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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

Application of Galtung’s ABC Model on the Naxalite Insurgency of India

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The conflict analysis model proposed by Johan Galtung in 1969 includes both symmetric and asymmetric conflicts. In the author’s opinion, a conflict can be viewed as a triangle whose sides are represented by A (attitude), B (behaviors) and C (contradictions.

Figure 1 GALTUNG’S ABC MODEL

The Naxalite Insurgency

The Naxalite revolt which developed in the 1960’s is the most seasoned of all. The Naxalite revolt gets its underlying foundations from a remote town called Naxalbari in West Bengal. They are the progressive communists bunches resulting from Sino-soviet split in Indian Communist Movement. The Naxalite uprising is a low-level war of Maoists against the Indian government. The insurrection began as a labor resistance in the eastern Indian town of Naxalbari in 1967 and has now spread to an extensive swath in the southern and eastern parts of the nation. In 2004 the Maoist dissident association People’s War Group and the Maoist Communist Center of India converged to shape the Communist Party of India (Maoist). The Movement was driven by Charu Mazumdar, Kanu Sanyal and Jangal Santhal.

Contradictions

The main conflict includes real or perceived “incompatibility of goals” between the conflicting parties. In symmetrical conflicts, the contradiction is defined by the parties, their interests and conflicts of interests. In asymmetric conflicts, the contradiction is defined by the parties, the relationship between them and the conflict within this relationship.

Before continuing with Galtung’s model analysis, it is necessary to highlight the differences between symmetric and asymmetric conflicts. When A and B have a relatively similar or equal position and they enter into a conflict due to diverging interests; we are talking about a symmetrical conflict. When in the relationship between A and B one of the parties has a clearly superior standing compared to the other (i.e. a clear situation of inequality between the two sides); we are referring to asymmetric conflict. This type of conflict occurs between the majority and a minority, between a government and a rebel group, between an employer and his employees, or between a master and his servants (“Transforming Civil Conflicts”, The Network University. The University of Amsterdam, June 2000).

A conflict in Galtung’s view = attitude + behavior + contradiction, where contradiction (C) is the root of the conflict, and attitude (A) and behavior (B) are meta-conflicts after (C). CAB is a possible example of a conflict sequence starting objectively with an attitude of inner life that is expressed externally through violent or not verbal and / or physical behavior. This definition helps us to talk about the CAB as a guiding conflict theory, as a dynamic phase of the conflict, or as an approach to solutions (Galtung, 2007, 22).

The contradiction here in this conflict is inequality and dispute over political rights and resources. The Naxalites get most help from Dalits and Adivasis. Together they sum for one fourth of India’s population; a large portion of them live in rural India. Their bases for supporting the insurgency includes unemployment, new timberland provisions with confinement for their jobs, cultural degradation, feeble access to social education, confined and constrained access to regular assets, social abominations, relocation, political underestimation and suppression of rebellions. The affected areas have rich mineral resources but the inapproachability and negligence of the government is another which has kept the insurgency alive.

The demands of the insurgents are not of succession rather they demand their democratic rights. They want the government to implement improvements in the farming sector, give accommodations and full authority to the farmers, and abandon all private finances taken by the agricultural community to stop suicides by farmers, prepare a lasting and unified plan for tackling the scarcity situation and to be given equal opportunities, jobs, education, acceptance from the upper caste people.

Attitudes

Includes the perception of the parties; It can be positive or negative, strongly negative especially in violent conflicts when the parties develop humiliating stereotypes about each other. Attitude consists of emotive and affective components (I like or I do not like X), cognitive components (favorable or unfavorable information about X) and cognitive/ behavioral components (desire, will).

Attitudes or we say perception of conflicting parties, i.e., Government of India and Naxal rebel’s groups are entirely negative. Indian government thinks of it as a national security threat and wants to counter it one way or the other. In 2006, the Ex-Prime Minister of India Manmohan Singh called the Naxalites “The single greatest inward security challenge.” As the insurgency is not in just one part of the country but it is expanding in many regions which is a serious threat to the state’s internal security. While the rebel groups being untouchables, think of the government as racist and discriminatory and want equal rights and opportunities as any other Indian.

Behavior

Involves cooperation or coercion / conciliation or hostility regarding the behavior, in case of violent conflict we talk about threats, coercion or destructive attacks.

The Indian National Congress is India’s oldest party. Hence has seen a number of conflicts and insurgencies. The INC government sought after a double pronged approach depended on military and cruel police activities.

SalwaJudum was launched as part of counterinsurgency strategy by the Indian government. The Naxals and SalwaJudum used to assault each other with much greater savagery; numerous individuals were killed by Naxals and SalwaJudum. The SalwaJudum was at long last prohibited by the Supreme Court in 2011 for damaging human rights and the Constitution itself. The government then presented “Operation Green Hunt”, an organized activity over a few states (Orissa, Madhya Pradesh, Chhattisgarh, Andhra Pradesh and West Bengal among others), to handle Naxalism. But the operation was also a failure.

The government then realized that using the military on their own people is not the solution to the problem hence, they made some developments in the affected regions but it did not give long lasting results; it resulted in the failure of the policies of Indian National Congress.

Andhra Pradesh has the best strategies to counter the Naxalite insurgents among all affected states. It perceived the Naxalite insurrection as a genuine risk. It has put resources into the Greyhounds; a unit arranged for a counterinsurgency reaction and has given extensive recovery bundles to repatriate the previous Naxalites.

They likewise made a few projects to help police faculty and their families if executed in the line of duty. Andhra Pradesh’s counterinsurgency approach is unmatched in the whole country.

The Naxalite rebellion entered in these states later. They are the most badly influenced states because of their topography and demography. Because of a crackdown by police and military against the naxalites, the movement spread into many states. Since these states have a huge population and forested territory, they were the ideal areas for the guerillas to develop. None of these states has a solid counterinsurgency approach. Chhattisgarh has connected comparable guerrilla strategies and many operations like Operation Shikhar, Operation X, Operation Thunder and Operation Hill Top but neither of these operations have been able to purge the insurgency in the state. Jharkhand has led a few hostile activities, Odhisa uptil now have no strategies that can manage the uprisings. Every one of the three states is rich with mineral resources but none of them have powerful counterinsurgency technique. West Bengal is relatively successful in countering insurgency. The state government additionally got assistance from the central government.

The BJP government counterinsurgency strategy against the Naxalites combines a twofold unit approach; one approach is to utilize safety powers to create security whereas the other is winning hearts and minds of the overall public. Past governments utilized the relative systems, yet in light of a nonappearance of coordination and uneven execution between influenced states, it didn’t give incredible results.

Social and economic inequity is seen as the main drivers of the Naxalite insurrection. Accordingly, the BJP government has reported sweeping policy, which incorporates improvement measures to manage social and economic degradation. The government has invested in the expansion of infrastructure which includes the creation of communication linkage and rail and road accessibility also in educating and providing basic services to the people. The number of violence decreased during BJP’s time period, the credit is not alone to BJP government but also to previous governments.

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Is Peace possible in Afghanistan without a clear vision?

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photo: UNAMA/Mujeeb Rahman

Peace is the absence of war, while war is the absence of peace! A negotiated peace in Afghanistan presents a number of challenges. The duration of the war over several decades has created a number of situations, that requires an in-depth examination in light of the peace negotiations that took place between the United States and the Taliban leading to the signing of an agreement without inputs from the Afghan government in spite of their being a strategic partner of the United States.

The war has been a very costly undertaking both in financial and human terms.

On the human side, there has been a large number of civilian casualties and a flow of both internal refugees and those that have fled to neighbouring countries, Iran, and Pakistan in particular. Will the conditions of peace allow their return and what employment possibilities will they find? In particular will the professionals and corporate managers of the diaspora return?

On the financial side, the income of the Government of Afghanistan is too meagre to finance the rebuilding of the country. Will the United States and other major donors such as the World Bank contribute in a significant way to assist in this momentous effort?

Afghanistan’s geographic position has attracted major powers in the past. How will the country still be viewed as a masterpiece in the Great Game and will it continue to be subject to constant instability?  Corruption may well prove to be one of the most important barriers to development. What policies can be put in place to reduce, or eliminate, corruption? What process will be put in place to disarm both the Taliban and the other armed groups to prevent a civil war?

Why do powerful countries always easily achieve their goals in Afghanistan? The answer is simple, because some leaders are ready to do anything to gain power by asking for the support of these countries. In order to be able to bring political stability to Afghanistan, it is essential and indispensable that the Afghan leaders come to an understanding among themselves in order to have internal stability. As soon as they manage to put this in place, they will have moral authority over powerful countries with a specific, clear, and lasting purpose for Afghanistan. Presently its political leaders are ready to negotiate in an aggressive, competitive, egocentric, and defensive manner to have the power in order to remain in their current positions without worrying about the interests of the country or the people.

Often, we hear that Afghanistan is a strategically positioned country. Of course, Afghanistan is well placed, but our analysis is different: we believe that something else is more important than that situation. Afghanistan is a weaker country in the region with leaders who are only interested in political power, with a lack of global vision for the development of the nation:  this is the reason why every powerful country achieves its goals very easily across Afghanistan, according to its wishes. At any time, they may abandon Afghanistan. At the same time, Afghanistan faces major economic and development challenges. Although the country is rich in natural resources, gas, minerals, and oil (estimated at over a trillion dollars), insecurity, war, lack of infrastructure, weak leaders, have limited the possibilities of finding and extracting these resources and Afghanistan is still among the poorest countries in the world.

Each country has its advantages and disadvantages, but Afghanistan has two major drawbacks that need to be addressed:

1) Very weak leaders or leaders by accident, who think only of their personal interests and who settle in power for life.

2) As mentioned above, Afghanistan is the weakest country in the region.

Every leader, when he comes to power, forgets his real job, which is to create enduring systems and values ​​for today, tomorrow and the day after, and at least reduce existing problems and use their power to serve the people and the country, instead of monopolizing this power for personal interests.

On the contrary, unfortunately, when a leader comes to power, he increases the problem because he thinks traditionally, and above all he puts his relatives in the most important positions, without looking at their qualifications, because competence is less important than relational confidence.

Although there are very qualified people, but since they do not belong to the ethnicity of the political leaders, and share their point of view, thinking more for the country than their private interests, such kind of people have very little place in the mind of these leaders.

Today, politics in Afghanistan is becoming like a business, and everyone is doing politics … However, the real job is still abandoned, because the vast majority of the People no longer trust the Politicians, and even the real ones, those Politicians who want to change something for their country.

Before having to manage peace, they must understand why we are at war. The war in Afghanistan has five dimensions:

1. A leadership crisis, meaning that the Afghan leaders do not agree with each other and look at power sharing.

2. Certain countries of the region, and more particularly Pakistan, are very involved in Afghanistan, which they destabilise.

3. Major powers, too, have their own agendas on the region.

4. Certain countries support terrorism and extremist groups.

5. The negotiation process must be led not by politicians, but by neutral Afghan experts.

Therefore, we make the following recommendations:

1.Encourage the leaders to have a government in which no single ethnic group monopolizes power. There should be one president and four vice-presidents. Each two years a rotation of the president would be put in place. The entire mandate would be limited to ten years. This would allow power sharing that would prevent having one ethnic group monopolising power through a rotation system of two years as President.     

This proposal would definitely solve the power problem while also allowing for government savings of time and money.

2.The United States should intervene in Pakistan to force a peace process between Pakistan and Afghanistan. Pakistan has been a major destabiliser in the region by harbouring terrorists and using them as their second army as indicated by several international sources. Should this problem not be solved, it would become, sooner or later, a global threat for democracy and humanity. It would not be a good inheritance for the future world leaders.

President Joe Biden, mentioned that the United States would again lead the world, we strongly believe that the above issue should be a priority, failing what, it may be too late to bring peace to the region and worldwide. The United States should avoid countries that back terrorism and, particularly, those actions that kill children and humanitarian workers.

3.As a major power, the presence of the United States in Afghanistan could develop a strong relationship, instead of a partnership, just as the United States has done in other countries, providing its presence in the area is of interest. This would be a break from the present situation in which the Afghan population lacks a clear understanding of its position. Should the United States develop a mutually beneficial relationship, the Afghan population would strongly support it.  A complete departure before peace puts in danger democracy, women, and children not only in Afghanistan but also worldwide.

4.The United States, as a powerful country, should sanction all countries, or groups and persons, that support terrorism, wherever the terrorists may wish to strike. As an example, economic sanctions banning the purchase of military material should be implemented. Doing so in Pakistan would be a good starting point.

5.The negotiation process cannot be done by people that are thirsty for power and have no vested interest in peace as they hold power. We would suggest that the negotiation process be led by neutral experts with politicians and the civil society backing-up them.

We are certain, if the United States takes into consideration the five points mentioned above, the peace process will be successful and lead to stability in the area. If there is no peace in Afghanistan, there will be a major threat in the area in the region and in the world. Afghanistan is the first line of defence against terrorism not only for themselves, but also for the entire world.

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Major Modi Programs Meet Success … And Failure

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modi airplane

A much admired quality, initiative, can in a leader improve the lives of his people.  The key of course is well considered and clearly thought-out initiatives. 

In his long political career Narendra Modi, the current prime minister of India has introduced some startling initiatives, although often with mixed results.

His clean India campaign aimed at ending open defecation, common in rural areas and estimated to be practiced by 620 million or by half of India’s population, was lauded even by opposition parties.  NGOs welcomed it and the Gates Foundation presented Mr. Modi an award.  By 2019, 110 million toilets had been built and there was hope that diseases like diarrhea, sometimes fatal for children, would be significantly reduced.

Rural India does not have sewage systems to remove and treat human waste.  So the toilets installed were open pit latrines requiring periodic emptying, a manual process performed by the lowest caste Indians, when available, for a fee.  In the meantime, a pervasive smell permeated the house compound.

Once toilets were built in a village, the Modi government considered it free of open defecation.  This was not factually true because installation is not the same as actual use.  No systems were in place for proper maintenance, say NGOs like RICE the Research Institute for Compassionate Economics. According to them, a survey in late 2018 revealed that some 44 percent of Indians in an area surveyed still defecated in the open, although down from 70 percent.  If one googles the question now, a figure around 620 million pops up.  That is 44 percent of India’s population of 1.4 billion, and not too different from the estimate in 2014.  To be fair the total population has increased since 2014. 

Another Modi initiative commenced just before he left on a state visit to Japan in 2016.  He delivered a speech (Nov. 8, 2016) announcing the abrupt withdrawal of 500 and 1000 rupee notes to be replaced by newly designed 500 and 2000 rupee denominations.  This would attack corruption and ferret out illegal cash holdings, he claimed.  The move removed 86% of cash in the economy almost overnight and naturally caused a liquidity crisis.

By the time Mr. Modi returned from Japan, the country was in chaos.  In a mostly cash economy, people lined up at banks to withdraw cash and presumably deposit any of the old notes in their possession.  Economic activity was disrupted, shops shuttered for lack of customers, weddings were canceled, and Indians were angry.

On Mr. Modi’s return from Japan, there was no mention of corruption — given the lines of ordinary middle class people at banks — instead it was now called a move to modernize India and turn it into a cashless economy.  How in a poor country with high illiteracy remains a mystery.  Economists now estimate the cost to the economy of Mr. Modi’s banknote initiative at roughly $15 billion or 1.5 percent of GDP.

The moral for Mr. Modi’s initiatives takes us all the way back to Aesop’s fable about the fox and the goat and the well, and its adage, ‘look before you leap’.  Unsurprisingly, Mr. Modi’s current visage has taken on the appearance of a sage even if the facts do not support it. 

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