Sunday, November 23, 2008

Green Hospitals

Critics say hospital buildings and food are enough to make you sick. Today there's a growing movement in health care to get hospitals to green their facilities and, as host Bruce Gellerman reports, it's transforming the medical community.

GELLERMAN: About a dozen years ago, the U. S. Environmental Protection Agency reported that medical waste incinerators in hospitals were the largest source of deadly dioxins in the country. The disclosure shook the medical community and led to the creation of an organization that takes its name from the doctor's Hippocratic Oath. Gary Cohen is the executive director of Health Care Without Harm.

COHEN: And we thought how ironic that is that hospitals whose mission is to heal people are contributing to environmentally related disease in this society and we said we need to redefine what that "first, do no harm" ethic means and it means clean up your act.

GELLERMAN: The hospitals quickly cleaned up their act. The number of medical waste incinerators went from 5600 to fewer than 70 still operating today and Health Care Without Harm has become a worldwide coalition of nearly 500 organizations in more than 50 countries. The mission: hospitals, heal thyself, go green. The group led the effort to safely rid medical facilities of toxic mercury found in thermometers and blood pressure devices. But Cohen says there are still things in hospitals that can make you sick:

COHEN: And in the case of patients, if you're getting your IV drip with a PVC medical device it is dripping a reproductive toxin into your veins. Nobody's telling you that but that's the facts, and so our challenge to the hospitals has been look, can't we build cancer centers without carcinogens? Can't we build pediatric units without chemicals linked to birth defects and asthma? This is what health care needs to do. They haven't looked at, except for the last number of years they haven't looked at their environmental health impacts of their operations and their buildings and the stuff they buy.

GELLERMA: From bedpans and surgical gloves to operating rooms and MRI machines, hospitals are enormously expensive to build, equip and operate. And when it comes to making life saving decisions, administrators aren't about to worry about buying energy-saving devices. Still, medicine is starting to use the power of the purse to go green. Architect Robin Guenther is co-author of the book "Sustainable Health Care Architecture."

GUENTHER: Health care is 17 percent of the gross domestic product so health care purchasing represents a huge market leverage around any goods and services a hospital may buy.

LEVY: This is not brain surgery to save energy and water in a hospital. This is common sense kind of stuff.

GELLERMAN: Paul Levy is CEO and president of Beth Israel Deaconess Medical Center. It's a teaching hospital - one of three in Boston's Longwood Medical area. It has three million square feet of space, seven thousand employees, and a 1.2 billion dollar budget. Levy's first priority is patient care; his second is green - as in money, not green as in the environment.

LEVY: Much of the energy work and environmental work in hospitals is driven more by cost issues than by a desire to make the world cleaner and reduce carbon emissions and the like, but that's okay because they end up being the same program anyway.

GELLERMAN: Cutting costs and emissions in hospitals requires a healthy dose of technology. The prescription calls for using automated devices that control lights and temperature, the flow of air and water. Most of these devices are hidden in walls and out of sight.


GELLERMAN: But at Beth Israel Deaconess some sensors can see you.

LEVY: It's your traditional vending machine, it's got a picture on the front that's brightly light. It has a refrigerator built to keep things cool, and on top of the machine is a little sensor to keep...

GELLERMAN: Oh, look at that. I wouldn't have noticed it...

LEVY: track of how many people walking by it, and when it detects that the traffic has dropped, it powers down the machine the same way your computer would go into rest mode.


GELLERMAN: Vending machines are energy vampires, so hospital utility manager Mark Lukitsch has installed automatic detection devices to curb their appetite. He says small change can add up.

LUKITSCH: We're able to save probably, with the 26 units we installed over the next 10 years, somewhere in the 70, 000 dollar range, just for a simple device that has a payback of less than a year.

GELLERMAN: Again, hospital CEO Paul Levy.

LEVY: The thing is about hospital buildings, because they're so big, and because they're so energy intensive, you can make a minor modification in the operation of building and actually result in a fairly substantial savings.


GELLERMAN: Down the street from Boston's Beth Israel is Brigham and Women's Hospital. It has nearly twice as many employees, 13,000.

MOMBOURQUETTE: It's a big business, it's a big business. About 9,000 babies are born here every year. It's the biggest in New England, and one of the biggest in the country actually.

GELLERMAN: Art Mombourquette is vice president of support services at Brigham and Woman's. The hospital is a city unto itself. A hallway a quarter of a mile long - called the pike - connects buildings.

MOMBOURQUETTE: We're walking on one of our green initiatives – this corridor is in the process of being replaced. It's an old vinyl composition tile that we're ripping out and replacing it with a renewable product, it's a rubber product. Not only is it a renewable product, it also doesn't require any floor finishes, which means it doesn't need any harsh chemicals to clean it off when it yellows. So it's much better for the people who need to clean it. It's also softer, to walk on, it's a nice product.

GELLERMAN: It's quiet.

MOMBOURQUETTE: It's very quiet.

GELLERMAN: The long hallway leads to Brigham's newest building, the Shapiro Cardiovascular Center, 300,000 square feet of highly specialized space. It's certified silver LEED – it was designed green from the get go. No new parking spaces were added. Instead, employees were given mass transit passes. Houses that once stood on the property were moved - recycled, in a sense - to preserve the community. And inside the building's soaring atrium, special glazing was used on glass to reduce heating and cooling needs. And every patient's room has floor-to-ceiling windows.

MOMBOURQUETTE: The patient rooms actually slope up at the window, so literally funneling light into the room.

GELLERMAN: This is a hospital. Can the things that you've changed, letting in more light, using environmentally sound cleaning materials, can that help save people's lives or improve their health?

MOMBOURQUETTE: I think there's beginning to be evidence that that's a true statement, and so while it's a little difficult to quantify, there is beginning to be evidence that natural light helps healing.

GELLERMAN: Studies show hospital patients with an outside view suffer fewer complications, need less pain medication and are discharged sooner. Similar benefits have been found in hospitals where family members can stay overnight. And many hospitals are starting to build green roofs to bring nature closer to patients. And they're improving the food they serve, buying organic and locally grown.

It's all part of what's called "evidence based design." It's a concept that architect Robin Guenther says expands the definition of what constitutes health care.

GUENTHER: Buildings ultimately are the clothing that we put on our institutions. Buildings embody all our values, so when you inhabit a green building, it changes how you think about who you are and what you're doing.

GELLERMAN: At Boston's Beth Israel Deaconess, changes in architecture are changing attitudes. Community director Jane Matlaw founded "Healthy Work/Healthy Home," a program encouraging employees to bring new green ideas to the hospital.

MATLAW: And now I have people calling me frequently, saying, "Why aren't we doing this? Could we be doing this? How do we do that? and How do we make it better?" So, it's really gone from, you're a lunatic out there doing your thing, to something people really have embraced.

GELLERMAN: The benefits from going green, says Bill Ravanesi, Boston Director of Health Care Without Harm will pay for themselves - in more ways than money.

RAVANESI: There's a big transformation. We have a green tsunami around us right now, and what we're seeing is a transformation in thinking in health care, going from a mindset that says "let's build an institution," into a different kind of vision, and this vision is a healing environment.

GELLERMAN: The green wave has gone mainstream - and hospitals, their workers, their patients, and communities are the better for it.


Saturday, October 11, 2008

Will There Be Another Alma-Ata?

What of the declaration from 1978 promising “Health for All”?

Thirty years have gone by since the “Alma-Ata Declaration” – adopted on September 12, 1978 at the end of an international conference on primary healthcare at Alma-Ata in the then Soviet Union (now, Almaty in Kazakhstan) – set the goal of “Health for All” by the year 2000, to be realised through universal, comprehensive primary healthcare.

The declaration, non-binding on the member-states of the United Nations, came at a time when the first and the second worlds were contending among themselves for advancing their respective power and influence in the World Health Organisation
(WHO), and the third world was pushing for a “new international economic order”. The world has since changed so very dramatically that one wonders if one should at all look at Alma-Ata 30 years on. Hardly had the dust in the aftermath of the declaration
settled down when neo-liberalism as an ideology and as an agenda began its hegemonic ascent. So what of Alma-Ata?

Alma-Ata happened five years after the democratically-elected Popular Unity government in Chile was overthrown in the coup d’état organised by Washington, in which president Salvador Allende was assassinated. Allende was a medical doctor who understood the social origins of disease and ill-health, just like Che Guevara, also a medical practitioner, did. Both of them saw “politics as medicine on a grand scale”.

Allende knew from his practice since the 1930s that a solution to the ill-health of the Chilean people lay not merely in the provision of healthcare but in bringing
about better conditions of work, housing, sanitation, nutrition, and so on. On its part, Cuba, a third world country that practised universal, comprehensive primary healthcare has attained health indicators corresponding to those of the developed world. Closer home, in our part of the world, Alma-Ata came at a time when the Maoist model of development in China – which had incorporated universal, comprehensive primary healthcare, among other things, as an integral part of a long-term programme – was being sought to be discarded following the third plenum of the 11th central committee of the Chinese Communist Party that announced the decision to launch “market reforms”.

The prospects of fulfilling Alma-Ata dimmed even further when conservative, right-wing governments in the United States and the United Kingdom headed by Ronald Reagan and Margaret Thatcher, respectively, took office. After all, Alma-Ata was informed by a
Weltanschauung that was wholly at odds with that of neoliberalism.

In the declaration, health “is a fundamental human right” whose attainment requires a multi pronged attack on the social determinants of ill-health and disease. Existing “gross inequality in the health status of the people is politically, socially, and economically unacceptable”. While the state is held responsible for the health of
the people, the latter “have a right and duty to the planning and implementation of their healthcare”. And, the conception and practice of primary healthcare should be informed by the understanding that social and economic relations and conditions profoundly influence health, disease and medicine (Paras VI
and VII of the declaration).

Sadly, on the ground, what was practised was selective primary healthcare, for instance, “targeting” children under age five with immunisation and oral rehydration salts (ORS), technical fixes that are useful but cannot go a long way in dealing with health problems whose roots are to be found in exploitation and oppression.

With World Bank-imposed structural adjustment programmes (SAPs) in the 1980s and the slashing of public health expenditure, poor families in the third world landed up at times spending a third of their daily earnings to buy the ORS packets that were being
promoted via “social marketing”. The SAPs adversely affected not only health expenditures, but also those related to education, food subsidy, public transport, etc, pruning a whole gamut of social welfare activity undertaken by states. User-fees, basically cost recovery measures, and the privatisation of health service functions
became the order of the day under the World Bank-mandated SAPs, even as the United Nations Children’s Fund (UNICEF) pleaded for undertaking them “with a human face”.

Whatever happened to healthcare as a “fundamental human right”?

The World Bank’s World Development Report 1993: Investing in Health, as David Werner wrote in an article in this journal 13 years ago (January 21, 1995), “put the last nail in the coffin of the Alma-Ata Declaration”. The World Bank has since pushed the
WHO into second place as the global agency influencing health policy, with a three-fold impact on the ground.

First, the responsibility for the coverage of health costs is a huge burden the poor have to bear more than ever before. Second, primary healthcare has become even more narrow and selective than it was in the 1980s. And, third, the private sector, including the insurance industry, has boomed in the “business” of healthcare. Yes, the business of healthcare – patients are now “clients” and clinical services are “product lines”.

The rights of the pharmaceutical corporations to their intellectual property precede the “fundamental right to healthcare”, which is anyway “non-binding”.

What then of Alma-Ata?

What goes around comes around. If disease is socially derived, then ill-health and disease are an indictment of the social, economic and political order. There will be many a “Sicko” (the title of the film on healthcare in the US by Michael Moore), and, sooner rather than later, the counter-movement against the market mechanism will generate its own Alma-Ata. The struggle for healthcare as a fundamental human right goes on.

Playing God: The Global Population Control Movement

Playing God: The Global Population Control Movement

Book Review, The Economic & Political Weekly, October 4, 2008

Fatal Misconception: The Struggle to Control World Population by Matthew Connelly; Harvard University Press, Cambridge, Massachusetts, 2008


Mohan Rao

This is a truly extraordinary book that I cannot recommend too
highly, not just to the small community of historians working in the area of health and population, but for public health workers, demographers, scholars in gender studies, feminist and health
activists and, indeed, even the occasional policymaker who reads.

The book has been reviewed favourably in extremely unlikely places, including the New York Times and the Economist. Both point out
that the author is born in a Catholic family, with many children, implying this would explain the critique of the global population control movement that this book is. Both reviews did not point out
that some of the harshest criticism in the book is reserved for the Catholic church’s stand on contraception and abortion.

Reviewers in both places seem to think ideas underlying population control is a thing of the past, like political incorrectness.
And here, they have some misguided support from the author himself, but more on this later.

Here is a scholar who had infamously written in the Atlantic Monthly, with that Cold Warrior Paul Kennedy, that population
growth in the third world, along with growing economic inequalities and migration, portended nothing less than a clash of civilisations, in a familiar replay of neo-Malthusian tropes. Here he is several years later, with extensive research under his belt, prepared not
only to critique his own earlier position, but examine what factors lead to that position itself. This self-questioning, selfdoubt,
is truly catholic – with a small c –and indeed a conversion.

Hopefully, reading this book will take others through the same journey of discovery. Being politically correct, influential
people in policymaking circles in the first world no longer talk of the yellow peril, or use phrases such as population explosion,
or metaphors like the population bomb. Nevertheless, neo-Malthusian thinking –that population growth is the cause of a host of problems, of hunger and poverty, or indeed famines, and today, genocide
and global warming – frames other policy discourses, that on immigration and the environment being prominent ones. “Most
Americans Want Immigration Drastically Reduced” reads a full-page advertisement in Harper’s, put forth by Negative Population
Growth. It goes on to argue about the “catastrophic effect of overpopulation on our environment, resources and standard
of living” (Harper’s 2004:19).1 Neo-Malthusian underpinnings are evident in some of the security discourses on refugees.

The ghastly Rwandan tragedy was seen as an inevitable consequence of
p opulation growth, not the politics of g enocide (Mamdani 2001).2 Hum do hamare do, who paanch, unke pachees (“The two of us have two, the five of them have 25”), was a slogan that won an infamous election in Gujarat after the genocide of Muslims in 2002 (Rao 2007).3 We only need to remember that as soon as the last elections
were announced in the UK, immigration became an issue, not just for the Conservatives but for the New Labour of Tony Blair as well. Both Italy and France have recently elected right wing presidents on an explicit anti-immigration platform.


At the same time, a sub-discipline of “strategic demography” has emerged, that seeks to locate the growth of slamic “fundamentalism”4 in the “youth bulge theory”. This fanciful theory argues that population growth in Islamic countries, characterised by a high proportion of youth, leads to the growth of Islamic funda mentalism, spelling political d anger, not just to democracy in these co untries but to the so-called free world (Hendrixson 2004).5 This search for biological metaphors to political and economic problems does not, for instance, explain the rise to political dominance of Protestant fundamentalism in the United States, which has of course no youth bulge, nor indeed significant po pulation growth. But such matters of truth or rigour rarely troubled demographic discourses in the past, and obviously do not, today. In other words, the population growth argument remains compelling, and truly protean, explaining just about everything, and thus of course
explaining nothing.

Here is a remarkable book, of solid scholarship (although rather overburdened with more than a 100 pages of notes and references. Another quick paperback edition is called for without this, cheaper, and thus accessible to more people). Along with a host of secondary
materials, the author has extensively tracked government and UN reports, and, most extraordinarily, been granted permission
to go through the records of organisations such as the Rockefeller
Foundation, the Population Council and so on – the prime players, or villains, in the population drama. Does this mean they have come to terms with their pasts? Or does it mean they do not really care?
Whatever it is, we must salute these organisations for the unusual courage they have displayed.

Fatal Misconception abjures rhetoric and conspiracy theories, indicating the concatenation of ideas, institutions and the
contingencies of global politics to, to use current jargon, deconstruct neo- Malthusian assumptions that lie at the heart of
population policies. It shows with meticulous attention to details of ideas, personalities and funding, how the global population
control movement was created, tracing the extraordinary unfolding of
population policies under the guidance of this movement, in India and China in particular. However, for a book that claims
to be “the first global history of population control” (p 10), the book does not give enough attention to events in Africa, Peru
(forced sterilisation of indigenous people), or indeed the US itself, with its history of eugenic sterilisations.

The book documents admirably this movement’s command over resources,
financial, and intellectual, and the strategies adopted to win friends and influence people – that is so overwhelming even
today.6 And how, in the process, was established a pattern of domination, and a network of institutions, that continues to be
effective in areas as diverse as HIV/AIDS policy and indeed reproductive health policy. Yet, it is not a simple, or simplistic,
first world – imperialism story, which it fundamentally is, but a nuanced, multilayered one. The book is above all rich in
tracing the ideas that influenced such a motley, and huge, group of people. Yes, imperialism is central to the population control movement, but there is also the element of individual freedom and rights it promises, especially to women. Yes, it was hugely racist – and sexist – and this was of course at the heart of the science of
eugenics, which saw its apogee in the Holocaust, but this was not unique to G ermany.7 Indeed the Scandinavian countries and Canada had eugenic sterilisation laws long after the Nuremburg trials discredited them. Yes, cold war politics – communism will spread because of population growth – dictated many of the urges of the movement in the hopeful post- second world war years. Yes, too, that the things done were terrible, but above all that there was consent, approval and indeed active participation from a host of
third world elites. This was a joint global elite project, using different threads of arguments at various times. The movement
felt it could decide who could be allowed to be born and where, and who could be allowed to die.

At times the arguments were eugenic: that the worst were breeding whilst the best were not. This argument seemed to find particular resonance in India with all the leading population control people,
predominantly upper caste Hindus (and indeed a few upper caste Muslims), being particularly suspicious, and fearful of
lower caste and Muslim reproduction. This argument was what led to the sterilisation laws in a host of states in the US, and indeed the US’ immigration policies early in the 20th century. Eugenics is of course currently being reinvented as n eo-eugenics in the wake of advances in biotechnology: parents can now “freely” decide, if they can afford it, what genetic characteristics they do not want in
their child.

Women’s Rights

At other places, the arguments were about women’s rights, as is the case today. It is indeed a case for women’s and men’s rights – but the problem was that this was used instrumentally. Margaret
Sanger, who made this argument forcefully, was also a eugenist, causing profound embarrassment to her erstwhile socialist colleagues. Matthew Connelly is inexplicably rather sweet on Sanger. I would suggest he quickly read Sarah Hodges (2006)8 and Sanjam Ahluwalia (2008)9 before the quick new edition of this book. A question Connelly does not raise is why Sanger, during her tour of
India influencing people to the population control cause,10 did not make overtures to Periyar or Ambedkar, both fierce proponents of birth control. The reason is of course very simple: for Sanger contraception was for eugenic purposes; for Periyar and Ambedkar, it was a quest for gender justice and a blow against
patriarchy and caste.

Above all, the arguments were about economics and development. Population growth in third world countries was seen as the primary reason for their horrible poverty. Colonialism, or indeed the continuing drain of resources from these countries, did not figure. Economic growth could only take place if population was
controlled, it was argued, if necessary with force. I was astonished to discover in this book that Kingsley Davis, the guru of
demographers, who gave testimony in the US senate as to why population control is necessary to combat communism, gave
approval to Sanjay Gandhi’s fearful policies of coercive sterilisations during the Emergency in India (p 320).

The many-headed, hydra-like beast that was created, acting globally, accountable to no one but themselves – which is unfortunately characteristic of most non-governmental organisations (NGOs) – comprised a network of organisations including the Population Council, the Rockefeller Foundation, the For Foundation, the
International Planned Parenthood Federation (with its clutch of poodle national family planning associations) and so on.
They obtained funding from organisations such as the World Bank, the USAID and the UNFPA, and in turn funded a whole range of activist NGOs. As the book documents, during the 20th century more money has
been poured into this movement by first world governments, and others, than any other cause. Linked through funds and people were the leading academic departments at Harvard, Princeton and so on,
and think tanks that increasingly influenced foreign policy. Significantly, all the major demographic journals were funded
by the same institutions and were thus largely responsible for the scientific sheen demography carried. The interconnection between these that Connelly demonstrates is both mind-boggling and
frighteningly impressive.

Revealing Facts

Connelly also shows us how these ideas were used to push the population control agenda globally. Utterly revealing was the
fact that leading donors knew what the Emergency was doing to family planning in India and welcomed it (pp 322-23). Similarly,
I was shocked to discover that donors knew that ultrasounds were
d istorting child sex ratios in China – but that, in their anxiety to control population, encouraged China to import ultrasounds
with aid funds (p 347), and indeed, that the World Bank used structural adjustment loans to push population control policies (p 349).

Connelly does not note the irony that it is precisely these groups and organisations that are involved with reproductive
health and rights today. He seems to believe, inexplicably, that population control is a thing of the past. Thus we have
some paeans to the idea of reproductive health and rights that came to centrestage at the International Conference on Population
and Development at Cairo in 1994. There is such a wealth of literature on the troubled relationship between this evocation of women and reproductive rights – and the wrongs that accompanied it. He misses the significant point that what was being pushed through as the Cairo consensus was the agenda of US feminists. It has been described as white, western and quintessentially bourgeoise.

From Angela Davis onwards, a whole lot of people have written about this. I have described this as an outcome of the marriage
of multinational feminisms with international debt. Surely it is significant that the Cairo consensus not only had the imprimatur of the World Bank, but was silent on what the Bank’s policies had
unleashed on women and their rights and entitlements globally through structural adjustment programmes. Indeed, the Cairo consensus came in for scathing criticism by the leading women’s groups in India on precisely this ground. There is also a movement for reproductive justice, which rejects this concept of
reproductive rights.

Birth rates are declining across the globe, although it is not clear if this is linked in any significant manner with population control programmes. Yet, as we have seen, ideas associated with this
movement have a way of resurfacing in inexplicable ways. Today, warns Connelly, we may already be witnessing something no
less pernicious: the privatisation of population control. It is governmentality without government, in which people police themselves, unconsciously reproducing and reinforcing
inequality with every generation.…

Parents increasingly experience genetic counselling and solicitous concern for foetal health as social pressure to have perfect children, even if standards for perfection are constantly changing. In everyday conversation, people ascribe a whole range of
behaviours to good or bad genes, faithfully reciting a eugenic catechism without the faintest idea of where it comes from or where
it can lead (p 382).


1 Harper’s (2004), Vol 309, No 1853, October.
2 Mahmood Mamdani (2001), When Victims Become
Killers: Colonialism, Nativism and the Genocide in
Rwanda, Princeton University Press, Princeton.
3 Mohan Rao (2007), ‘Saffron Demography: So
Dangerous, Yet So Appealing’, Different Takes,
No 48, Spring 2007, Amherst, Mass, Reprinted in
Babies, Burdens and Threats: Current Faces of
P opulation Control, Hampshire College, Mass.
4 The untroubled use of this word, as of the phrase
“Hindu nationalism”, to describe Hindu fascist
groups indicates the reach and dominance of
crude western thinking, repeated unquestioningly
in India and elsewhere. The word fundamentalism
of course derives very specifically from
the history of Protestant groups in the US, wishing
to reach into the fundamentals of their version
of Christianity to guide their politics and
everyday lives. There are enormous problems
with this characterisation of the Sangh parivar as
Hindu fundamentalist or Hindu nationalist. In
the first place, they do not represent Hindus, and
indeed seem to be deeply ashamed of Hinduism,
wishing to transform it into a more semitic, “masculine”
religion, like Christianity or Islam. There
are of course no fundamentals in Hinduism. Their
claim to be nationalistic is equally moot since
they played an extremely marginal role in India’s
freedom struggle. Indeed, the assassin of
Mahatma Gandhi, a good and proper Hindu, was
a member of the Sangh parivar as it then existed.
5 Anne Hendrixson (2004), Angry Young Men,
Veiled Young Women: Constructing a New Population
Threat, Cornerhouse Briefing No 34, December,
6 As I write the review I see a news item in the
Times of India (‘In Kerala, Having a 3rd Kid May
Invite Penalty’, July 30, 2008) that Kerala seeks
to introduce a two-child norm, with a number of
penalising disincentives. The Kerala Law
C ommission that has mooted this, under the
leadership of the progressive justice Krishna Iyer,
does not seem to know that Kerala has long completed
her demographic transition. In other
words, that even for purely instrumental reasons,
the move is entirely unnecessary, and equally
entirely foolish.
7 Indeed, many doctors and scientists involved in
eugenic sterilisation, and worse, in Nazi G ermany,
got away at the Nuremberg trials where it was
pointed out that the German laws were modelled
on ones current in the US and in many other countries.
Indeed, the US Supreme Court had found
these laws constitutionally valid and thus acceptable.
See Harry Brunius (2006), Better for All the
World: The Secret History of Forced Sterilisations
and America’s Quest for Racial Purity, Alfred
A Knopf, NY.
8 Sarah Hodges (2006), Reproductive Health in
India: History, Politics, Controversies, Orient
Longman, New Delhi.
9 Sanjam Ahluwalia (2008), Reproductive
Restraints: Birth Control in India, 1877-1947,
P ermanent Black, Ranikhet.
10 This, incidentally has been famously rebuffed by
Gandhi. Gandhi rejected contraception sometimes
arguing that contraception would lead to sin and
the weakening of individuals and nations; he sometimes
also rejected contraception on the grounds
that neo-Malthusianism was fundamentally flawed;
at all times arguing that celibacy was the solution
where women, and indeed men, were concerned.

Health care costs: A market-based view

If health care costs continue to rise at current rates, they could amount to 20 percent or more of the GDP of many developed countries. To understand how to manage—or influence—this expenditure, decision makers should look at the factors that influence the supply and demand of health care services.

* Throughout the world, leaders of government health agencies, heads of health care companies, and even patients—collectively, the shapers of the modern health care system—behold the growth of health care spending with alarm. For almost 50 years, spending has grown by 2 percentage points in excess of GDP growth across all Organisation for Economic Co-operation and Development (OECD) countries. As a result, health care has become a much bigger part of most of these economies.
* If current trends persist to 2050, most OECD countries will spend more than a fifth of GDP on health care. By 2080 Switzerland and the United States will devote more than half of GDP to it—and by 2100 most other OECD countries will reach this level of spending.
* Health care leaders fervently hope that the projections are off the mark. What will have to change to prevent health care from devouring half of a national economy?

This article contains the following exhibits:

* Exhibit 1: In the health-care market, the line between supply and demand is sometimes blurred.
* Exhibit 2: Per capita spending on health care strongly correlates with national GDP.
* Exhibit 3: The median increase in health-care spending in member countries of the Organisation for Economic Co-operation and Development (OECD) has been two percentage points above GDP for nearly 50 years.
* Exhibit 4: At the historic growth rate, health care will consume an ever-growing proportion of developed nations' wealth.
* Exhibit 5: In many countries, the tax-financed part of health care represents a massive transfer from young taxpayers to older health care users.

The McKinsey Quarterly

The Corner House on Health

Who Owns the Knowledge Economy? Political Organising Behind TRIPS

by Peter Drahos with John Braithwaite

When TRIPS was signed in 1994, the United States, Europe and Japan dominated the world's software, pharmaceutical, chemical and entertainment industries. The rest of the world had little to gain by agreeing to these terms of trade for intellectual property. They did so because a failure of democratic processes nationally and internationally enabled a small group of men within the United States to capture the US trade-agenda-setting process, to draft intellectual property principles that became the blueprint for TRIPS and to crush resistance through US trade power.

A Decade After Cairo Women's Health in a Free Market Economy

by Sumati Nair and Preeti Kirbat with Sarah Sexton

This briefing evaluates the 1994 UN International Conference on Population and Development. It assesses several processes that affect women's reproductive and sexual rights and health: the decline and collapse in health services; neo-liberal economic policies and religious fundamentalisms; and development policies underpinned by neo-Malthusianism.

GATS, Privatisation and Health

by Sarah Sexton

The World Trade Organisation's General Agreement on Trade in Services (GATS) could have a significant effect on human health, and health care services.

Trading Health Care Away? GATS, Public Services and Privatisation

by Sarah Sexton

If Cloning is the Answer, What was the Question? Power and Decision-Making in the Geneticisation of Health

by Sarah Sexton

Most discussions about human embryo cloning focus on ethics and potential health benefits. In the process, the many social, economic and environmental aspects of health and disease are increasingly hidden, while issues such as how the potential benefits of biotech would be obtained and distributed are sidelined. It has therefore become hard to raise key questions about the increased geneticisation of our lives and societies.

Saturday, September 20, 2008

Contaminated milk kills Babies

China is once again rocked by a baby milk formula scandal. Four babies have died and at least six thousand are suffering from kidney stones, which has led to acute kidney failure in many of the sick children. Originally, only the San Lu brand was thought to be contaminated, but it has since transpired that twenty other brands have been tested positive for melamine. The World Health Organisation has called on the Chinese authorities to explain how the scandal was allowed to develop.

Baby milk inspection in ChinaAnd while hospital waiting rooms across China are filling up with worried parents and babies with kidney stones, TV commercials promoting baby formula are still on air:

"This is a TV commercial for formula. A special ingredient makes this formula easier to digest - specially designed for your baby's delicate digestive system. Nestle Grow Formula Number 3 - for babies growing the healthy way."

The text for this commercial typifies the kind of claims made by the marketers - they emphasise the special quality attributed to their brand. Aggressive advertising campaigns like this have led to a sharp decrease in the number of women breast-feeding their babies.

And now the magic formula has been found to contain melamine, a chemical used in the manufacture of durable household products like plastic dinnerware and cutlery. Suppliers - be it the farmers or the dairies - are suspected of diluting milk to cut costs, then adding melamine to make it appear higher in protein. More protein means more money.

Kidney stones

It also means more babies - thousands of them - with kidney stones. John Foreman, an American paediatrician and kidney specialist:

"We know that melamine can form stones, and presumably that's what's happening to those children. They are getting stones in their kidneys and that's blocking the flow of urine, which is backing up in the kidneys and causing them not to function properly."

The San Lu Group knew that melamine was being added to formula for three years, but opted to remain silent. Local authorities also chose not to investigate the affair, for fear of bad press just when the spotlight was on Beijing for the Olympic Games.

The Chinese media released the information about the contaminated San Lu milk on 11 September. On 16 September, it was revealed that 21 other brands had the same problem, including Olympic Games sponsor Yili.

Confidence waning

Now the public has little or no confidence in any of the popular dairy products. In a supermarket at the Workers' Stadium, an old woman is looking up and down the shelves:
"I wouldn't dare buy [Yili] anymore. Only foreign milk; that should be alright."

Imported milk is three times more expensive, but many are prepared to pay to be safe. On an internet forum for mothers, 94 percent of those questioned have said that they will not use Chinese brands. And now, not even regular milk is an alternative. On Friday, it was announced that liquid milk from three of China's largest dairies was tainted with melamine.

The current milk crisis is the last in a series of food scandals in China. Eggs, steamed sandwiches, animal feed and prawns have all featured in the string of health scares. Three years ago, 13 babies died in the Anhui province as a result of malnutrition. They had been fed a kind of fake formula containing no nutrition.

Indeed we need to reach far beyond the actual consumers of baby milks. This is a case of Globalised Contamination.

The hue and cry around the Sanlu baby milk tragedy in China is focusing very narrowly on the quality of the milk produced by one Chinese company. This detracts from the fact that formula feeding regardless of brand and origin has inherent risks. What is also being overlooked is the large number of babies dependent on formula feeding at an age when breastfeeding should be the norm. The fact that aggressive marketing may be one key factor that is tilting the balance against breastfeeding
is also not being addressed.

China has had regulations that implement the International Code of Marketing of Breastmilk Substitutes since 1995. The regulations are incomplete and have regrettably never been fully implemented or enforced despite ICDC's past and recent efforts. Maybe this latest episode of babies dying and suffering as a result of formula feeding will get the Chinese authorities to sit up and give breastfeeding the support it deserves. They must act to protect their children. It is the least they can do. There will doubtlessly be more muck-ups with milks but the harm will be
minimised if breastfeeding is made popular and routine.

Until that time, foreign companies selling formula in China will be gloating over increased sales.

Tuesday, March 18, 2008

No package deal

Rajib Dasgupta and Rama V. Baru

Health and education are fundamental rights of every child and it is imperative that the state and civil society ensure that these services are available, accessible and of good quality. Data from the National Nutritional Monitoring Bureau and the National Family Health Survey 3 indicate that child malnutrition continues to be a serious concern.

The government is now considering the replacement of cooked meals with packaged foods and biscuits in its Mid-Day Meal (MDM) and Integrated Child Development Services (ICDS) programmes. It is argued that this shift would improve efficiency and help overcome fiscal and managerial constraints faced in the implementation of these programmes. Reports also point to the role of the packaged food and biscuit industries that see the potential for furthering their business interests through these government programmes. The proposed policy shift has evinced concern from the academic community of senior scientists, medical professionals, educationists, nutritionists, public health experts and civil society organisations.

The objective of the mid-day meal programme was to increase enrollment and ensure better nutritional status among children. Several studies have demonstrated the positive impact of mid-day meals on school enrollment. The extent of impact on the health and nutrition of children is largely dependent on whether the meal that is provided is supplementary or a substitute for a full meal.

Several civil society alliances, professional networks like the Indian Association for Preventive and Social Medicine (IAPSM) and academics came together at a consultation that was initiated by the University School Resource Network project at Jawaharlal Nehru University. This consultation sought to review the scientific evidence that favoured cooked meals in the nutritional support programmes. Those present at this consultation unanimously opposed the idea of replacing cooked meals with packaged foods. A review of available evidence showed the value of cooked meals over dry rations or biscuits. Several studies have shown that not only is the quality variable but the nutritional impact of dry snacks is also questionable.

A fresh meal offers a better range of nutrients and is less costly in terms of per rupee nutrient yield when compared to packaged food. Calorie deficiency is by far the single most important challenge and its correction through wholesome balanced diets will go a long way in tackling micronutrient deficiencies as well. The other benefits of cooked meals are that they address ‘classroom hunger’ and also provide protection against acute hunger among children in drought affected areas.

A wholesome cooked meal makes the school attractive for the child and along with improved enrollment and attendance helps the learning process. Children learn to sit and eat together and that contributes to breaking caste and class barriers.

Despite overwhelming evidence regarding the positive contribution and demand for these schemes, these programmes are not without problems. These are related to resources, infrastructure, problems in delivery and issues of quality and quantity. Different states have different experiences related to the cooked meal programme that need to be properly studied.

The consultation was of the view that the constraints of finances and management that are faced by these programmes need to be addressed by context-specific fiscal and managerial solutions. In the context of hunger and malnutrition, the MDM and ICDS programmes have contributed significantly but they need to be strengthened further. Therefore those present at the consultation argued against any shift in policy without acknowledging the overwhelming scientific evidence regarding the value of cooked meals at feeding programmes.

In response to a public interest litigation on the right to food, the Supreme Court had in 2001 ordered that each child was entitled to a cooked meal that had 300 calories and 8-12 gm of protein per day for a minimum of 200 days a year. Malnourished children were entitled to 600 calories and 16-20 gm of protein. At present, the allocation per child does not allow for variety in the menu and therefore it is necessary to enhance financial allocation. This would ensure an increase in both quantity and nutritional quality of the food that is being served.

Instead of a supplementary feeding programme, the children would get a full meal that takes into account locally available foods with nutritional adequacy. Infrastructure in schools — water supply, toilets, kitchen area and hiring of cooks — often does not receive adequate attention. Monitoring systems to check quality and possible corruption and leakages in food grain supply need to be strengthened.

The strategy for implementation needs a decentralised approach taking into account the regional and local contexts. This would also result in greater accountability and transparency at every level of the programme.

Rajib Dasgupta is assistant professor and Rama V. Baru is associate professor at the Centre of Social Medicine and Community Health, JNU

March 18, 2008
Indian Express

Tuesday, February 19, 2008

Apology & a Bitter History of Stolen Generations

Australia's prime minister delivered an historic apology to the Aboriginal people in a gesture of reconciliation for injustices committed over two centuries of white settlement.

"We apologise for the laws and policies of successive parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians," Kevin Rudd told the Australian parliament.

His speech focused in particular on the suffering of what have become known as the "Stolen Generations" - mostly mixed-race children, who were taken from their families up until the 1970s in a bid to assimilate them into white society.

But Rudd's address also took in a broader apology over what he called "a great wrong" committed against Australia's indigenous peoples, repeatedly using the crucial word "sorry".

"As prime minister of Australia, I am sorry. On behalf of the government of Australia, I am sorry. On behalf of the parliament of Australia, I am sorry," Rudd said.

Use of the word "sorry" carries major symbolism for Aborigines after Australian Prime Minister Kevin Rudd's conservative predecessor, John Howard, refused to utter it when he was in power. Howard was the only one of Australia's five surviving prime ministers who was not in parliament on February 13, 2008 to hear Rudd's speech, although his Liberal party, now in opposition, backed the motion of apology.

Howard lost his parliamentary seat in last November's national elections which saw a landslide victory for Rudd's Labor party.

The full text of the speech is available at:

A Bitter History

Aboriginal population of Australia estimated between 750,000 to two million prior to arrival of first white settlers in 1788.

Combination of disease, loss of land and violence reduced numbers by 80 per cent over the following century. Smallpox wiped out more than half the population.

Between 1900 and early 1970s estimated 100,000 Aborigines were taken from their natural parents as part of an assimilation programme, now dubbed the Stolen Generation.

Aborigines not granted vote in federal elections until 1962.

Aboriginal population was not counted in national census until 1967, prior to which Aboriginal affairs were governed under Australian flora and fauna laws.

According to 2006 census, Aboriginal and Torres Strait Islanders population stood at 455,031, out of total Australian population of 20,061,646.

Many aboriginal communities are plagued by high unemployment, juvenile delinquency, school dropouts, drugs, crime, domestic and sexual problems, and alcoholism.

Government statistics show an indigenous Australian is 11 times more likely to be in prison than a non-indigenous Australian, while indigenous Australians are twice as likely to be a victim of violence.

A 2007 study found standards of healthcare for Aborigines 100 years behind rest of Australia, with Aboriginal men having life expectancy 18 years below national average.

On 21 June 2007 then Prime Minister, John Howard, and the Minister
for Indigenous Affairs, Mal Brough announced 'national emergency
measures to protect Aboriginal children in the Northern Territory from
abuse and give them a better, safer future'. This initiative was bi-
partisan and endorsed by then opposition leader Kevin Rudd. Although the intervention is presented as a broad based social welfare initiative, it has a significant public health component.

The paper available at briefly analyses the public health implications and the overall context of the intervention.

Monday, February 11, 2008

Rambling notes on Union Budget 2008

Ramon Magasasay once said: "Those who have less in life should have more in law."

Era Sezhiyan, A former Member of the Lok Sabha says, "While the Budgets are growing richer and richer, the poor are growing poorer and poorer without having any worthwhile share in the benefits of budgeting and the government expenditures.
In India, those who have less in life have much less in law. "

How long will it take, for the fury of the long-suffering masses to explode?

The Finance Ministers of India: First row: R.K. Shanmukham Chetti, John Maththai, C.D. Deshmukh, T.T. Krishnamachari, Jawaharlal Nehru and Morarji Desai. Second row: Sachindra Chaudhuri, Indira Gandhi, Y.B. Chavan, C. Subramaniam and H.M. Patel. Third row: Charan Singh, R. Venkatraman, Pranab Mukherjee, V.P. Singh, and Rajiv Gandhi. Fourth row: N.D. Tiwari, S.B. Chavan, Madhu Dandavate, Yashwant Sinha, Manmohan Singh and P. Chidambaram.

Union Budget 2008 will be announced on 29th February 2008. "The Budget for 2008-09 will be the least taxing (no pun intended!) for the Finance Minister, P. Chidambaram, in several respects and for various reasons." The budget document is not only a statement of its accounts but also a charter of the government’s economic policies. These policies are reflected at the macro-level in instances like allowing of 51% foreign direct investment in certain sectors in 1999 by Manmohan Singh to the micro level in 1962 when Morarji Desai specified the number of matchsticks(50 in each packet) that a matchbox could contain in order to get excise exemptions.

Given the fact that the Finance Minister is formulating his last budget in the backdrop of a good economic performance of nine percent growth and the upcoming parliamentary elections, he is expected to announce seemingly socialist programmes. These would include token measures in the field of education, health and water concerns.

Hospitals and doctors must be brought in the service tax net. Also the Minister must not cave in to pressure from Bar Associations and to his own bias towards his and his wife's profession by imposing service tax on advocates in this Budget and treat them at par with the other professionals in the country.

Indeed any doctor and advocate who earns more than Rs 800,000 in a year, can definitely afford to pay the service tax.

The Telegraph talked of how Budget can go Nano:

2008 is the year of the Nano, and by now, Nano has come to stand for anything that is small — small in size and small in means. In keeping with the trend, this year’s budget is going to be a Nano budget. Lest readers misunderstand, one must quickly add that there has been no official proposal to curtail the lengthy budget speech. But when budget-minister P Chidambaram went to meet his party colleagues at 24 Akbar Road, the message was loud and clear: aam aadmi is passé, zero in on the garib aadmi. The latter, Chidambaram was told, was not getting the benefits of the 9 per cent growth rate of the GDP. Here’s what the Nano-budget might contain: a Nano loan-waiver programme for small farmers, and a Nano housing scheme (with Rs 1 lakh houses, silly!). So what happens to the aam aadmi, and aurat for that matter? He and she must Nano-ize their aspirations, what else? And hope that the GDP growth rate doesn’t go the Nano way.

The Economic Times carried a piece Men who shaped up India's economy

India had as many as 30 finance ministers after it secured independence from imperialist British rule in 1947. And, these gentlemen shaped up India’s economy which has grown in size to about US$ 800 billion. India has also emerged as the fastest growing economy after China and become a major provider of services and goods to the world.

The story of India’s evolution as a major economic power is an interesting saga intertwined with political happenings. While three Prime Ministers held the coveted portfolio of Finance, only four ministers presented more than five budgets. A brief profile of these men is given below.

Nawabzada Liaquat Ali Khan (1896 - 1951) was an Indian Muslim politician and a leading member of the All India Muslim League (AIML). He played an influential role in the partition of India and the creation of Pakistan. He was closely involved in the negotiations over the form of independence to be granted to India after World War II.

When the Indian political leadership asked the Muslim League to send its nominees for representation in the interim government, Liaquat Ali was asked to lead the League group in the Union Cabinet. He was assigned the finance portfolio by the first Indian Prime Minister Pandit Jawahar Lal Nehru. Acknowledged as Jinnah's "right hand" and as such Liaquat was the obvious choice to become prime minister of independent Pakistan in 1947. He went on to become the country's senior most leader after Jinnah's death in 1948.

India’s First FM R K Shanmukham Chetty
(1947-1948): Independent India's first Budget was presented by the country's first finance minister, R K Shanmukham Chetty, on November 26, 1947. And, that was an interim Budget. It was a review of the economy and no new taxes were proposed as the budget day for 1948-49 was just 95 days away. He resigned shortly. It is believed that he was asked to resign by Jawaharlal Nehru, the Prime Minister of India due to a minor dereliction of duty by a subordinate official, so as to ensure probity.

K C Neogy
: 1948 K C Neogy then took charge. He was the second Finance Minister of free India. He held office for just 35 days and didn't get an opportunity to present a Budget.

John Mathai (1948-1950): John Mathai was an economist who served as India's first Railway Minister and subsequently as Finance Minister, taking office shortly after the presentation of India's first Budget, in 1948. He presented two budgets for 1949-50 and 1950-51. He resigned after presenting the 1950 Budget following protests against vesting large powers with the Planning Commission and P C Mahalanobis.

C D Deshmukh (1950-1956): C D Deshmukh was also the first Indian Governor of the Reserve Bank of India. He presented an interim budget for 1951-52. The first general elections in post-independence era were held between December - February 1952. Deshmukh was given the Finance portfolio after the new ministry assumed office. He felt honoured to present the first budget to the first-time elected members of Lok Sabha. Hindi crept into the budget documents beginning 1955-56. His stewardship of the country's finances was marked by prudence and humane perspective. He provided the much desired vision to deal with the changing financial needs of a young, independent and under-developed country like India.

He made significant contributions to the formulation and implementation of the country's First and Second Five Year Plans that provided strong base for the years ahead. He was responsible for ensuring social control of the financial structure such as the enactment of a new Companies Act, and nationalisation of the Imperial Bank of India and life insurance companies. He resigned from the Union Cabinet after protesting separation of Mumbai from Maharastra.

T T Krishnamachari
(1957-1958): T T Krishnamachari took over from him. He found that the calculations made in the budget for 1955-56 had gone awry. So, on November 30, 1956 in a five-thousand-word speech he described the changed economic situation and underlined the need to levy fresh taxes even before the next budget was presented. The Second General Elections were held in February-March 1957 and he presented an interim budget for 1957-58 on March 14, 1957 and the full budget subsequently. He was instrumental in setting up the country's three major steel plants and financial institutions like IDBI, ICICI and UTI. He introduced path-breaking tax reforms during his stint as Finance Minister. Krishnamachari had to resign in Feburary 1958 when one man Justice Chagla Commission found him guilty of corruption.

Jawaharlal Nehru
(1958-1959): Following Krishnamachari's resignation, the then Prime Minister, Jawaharlal Nehru, himself took charge of the Finance portfolio and presented the budget for 1958-59. In the opening para of his budget speech Nehru had said ... "According to custom, the budget statement for the coming year has to be presented today (February 28, 1958). By an unexpected and unhappy chain of circumstances the Finance Minister, who would normally have made this statement this afternoon is no longer with us. This heavy duty has fallen upon me almost at the last moment."

Morarji Desai (1959-1964): Morarji Desai became the next Finance Minister and he presented the maximum number of budgets so far- ten. They included five annual and one interim budget during his first stint. In his second tenure, he presented three full budgets and one interim as Finance Minister and Deputy Prime Minister. His annual budgets were for the years from 1959-60 to 1963-64 and the interim budget for 1962-63.

T T Krishnamachari
(1964-1966): After the first stint of Morarji Desai, Krishnamachari once again became the Finance Minister for the second time. He presented the budgets for 1964-65 and 1965-66. Embarking upon measures needed for providing social security, Krishnamachari expanded the pension scheme to cover family members of the deceased government servants by introducing a new Family Pension Scheme in 1964. He planned schemes like the Rajasthan Canal Schemes, Dandakaranya and Damodar Valley Projects. The Neyveli Lignite Projects owe their existence to the fillip given by Krishnamachari. He resigned in late 1966.

Sachindra Choudhuri
(1966-1967): Sachindra Choudhuri presented the budget for 1966-67 after the resignation of T T Krishnamachari. It was an interim arrangement.

Morarji Desai (1967-1969): After the fourth General Elections in 1967, Morarji Desai once again became the Finance Minister. This was his second stint. The annual budgets for three years 1967-68 to 1969-70 and the interim budget for 1967-68 were also presented by him. The interim budget for 1967-68 was on account of the General Elections in March 1967. He was the only Finance Minister to have had the opportunity to present two budgets on his birthday - in 1964 and 1968. He was born on February 29. Desai resigned in July 1969 in protest against the nationalisation of major banks by an ordinance on a Saturday evening. He felt social control of banks would regulate their functioning and make them accountable.

Indira Gandhi (1969-71): After Morarji Desai's resignation, Indira Gandhi, the then Prime Minister assumed the Finance portfolio. So far, she has been the only woman Finance Minister.

Y B Chavan (1971-1975): Following the Fifth General Elections in March, 1971, Y B Chavan became the Finance Minister. He presented the interim budget for 1971-72 and the final budgets for four years - 1971-72 to 1974-75.

C Subramaniam (1975-1977): C Subramaniam presented the budgets between 1975-76 and 1976-77. He cast the widest net to increase revenue through excise.

H M Patel (1977-1979): After the Seventh General Elections in March 1977, the first non-Congress Ministry under the then Janata Party assumed office at the centre. Morarji Desai was elected as the Prime Minister. H M Patel held the Finance portfolio. He presented the interim budget for 1977-78. He also presented the annual budget for 1978-79.

Chaudhary Charan Singh
(1979-1980): The budget for 1979-80 was presented by Chaudhary Charan Singh who was also Deputy Prime Minister.

Ramaswamy Venkataraman
(1980-1982): After the seventh General Elections in January, 1980, the Congress Party returned to power. Venkataraman presented the interim and final budgets for 1980-81 and the annual budget for 1981-82. Later he rose to become the country's Vice President and President.

Pranab Mukherjee
(1982-1984): Pranab Mukherjee presented the annual budgets for 1982-83, 1983-84 and 1984-85. He was the first Rajya Sabha member to hold the Finance portfolio.

V P Singh (1985-1987): After the Eighth General Elections in 1984, V P Singh presented the annual budgets for 1985-86 and 1986-87. There was no interim budget since the elections were held in December 1984. He was part of the ministry headed by Rajiv Gandhi.

He oversaw the gradual relaxation of the license raj that Rajiv had in mind. He also gave extra power to the Enforcement Directorate of the Finance Ministry, that was given charge of tracking down tax evaders. Following a number of high-profile raids on suspected evaders - including Dhirubhai Ambani - Rajiv Gandhi was forced to sack him as Finance Minister, possibly because many of the raids were conducted on industrialists who had supported the Congress financially in the past.

Rajiv Gandhi (1987-1988): Rajiv Gandhi presented the budget for 1987-88. He was the third Prime Minister to present a budget after his mother, and grand father. The exercise in zero-based budget began in 1987-88. The zero-based budgeting is a process of review, analysis and evolution for each budget request in order to justify its inclusion or exclusion from the integrated whole budget before it is finally approved. In India, the zero-based budgeting was implemented in three phases - one third in the first year, two thirds in the second year and fully from the third year. It is a continuous process.

N D Tiwari (1988-1989): N D Tiwari presented the budget for the year 1988-1989.

S B Chavan
(1989-1990): S.B. Chavan did the budget exercise for 1989-90. He also served twice as the Chief Minister of Maharashtra.

Madhu Dandavate (1990-1991): After the General Elections in November 1989, the then Janata Dal Government's Finance Minister Madhu Dandavate presented the annual budget for 1990-91.

Yashwant Sinha (1991-1992): Following subsequent political developments, Yashwant Sinha became the Finance Minister and presented the interim budget for 1991-92.

Manmohan Singh
(1991-1996): Manmohan Singh served as the governor of the Reserve Bank of India in the late 1980s, and was given the portfoilo of finance in 1991 by Prime Minister Narasimha Rao. He presented the final budget for 1991-92 in July 1991. This was the first occasion when the interim and final budgets were presented by two ministers of two different political parties. The next four annual budgets of Manmohan Singh had an orientation different from the one followed till then.

The economic liberalisation package pushed by Singh and Rao opened the nation to foreign direct investment and reduced the red tape that had previously impeded business growth. The liberalisation was prompted by an acute balance-of-payments crisis whereby the Indian government was left without sufficient reserves to meet its obligations, and had begun preparations to mortgage its gold reserves to the Bank of England in order to obtain the cash reserves needed to run the country. As such, he was instrumental in making of an opened economy. He reduced the peak import duty from 300 plus to 50 per cent. He will be remembered best for making the rupee convertible in current account in just two phases. Introducing the concept of 'service tax' was his idea.

Jaswant Singh (1996): He served as Finance minister in the short-lived government of Atal Bihari Vajpayee, which lasted just from May 16, 1996, to June 1, 1996.

P Chidambaram
(1996-1998): The general elections held in 1996, paved way for a coalition government supported by the left parties. This came as a big break for Chidambaram, who was given the key cabinet portfolio of Finance; this put him in the limelight. The final budget for 1996-97 was presented by P Chidambaram of the then Tamil Maanila Congress.

It was the second time that interim and final budgets were presented by two ministers of different political parties. Following a constitutional crisis, the I.K. Gujral Ministry was on its way out and a special session of Parliament was convened only to pass Shri Chidambaram's 1997-98 budget. It was passed without a debate. Although the coalition government was a short-lived one (it fell in 1998), it showed Chidambaram's competence as Finance Minister, a factor which was to lead to his re-appointment to the same key portfolio under Prime Minister Manmohan Singh in 2004.

Yashwant Sinha (1998-2002): After the General Elections in March 1998, Yashwant Sinha got the Finance portfolio in the first ever BJP-led Atal Bihari Vajpayee Government. He presented the interim and final budgets for 1998-99. After the 13th General Elections in 1999, he became the Finance Minister once again. He had presented four annual budgets - from 1999-2000 to 2002-2003. Yashwant Sinha presented the budget for 1999-2000 in the forenoon. Earlier, the budgets used to be presented at five in the evening as a pre-independence custom introduced by British establishment. While Manmohan Singh concentrated on making imports flexible, Sinha paid great attention to rationalization of excise and reduced the slabs from 11 to one.

Jaswant Singh (2002-2004): In July 2002 he became Finance Minister again, switching posts with Yashwant Sinha. He served as Finance Minister until the defeat of the Vajpayee government in May 2004 and was instrumental in defining and pushing through the market-friendly reforms of the government.

P Chidambaram: Incumbent Chidambaram became Minister of Finance again in the congress party-led United Progressive Alliance government on May 24, 2004.

In 2004, A K Bhattacharya wrote a historical piece about "All about interim Budgets ":

Independent India's first Budget was presented by India's first finance minister, R K Shanmukham Chetty, on November 26, 1947. And that was an interim Budget!

So when Finance Minister Jaswant Singh presents the interim Budget for 2004-05 on Tuesday, he won't be doing something unique. In fact, between him and Chetty, the Indian Parliament has seen the presentation of 10 interim Budgets.

Five of these interim Budgets were presented by finance ministers of newly elected governments that did not have sufficient time to prepare a full Budget before March 31.

And five of them were presented by governments that had decided to go for general elections immediately after or before the end of the financial year.

An interim Budget or a vote-on-account becomes a necessity because every year, Parliament's approval for drawing funds from the Consolidated Fund of India (CFI) for expenditure is usually obtained by March 31, the last day of the financial year.

If a regular Budget is not presented before March 31, and further approval for drawing funds for expenditure beyond March 31 is not obtained, the government can come to a halt.

So, all the interim Budgets so far have been presented primarily to enable the governments to continue incurring their obligatory expenditure until a regular Budget is passed by Parliament.

The exception was the first interim Budget on November 26, 1947. When he presented it, Chetty did not describe his Budget as an interim exercise.

But in the second Budget he presented to Parliament on February 28, 1948, he said his first exercise was an interim Budget. Under normal circumstances, there was no need for the Indian government to present a Budget so soon � less than four months after independence.

But as Chetty explained in his speech: "With the division of the country and the emergence of two independent governments in place of the old central government, the Budget for the current year 1947-48 passed by the legislature last March ceased to be operative. Although, under the transitional provisions of the Constitution, the government could authorise the expenditure necessary for the rest of the financial year, it was felt that it will be in accordance with the public wish that a Budget should be placed before the representatives of the people at the earliest possible moment."

Chetty's first Budget speech also contained a detailed assessment of the state of the Indian economy. He hoped to end the financial year with a deficit of Rs 25 crore, but only after he had proposed an increase in export duty on cotton cloth and yarn to fetch an additional annual revenue of Rs 8 crore.

That was the only new tax proposal in the first interim Budget. But then, that was an indirect tax proposal that could be enforced through a notification and did not require Parliament's sanction.

The next interim Budgets were all presented before general elections. That was quite understandable. The Congress was the ruling party and there was hardly any opposition to its return to power. All these interim Budgets were presented with Jawahar Lal Nehru as prime minister.

On February 29, 1952, C D Deshmukh presented the second interim Budget and set a new trend. Along with the revised estimates for 1951-52 and the Budget estimates for 1952-53, Deshmukh presented a "white paper" on the state of the economy.

But Deshmukh's interim Budget would be remembered for his claim of how he had converted a Budget deficit projected earlier into a Budget surplus by the time the year was coming to a close.

Equally significant was his bold announcement that food subsidies would have to be abolished to relieve the exchequer of this growing burden.

When he returned to Parliament with a regular Budget, Deshmukh proposed no new taxes, although he had to leave a deficit of about Rs 75 crore uncovered.

Instead of looking for more revenue, Deshmukh had initiated an exercise to identify areas where government expenditure could be cut.

T T Krishnamachari (TTK) also presented his interim Budget for 1957-58, just before the general elections. The highlight of his interim Budget speech was his reference to a growing foreign exchange shortage and the need to mobilise adequate resources to fund the second Five-year Plan that was then being finalised.

TTK's interim Budget showed for the first time the finance ministry's scant regard for the sanctity of the revenue and expenditure numbers presented to Parliament.

The interim Budget brought down the revised estimates for the deficit in 1956-57 to Rs 216 crore. But after the elections, the regular Budget presented a few weeks later showed that the actual deficit was Rs 368 crore.

Morarji Desai presented two interim Budgets � one for 1962-63 and the other for 1967-68. The first one was presented in his capacity as finance minister under Nehru's prime ministership, while the latter was as finance minister and deputy prime minister in Indira Gandhi's government. Both interim Budgets were significant for different reasons.

The interim Budget for 1962-63 was presented before the 1962 general elections. In it, Desai presented a full-scale economic survey along with his speech that dwelt on the critical issue of foreign aid from developed countries and the World Bank.

He justified the need for loans to developing countries at concessional terms, paving the way for the setting up of the Aid India Club.

The revised estimates for 1961-62 showed a surplus instead of a deficit projected in the Budget estimates. That was clearly aimed at wooing the electorate. Another attempt at pleasing the voters was to outline the details of expenditure allocation for different sectors for 1962-63. This was the first time that an interim Budget indicated expenditure outlay for the coming financial year.

Desai's second interim Budget was even more significant. This was soon after India's currency devaluation in 1966. Indira Gandhi was the newly elected Congress leader and prime minister, having returned to power after a well-fought general election. Also, this was the first interim Budget of a government at the start of a new five-year tenure.

Not surprisingly, Desai used the speech to outline quite a grim picture for the economy. He touched on the need for more foreign aid, the deteriorating foreign exchange reserves, the need for import restrictions and declining exports. But there was no indication of a Budget deficit. Indeed, Desai's regular Budget presented some weeks later balanced the revenue with expenditure.

The interim Budget presented by Y B Chavan for 1971-72 had no special features. It reviewed the economy, but gave sufficient indication of the need for new taxation in the regular Budget that he would present a few weeks later.

There was a longish section in his speech where Chavan waxed eloquent on the positive impact of the government's policy of nationalising 14 banks in July 1969.

H M Patel's interim Budget had many firsts. This was the first interim Budget to be presented by a former bureaucrat and also a finance secretary. No wonder his speech was the shortest of all interim Budget speeches delivered so far.

Although he had the opportunity to rubbish the Congress government's claims of an economic miracle during the Emergency (1975-77), Patel avoided all such temptations.

Instead, he let the figures do the talking. The Budget deficit in 1976-77, he said, increased from the earlier estimate of Rs 328 crore to Rs 425 crore in the revised estimate.

Patel's interim Budget also clearly hinted at the need to raise revenue through non-inflationary methods and for economy measures.

In sharp contrast to Patel's restraint, R Venkataraman converted his interim Budget speech for 1980-81 into a political statement aimed at attacking the Janata government's economic policies. And like Desai and Chavan, Venkataraman presented a long speech of over 40 paragraphs.

Yashwant Sinha's debut as finance minister was with an interim Budget, caused by the fall of the Chandra Shekhar government requiring a general election in May 1990.

This was at the height of India's economic crisis. Sinha's interim Budget will be remembered for his announcement that the government would disinvest equity in public sector undertakings.

In comparison, Sinha's second interim Budget was sober and mildly critical of his predecessor P Chidambaram's failure to meet the various revenue and expenditure targets.

Sinha also announced the government's decision to accept the Tenth Finance Commission's new formula for sharing of tax revenue among the Centre and the states through an amendment to the Constitution.

That leaves Manmohan Singh with his only interim Budget. He made it into a full-fledged election speech, outlining the Narasimha Rao government's achievements in economic policy.

He also announced a series of policy imperatives that the government ought to pursue, apart from presenting a sector-wise break-up of his expenditure plan for 1996-97.

He projected a fiscal deficit of only 5 per cent of gross domestic product, much lower than the 5.9 per cent achieved in the revised estimates for 1995-96. Singh ended his interim Budget speech with a virtual call to the voters to return the Congress party to power.

Like Manmohan Singh, Jaswant Singh also presents an interim Budget before the elections. The key question is: Will Jaswant Singh restrict himself to an election speech or set a new trend by announcing some new tax proposals too?

Electronic journal for medical colleges

Union Health Secretary Naresh Dayal launched the ERMED portal

The National Medical Library has started an electronic journal consortium, “Electronic Resources in Medicine” (ERMED), for providing full-text electronic journal service to 39 medical colleges and institutions across the country. These include ten Directorate-General of Health Services libraries and 28 Indian Council of Medical Research libraries and the All-India Institute of Medical Sciences library.

Union Health Secretary Naresh Dayal launched the ERMED portal According to a release issued by the National Medical Library, the facility offers over a million articles in the open-access mode from over 1,515 medical journals. Articles can be searched by using the choice of journals, publishers, subjects and keywords of database.

“The library has adopted the most cost-effective strategy to put together the project that is aimed at building up a sustainable health information base and is committed to dissemination of a free flow of information,” said an official release.

The Director-General of Health Services is financing the entire project for 39 libraries. “The National Medical Library is the one-stop resource-sharing centre for medical literature across the country,” said National Medical Library director Anjana Chattopadhyay.

Rewrite the health petition

The petition initiative ( targeting Health Minister must be revised, rewritten and made holistic. It should also be updated and should target Finance Minister.

Currently, Union Health Secretary is Naresh Dayal (not Mr J V R Prasad Rao) who is seized with the corruption in the health sector. An inquiry is underway since 2006 by the Central Bureau of Investigation in the health projects.

Comptroller and Auditor General (CAG) report that was tabled before Parliament in November 2007 revealed that mismanagement rules the roost in the department of health and family welfare and in government-run hospitals. The petition must include these and other aspects as well.

The petition notes that "80% of the population lives in rural areas, but 80% of health provision is urban. Over 85% of health provision is through private enterprise" but does not articulate any specific solution and does not state that private health sector in India is burgeoning, but at the cost of public health care.

A Transparency International survey had noted that 30% of patients in government hospitals informed that they had had to pay bribes or use influence. This aspect also needs to be addressed.

The petition refers to the recommendations made in the World Bank Report, "India, raising the sights: better health systems for India's poor. Health, Nutrition, Population Sector Unit, India, South Asia Region, 2001" but does not suggest any remedy in recognition of the conclusion of the report. The report concluded: "The hospitalised Indian spends more than half his total annual expenditure on buying healthcare; more than 40% of hospitalised people borrow money or sell assets to cover their expenses, and 35% fall below the poverty line."

It appears that the petition is quite "Medical Council of India" and "medical practitioner's salary" centric. It fails to note that although expenditure on health has increased in absolute terms, the proportion of GDP it represents has declined despite the promises made by th UPA government.

Wednesday, February 06, 2008

Health schemes caught between government & World Bank

Health schemes caught between government & World Bank

india is set to make another round of changes in procurement norms for health schemes funded by World Bank loans. This follows the bank’s review of Indian projects running on its loans, highlighting corrupt practices in procurement of drugs and other items by the government and drug companies. While such practices are well known—the bank’s own reviews have repeatedly mentioned them—the timing of the latest review has raised eyebrows.

Public health researchers doubt the bank’s motive: the review is more about wresting control than removing corruption. There are suggestions that it’s about getting the bank’s favourite firms on board. How this will arrest corruption is not clear.

In 2006, Pricewater-houseCoopers had appraised the bank’s review system, finding it inadequate.

The review detailed the nexus between government bodies and pharma firms. This leads to corruption at several levels (see box: News you can’t use). The centre accepted the report and announced a series of changes in procurement norms. The schemes at stake deal with critical health concerns: tuberculosis, hiv/aids, malaria, and reproductive and child health. Procurement—of drugs, testing kits, bandages and equipment—is a major part of these programmes.

The schemes had recently completed five-year cycles, and were up for renewal. In fact, the bank has already sanctioned the next lot of funds, but hasn’t released them. This is where the questions arise. When the bank knew of corruption all along, why did it continue funding projects for years? The bank reviews projects every six months. What’s the point if they don’t help check corruption?

The striking aspect of these reviews—conducted by consultants at the bank’s high rates—is that they are paid for out of loans. Independent reviews show that up to 20 per cent of loans is spent on consultants.

Musical chairs
In 2005, the bank had released some findings of its review of the first phase of the reproductive and child health project. It had ‘found’ inconsistencies in the purchase of vitamins. The bank suggested funds go directly to states, instead of being routed through the centre. It recommended Tamil Nadu’s methods, which cut corruption and delays: the state was buying drugs directly from suppliers, instead of dealing with procurement agencies. It didn’t take long to realize that all states did not have this capacity. A year ago, the bank came up with an alternative to government agencies buying through their flawed tendering process: the un Office for Project Services (unops) was called in to handle procurement for projects running on the bank’s loans. The assumption being a un agency wouldn’t be corrupt.

Around that time, the Union Ministry of Health and Family Welfare realized it was time for another government agency, and decided to call it the Empowered Procurement Wing. A British consultant, Crown Agent, was en-gaged to streamline procurement. All solutions featured foreign agencies. Little attention has gone into a investigation and punishment.

If the bank wanted to clean up health schemes, it would have tried to bring the guilty to the book. But it provides nothing for criminal proceedings and is not usable as evidence in a court. Nor does it identify corrupt officials and suppliers. After the bank released the long-term review, health secretary Naresh Dayal has announced a probe.

Look who’s talking
What really weakens the bank’s position is recent events in its own house. Suzanne Rich-Folsom, director of the bank’s Department of Institutional Integrity that published the review of Indian health schemes, resigned on January 18. There is talk of corruption. Her credibility suffered further because she was also a counsellor to the previous World Bank president, Paul Wolfowitz, who resigned under a cloud.

Which is why when the bank talks about corruption in the Indian government, it doesn’t sound convincing.

News you can’t use
The World Bank’s assessed five projects: one each on HIV/AIDS, malaria and tuberculosis; the Food and Drug Capacity Building Project; and the Orissa Health Systems Development Project. These use bank loans of US $569 million. The review showed the following problems were common:

* Some bidders were favoured in violation of bank’s bidding norms
* Fraudulent bids
* Uninstalled and improperly installed equipment; substandard material
* Ministry set up panel to oversee bids. It often overruled project’s bid evaluation committee’s decisions.
* Bank had okayed contracts in spite of finding shortcomings
* lack of financial record-keeping
* Fictitious NGOs awarded contracts
* Lack of controls to monitor funds
* Bribing of health ministry officials



Addressing the plenary meeting of the 60th World Health Assembly in Geneva on 16th May, 2007, the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss said that the World Health Organisation (WHO) needs to develop the capacities of many countries to participate in the Intellectual Property Rights (IPR) regime and reap its benefits. He said there are valid reservations on whether or not the IPR regime will lead to innovations in so far as neglected and tropical diseases are concerned. Ms Jane Halton, President, World Health Assembly and Dr Margaret Chan, Director-General, WHO were also present on the occasion.

The following is the text of the Minister’s speech:

It is indeed a pleasure for me to address the WHA once again. Last year I also had the privilege of chairing the proceedings of Committee-A. This provided me with a deep insight into the wide gamut of issues placed before the World Health Assembly. While it was no doubt enlightening for me to participate in these deliberations I cannot but help suggesting that WHO needs to progressively assume a more proactive role on global health issues rather than on advocating remedial measures after events have taken place. In particular WHO can be a bridge between developed and developing countries on issues relating to human resources, technology transfers, building consensus as well as capacities on emerging issues such as Intellectual Property Rights, Innovation and Public Health. There is also a case for a fresh look on the representation of developing countries like India and China on different WHO fora considering their population size and share of global disease burden.

The theme adopted by the 60th WHA, “Health Security” is of great interest to all of us. The global threat of emerging and re-emerging infectious diseases has been demonstrated by the emergence of Human Immunodeficiency Virus (HIV) in the 1980s, Avian Influenza H5N1 in Hong Kong originally seen in 1997 and continuing through today and a global epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003. No country is immune to the occurrence of these diseases. It is therefore altogether appropriate for the WHA to focus on health security.

Development issues including health, nutrition, drinking water, education are today at the forefront of world politics. Health, as we all know is fundamental to social and economic development. The Millennium Development Goals 2015 are less than a decade away and most countries are feeling the pressure from all stakeholders to design policies which accelerate the achievement of the goals as per schedule.

In India, the state supported public health delivery system is being comprehensively rejuvenated under the National Rural Health Mission which is the biggest and most ambitious programme in the health sector ever in India. The National Rural Health Mission which is a convergence of health, nutrition, sanitation and drinking water, seeks to provide accessible, affordable and accountable quality health services specially to the poorest households in the remotest rural regions, focusing on reducing IMR and MMR. The thrust of NRHM is on establishing a fully functional, community owned, decentralized health delivery system with inter sectoral convergence at all levels. Quality care through adoption of the Indian Public Health Standards, focus on outcomes and adoption of evidence based strategies are some of the other salient features of NRHM.

We realize the need to target programmes for our women and children. We are going for major capacity building initiatives both for human and physical resources to ensure nutritional adequacy, deliveries at institutions and by skilled birth attendants, referral transport and emergency obstetric care. The Janani Suraksha Yojana, a path breaking programme for cash support for institutional deliveries, has had an overwhelming response.

Newborn and child health strategies range from the integrated management of neonatal and childhood illnesses, immunisation strategies, including this year, a US$300 million polio eradication programme and the recently launched Norway-India partnership initiative.

We have more than 400,000 Accredited Social Health Activists (ASHAs) who are empowered village women forming a link between the government and our clients for better service delivery.

The double burden of diseases experienced by a large number of low and middle income countries of the world has made it necessary for these countries to initiate mechanisms for effective prevention and control mechanisms.

The initiatives taken by us in addressing communicable diseases have given dividends. The progress made by the various national programs for control and elimination of TB, Malaria, Leprosy, HIV/AIDS are noteworthy.

A national program for prevention and control of Non Communicable Diseases like Diabetes, Cardiovascular diseases and stroke has been initiated. Taking care of the elderly population, a national programme for the care of elderly is also on the anvil. Issues of emergency and trauma care are being taken as priority areas.

The consumption of tobacco is also a major cause of morbidity. The global community is slowly recognizing the threat of the tobacco epidemic and the WHO Framework Convention on Tobacco Control (FCTC) is an important step in this direction. India, one of the first signatories of the FCTC, is in the process of launching a National programme on Tobacco Control. An anti-tobacco law was enacted as far back as 2003 and rules have been enacted banning smoking in public places; direct and indirect advertisements and sale of tobacco products to minors.

India is a key participant in the WHO supported Tobacco Free Initiative (TFI) and we are actively engaged in developing surveillance systems, building capacities of key stakeholders, undertaking advocacy measures and intensifying training programmes to combat consumption of tobacco. A Tobacco Regulatory Authority is on the anvil which will make recommendations on tobacco taxation policy, advertising, anti-smuggling measures, enforcement of the Act as well as on other measures both for disease prevention as well as prevalence reduction.

I believe that in the new Millennium the future of the health sector is going to be in substantial measure determined by the quality and availability of human resources; the spirit of innovation and enterprise, which alone will find cost effective solutions to seemingly intractable problems and by technological advancements in information technology as well as biotechnology. There are issues relating to migration of qualified health work force, which are leaving gaps within the exiting infrastructure and services, both within and outside the public sector.

The WHO needs to help the affected countries to address contributing factors to human resource shortages. The Intellectual Property Rights regime is both an opportunity as well as a challenge before the Member States. There are valid reservations on whether or not the IPR regime will lead to innovations in so far as neglected and tropical diseases are concerned. Similarly access and pricing of essential drugs is indeed a matter of concern.

The WHO will need to develop the capacities of many countries to participate in the IPR regime and reap its benefits.

Finally technology and technological advancements cannot be wished away and must in fact be relied upon to provide solutions to improve health care systems, both technical as well as managerial.

From some perspective I can say that if the Information Technology Industry was responsible for the present growth of India, then the future of India lies in the growth of the bio-medical industry. The WHO needs to position itself as the harbinger of technology to nations.

Consultation on “Healthy Environment Programme in India”

Stephen L. Johnson, Administrator, Environmental Protection Agency, USA visited New Delhi on 2-3 April 2007. The Ministry of Health and Family Welfare, Government of India, and WHO India jointly organized a Consultation on “Healthy Environment Programme in India” on 2 April 2007. The meeting was chaired by the Secretary, Ministry of Health & Family Welfare.

Dr S J Habayeb, WHO Representative to India, introduced the basic objective of the consultation and narrated the three ongoing joint collaborations between WHO and US-EPA, namely Water Safety Plan, and the risks of Lindane and Mercury. Welcoming the participants, Naresh Dayal, Secretary for Health and Family Welfare, highlighted the needs of healthy environment with special reference to drinking water quality monitoring. He also suggested regulated use of water and impact of climate change on the water balance. Johnson, in his introductory remark, highlighted various activities being carried out by US-EPA in USA for a “Healthy Community Programme”. He mentioned that around 25% of the disease burden is due to environment factors. He also highlighted the Indo-USA joint activities in the field of environment, benefiting the public health programmes.

Ms. Shantha Sheela Nair, Secretary, Department of Drinking Water, explained the rural water and sanitation scenario in the country. This was followed by a presentation from Dr. B Sengupta, Member Secretary, Central Pollution Control Board on “Environmental concerns and Waste Management” in the country. The salient features of “Jawaharlal Nehru National Urban Renewal Mission” and its impact on the urban poor were presented by Dr. P K Mohanty, Joint Secretary, Ministry of Housing and Poverty Alleviation. The various ongoing joint activities of ICMR with US-EPA, with special reference to occupational health, were explained by Prof. N K Ganguly, DG, ICMR. This was followed by thought provoking discussions on healthy environment issues being faced by the country.

Finally, the ‘Guidance Manual for Drinking Water Quality Monitoring and Assessment’ was jointly launched by Stephen L Johnson and Naresh Dayal. The Manual, developed by NEERI, Nagpur and NICD, New Delhi, is a joint effort of Ministry of Health and Family Welfare; Ministry of Environment and Forests; Central Pollution Control Board; Department of Drinking Water; Ministry of Urban Development; Ministry of Water Resources; WHO, Country Office for India; and US-EPA. The Manual will be released for dissemination in May 2007.

The meeting ended with a vote of thanks proposed by Dr. Shiv Lal, Additional DG & Director, NICD.