know that Wal-Mart is a failure in four countries , please produce a report on those four countries .

Also, let us examine that how many small mom & pop stores have shut down with the advent of Wal-Mart in the United States ? Similar study we must do in China .

Let me also tell you why Biyani’s & Ambani’s of the world are wanting FDI ?

Let me ask these retailers one question ? If the retail trade is so good and profitable , why they have the problem in raising money , investing and growing their business – why do they need foreign investment ? The talk that these MNC retailers bring latest technology is also misleading , as Indian retailers are working in a different environment and all foreign CEO’s have been an utter failure so far in India . You can see the example of Reliance Retail ; How many CEO’s have been brought from outside India in the last four years ? I understand that recently a new CEO was hired from Wal-Mart China !! These traders are actually looking at exiting the business by selling their business to these multinationals to make a quick buck !! That’s the real reason they need FDI .

Once FDI comes , farmers will cry for a good deal and Wal-Mart would never give them a fair deal . On one side , farmers are forced to sell land and other side whatever is left with land & cultivation , they would be forced to sell to these MNC chains at a wafer thin margin .

Congress is a killer party for the poor !! Prime Minister Singh , where is your plan to upgrade the current Kirana stores ? Why are you not excited with their welfare . Give them FDI ( Finance from domestic institutions ) , and provide them training .

I call upon Shri Nitin Gadkari , President BJP to stand behind these standalone Kirana store and oppose FDI . We should post pone FDI for another five years and then revisit the issue. A massive peaceful agitation is called for to stop FDI in Retail for the next five years .

Mail is marked to Montek, Raj Jain of Wal-Mart , CAIT and all leading retailers & political parties in India

A Common Man

Rajendra Pratap Gupta

http://www.rajendragupta.wordpress.com

Lame duck PM ? Not at all, a duck cannot fly but at least ruffles its feathers to keep afloat

Dear Dr. Singh ,

I read your statement made at the press conference today, that you are not a Lame duck PM. Well, Lame Duck is too generous a word to describe you !! A lame duck will at least ruffle its feathers , you don’t even do that !!

Let me walk you through your years as a PM. What have you done to this nation ?

Share market collapsed

Oil Prices have hit through the pocket of the common man and he is struggling to make two ends meet

You defended CWG and created a massive scam of the games

There was a wheat export scam ………….

You defended A. Raja and gave him a clean chit , and finally created scam out of telecom airwaves auctions which is so far the biggest in history

Finance minister’s office was under the influence of spies and you did nothing compromising heavily with the security of the nation

Somali pirates are operating on our border

Fiscal deficit has not been addressed

Your ministers have no understanding of the collective responsibility and your party and government speaks different language

NAC is operating as a super body and the office of the PM has been denigrated to its lowest level since independence

You blamed inflation on poor rain , then recession and finally on growth !! Do you think that the opposition and public does not know economics and politics ??

You are pushing for FDI in retail , which will create mass social unrest in the country and will be the biggest mistake for this nation , as it will endanger the livelihoods of over 12 million families directly, and more indirectly .

For inflation , your government has been giving deadlines to control it every 2-3 months , and missing it every time . The Reserve Bank of India’s (RBI) original inflation estimate for fiscal 2011, made in April 2010, was 5.5%. After two revisions, the latest being in March, it was raised to 8%.The annual average inflation figure for fiscal 2011 now works out to 9.43%, the highest since 1995, and it could be even higher when provisional figures of February and March are revised. You are clueless about measures to control inflation , as Chidambaram once expressed .

A government in power , if it makes statements and repeatedly fail , you are misrepresenting the facts and misleading the nation . It calls for a serious action against the government & its leadership

Now let’s talk of the biggest deal of your lifetime – Nuclear deal : Here is the truth : There is no blanket waiver from NSG.

During the more than three-year-long process to finalize the terms of the nuclear deal with the US, you kept meretriciously reassuring the nation that he would operationalize the deal only after securing a broad political consensus in support. you even pledged: “Once the process is over, I will bring it before Parliament and abide by the House.” Yet, you completely bypassed Parliament. And instead of any attempt at consensus building, the country witnessed a polarizing single-mindedness to clinch the deal at any cost.

Now, with several of your key assurances to the nation falling by the wayside, the nuclear chickens have come home to roost. The Nuclear Suppliers Group’s (NSG’s) new ban on enrichment and reprocessing (ENR) equipment transfers fulfils one of the last remaining conditions of US’ Hyde Act, highlighting the rising costs for India of a deal whose much-trumpeted benefits are likely to remain elusive. India also has ended up without a legally binding fuel supply guarantee, despite its bitter experience over the US-built Tarapur plant. And it has secured no right to take corrective measures even if the US again unilaterally terminates cooperation, as did in the 1970s.

That NSG granted India a clean, unrestricted waiver in 2008 is a myth the politically besieged government created to save face in public. In truth, it had signaled to the US earlier that it could live with a conditional waiver as long as the conditions were not embarrassingly conspicuous. Indian diplomacy sought to ensure that prohibitions on nuclear testing and ENR transfers remained implicit, or else you would stand exposed at home……..So Dr. Singh , what are you going to say now?

Mr. Manmohan Singh , you have cheated the nation on every issue , and you had the audacity to say today in the press meet that Sonia Gandhi is the Super president for over 15 years ? Actually , she has been the super Prime Minister ! Sonia has brought down congress to its knees, and now this selfish lady is gambling by sending her son , a political novice with Gandhi brand as a fake youth icon to win UP & 2014 Elections !! Sonia needs to understand India a little better .

As a Congress President, she has brought this 125 year old party to its lowest ebb. PM , you have fooled the nation that you drove the reform in 1980’s, it was actually P.V.Narasimha Rao and not you. So actually , your performance speaks for itself .

Your own General Secretary have no faith in your leadership and are so frustrated with your performance and leadership that they are proposing Rahul as PM , When he has not even managed a state , leave along managing a nation !

Your government has crushed unarmed people in cold blood and talks about checking corruption ?? These common men were just making a demand in a Gandhian style seeking action against corruption. Manmohan ji , you have even dumped the Gandhian philosophy. I would have addressed you as PM – Gen. Dyer ………….hope you remember the Jallianwallah Bagh !! You did the same on 4th June .

Your government has growth without development and job creation . You just could create 400,000 jobs every year , and the NDA government created 12 million jobs every year !! Who did better ??

Do you understand the 30 times more job creation makes for a better economy !!

Lastly, had the supreme court not intervened , the public outcry would have spread like wild-fire and transformed into a civil rebellion ? You are a totally failed Prime Minister, who has brought the nation to disgrace and let down the Indians in the global arena .

India is today perceived as a grossly corrupt nation . Thanks to your ‘I don’t know attitude – Mr. Lame Duck PM’ A common man is being let down miserably , and ashamed of the fact that an educated person like you did not make great political Leader and stooped low to please the Super PM – Sonia Gandhi !!

A Common Man

Rajendra Pratap Gupta

http://www.rajendragupta.wordpress.com

Points raised at the Interactive Civil Society Hearing at the United Nations 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.

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.

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

It’s time to act now .

Thank you.

Rajendra Pratap Gupta

The points i talked about as mentioned above ,were highlighted by Sir George Alleyne , UN Special Envoy in his closing remarks.

History repeats in Congress – Mrs. Sonia Gandhi & Dr. Manmohan Singh , you must go now !

Mrs. Gandhi , Rahul & Dr. Singh,

Today, this great country is ashamed & aghast due to your cowardly & cold-blooded attacks at Ram Lila Maidan on 4th June 2011. India has reached a new low under your regime !

Every now and then, the supreme court has to intervene and direct the PM & his government to discharge routine duties towards the nation & its citizens. When the constitution of India was written , the constituent assembly laid the foundation of an independent judiciary , legislative & the executive , but due to gross misuse of constitutional powers bestowed upon the Prime Minister through his remote control boss ( Sonia Gandhi ) , you all have forced the Supreme court to run the government on important issues like corruption and high handedness , and this has never happened in the history of India .

Politics & governance under congress has reached the lowest level , and today, everyone realizes that the supreme court is running the nation on a day-to-day basis ( directly or under its fear of intervention ! ). After 4th June , Supreme court will have to make bureaucrats discharge their duties . Jai ho Supreme court and shame -shame for congress !

Congress created hue and cry when Rahul was arrested by Mayawati & now that you have mercilessly beaten up the sleeping protestors ! This clearly indicates a few things :

1. If one makes black money and does wrong , Congress will not kick you out ! ( means that Congress patronizes people who do wrong things and make money ). I believe, that you could not buy Ramdev through your so-called negotiations , and so you tried to assault him to kill him in cold blood ! I am sure that your government must be now planning to invoke your cronies in CBI , IT , ED & FDA etc to raid Ramdev’s establishments and take him to task. Same you have done to those who decided not to toe your line like Amitabh Bacchan and Narendra Modi

2. If people peacefully fast and demand the black money back , Congress will go and kick out people in mid night ?

This act on 4th June was not short of what is happening in the Arab World !! Mrs. Gandhi , since Congress party is running the government, and you have been the President of AICC & the Chairman of NAC , you have proven to be the most incompetent person in Congress as its leader. All your top functionaries are economists ( Chidambaram , Manmohan , Pranab, Montek ) , still you have failed to bring down the inflation , which was to be done in the first 100 days of coming to office !! , Common man has been left behind in all that your party is doing !

Congress has been reduced to the party of scams in the name of social schemes ! Corruption has become the order of the day & currency in this nation . Foreign media has tagged India to be more corrupt than developing ! A. Raja has become amongst the top most corrupt person in the recent international list released by a leading magazine . You are bringing down the country before the global forums . We cannot tolerate this as Indians , and I request you as a common man to resign and go immediately !!

I request the opposition parties to declare a “Corruption , mehagaye aur tanashaye ke virudh Bharat Bandh” ( preferably on a Sunday , to cause least inconvenience to people ) as a show of resentment against your dictatorial and corrupt rule . Congress has always played the politics in the name of Poor , Gandhi family and Religion and cheated the innocent poor for decades , it is time to end this rule . All national leaders marked in this email must come forward so that we do not repeat what happened on 4th June .

I must put these facts before you

The Indian Emergency of 25 June 1975 – 21 March 1977 was a blot in the name of democracy by Indira Gandhi

4th June 1989 , Tiananmen Square happened, and Sonia Gandhi’s Congress did it again on 4th June 2011

3– 6 June 1984, Congress stormed the Golden Temple and killed Sikhs in Operation Blue star Congress leaders led to mass killing of Sikhs post the death of Indira Gandhi

4th June 2011, Congress brutally attacked peaceful protestors in cold blood with an aim to assault Baba Ramdev, repeating the history of Gandhi’s & Congress , and the party has the audacity to call itself as United Progressive Alliance (UPA ) ? Shameful acts . This is what happens when you are afraid of being exposed and your black money is under threat ; Go out and kill innocent in cold blood , and , finally, the Supreme court has to take suo moto action for this cowardly act.

If you have to show courage , go to Pakistan and do an act like America did to capture Dawood Ibrahim !

Though this email , I request our national leaders in the opposition to promise that they will honor our Supreme court judges with at a least Padma Vibhushan ( if not Bharat Ratna ), who woke up our highly educated but ignorant PM to act against Raja, and the judges who took suo-moto action for the cold-blooded attacks on peaceful protestors on 4th June .

Our Tiananmen Square has happened, and now our Egypt like protest must happen . Time for India for a ‘Doosri Azadi’ from this inefficient , corrupt , bankrupt & dictatorial government . Sonia and Rahul are failed politicians and bankrupt with ideas , and a liability on the congress . I am hoping congress will stop idol worship of these two leaders; who brought down the congress in the eyes of a common man, and India in the eyes of the world & hopefully opposition will rise up to restore the faith of the common man

A Common Man

Rajendra Pratap Gupta

www.rajendragupta.wordpress.com

Mental Healthcare Act 2010 – Needs revisions

Rajendra Pratap Gupta

President

Registered Speed Post / E-Mail

Dated: March 24th 2011

Shri. Ghulam Nabi Azad

Hon’ble Health Minister

Government of India

Nirman Bhavan,

New Delhi -110108

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

Dear Shri Azad ji,

This needs your esteem, kind and personal attention.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

With best regards

Rajendra Pratap Gupta

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

Include Homeopathy in National Health Schemes

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

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

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

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

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

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

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

http://www.pharmabiz.com/NewsDetails.aspx?aid=62119&sid=1

Rajendra Pratap Gupta

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

Dear Dr.Singh,

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

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

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

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

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

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

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

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

Read the article below from the Economist !

A Common Man

Rajendra Pratap Gupta

www.rajendragupta.wordpress.com

Article from the latest issue of The Economist

Corruption in India

A rotten state

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

Mar 10th 2011 | from the print edition

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

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

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

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

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

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

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

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

Good Morning friends !

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some of you could maybe set up veterinary care centres ?

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

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

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

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

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

Rajendra

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