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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

‘External forces’ won’t decide the actions of New Delhi

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India’s farmer’s protest is in the news for a while for the obvious reasons. In a democracy there should be protests, it keeps the power balanced. However, in India, the protestors and the government are both facing a common challenge, that is the external influence. To which, Indian External Affairs Minister and other government wings already made public statements. Before understanding the external factors, one needs to look into the farmer’s protest.

What are the farm laws?

Last year Government of India passed three laws in order to bring a reform in the agriculture sector in India, which are:

  1. The Farmers’ Produce Trade and Commerce (Promotion and Facilitation) Act – provides for setting up a mechanism allowing the farmers to sell their farm produces outside the Agriculture Produce Market Committees (APMCs). Any licence-holder trader can buy the produce from the farmers at mutually agreed prices. This trade of farm produces will be free of mandi (marketplace) tax imposed by the state governments.
  2. The Farmers (Empowerment and Protection) Agreement of Price Assurance – Allows farmers to do contract farming and market their produces freely.
  3. Farm Services Act, and The Essential Commodities (Amendment) Act – amendment to the existing Essential Commodities Act. This law now frees items such as foodgrains, pulses, edible oils and onion for trade except in extraordinary (read crisis) situations.

According to the government – the new laws will help to strengthen basic farm sector infrastructure through greater private investments. Successive governments have found financial constraints in investing in farm and rural infrastructure. It is argued that with food markets growing exponentially in India, private players would make agriculture profitable for the farmers.

Why farmers are protesting?

It’s been around 3 months since the Farmers are protesting in North India, on the highways en-route Delhi. Despite having rounds of talks between the government and the farmers, they’re yet to find a common understanding.

Farmers are worried as they feel this may impact the existing structure and lead to the corporatization of the agriculture sector in which the big corporations will exploit the farmers. Moreover, the new farm bill talks about the establishment of the private Agriculture Produce Market Committee, which in turn will end the role of middleman involved in the market, However, the middleman is seen by farmers, not as one exploiting them but one who provides services to them. Their number in two states – Punjab & Haryana could cross 100,000. So, farmers and middleman fear that this will ultimately result in huge job loss and impact the structure.

Another point farmers fears that from individual-to-individual relation, these bills will change the market into the individual to corporate relations. With a changed dispute settlement mechanism the farmers also are worried that their pleas could not get the desired settlement.

MSP – Minimum Support Price is another demand forwarded by the farmers, which they apprehend that allowing outside-APMC trade of farm produces would lead to lesser buying by the government agencies in the approved Mandis (marketplace). The protesting farmers say the new laws would thus make the MSP system irrelevant and they would not have any assured income from their farming. Right now, the government announces fixed MSP for around two dozen crops.

The working of the MSP system has been such over the years that it benefits only a handful of farmers at the all-India level. The Shanta Kumar committee set up by the Modi government in 2015 says that only six percent of farmers benefit from the MSP regime.

The catch here is that for farmers of some states such as Punjab and Haryana, the MSP system has worked well. In these two states procurement of paddy and wheat range around 75-80 per cent.

So, the fear that the MSP system may crumble and get dismantled after the new farm laws are implement has become a very emotive issue for the farmers of Punjab and Haryana. And, that is why they are the ones who are most vocal in their protest against the farm laws and demanding that the MSP should be made mandatory for both APMC and private Mandis (marketplace).

The government, however, is constantly in touch with the farmers and trying to resolve the issues through dialogue and till then the laws have been kept on hold while talks are held.

External group’s interference

Many external elements are interfering in the protests and challenging the government, including a few fringes and notorious separatist organisations which are based and nurtured by the West during the days of the cold war days for the obvious reasons. In the garb of human rights and democracy, they know it very well that how to destabilise a nation. There are many examples in front of us, the Russian protests being one of them. 

The world has seen how after the new U.S. government’s arrival in the United States set the narrative for the socialist lobby around the world. President Trump very well assessed the threats of such groups and kept them in check but the new administration seems to propagate their ideology as the state policy. 

When President Biden said, “We must meet the ‘new moment’ accelerating global challenges” it indicates toward continuing the policies of Obama administration with new added ‘Biden’ characteristics. 

The tweets by American celebrities and people with clear political leaning are not about the protests, they in fact, do not know much about the protest, and their idea is to attack the ideology which doesn’t meet theirs. India is a land of protests, revolution, ideas and ideologies and both the Government of India and Indians respect the thoughts across the spectrum.

One of the American Congresswomen said that she will continue to monitor this situation closely and another expressed the solidarity but their thoughts are not driven by the plights of farmers, rather a particular ideology.

Recently, the State Department welcomed the reforms by the Indian government and also advocates for the protests. Which is contradicting in itself. India as a bearer of an Independent Foreign Policy should avoid any validation by any foreign government and let not the tweets by a particular mindset decide the course of protest or government actions.

India as a democracy respect different ideas but can’t allow any ‘vested interest’ groups influence any actions by New Delhi.

From our partner International Affairs

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Forced Cremation: Another bout of marginalisation in Sri Lanka

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A thermometer gun is used to take a boy's temperature in Sri Lanka. © UNICEF/Chameera Laknath

The agony of the Sri Lankan civil war is not worn off from history as yet. The 26-year war decimated the foundations of the country and highlighted the separatist fragment of the society. The massacre of the Muslim community and the wounds left to fester since 1990’s riots have still not subsided even after three decades. While the clash of the Sinhalese and Tamils climaxed in 2009, the violence against the Muslim minority never ceased. The recent strike over the rights of minorities is the forceful cremation of the deceased in the line of Covid prevention adopted by the Sri Lankan government. Regardless of the religious doctrines guiding the final proceedings of the dead, the Sri Lankan regime continues to ploy to utilise the pandemic as a tool to forcefully cremate the deceased Muslims irrespective of the sentiments of the Muslim families.

Sri Lanka, officially known as the ‘Socialist Republic of Sri Lanka’, is a South Asian country forming a tear-drop below the Indian subcontinent and located at the southwestern edge of the Bay of Bengal. The country was bloodied by the infamous civil war that incited in 1983; claiming mounds of lives and consuming countless communities. The 1990 Massacre was the flash point of the civil war; mosques attacked in the town of Batticaloa resulting in 300 Muslims brutally slain as a drive against the Sinhalese government. The end of the civil war should have marked an end to the inhumanity bestowed upon the Muslim minority given the fall of the ‘Tamil Tigers’; the main culprits of the 1990 massacre. However, the religious violence exponentiated instead of contracting under the Sinhalese dominated Sri Lanka as the anti-Muslimism campaigns picked up pace over the last decade, leaving the Muslim minority, making only 9% of the total population, insecure with respect to safety of life and prosperity.

Over the course of the decade, the spree of violence and discrimination against the Muslims transitioned into bloody chaos claiming mosques, shops and even crippling entire towns dwelled by the Muslims. The anti-Muslimism rhetoric led by the extremist Buddhist group ‘Bodu Bala Sena (BBS)’, backed by the Sinhalese government, paved the riots against the Muslim community in the form of mobs ravaging the Muslim towns during systematic protests. The repeated calls for protection went unheeded by the Sinhalese Buddhist Revivalist Groups, further nudging and encouraging the extremist monks to spread hatred against the Muslim community which came across as the mobster mentality boldly continued to oppress the Muslims.

The Human Rights abuse under the regime of president Gotabaya Rajapaksa and his brother, the Prime Minister Mahinda Rajapaksa, has surpassed all the records of injustice etched in the Sri Lankan history. His promises to bring back the Muslims displaced amidst the civil war went in vain and he proved to be as much of a biased leader as his brother. When Gotabaya came into power in 2019, the Sinhalese Buddhist Nationalist Party (SLPP) had been mongering extremism under the pretence of mob-attacks while backing groups like BBS to simmer hatred and prejudice against the Muslim community. The Rajapaksa brothers are notorious of their Burma-like mentality of ethnic cleansing, rumoured to be following the footsteps of Myanmar to thin the Muslim minority in a similar exercise of genocide as against the Rohingya Muslims. Though the ‘ethnic cleaning’ allegations have been repeatedly put down by the SLPP leaders, the historical bloodletting of the Muslim community and the irrational policies adopted under the charter of litigation point to a very different and bleak picture of politics in Sri Lanka.

Since the Sri Lankan government adopted the mandatory cremation policy in March 2020, more than 80 deceased Muslims have been forcibly cremated against the will of their families. While the Rajapaksa-regime uses forced cremation as another tool to torment the Muslim community by trampling on their basic rights in the guise of Covid-prevention, World Health Organisation (WHO), along with the Sri Lankan doctors, has rejected the justification provided by President Gotabaya for adopting cremation as a safety procedure to prevent water contamination due to rituals related to burial. Despite of the assurance of WHO, the Sri Lankan government not only refused to consider burial as an accepted method but even the Supreme Court expended no time to shun the petitions filed against the forcible cremation law, pushing injustice in the face of the Muslim minorities. The UN experts remarked on the systematic persecution of the Muslim community: “We deplore the implementation of such Public Health decisions based on discrimination, aggressive nationalism and ethnocentrism amounting to persecution of the Muslims and other minorities of the county”.

It is clear from the stern attitude of the Rajapaksa-regime that it aims to undermine the voice of the minorities by crushing the rights and subsequently silencing the protests that ensue from the inhuman treatment. Though the global political circles have responded strictly to the ghastly abuse of power in Sri Lanka; UK being the prime country to hold active protests against the violation of human rights and even UN High Commissioner for Human Rights, Michelle Bachelet, threatening sanctions on Sri Lanka for proactively transgressing the rights of minorities. However, despite of the pressure building up, the spokesperson of the Sri Lankan government, Keheliya Rambukwella, rebutted the allegations by stating: “We do things only on expert advice and cannot take ad-hoc decisions”. The juvenile statements followed by the aggressive attempts to subterfuge the global community are enough to expose the extremist mindset of the Sri Lankan government. The debacle that is to follow, in retrospect, could be far worse than the civil war since even the dead are not spared of the tyranny in today’s day and age.

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From Gandhi to Modi: Exploitation of Svadharma

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Hinduism is depicted as the world’s oldest religion, with roots and customs dating back to more than a 4,000 years. As of now, it constitutes of around 900 million followers, and is the 3rd most practiced religion after Christianity and Islam. In essence, Hinduism carries main concern over the mind, spirit and body of individuals, where non-violent actions that result spiritual peace of these identities are idealized. Moving forward, the central notion of Hinduism revolves around dharma, which can be associated with the overall duties and responsibilities of individuals in society, with accordance to ethical and moral practices that highlight non-violence. Notwithstanding, Hindus are also disposed to choosing their individual dharma in accord with their consciousness, intellect, and circumstances. This is coined as svadharma, and includes the duties and responsibilities of Hindus in relation to fellow beings and the total environment they reside in. Consequently, the attainment of peace is promoted through fulfilment of life goals, and the abandonment of stormy conditions. Since Svadharma as a concept is up for interpretation, it varies from individual to individual. In fact, due to its subjective nature, it also leaves room for religious exploitation in the lust for political objectives. This essay will aim to put forward the true depiction of svadharma through analyzing Mohandas Karamchand Gandhi’s Satyagraha; adding on, the exploitation for political incentives shall be explained through BJP’s Hindutva ideology.

To begin, Mohandas Karamchand Gandhi’s interpretation of svadharma resulted in Satyagraha, which can be portrayed as a revolutionary step towards non-violent non- cooperation against the British rule in India. Gandhi’s philosophy of Satyagraha was a natural outcome of the supreme concept of truth. According to which, if the truth can be deemed as the ultimate reality, its protection is critical. Hence, Satyagraha refers to the exercise of the truth against all injustices, oppressions and exploitations; which ultimately results in peace on an individual and societal level. It essentially embodies the notion of peace from Hinduism. To add on, for the attainment of fighting oppression through non-violent means, he embraced yogic strength to endure the most intense physical pain, including food and sleep deprivation without any flinching or any fear. Gandhi served as an influence to millions of his unarmed followers, through serving as a symbol of divine strength and passion. Consequently, a mass revolution was launched against the then British Empire, formally regarded as the non-cooperation movement.

 In order to stay true to the divine and peaceful teachings of Hinduism, he commanded individuals to undertake the process of obeying the civil and moral laws of the state, while simultaneously resisting laws that were oppressive and barbaric. As a result, Gandhi laid down certain standards of moral discipline for the Satyagraha process, which were: complete faith in God in order to calmly bear the physical barbarisms directed towards individuals by the British forces, not yearning after wealth and fame, submitting to the leader of the Satyagraha unit, absolutely fearlessness and firmness against brutality, single-minded purposefulness, and individuals losing sight of their duty through the virtue of anger or any other passion. Thus, Gandhi wanted to incorporate attitudes penetrating towards toleration and acceptance of the hardships that came along with this movement. Overall, Gandhi’s svadharma allowed him to attain political gains without resorting to violence, which resulted in peaceful change. In Gandhi’s words, complete civil disobedience through refusing to serve compliance to state- made-law can be an extremely powerful movement. In fact, it can become more effective in comparison to than an armed rebellion; as, it does not include the suffering of the innocent individuals on a wide scale.

Satyagraha was a peaceful and inclusive movement that arose of svadharma; nevertheless, the concept of svadharma also introduced Hindutva, which is an extremist ideology with aims to disintegrate India’s secular outlook through transforming the country into a Hindu Rasht (a majoritarian Hindu religious-nationalist state that directs its 200 million Muslims and 30 million Christians into second-class citizens). In theory this concept goes against the very teachings of Hinduism, which revolves around peace and non-violence. Nevertheless, the concept of svadharma has been exploited and misused; as, Hindu extremists incorporate this notion to justify their horrific acts to attain political interests. The word Hindutva was introduced by the 20th century ideologue V.D. Savarkar, and it literally means “Hinduness.” The central concept was the embodiment of religious nationalism with territorial belongings and citizenship. Meaning, being an Indian was equated to following the religion of Hinduism; as, India was the spiritual motherland of Hindus. This was a problem for Indian Muslims and Christians; as, their holy lands were constituents of other states. Therefore, Hindutva followers disregarded Muslims and Christians as citizens of India. The current Indian government Bharatiya Janata Party (BJP) led by Prime Minister Narendra Modi has been assimilated under the ideology of Hindutva, and this notion has brought them popularity in India. In fact, this ideology was incorporated by them to come into power, which highlights the exploitation of svadharma. As a result, forcible integration into an outward Hinduness is being conducted in India. In recent years, India has witnessed Hindutva extremists killing Muslims due to various reasons ranging from consumption of beef to failing to chant the slogan “Jai Shri Ram” to hail a Hindu deity. Such actions are being conducted in order to compel the non-Hindu population into embracing Hinduism. However, at the end of the day, Hindutva is simply an exploitation of svadharma; as, it does not acquire to its peaceful and non-violent requirements. Moreover, svadharma aims to bring about peace on an individual and societal level; and, Hindutva is simply leading to chaos and riots in India. Through this the fact that Hindutva was a political goal for Modi to come into power is highlighted.

In conclusion, Hinduism is a religion that promotes the concept of non-violence and peaceful co-existence. Over the years, svadharma has been carried out by multiple personalities across India, in order to highlight their roles and responsibilities in insuring a peaceful through their personal interpretation, most notable of which are Gandhi and Modi. Nevertheless, the difference lies in their intentions and ultimate goal. While Gandhi carried a goal of attaining interests of the Indian population through non-violent means, Modi carried the aim of coming into power. Thus, Modi did not follow the true essence of svadharma and simply exploited.

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