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Promoting Projects and Practices in Community Health in India

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Street scene in India, August 2020. © UNICEF/Vinay Panjwani

One of the most populated countries in the world, India has been facing problems with regard to well-being of its citizens while sustaining their developmental needs. The need for better health facilities, and developing antidotes for new kinds of pathogens and viruses have made the task more challenging. The respective governments, pharma companies, and testing labs are trying to develop safe trial mechanisms and developing safeguards for protecting the lives of vulnerable sections of society. Within India, the community health programme involves the non-governmental sector, healthcare professionals, economics aspects and social interaction through people and voluntary workers. While the health ecosystem exists, the problem has been finance, support and critical knowledge repository. India did well to address issues such as polio vaccination and creating community awareness for regular medication against tuberculosis. There is a mounting impact of chronic diseases in economic and social sectors, need for quality health services in the wake of changing demographics, and increasing life expectancy have made matters more complex.

In terms of understanding the requirements for building better resilient and health-conscious societies, it is important that the vaccines, lifesaving drugs, and medicines should be developed with certain generalised regulations which can improve the health of the society and address problems faced by people living across regions. While India is a subcontinent comprising of all geographical features, it is also a cauldron of different ethnic communities, and physical features which provides exceptional opportunities for testing and developing medicines which can cater to different physical and pathological profiles of people. Within India, one can find people with different levels of immunity. As the eating and food habits have been different, there is higher incidence of diabetes, hyper tension and cardio diseases in a cross-section of people. It has also been seen that people who are above 40-70 years of age have been more vulnerable to pandemics, and other communicable diseases. A sizeable mortality profile of people suggests that.

In this context it becomes very important that medicines which should be developed should have a better shelf life and give results which can be corroborated with testing facility, with a cross-section of people. The results have usually varied with regard to people with different eating habits and also nutrition factor. Pandemics such as COVID-19 have brought to the fore that India has better resistance mechanisms which has helped in relatively less mortality rate when these people have been infected with COVID-19. The duration of sickness because of COVID -19 has varied from five days to more than three weeks. In such certain times, it has been found that because of lack of any effective medicine or any sure shot diagnostic mechanisms the treatment has prolonged and the recovery has been slow. In terms of legal and other regulatory mechanisms, it has been found that most of the clinical trials which are done in India enroll the vulnerable  and poor people and human trials are conducted. There is a grey area of medical compensation and addressing post-tests complications from legal point of view.

For India it has become imperative to develop projects and conduct feasibility studies through government mechanisms rather than through medical companies. While projects have been undertaken to study different kind of diseases that school children and adults will be facing in the next two decades, it has been found that most of the complications will be related to teeth, eyesight, anxiety and mental well-being. However, in the case of pandemics and community health programmes it has been encouraging signs that initiatives such as creating awareness with regard to AIDS, mental well-being, depression and anxiety disorders have been fruitful and rewarding with institutionalising counselling and telephone helplines. Most of the programs have been done and supported by NGOs as well as a few voluntary organisations.

The projects and programmes which can be initiated in India should address core issues. Firstly, the incidence of non-curable diseases, depression, immunity disorders, other issues related to community transmission, and the development of proper safeguards and awareness with regard to pandemics and life-threatening diseases. Secondly, the COVID-19 has opened a Pandora’s box with regard to the incidence of diseases which impact community, and thereby also affect government health budget. Lastly, it is necessary that India will have to create medical soldiers and inform voluntary workers so that the community transmission and community health well-being should be addressed on a priority level.

As the COVID vaccine is in different trial stages, many countries are looking for testing facility in India and also conduct human trials, as legal structure in medicinal trials is still in infancy. India needs to address the issue of IPR on developing vaccines and medical history should be addressed jointly as it has been found that many western countries have been purchasing medical history of the patients living in developing Asia, providing vaccines through great testing mechanisms and subsequently using copyright laws to deny cheap medicines to the larger community.

 In this regard it is important that India should conduct research on immunity vectors of its population and develop generic drugs which can help in protecting communities from most transmissions. It is also pertinent to note that in terms of the temperature variance across India it provides unique testing opportunities in different conditions. However, there is a need for a holistic approach and therefore it is important that training and sensitisation of the personnel working in this field is of paramount importance. Initiatives related to preventive and therapeutic services is critical. Also, looking for quick alternatives would save the lives of personnel.

Just like any emergency, there is a need for rapid action medical force which can provide immediate assistance and better cognitive abilities track critical illnesses and the reasons thereof. It has been seen in the case of midwifery and associated postnatal diseases that it has worked wonders with a better equipped and knowledgeable person existing in each society for better assistance and awareness.

The critical importance of voluntary workers is that with sufficient technical assistance (which might come from government and state units) gives them confidence and also strengthens their application of knowledge for better informed public health practices and policies. Technical assistance and quick action through centralised control centre has to create the first line of defence in case of a pandemic. 

The institutes which have been working in this field are Public Health Foundation of India, Indian Institutes of Public Health and All India Institute of Hygiene & Public Health, which have been disseminating information through online workshops, seminars, and social media. They have created affiliates and sister agencies working in the field all across India. Networking of public health institutions in medical education need to address issues such as environmental health and countering new kind of diseases which are dominating.

This clearly highlights the fact there is a need for understanding pandemics, developing awareness among communities about public health, and stress on hygienic environment, conducting long term  research on emerging diseases and promoting research in tropical medicine.

India need to allocate separate fund for public health initiatives and promote exchange of medical workers with third world countries for better understanding the nuances of medical and health research. In fact, in most of the think tank meetings, public health and awareness is not listed as topics whenever Track II dialogues are held. There is also a need for better practices in public health, education, and developing health demonstration projects, barefoot nurses and doctors, strengthening an eco-system of education, training, and scholarship. Developing traditional medicine and making it easily accessible should be the bulwark against diseases. Restructuring Community Medicine/ Preventive and Social Medicine colleges which impart this kind of education in developing countries is required as the number is relatively less. Across developing world scholarship in community medicine and hospital administration is low and needs structural financial support. The data collection and diagnostics apparatus need micro management to create better response chain. COVID-19 has provided the reason for public health to be taken as a national initiative.

Pankaj Jha is faculty with Jindal School of International Affairs, O P Jindal Global University, Sonepat. He can be reached at pankajstrategic[at]gmail.com

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South Asia

As Sri Lanka struggles with Chinese debt-trap, Maldives moves closer to the Quad

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The Indian Ocean’s geopolitical currents have witnessed drastic transformation this year, particularly in the past three months, with India shedding the exclusive right of its sphere of influence over the Indian Ocean, by allowing the United States in its own backyard. Washington and New Delhi seems to have entered into what few analysts call a ‘soft alliance’.

Sri Lanka and Maldives are strategically located in the northern section of the Indian Ocean, and have long been historically, culturally, and geopolitically under India’s sphere of influence. But, things are beginning to change as Chinese debt-trap looms over these islands.

The Quad grouping, consisting of India, Japan, the United States and Australia, has demonstrated its collective military might in the maritime sphere of India with the recently concluded annual Malabar naval exercise. It also led to the emergence of new dynamics of cooperation in previously reticent areas, built upon confidence in each other’s abilities and consciousness of where it stands in the newly unravelling geopolitical equation.

India’s new strategic comfort with bringing in partners from the Quad partners lying external to the Indian Ocean Region, namely the US and Japan into its long-held exclusive sphere of influence signals a tilt in strategic imperatives for New Delhi in favour of the US that too in an evolving cold war-like situation involving Washington and Beijing with different set of countries rallying behind each side.

India has recently welcomed the US-Maldives Defense Cooperation Agreement signed in September, this year. The following month saw US Secretary of State Mike Pompeo’s visit to Male where he announced Washington’s intent to open an embassy soon.

Less than three months after the defence pact with Washington, Male signed a new agreement with Tokyo this month, for availing a Japanese grant of $7.6 million to strengthen the archipelago’s Coast Guard capacities, in a second major pact with a Quad member.

New Delhi’s newfound willingness to work with external actors in the Indian Ocean is a sign of strategic comfort stemming out from realist foreign policy considerations to expand its circle of friends and coalition partners in its own backyard against a common and more powerful adversary, Beijing, with which it also have decades-long tensions in the Himalayan frontiers.

Even though both these two countries succumbed to disproportionately superior Chinese economic might since the past one decade, it seems Maldives has somehow managed to come out of its dangerous level of dependency on China since Ibrahim Mohammed Solih of the Maldivian Democratic Party assumed presidency of the island nation two years back in November 2018.

The Sri Lankan economy went into a tailspin since the civil war ended in 2009. The country’s exchequer was badly in need of financial support to sustain itself. It was also the time when Beijing just began to project its military and economic power in its neighbourhood and beyond as the flamboyant 2008 Beijing Olympics concluded.

The island of Sri Lanka soon acquired new geoeconomic significance when President Xi Jinping launched the most ambitious infrastructure project of this century in 2013, the Belt and Road Infrastructure, connecting three continents with the Indian Ocean as its epicenter of vitality.

With BRI, a tangled web of debt-trap rapidly began to loom over Sri Lanka as Beijing pumped-in investments into the war-battered island with malicious intentions.

The story of handover of Hambantota port, strategically located in the southern tip of Sri Lankan coast, to China for a 99-year lease in 2017, and the Colombo Port City project being built with Chinese assistance are just examples of how economic leverage gained geopolitically advantageous positions for Beijing overlooking the Indian Ocean. These assets are going to play a significant role in the connectivity of BRI’s ‘Maritime Silk Road’ aspect.

Chinese-led projects are built and managed by Chinese workers themselves as they do in any other part of the world, naturally bringing presence of Chinese personnel to the areas where it operates.

The BRI, however, enhances Sri Lanka’s significance in what theorists call the String of Pearls, wherein Beijing attempts to encircle India by a series of ports and maritime installations under its control in the Indian Ocean such as the overseas military base in Djibouti, Gwadar in Pakistan, and the ports in Bay of Bengal under Chinese influence hosted by either Bangladesh or Myanmar. Chinese submarine presence is also a new reality, particularly in areas surrounding the Malacca Straits.

All these factors naturally brought New Delhi closer to Washington to formulate a ‘collective strategy’ against the expansionist tendencies manifested by Chinese behaviour. At the same time, India has been taking proactive steps in its individual capacity to boost ties with other island and littoral states in the Indian Ocean Region (IOR), like Mauritius and Seychelles where India’s listening posts to monitor sea-lanes also operate.

The Indian Navy has always been the first responder to any HADR (Humanitarian Assistance and Disaster Relief) situations in the IOR which earned significant soft power and respect for India in the countries of the region. This vision has been immortalized in India’s maritime doctrine for regional cooperation in the Indian Ocean, SAGAR (Security and Growth for all in the Region), that was unveiled in 2015.

With the entry of the US, which already has its presence in the British Indian Ocean Territory of Diego Garcia lying mid-way of the ocean, that too with India’s approval, and France in Reunion in the western Indian Ocean, the geostrategic picture of IOR is beginning to change.

Maldives stands as a good example of how to overcome Chinese dominating agenda by boosting cooperation among democracies. But, the Abdullah Yameen-era nightmare of Chinese debt burden is still far from over. In fact, Sri Lanka too is well aware of the Chinese trap from which it yearns to decouple itself. But, Colombo is left with limited options or alternatives to do so.

The renewed Indo-US strategic cooperation, if not translated into offering a viable solution to the debt-trap conundrum, Sri Lanka might irreversibly evolve into another extension of Beijing’s legs in the Indian Ocean threatening the sovereignty of democracies in the region.

Recent steps in the strategic realm are welcome, but the Indo-Pacific democracies, particularly India and the US, should cooperate with these two key island states more in the economic realm as well, if possible near to the extent of Beijing as a collective move.

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South Asia

The Dysfunctional Pakistan’s Legislature

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The legislature of Pakistan has several problems and because of this very reason governments are unable to make any landmark laws for the state that can prove to be effective in resulting some socio-political or economic changes in the society. The noncooperation among the parties in the house is the major problem that leads no healthy debate. People have never seen the political parties having a healthy debate among the political parties on some key matters that need to address. Political parties prefer crosstalk on each other that mostly ends up on the dismal of legislature. Mostly in the house the opposition and the party in power never each on consensus on anything that shows their no seriousness towards the legislation.

 In my opinion the opposition of Pakistan perceives its role to be negative always. The opposition perceives as their duty to walk out from the house, make fun of their fellow colleagues, bringing our historical facts to propagate negativity about the agenda. This attitude results in no fruitful law-making.

The scenario of national assembly of Pakistan is that if the ruling party does not has two-third majority in the house they will be paralyzed as the opposition has imagines role of not supporting the government to pass laws and bills that can benefit their reputation among the public. In this game of interest the parties forget the importance of legislation and national interest rather they are more focused on protecting their own interests and interests of their political parties.

The tussle between the government and the opposition is endless that is negatively impacting the legislative system of Pakistan.

Another factor that weakens the legislative process of Pakistan is the issues within the upper house. This plays a vital role in enacting the laws without senate’s cooperation legislation cannot improve and strength.

 The sustained bitterness and confrontation with the government and opposition leads to no progress in the making of legislation and strengthening the rule of law. For example the PTI coalition passed the bills and introduced 8 ordinances in its first year of government.

The ten bills passed by national assembly faced a new challenge which was the Senate of Pakistan where PTI also does not hold the majority. Ten out of 4 bills sailed through Senate whereas 3 remained pending in Senate. Only 7 bills turned into acts in the first year of PTI government.

The lack of coordination and seriousness in the parliament is affecting the progress of Pakistan. Without rules and making of new legislation how can the country progress? In a democratic system the rule of law is one of the pillars for true democratic practices but unfortunately in Pakistan we only see leg-pulling and blame game between the institutions.  The lack of political consensus among the parties is another problem. On the other hand the formation of Standing Committees of national assembly is important for the functioning of the system. According to the Rules of Procedure of national assembly the members of Standing Committees has to be elected within 30 days after the elections of the leader of house but according to the data of PILDAT previous assembly managed to form these in 3 months instead of 30 days. This indicated lack of seriousness of the members.

The current government has only got the executive authority and not the legislative competence that makes them dysfunctional as they are dependent on the opposition and then Senate for passing of the legislation and making it a law.

Another factor that weakens the legislative system of Pakistan is the overactive judiciary and the intervention of the military in law making. Through this intervention the legacy of the military rule is still being kept alive. Most of the time the Supreme Court and the judiciary intervene in the legislation to serve their interest and weaken their opponents sitting in the government. The overactive judiciary encroaches the governance agenda, legislative advice etc. the legislative procedure in Pakistan is still developing its institutional identity.

The duty of the legislature is to respond to its public needs and also exercise oversight of the executive, but there is not engagement in the civil society and no research is being conducted on the public policy for better and effective policy making.

In the end it can be concluded that the system is also faulty but the attitude of the parliamentarians is more disappointing and discouraging. The whole system is unsuitable for a less educated population of Pakistan as most of the parliamentarians are unaware of policy-making and its importance for the state. The process is also complex and complicated as it has to go through several steps for making a bill a law.

Through this process, law-making on controversial issues is nearly impossible because in Pakistan people protect their interest instead of their state. Even if the government is serious for law-making the judiciary, military and bureaucracy will not allow the government to do its job. This is high time to adopt a new system in this country and draw lines for every institutions particularly judiciary that is the most rigid institutions and creates hurdles for every government by interrupting them.

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Reinforcing the Role of the International Community in Resolving the Rohingya Crisis

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A young Rohingya girl holds her brother outside a youth club in Cox's Bazar, Bangladesh. © UNHCR/Vincent Tremeau

Bangladesh is hosting more than 1.1 million Rohingya refugees since August 2017. The United Nations defined Myanmar’s August 2017 atrocities to the Rohingyas as “Textbook case of ethnic cleansing”. On July 02, 2018, during his visit to Cox’s Bazar, Bangladesh, António Guterres, the UN Secretary-General noted that “I have no doubt that the Rohingya people have always been one of, if not the, most discriminated people in the world, without any recognition of the most basic rights starting by the recognition of the right of citizenship by their own country – Myanmar”. Thus, the severity of the Rohingya crisis is well-recognized by the international community. This article focuses on the necessity of the international community’s role in facilitating a safe and sustainable Rohingya crisis solution.

The ironic story is that though it is already three years passed, no concrete action is manifested to facilitate the Rohingya refugee repatriation. In the United Nations Security Council, Russia and China applied veto power in the case of Rohingya refugee resolution, which made strong impediments to the repatriation process. Russia and China did this calculating their narrowly defined interest rather than humanity which is in fact, ironic for the world. Thus, the United Nations could not play a crucial role in facilitating the Rohingya refugee repatriation.

Bangladesh is one of the densely populated countries in the world. Though Bangladesh is a rising economic power, feeding more than 170 million people is not an easy task. Also, more than 1.1 million Rohingya refugees have added extra socio-economic pressures in the country. For Bangladesh’s continued growth, prosperity, and stability, there is no alternative to repatriate the Rohingya refugees in Myanmar as early as possible. Since Myanmar committed ethnic cleansing to the Rohingyas, and the country is not interested in taking back the Rohingyas, only the international community including the United Nations, the European Union, the Organization of Islamic Cooperation (OIC) can pressurize Myanmar to ensure a safe and sustainable repatriation.

Bangladesh strongly believes that the international community can play an essential role in resolving the Rohingya refugee crisis permanently. For instance, at the 72nd United Nations General Assembly, Sheikh Hasina, the Prime Minister of Bangladesh, offered five points proposal including the full implementation of recommendations of the Kofi Annan Commission, and the establishment of civilian monitored safe zone in the Rakhine State to the international community to resolve the issue. Similarly, at the 74th Session of the United Nations General Assembly, Sheikh Hasina offered a four points-proposal to resolve the Rohingya crisis highlighting the role of the international community. Sheikh Hasina emphasized that the international community must ensure that the root causes of the Rohingya problem area addressed and the violation of human rights and other atrocity crimes committed against the Rohingyas are accounted for.

The good news is that the on November 19, 2020, the United Nations has adopted a resolution on “The Situation of Human Rights of the Rohingya Muslims and other minorities in Myanmar” while Bangladesh seeks a peaceful solution to the Rohingya crisis. The Resolution called for taking concrete actions by Myanmar to address the root causes of the Rohingya crisis, i.e. granting them citizenship, ensuring the safe and sustainable return of the Rohingyas to their homes by creating a conducive environment. Bangladesh Permanent Representative to the UN Ambassador Rabab Fatima notes that “As a country that hosts over 1.1 million forcibly displaced Rohingyas, Bangladesh continues to seek a peaceful solution to this crisis, which lies in their safe and dignified return to Myanmar”.

Notably, Germany on behalf of the European Union and Saudi Arabia on behalf of the OIC co-tabled the Resolution which was sponsored by the 104 member states including the USA, Canada, and Australia. It is also a positive development that a total of 132 countries voted in favour of the Resolution while nine countries voted against and 31 countries abstained. It demonstrates that most of the countries in the world want a permanent, sustainable and peaceful solution to the Rohingya crisis. It also signifies that these countries care for the humanity while the nine countries who voted against the Resolution only care for their narrowly defined interest. The future generations will undoubtedly read and know the actions of those nine countries who do not care for humanity. Those nine countries need to know that despite several domestic challenges, Sheikh Hasina has shown kindness, humanitarian gesture and thus protected and sheltered those Rohingyas from killing by the Myanmar armies.

Notably, Bangladesh is one of the top ten countries in the world in terms of hosting refugees. This will remain as a humanitarian example in the world. One also needs to keep in mind that the socio-economic realities of Turkey (who is the top in hosting refugees), and Bangladesh is not the same. While the GDP (per capita) of Turkey is US$ 9043, Bangladesh’s GDP (per capita) is US$ 1856, the population density of Turkey is 108 per square kilometres, and Bangladesh’s population density is 1116 per square kilometres. Thus, considering the contexts, and socio-economic realities of Bangladesh, the international community needs to reinforce the Rohingya refugee repatriation process. Most importantly, the international community needs to execute the adopted Resolution as early as possible for the sake of humanity, for the sake of a just cause. The future world will certainly note the noble actions taken by the international community for such a just, and reasonable cause.

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