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Date:01-02-18

Served by Indians

For India to be a services superpower, diversify beyond IT to medical services

Devi Shetty is a cardiac surgeon and Chairman and Founder, Narayana Health

I have spent most of my early years, growing up in rural India, around farmers. I cannot recall, looking back at those years, a single example of a farmer becoming financially secure.We are still a rain based economy. No rain, no crop, no money; too much of rain, no crop, no money; adequate rain, bumper crop, prices drop, no money. It is only a matter of time before a farmer goes bankrupt. Even though farming contributes only 13.7% of GDP, it is responsible for 50% of employment. By contrast, only 2% of US jobs are from farming. The conclusion is inescapable: we need to look at alternative jobs for farmers’ families.

Contrary to popular perception, the health sector at $8 trillion is the world’s largest industry (IT is $3.4 trillion, oil $2 trillion, automobiles $2 trillion). In the US and UK the health sector is the largest employment generator today. UK’s National Health Service is the world’s fifth largest employer.India’s iconic manufacturer Maruti directly employs only 13,500 employees for a revenue of Rs 66,500 crore, while Narayana Health directly employs 15,500 employees for a revenue of Rs 1,878 crore. Thus the health sector creates disproportionately higher number of jobs for companies’ top line, especially for semi-skilled and unskilled youth which is the need of the day.

In Mangalore there are agencies that recruit and provide “40 day ladies” to take care of new born babies and their mothers; they earn Rs 55,000 for just 40 days of work and their only qualification is that they were once mothers themselves. These jobs which have flexible schedules are ideal for women from rural India. Let’s assume that only 10% of Indian expectant mothers can afford this service, and we are talking about a few lakh well-paying and flexible jobs. To scale this up we just need short term training, and an interactive portal to promote and monitor.For optimum care, behind every doctor there are four nurses, four technicians and five administrators. Most of them require a licence to practise, restricting supply. According to the US bureau of labour statistics, out of the 20 fastest growing US occupations nine are in healthcare. Unfortunately, none of the nine training and licensing systems exists in India.

Recognition by the statutory body is important for skill building. The greatest challenge to training the rural poor is the cost of training. There are at least 5,000 hospitals across India capable of training home health aides. But government or donors must reimburse the cost of training the rural poor by grants or educational loans.India needs two million nurses and the rest of the world nine million. The nursing profession is not attracting talent in India because of lack of career progression. In the US 67% of anaesthetic procedures are done by nurse-anaesthetists. In India a nurse who has worked in intensive care for 20 years is legally not allowed to prescribe even a pain killer. A 25-year-old nurse intensivist can easily earn a lakh rupees a month in India. All it requires is regulatory changes to make healthcare delivery inclusive and not the exclusive domain of doctors.

According to the World Bank there will be a demand for 80.2 million health workers across the world in just 13 years. Healthcare jobs are not attractive for people from wealthy countries. We should train rural youth to become doctors, nurses and paramedics for the world. There are 45,000 doctors and nurses from Cuba working in Central America earning about $8 billion a year. Philippines receives $29.7 billion in remittances, mostly from its 1,50,000 nurses and 18,000 physicians working abroad.We should convert 600 district hospitals as medical nursing and paramedical schools to train 5 million doctors, nurses and paramedics for the global requirement. They can remit about $100 billion of precious foreign currency every year over a period of time. It doesn’t cost Rs 400 crore to build modern medical schools. There are 35 medical schools in the Caribbean region training doctors for the US. These medical schools occupy about 50,000 sq ft rented space in shopping malls, where most of the teaching is done by Indians.

We can start by converting 60 district hospitals in “Naxalite” affected regions as medical schools with less than Rs 50 crore investment to train doctors, nurses and paramedics. They should be trained primarily to pass the entrance exams of the US and UK. It’s important to train children from poor families to become doctors because outstanding doctors across the world with magic in their fingers generally come from deprived backgrounds.Unfortunately, Indian medical education has become an elitist affair. By creating a parallel medical education predominantly for the Western market we can demonstrate high quality affordable medical education, at the same time making a big impact on our rural economy.

We should make India the service provider for the world, as China has done for manufacturing. Remuneration for overseas health workers is significantly higher than most other professions. A 24-year-old nurse from Kerala, working at our hospital in Cayman Islands, recently took her parents on a holiday to Disneyland. India, with over 2 million beds, can easily train the global requirement of health workers just by changing our policies governing medical and nursing education.Like ‘Make in India’, our slogan should be ‘Served by Indians’. We missed the Industrial Revolution, let us not miss the healthcare revolution which doesn’t need money. It just needs youth with passion and compassion, which we have in abundance.

Date:01-02-18

What explains so many Nirbhayas in our land

ET Editorials

The Economic Survey’s finding that some 21 million girls in India are ‘unwanted’ by-products of son preference should not come as a surprise but is still shocking. These girls, denied resources and care on par with their male siblings, however, escaped the fate of the 63 million missing women, aborted at the altar of son preference. The remedy is to empower women, valuing every girl child as an individual. This calls for a radical change in culture, customs and societal norms, since the nub of the problem is India’s attitude towards women. The process should begin at home, treating girls on par with boys.

The Survey presents a grim picture. Parents keep having children till they get the desired number of sons, called metapreference, that will manifest itself in the sex ratio of the last child being heavily skewed in favour of sons. In 2005, the law was amended to give daughters equal rights to property as sons. It was supposed to reinforce the battle against dowry, retain the woman’s connection to her natal family. Regrettably, Indian women are perilously placed on every point in the spectrum of human development: from survival to basic health and education opportunities available to realise one’s human potential. That development “has not proved to be an antidote” for India’s adverse sex ratio, low contraceptive use and lack of women in work underscores the need for robust policy interventions to empower women in practice.

Ajoint paper by IMF chief Christine Lagarde and Norway’s Prime Minister Erna Solberg ahead of the World Economic Forum, showed that raising women’s participation to the same level of men can boost India’s GDP by 27%. Ending misogyny would help men, too. Policy and government schemes can play a role, civil society must act as well.

Date:01-02-18

सिर्फ इलाहाबाद हाई कोर्ट तक सीमित नहीं है साख

संपादकीय

न्यायपालिका ने अपनी साख बचाने के लिए इलाहाबाद हाई कोर्ट के न्यायमूर्ति नारायण शुक्ला से कामकाज छीनकर उचित ही किया है। इस तरह की सख्त कार्रवाई के बिना लोकतंत्र की इस महत्वपूर्ण संस्था की प्रतिष्ठा को लगा धक्का दूर होने वाला नहीं है लेकिन, अभी न्यायमूर्ति शुक्ला इस्तीफा देने को तैयार नहीं हैं और न ही उन पर महाभियोग की कोई स्पष्ट रूपरेखा बन रही है। मामला सिर्फ न्यायमूर्ति शुक्ला तक सीमित नहीं है। लखनऊ के एक निजी मेडिकल कॉलेज में प्रवेश की अनुमति से संबंधित इस घोटाले में उड़ीसा हाई कोर्ट के एक पूर्व न्यायमूर्ति आईएम कुद्‌दूसी और प्रसाद ट्रस्ट के पदाधिकारी जेल जा चुके हैं। इस विवाद के कारण हाल में सुप्रीम कोर्ट के चार वरिष्ठ न्यायमूर्तियों ने मुख्य न्यायाधीश के विरुद्ध बगावत करके प्रेस कॉन्फ्रेंस की थी। उन चारों वरिष्ठ न्यायमूर्तियों ने प्रकट रूप से तो यही कहा था कि रोस्टर के बारे में भारत के मुख्य न्यायाधीश उन्हें महत्वपूर्ण मुकदमों को देखने का मौका नहीं दे रहे हैं पर परोक्ष रूप से उन्होंने भारत के मुख्य न्यायाधीश पर भी संदेह व्यक्त किया था। मुख्य न्यायाधीश दीपक मिश्र ने इन तमाम विवादों को हल करने के लिए प्रेस कॉन्फ्रेंस करने वाले न्यायमूर्तियों से कई दौर की बातचीत की है और रोस्टर में पारदर्शिता लाने का वादा किया है। इसी क्रम में मद्रास हाई कोर्ट, सिक्किम हाई कोर्ट और मध्यप्रदेश हाई कोर्ट के न्यायमूर्ति की तीन सदस्यीय समिति बनाकर न्यायमूर्ति शुक्ला के आचरण की जांच की गई और आरोपों में दम होने के कारण ही उनसे कामकाज छीनकर इस्तीफा देने को कहा गया है। क्या इतने कदम भर से न्यायपालिका की पवित्रता बहाल हो जाएगी या यह मामला कई महाभियोगों तक जाएगा और न्यायपालिका की राजनीतिक छीछालेदर होगी? मौजूदा कार्रवाई के औचित्य से कोई इनकार नहीं कर सकता लेकिन, जिस स्तर की समस्या है उसके लिए पूरे कायाकल्प की जरूरत है और वैसा करने के खतरे भी हैं। इसके बावजूद न्यायपालिका और उसके सगुण रूप कहे जाने वाले न्यायमूर्तियों की साख देश की सभी संस्थाओं के ऊपर होनी चाहिए। उन पर किसी तरह का संदेह होना ही नहीं चाहिए। इस उच्च आदर्श को प्राप्त करने के दृढ़ संकल्प के साथ काम करना होगा और उसमें किसी प्रकार की कोताही भ्रष्टाचार की बीमारी को लोकतांत्रिक देह में और फैला सकती है।

Date:31-01-18

Choice in Nagaland

In the run-up to an election opposed by the main players, Centre needs to clear the air about the peace deal

Editorials

The Nagaland assembly elections, scheduled to be held on February 27, could be a tricky affair if political parties in the state hold on to their “no-election” joint declaration released on Monday. Representatives of 11 parties, including the ruling Naga People’s Front, ally BJP and the main Opposition, the Congress, signed the declaration following an appeal by the Core Committee of Naga Tribal Hohos and Civil Society Organisations that they abstain from the election if the Centre goes ahead with it without concluding the Naga peace agreement. The Nagaland assembly had adopted a resolution on December 14 last year asking the Centre to take steps for “an honourable and acceptable solution” to the Naga political issue before starting the election process in the state. Indications are the Centre will go ahead with the elections as scheduled. On Monday, the BJP suspended the two state leaders who signed the poll-boycott declaration and Union Minister of State for Home Kiren Rijiju announced that the Centre and the BJP will ensure that polls are held on schedule.

The demand for a peace deal before the holding of elections follows from the expectations triggered by the framework agreement signed by the NSCN (I-M) and the Centre in August 2015. Prime Minister Narendra Modi had then said that “we mark not merely the end of a problem but the beginning of a new future”. More than two years later, however, the details of the agreement are still not in the public domain. Few seem to know what has been agreed upon between the rebels and the central government. This lack of transparency about an agreement with far-reaching implications for the region has led to widespread speculation, including on Naga sovereignty and the making of Nagalim or Greater Nagaland. The Centre needs to clear the air about the framework agreement. In the absence of details, there is fear and suspicion in Nagaland’s neigbouring states, including Assam, Manipur and Arunachal Pradesh, that areas populated by Naga tribes will be transferred to Kohima under the peace deal. A statement to this effect, attributed to an RSS fu nctionary, had led to protests and police firing in Dima Hasao district in Assam last week causing the death of two persons. Any conclusive, peaceful settlement of the Naga issue, particularly if it involves redrawing state boundaries, will need the concurrence of not just the state governments, but also of local communities. A sustained dialogue among a larger pool of stakeholders in a climate of transparency and mutual trust is necessary to make it happen.

Going ahead, the Centre must tread carefully. If it goes ahead with the elections, there is hard work waiting to be done to prevent a situation like Assam 1983, when elections held despite a boycott call by the All Assam Students Union and the All Assam Gana Sangram Parishad, triggered violence across the state. The onus is, equally, on the political parties. They must desist from any move that will unsettle the peace in Nagaland.