Public Outrage against Private Health Care as Marxist Brahaminical Hegemony allies with Zionist ISRAEL.
Health mission likely to get extension till 2020.
Dantewada martyr's family left in the lurch
It's been a week since 76 CRPF jawans lost their lives in the Naxal ambush in Dantewada.
CRPF stops anti-Maoist drive in Bastar: Police
A high level source in the Chhattisgarh Police said that CRPF men are in a state of shock following the Dantewada massacre.
Don't comment on Maoists: PM tells ministers
Prime Minister says the Union Home Minister is the only one authorised to deal with internal security issues.
Govt prepares new plan to crush Maoists
Special commandos will now be in charge of tackling armed Maoist cadre in some areas.
Dantewada ambush celebrations spark protest
Clashes broke out at Jawaharlal Nehru University after two student organisations celebrated the massacre.
The big Naxal debate
Rajdeep Sardesai speaks to a panel of experts and tries to find out solutions to deal with the Naxal problem.
Maoist menace: States not backing Chidambaram
The Home Minister says states affected by Maoist menace have a role to play in curbing the rebels.
Resignation is a closed chapter: Chidambaram
P Chidambaram says the state governments also have a role in tackling the Maoists.
Country bids farewell to Dantewada martyrs
The 75 CRPF jawans killed in the Dantewada Naxal attack came from every corner of the country.
BJP backs Chidambaram, says no need to quit
BJP says Chidambaram deserves the support of all the political parties in the fight against the Maoists.
Israel to help West Bengal tackle Maoists
Israel will discuss the issue of homeland security with West Bengal [ Images ] which is reeling under the brunt of Maoist extremism.
"Homeland security is becoming important and affecting each of us. In this field we feel there is something which we can augment for the state of West Bengal," Ambassador of Israel to India [ Images ] Mark Sofer said while addressing the Bengal National Chamber of Commerce and Industry in Kolkata [ Images ] on Monday.
He will meet Chief Minister Buddhadeb Bhattacharjee [ Images ] and Governor M K Narayanan tomorrow to deliberate on the matter.
He said Israel would be able to provide sophisticated equipment like night vision devices which were not necessarily meant for the defence sector.
Besides homeland security, Sofer would also discuss issues like water management, dairy farming and drip irrigation with West Bengal.
The Chhattisgarh police confirmed that they were investigating a complaint filed against award-winning writer Arundhati Roy for violating the provisions of the Chhattisgarh Special Public Security Act 2005 (CSPSA). As per the complaint filed by one Viswajit Mitra in Raipur, Ms. Roy's recent essay "Walking with the Comrades," in which she travelled extensively with a Maoist company, came under the purview of the Act as the essay could be construed as intended to create support for the Maoists.
The essay was published in the March 29 2010 issue of Outlook, a weekly news magazine.
"I have filed the complaint as meeting with or engaging with an outlawed organisation is clearly forbidden by the CSPSA," said Mitra, who describes himself as "an ordinary citizen." "In such a sensitive time, the police should investigate."
"The complaint has been forwarded to the legal department," said Chhattisgarh Director General of Police Viswa Ranjan. "The matter shall be investigated before taking any further steps." In a telephonic interview, Mr. Viswa Rajan refused to set any fixed time frame for the enquiry.
"This is clearly an attempt to cordon off the theatre of war and choke the flow of critical information coming out of the forests," said Ms. Roy in a statement emailed to The Hindu.
"There is very little news and no record of adivasis who have been killed in remote forest villages or of the situation which can be described as a State of Emergency."
Refuting charges that her article "glorified" the Maoists, she described her essay as "a writer's account of a journey behind the 'battle lines' of Operation Greenhunt." "I think it is crucial for the people of the country to know what is going on, on the other side, in order to make informed decisions," she said.
Broad definition
The CSPSA 2005 has been criticised by some for its broad definition of unlawful activities and the stringent penalties for those convicted. As per the law, anyone who "in any manner contributes or receives or solicits any contribution or aid" for an unlawful organisation can be punished for up to two years.
"The loose and broad language used to define and criminalise support for an unlawful organisation can, and has been misused in the past," said Supreme Court lawyer Prashant Bhusan. "Under the Act, even a lawyer representing a Maoist in court or a doctor treating a wounded Maoist can be prosecuted."
Maoists justified in taking up arms: Arundhati Roy
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New Delhi: Maoists are "justified in taking up arms" because the government has been unjust to them and is waging a war on them, says writer and activist Arundhati Roy.
"My fear is that because of this economic interest the government and establishment actually needs a war. It needs to militarise. For that it needs an enemy. And so in a way what the Muslims were to BJP, the Maoists are to Congress," Roy said in an interview with Karan Thapar on CNN-IBN's show Devil's Advocate.
"If I was a person who is being dispossessed, whose wife has been raped, who is being pushed of their land and who is being faced with this 'police force', I would say that I am justified in taking up arms. If that is the only way I have to defend myself," said the Booker Prize-winning novelist. "There should be unconditional talks with the Maoists."
"We should stop thinking about who is justified. You have an army of very poor people being faced down by an army of rich that are corporate-backed. I am sorry but it is like that. So you can't extract morality from the heinous act of violence that each commits against the other," she said.
Roy, in a debate on CNN-IBN last week, had alleged that the government was a planning a war on Maoists to take away their resources on behalf of the multi-national companies.
"The real fact is--and I believe this--that it is the Government that wants a war to clear out the forest areas because there is a huge backlog of MoUs in Jharkhand as well as Chhattisgarh that are not being activated," she had said.
(Watch the full interview and read transcript at 2030 hrs IST on CNN-IBN and IBNLive. )
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Arundhati Roy: Pulp Fiction Or A Concrete Analysis?
By P.A.Sebastian
13 April, 2010
Countercurrents.org
The Indian state has unleashed a war on tribals (indigenous people) in Dandakaranya, India. Dandakaranya is a vast forest area spread over several provinces of India such as Andhra Pradesh, Maharashtra, Chhattisgarh, Madhya Pradesh, Jharkand, Orissa, Bihar and West Bengal.
The tribals had been living in this area for millennia. Some 200 years ago the Indian state legislated that all the forests in India belong to the state. This rendered the indigenous people of India illegal occupants, trespassers in their own land where they lived ever since they reached India from Africa. Now the government can take over their land at its sweet will and throw them out.
Dandakaranya has different ores in abundance worth billions of dollars. Of late, the government of India has entered into memoranda of understanding for the mining of the ores with some hundred multinational, Transnational and Indian monopoly companies. Such extractive business ventures face stiff opposition from the tribals led by Communist Party of India (Maoist).
The media have been distorting the happenings in Dandakaranya and projecting them as senseless criminal activities. It is in such a background that Arundhati Roy visited the area and presented a factual account of the real developments there. This partially breached the boycott of the CPI (Maoist) activities imposed by media barons, and penetrated the main stream media. This, however, was bit too much for some of our intellectuals to take. They called her writing pulp fiction and even claimed that she sleepwalked through the red corridor. One can only recommend that the critics take a walk through the corridor and see things for themselves. They can rest assured that the comrades will take care of them. And the police will do them no harm either.
Then there are some idealogues who theorize that Dandakaranya is at the stage of feudalism and the place must undergo capitalist transformation before it reaches the stage of Socialist revolution. So at this stage the government must facilitate the activities of companies like Vedanta, of which P. Chidambaram was a director until he entered the cabinet. This theory is erroneous on two counts. Firstly the extraction of minerals does not lead to industrialization of Dandakaranya while it leads to eviction of tens of thousands of tribals from their homeland. This will also lead to the devastation of their land. The minerals will be exported to already industrialized countries. The second assumption is that the industrialization will generate proletariat who will act as bearers and agents of revolution. This is a dogma frozen in time. In the nineteenth century itself the goal of the workers' movement had become an improvement in their conditions within the framework of capitalism rather than the revolutionary overthrow of the system. Marx and Engels were not blind to the gap between the early image of the proletariat and the reality they saw around them as the years and decades passed. As one of the instances, Engels wrote in a letter to Marx on 08th April 1863: "All revolutionary energy had faded practically entirely from the English proletariat, the English proletarian is declaring his complete agreement with the rule of the bourgeois". This happened because a very high and frequently rising rate of exploitation in peripheries has enabled the ruling classes of the west to distribute the resulting surplus product between local elites, the ruling classes in the centre, and to a certain extent, the working classes of the centre. Simultaneously, the spread of capitalism to periphery has created a mass of human beings whose living conditions represent the focal point of all inhuman conditions in modern society. The new proletarians in the original Marxist sense are rapidly increasing masses of dehumanized humanity among whom are the tribals of Dandakaranya.
After all, Marxism is the concrete analysis of a concrete situation. Arundhati has concretely narrated what she observed in Dandakaranya, not in sleepwalk but in full and sharp awareness.
PA Sebastian is President, Committee for Protection of Democratic Rights, Mumbai.
E-mail: sabs1848@gmail.com
By Amy Kazmin in New Delhi
Published: April 13 2010 13:09 | Last updated: April 13 2010 13:09
An angry mob ransacked a private hospital in the eastern city of Calcutta on Tuesday morning, enraged by its alleged refusal to admit more than a dozen rural villagers critically injured in a severe road accident.
Officials in Calcutta said Peerless Hospital demanded Rs50,000 ($1100) – a sum far out of reach of most Indians – to admit each of the accident victims, three of whom, including a seven-year old girl, subsequently died of their injuries.
EDITOR'S CHOICE
Those who accompanied the victims – and other bystanders – then rampaged through the hospital, smashing computers, medical equipment, pharmaceutical supplies and windows, burning the cafeteria and damaging the operating theatres. Vehicles parked outside were later set alight and the mob threw stones at police, who fired into the air and beat the crowd with batons to restore order.
The violence highlights the growing tension over vast inequities in access to quality healthcare in India, where the government spends just 0.9 per cent of gross domestic product on public health, one of the lowest levels in the world.
"The government has let the public sector run into the ground, so invariably everyone runs to the private sector to help," says Leena Menghaney, a health access campaigner for charity Medicin Sans Frontiers. "But the private sector is not accountable to anybody. They let people die on their doorsteps."
Across urban India, large local healthcare companies, such as Apollo, Fortis Healthcare and Max India, and foreign companies such US-based Columbia Asia are building new hospitals, well equipped with the latest high-tech diagnostic equipment, for the country's increasingly affluent middle class.
India Today, the weekly news magazine, recently exalted a healthcare boom that it said had brought "world class technology and five-star service" to India, and of one new Mumbai hospital said, "it's a pleasure to come to this den of luxury".
Meanwhile, India's state hospitals, on which most people must depend, are run down with patients lying in unsanitary, foul-smelling corridors, and scarce equipment and overwhelmed doctors.
Both India's government and courts have repeatedly told private hospitals they are obliged to provide emergency medical treatment to any who seek it at their door, regardless of their ability to pay. But Ms Menghaney said private hospitals routinely reject poor patients, even in life-threatening emergencies.
"There is a lot of indifference," she said. "These hospitals cater to the affluent middle class and they don't want anybody else. You need a law to strictly regulate private healthcare in this country."
Calcutta officials said they were investigating the incident, publicly reminding private hospitals of their obligation to provide primary care in medial emergencies.
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Six persons, including two women and a five-year-old child, were killed and several others injured when a mini-truck carrying 30 persons collided with a truck at Patuli area in the district at around 5.45 am, IGP (Law and Order) Surojit Kar Purokayastha said.
The injured were rushed to the nearby Peerless Hospital. The locals alleged that the nursing home turned down their plea to offer emergency first-aid to the injured and demanded money to be deposited in advance before initiating treatment.They went on the rampage after the hospital authorities refused to do so, police said. The mob then set fire to furniture, medical equipment, including stretchers, and ransacked the restaurant inside the hospital.
The mob also set fire to some vehicles present near the hospital obstructing the fire tenders from approaching the spot. They also damaged the fire tenders, police said.
The injured were then rushed to state-run M R Bangur Hospital.
West Bengal Sunderban affairs development minister Kanti Ganguly went to the spot to persuade the mob which fought a pitched battle with the police. Reinforcements were rushed and the situation was now under control, police said.
While the locals alleged that the hospital turned down their plea to offer emergency first-aid to the injured, the hospital authorities were not available for comment.
Editorial
The private health sector in India
Is burgeoning, but at the cost of public health care
| The first 150 words of the full text of this article appear below. |
Foreigners in increasing numbers are now coming to India for private health care. They come from the Middle East, Africa, Pakistan, and Bangladesh, for complex paediatric cardiac surgery or liver transplants—procedures that are not done in their home countries. They also come from the United Kingdom, Europe, and North America for quick, efficient, and cheap coronary bypasses or orthopaedic procedures. A shoulder operation in the UK would cost £10 000 ($17 460; 
14 560) done privately or entail several months' wait under the NHS. In India, the same operation can be done for £1700 and within 10 days of a first email contact.1
The recent remarkable growth of the private health sector in India has come at a time when public spending on health care at 0.9% of gross domestic product (GDP) is among the lowest in the world and ahead of only five countries—Burundi, Myanmar, Pakistan, Sudan, and . . . [Full text of this article]
Amit Sengupta, joint convenor
Peoples Health Movement, D-158, Lower Ground Floor, Saket, New Delhi-110 017, India
(ctddsf@vsnl.com)
Samiran Nundy, consultant
Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi
(snundy@hotmail.com)
Healthcare System in India
http://www.recoverdiscover.com/healthcare_system.phpUp until the 1980's Government run hospitals were the main providers of healthcare in India. However, over the last decade the Indian medical system has undergone a sea change with increasingly strong participation by the corporate and the private sector. These days private and corporate hospitals, nursing homes and clinics play a major role in administration of Indian healthcare. These private hospitals and clinics are highly advanced and provide world-class medical services. As part of the social and economic needs of the country corporate hospitals are also obliged to care for patients who are economically disadvantaged.
Corporate hospitals use the latest technology available and perform more complex procedures and treatments. Most state of the art equipment is imported from countries like USA, UK, Germany, Japan etc.
Doctors employed at these hospitals are highly educated with years of experience, including specialists for every department of medical care. Most of the doctors have had a good exposure working in the west and understand patient needs.
In order to provide world-class service most of the private and corporate sector hospitals use high end technology and high-end specialists for complex treatments like open heart surgery, joint replacements, neurosurgery etc.
The Indian medical education system is organized and strict, which ensures that the doctors, nurses and medical staff are suitably qualified and have proper potential and experience to deliver best quality medical; treatment. The Indian medical education system is different from that in the USA and many other countries in the fact that there are no premedical subjects taught in the first year of medical university, instead they are introduced to the basic medical subjects. This is made possible by India's Higher Secondary School System, which covers all those pre medical subjects and the students need to qualify for the Higher Secondary Exam before they can even appear for the qualifying entrance examination for Medical colleges. The Higher Secondary School Syllabus in India is considered to be one of the toughest and most advanced in the world.
The duration of MBBS (the basic course to get a license as a Doctor of Medicine) is five and a half years, of which four and half years are spent learning and one year as an intern. The first four and a half years are again broken down in to three parts and a candidate needs to successfully pass all the three parts through rigorous exams and practical training only after which he is allowed for internship in the hospitals attached to the medical college. A student gets to practice as a licensed doctor only after he has successfully completed his internship.
Most doctors in India would often go for further education in terms of post graduation and other specialized medical courses that will increase their expertise and knowledge. Most of the Doctors who work at our affiliate hospitals have various levels of experience in hospitals abroad. A large number of doctors have done their specialized internships at countries like the US, UK, Australia, Germany etc.
India's private healthcare system is booming and is expected to be worth billions of dollars in the decades to come. This growth comes on the back of a large (200 million plus) middle class with very high expectations, and coupled with the fact that an increasing number of people from overseas see India as a potential destination where they can combine high quality affordable healthcare along with the possibility of seeing and experiencing one of the world's oldest living cultures. Another key driver is that Indian corporate hospitals have no waiting times for surgeries. In fact most elective procedures can be performed within 8-10 days of the first contact with an Indian hospital.
India has established world-class expertise in complex medical practices such as cardiac care, cosmetic surgery, joint replacements, neurosurgery, ophthalmology and dentistry. While the treatment in Indian private hospitals are at par with the hospitals in USA and UK the cost for such treatment in India is actually a fraction of what it would cost in any of those countries.
India received a little over 500,000 overseas visitors who flew over for healthcare related surgeries and medical tourism.
At Recover Discover, we ensure that you get the best quality treatments at any of our alliance partner hospitals at very affordable rates. We could also assist you to discover the natural, cultural and historical beauty of India by planning and organizing a tour that sufficiently meets your inquisitiveness about the mystic wonderland called INDIA.
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The National Rural Health Mission (NRHM), the flagship central government scheme for better healthcare in rural India, is likely to get an eight year extension from its current target year of 2012, a top health ministry official said Tuesday.
'The scheme has just completed five years and I think it will take not less than 15 years to bring a certain degree of desired outcome,' Health Secretary K. Sujatha Rao told IANS on the sidelines of a programme here.
'You know how vast India is. We have achieved certain goals but there is a lot of ground to be covered. If you go to the rural areas you will see the situation. Why far, go to Bundelkhand (in Uttar Pradesh) to see the amount of work needed to be done,' she said.
The scheme, which was rolled out by Prime Minister Manmohan Singh in April 2005, had an initial mandate for seven years. But looking at the huge task of providing affordable health and reaching rural hinterlands, the scheme is expected to get an eight year extension.
In the last five years, India has spent at least Rs.53,000 crore on this project. Under this scheme, the government has appointed 700,000 accredited social health activists better known as ASHAs and constructed and repaired over 10,000 primary and community health centres across the country.
The rural health programme has also helped in reducing maternal mortality from 301 to 254 for every 100,000 live births. Similarly, the infant mortality has gone down to 53 as against 58 for 100,000 live births.
However, the situation in primary healthcare centres remains grim with nearly 150,000 of them not having a single doctor, according to the data. The shortage of doctors in rural areas has pushed poor people to avail private medical services.
On Monday Health Minister Ghulam Nabi Azad had said that due to inadequate facilities in villages, poor people go to private hospitals and get debt ridden. They sell their property, home assets to pay the medical bills.
Photo: AP
President Barack Obama addresses the opening plenary session of the Nuclear Security Summit in Washington, Tuesday, April 13, 2010
U.S. President Barack Obama has opened the 47-nation Nuclear Security Summit in Washington with a warning about the potential of nuclear terrorism. The president says al-Qaida and other terrorist groups are trying to acquire nuclear material, and must be stopped.
Pakistan Prime Minister Yousaf Raza Gilani walked up to Indian Prime Minister Manmohan Singh and talked to him for a couple of minutes at a dinner hosted by US President Barack Obama for visiting world leaders at the Nuclear Security Summit.President Obama says the summit is an unprecedented gathering to address an unprecedented threat.
"Two decades after the end of the Cold War, we face a cruel irony of history: The risk of a nuclear confrontation between nations has gone down, but the risk of nuclear attack has gone up," Mr. Obama said.
In his address to the first full day of the summit, Mr. Obama said terror networks such as al-Qaida are actively seeking material for nuclear weapons. He said if they get it, they will use it.
"Were they to do so, it would be a catastrophe for the world, causing extraordinary loss of life and striking a major blow to global peace and stability," Mr. Obama said.
The conference follows two days of meetings between Mr. Obama and other heads of state on efforts to keep nuclear materials out of terrorists' hands.
Mr. Obama met Monday with Chinese President Hu Jintao, who agreed to work with the United States on sanctions against Iran for its nuclear activities. China has been reluctant to place more U.N. sanctions on Tehran.
Also Monday, a spokesman for Ukrainian President Viktor Yanukovich announced Ukraine will get rid of its highly enriched uranium by 2012.
President Obama said he hopes for further progress.
"Last night, in closed session, I believe we made further progress pursuing a shared understanding of the grave threat to our people," Mr. Obama said. "And today, we have the opportunity to take the next steps."
Mr. Obama was to meet one-on-one with German Chancellor Angela Merkel, Argentina's President Cristina Fernandez de Kirchner and Turkish Prime Minister Recep Tayyip Erdogan.
The president announced South Korea will host another summit of this kind two years from now. South Korean President Lee Myung-Bak invited this year's participants to return.
"I will do (my) best to make this summit a success. So I hope to see all of you in Korea," Mr. Lee said.
This year's meeting is expected to end with a joint declaration to guide work in preventing terror groups and criminal gangs from getting access to nuclear material. Mr. Obama says that is a first step toward his long-term goal of ridding the world of nuclear weapons.
Kicking off the first plenary session on the second day of the Nuclear Security Summit here, President Barack Obama underscored the gravity of the threat of nuclear terrorism, arguing that "Just the smallest amount of plutonium, about the size of an apple, could kill and injure hundreds of thousands of innocent people... Terrorist networks such as al-Qaeda have tried to acquire the material for a nuclear weapon," he said.
Assuring the delegates of the 47 attending countries that al-Qaeda would surely use nuclear materials as a weapon if they ever succeeded in obtaining it, he said, "Were they to do so, it would be a catastrophe for the world -- causing extraordinary loss of life, and striking a major blow to global peace and stability." In this light it was increasingly clear that the danger of nuclear terrorism is one of the greatest threats to global, collective security.
Recalling his speech in Prague a year ago Mr. Obama said that he had called for a new international effort to secure all vulnerable nuclear materials around the world within four years. Combined with the U.S.'s efforts to reduce its nuclear arsenal and halt the spread of nuclear weapons it was "an agenda that will bring us closer to our ultimate goal of a world without nuclear weapons," he said.
Mr. Obama said, "Over the past year, we've made progress. At the United Nations Security Council last fall, we unanimously passed Resolution 1887 endorsing this comprehensive agenda, including the goal of securing all nuclear materials."
India & the Nuclear Security Summit
That the Indian leadership has been invited to be a participant on an equal footing with the "official" P5 nuclear powers is an indicator of its increasing acceptability at the nuclear high table.
The Nuclear Security Summit of world leaders in Washington today and tomorrow is a follow-up of the promise United States President Barack Obama made last year in his Prague speech. He said "… We must also build on our efforts to break up black markets, detect and intercept [nuclear] materials in transit, and use financial tools to disrupt this dangerous trade … And we should start by having a Global Summit on Nuclear Security that the United States will host within the next year."
Although the stated focus of the summit is to secure nuclear materials around the world, the conference has a much broader significance. For one thing, the summit marks the restoration of Mr. Obama's arms control initiatives set in motion last year. Until recently, it looked as if these initiatives had been derailed by the Obama administration's preoccupation with domestic issues such as healthcare and the economy. But with the healthcare bill having been passed, the extension of the Strategic Arms Reduction Treaty with Russia negotiated and the new, less belligerent Nuclear Posture review announced, the prospects of making further progress on disarmament and arms control seem brighter now.
Aside from this, the actual discussions taking place on the two days will cover a much wider range of issues than nuclear material security. With so many heads of important nations attending it, there will no doubt be the usual hum of bilateral meetings on the sidelines of the main conference dealing with a variety of regional issues and perspectives. India, in particular, will be involved in many of these private discussions.
We will return later to these larger issues that may come up in the summit, but the main agenda, that of securing nuclear materials, is important enough in its own right. Because of their somewhat technical and specialised nature, public awareness of the dangers posed by unsecured nuclear materials is much less than it deserves to be.
What are these nuclear materials and what makes their security so vital as to warrant such a high level summit of about 40 nations? The term 'nuclear materials' (also known as fissile materials) refers to the substances which, by undergoing rapid nuclear fission, provide the explosive energy of nuclear weapons. There are very few such substances. They are mainly plutonium and two isotopes of uranium, U-235 and U-233.
Although a nuclear weapon has several sophisticated components in it, the most difficult to get hold of is its fissile material core. That is because plutonium is not available in nature, nor are large quantities of those two isotopes of uranium. Natural uranium mined from under the ground is predominantly U-238, a non-fissile material, and contains less than 1 per cent of U-235 and even smaller traces of U-233.
Therefore, in order to be used as nuclear weapon fuel, natural uranium has to be "enriched" in its U-235 content by removing most of the unwanted U-238 from it. This process of converting natural uranium into "Highly Enriched uranium" (HEU) is done in giant centrifuge plants (of A.Q. Khan fame). In the case of plutonium, it has to be entirely produced artificially by reprocessing the spent fuel of reactors. Both uranium enrichment and plutonium reprocessing involve very advanced, expensive and painstaking technology.
As a result, getting hold of weapon-usable fissile materials is the single biggest impediment to non-nuclear nations embarking on a nuclear weapon programme and to non-state actors producing a weapon illicitly. It is therefore obvious, especially when the danger of nuclear terrorism is no more a paranoid obsession but a possible reality, that all the fissile materials produced for weapon purposes and submarine fuel, as well as for certain research reactors by different nations should be very strictly accounted for and secured. This also includes material released from weapons dismantled in the arms reduction process.
According to the latest figures given by the International Panel on Fissile Materials the world has accumulated, in the 60 years since the birth of the nuclear age, a huge stock of such materials. There are altogether over 1,670 tonnes of HEU. Of this over 95 per cent is in the U.S. and Russia. The worldwide stock of separated weapon usable plutonium is about 500 tonnes, of which again Russia and the U.S. have the largest amounts. The U.S. has 92 tonnes, Russia 140-190 and the bulk of the rest is in the U.K., France and Japan. (More details of these stocks, their location and various other aspects of FM are available at the website www.fissilematerials.org)
That these are very large amounts can be appreciated by noting that it takes only about 5 kg of plutonium or about 25-40 kg of HEU to make a typical Hiroshima-Nagasaki level weapon. You can hold that much plutonium in your palm. Thus all that terrorists have to do is to pilfer a tiny fraction of the hundreds of tonnes spread around the globe to threaten a disaster far worse than 9/11 or any other terrorist attack thus far.
The goal of global nuclear disarmament provides another motivation for ridding the world of fissile materials. A serious conceptual problem often raised about universal disarmament is that even if you succeed in eliminating all nuclear weapons on earth, you cannot eliminate man's knowledge of the science behind it. That genie is out of the bottle for good. What is to prevent some groups from starting to produce these weapons all over again? Is a nuclear weapon-free world a robust and stable concept? Clearly one prerequisite for preventing illicit building of nuclear weapons is to gather, fully secure and eventually eliminate all weapon-usable fissile materials.
On the same day as the Obama summit of world leaders, and parallel to it, there will also be a non-governmental summit at Washington (on Monday) in which dozens of experts from around the world are expected to participate. We will discuss at a more technical and operational level, ways of initiating multinational efforts to make the vision of securing all vulnerable materials worldwide in four years closer to reality. Our recommendations will be conveyed to the political leadership at the summit.
Rise to the occasion
Let us return to the larger implications of the summit, particularly for India. That the Indian leadership at the highest level has been invited to be a participant on an equal footing with the "official" P5 nuclear powers is an indicator of its increasing acceptability at the nuclear high table. As a country which has vehemently (and rightly) complained in the past of the discriminatory nature of NPT and other such regimes India should, now that a non-discriminatory gathering has been called, rise to the occasion and behave as an active partner in international efforts to reduce nuclear dangers. It must adopt a statesmanlike posture, as befits a responsible nuclear power, confident of taking initiatives in this regard.
The time has come for us to regain some of our stature as crusaders for nuclear disarmament. In the old Nehruvian days, we were leading proponents of nuclear disarmament at various international forums. But our efforts lacked bite, in part because we ourselves had no nuclear arsenals to give up at that time. The situation is quite different now.
Reports that India may be willing to set up an international centre on nuclear security, if true, are welcome. But it must be remembered that nuclear security is different from the security of VIPs, bank vaults or even conventional military installations, with which we are more familiar. Apart from the normal security apparatus of walls, fences, armed guards and so on, protecting nuclear materials requires familiarity with the latest technical information on fissile material detectors, and the special properties of these highly radioactive materials, even a handful of which may be sufficient to make a full-fledged nuclear weapon. There is a fair amount of information on this among expert groups both within India and abroad.
If the proposed centre on nuclear security is to be of truly high international quality, our government will do well to involve in its formation and functioning not just the expertise within government agencies, but also non-governmental experts with a high international reputation. The "daddy knows best" policy of government technocrats has cost us enough already.
(R. Rajaraman is Co-Chair, International Panel on Fissile Materials and Emeritus Professor, Jawaharlal Nehru University, New Delhi.)
Keywords: India's Nuclear Policy, Nuclear Security, Nuclear Powers
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Modi using unethical efforts to thwart Kochi IPL, says Tharoor
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| NDTV Correspondent, Tuesday April 13, 2010, New Delhi |
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Like other controversies that have centered on Tharoor, this one is playing out extensively on twitter. In the past, Tharoor's tweets have been described as flip and insensitive (referring to flying economy as travelling cattle-class) or indiscreet (questioning the new visa policies initiated by his ministry for foreigners.) They forced him, and in the case of his cattle-class comments, the Prime Minister, to explain that Tharoor didn't mean any harm. (Your comments)
But this time around, the allegations are serious. Did Tharoor use a close friend, Sunanda Pushkar, as a front to collect Rs 70 crores for helping to get Kochi its own IPL team? (Read: Who is Sunanda Pushkar?)
Yes, alleges, the BJP, which, on Tuesday, demanded that the Prime Minister sack Tharoor, who it quipped, has turned the IPL into CPL (Corruption Premier League). BJP spokesperson Ravi Shankar Prasad said that his party is not interested either in Tharoor's personal life or in the IPL, but that Tharoor's position as minister and Pushkar's link to him puts this matter in the public domain. He also called Tharoor the enfant terrible of the Congress and said in reference to his controversies that Tharoor had migrated from "twitter to corruption."
After initially describing the BJP's request as "absurd", the Congress distanced itself from the scandal, stating that the controversy was a personal affair and that Tharoor should explain his position.
The lid was blown off the box by IPL Commissioner Lalit Modi on Monday, who tweeted that Sunanda Pushkar, a close friend of the minister, had been gifted stake worth Rs 70 crores in the Kochi team, bought last month for Rs 1,530 crores. Modi then tweeted the details of the different partners who won the bid for the Kochi team. His most damning tweet may have been that Tharoor called him asking him not to investigate the different stakeholders in the Kochi franchise.
On Tuesday morning, Tharoor tweeted 'I've had enough' along with a link to his official press release in which he reasserts that he was a mentor and advisor to Rendezvous Sports World, which led the consortium that bought the Kochi team. (Read Tharoor's press release)
"Rendezvous includes a number of people, including many I have never met, and Sunanda Pushkar, whom I know well," he states. Adding that Modi guided the winning bid and presented himself as "a trusted friend," Tharoor says, "various attempts were made by Mr Modi and others to pressure the consortium members to abandon their bid in favour of another city in a different state. His extraordinary breach of all propriety in publicly raising issues relating to the composition of the consortium and myself personally is clearly an attempt to discredit the team and create reasons to disqualify it so that the franchise can be awarded elsewhere."
Tharoor's allegation is that Modi was upset that that the Kochi bid defeated that of the Adani Group from Ahmedabad which had been considered the front-runner. Tharoor also says that he called Modi not to ask him to back off from investigating the owners of the team, but to request him to stop delaying the formal notification of ownership.
As Tharoor emphasized that he had not and does "not intend to financially benefit" from the Kochi franchise, the BJP said his "patronage and protection" of the team is inappropriate, and that this seems to be a "copybook case of corruption."
The Kochi team-owners shot off an angry email to the Board of Cricket Control for India (BCCI), accusing Modi of breaching confidentiality agreements. Vivek Venugopal, a co-owner of the Kochi team told NDTV, "We have ... asked for Mr Lalit Modi to reveal the shareholding structures of all the other IPL teams owned by consortiums like Kings XI, Kolkata Knightriders and Rajasthan Royals. Why are the various owners of these teams and their stakes not being revealed?" (Read: Modi-Tharoor - Kochi strikes back)
Rendezvous says it will meet with its partners on Wednesday to decide whether to take legal action against Modi.
The group also offers a staunch defense of its decision to give away equity worth Rs 70 crores to Pushkar. As a Sales and Marketing Expert who knows the Kerala and Middle East market well, the group tells NDTV, she deserves to be rewarded for the expertise she offers to the consortium. As far as her close association with Tharoor goes, sources say "several other teams have owners close to politicians. Does that mean that it's the politicians who have invested?"
The BJP refutes the cited invaluable experience of Pushkar, arguing that she has no earlier connection to either cricket or Kerala.
While Tharoor deals with the political controversy, Modi has his own fire-fighting to do. Shashank Manohar, the President of the BCCI, has written to him, rebuking him over his public disclosure. "The issue, if any, could have been discussed at the governing council meeting and that action on your part of raising it on twitter is unbecoming of you as a chairman of the a sub-committee of the board. Your action is in serious breach of the confidentiality clause in the agreement....The BCCI is a body which functions in accordance with its constitution and doesn't function through media."
In his reply to Manohar, Modi said, "It is the Kochi franchisee who has a lot to hide and as such have lied about who is the actual owners of the shares. Which I informed you earlier today....I have minutes of what they said at the meeting. And in fact, when I questioned who the shareholders are - they had no answer. In fact, they said they would revert back. Within minutes of me asking the same - I got a call from Shashi Tharoor asking me not to ask about who these share-holders are."
Sources in the BCCI say it will fall upon Union Minister for Agriculture Sharad Pawar, who doubles up as President of the Mumbai Cricket Association, to broker peace between Modi and other cricket officials.
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Buying health: who pays?
India's health care industry stands at a crossroads. While corporates are eager to take charge of public health care, they only understand the problem partially. Privitisation of the health system is hardly the answer
With World Health Day just past us, (April 7) we in India might have something to cheer. Government initiatives like the rural medical course and health insurance for the poor (including specialist care) are good, fresh ideas. But they need the right heads to think them through. A high-profile specialist in Bangalore wrote some months ago: "Millions will still perhaps be living in slums with no running water or sanitation, but when they are unwell, they will have access to high-tech health care with dignity, like in the developed world." He feels that health care is a complicated business, best handled by people like himself.
Many corporate hospitals endorse this idea and have started expanding their empires. They will build mega hospitals in more cities and towns, train more specialists, increase their bed-strength and wait eagerly for patients to fall ill. With cheap health insurance paid for by the government, they are assured of their clientele and applauded for their altruistic service to the poor. Privatisation of the entire health system is what they would like, with the government merely bearing the financial burden of providing insurance. They also want low lending rates from international funding agencies, exemption of import duty for expensive medical equipment and subsidised rates for land to build their hospitals. The government may actually go along with this idea and thus shrug off its own responsibility in the delivery of health.
Specialists' understanding
My reservations about turning health care into a private, corporate industry stem from the fear that these experts do not understand health. What they understand are the diseases that fall within their specialist domain and which they are trained to cure. These comprise less than 20 per cent of all illnesses in our country. They should continue their excellent work in what they know best and not demand that they be made health care providers for the entire country. That will be much like an instant-noodle company being asked to provide nutritious meals for school children. I hope my esteemed specialist colleagues will not take offence but there can be no mincing of words when the health of an entire nation is at stake.
Four-fifths of diseases in India are caused by five factors: lack of clean drinking water, insanitary living conditions, pollution of all types, inadequate nutrition and stress. Typhoid, malaria, dysentery, TB, skin and lung infections – which kill millions every year – are produced by insanitary conditions. Stress causes heart disease, high blood pressure, peptic ulcers, asthma, allergy and mental illness. Although many see stress as a privilege of the upper class, the poor are subject to unrelenting anxiety and stress caused by hunger, homelessness, unemployment and the loss of dignity. No Art of Living or Stress Management course will give them relief. To wait for them to fall sick and then rush to their doorstep with high-tech cures is as insulting as throwing a piece of chocolate to a hungry stray dog.
Simple measures can prevent 80 per cent of diseases afflicting our people. Every developed country has dealt with them decades ago and done away with most infectious and communicable diseases. India, which has built steel plants, huge dams and National Highways, can surely provide clean drinking water to its citizens. A nation that can reach the moon can certainly attend to its garbage and provide clean public toilets. Doctors who boast of attracting patients from foreign countries will surely be able to address every one of our public health woes.
In most important health care indicators like nutritional status, maternal and infant mortality, India is near the bottom of the list. We can learn some valuable lessons by seeing how welfare works in other countries. The British National Health Service (NHS) established in 1948 is one of the most successful medical organisations in the world. It is funded by the government and through National Insurance by which a percentage is deducted from the salary of every working citizen. The NHS has a two-tier system of general practitioners and hospital doctors. The GP provides the first-contact care and treats common ailments. Serious cases are referred to hospital. All NHS doctors and staff are salaried. Once they reach a senior position, the job is permanent, with no transfers.
Private practice is allowed at a senior level but it is carefully monitored so as to not allow malpractice or exorbitant fees. The NHS pattern of welfare is followed in Commonwealth countries like Canada, Australia and New Zealand and is an excellent example of socialised welfare. For the last ten years, the NHS has faced problems caused mainly by increasing expenditure. If misuse (like patients seeking emergency service for trivial complaints and the mindless wastage of hospital resources), are left unchecked, its efficiency will be undermined.
In the USA, the health care bill introduced by Obama is set to change things for the better. What I record here is the state of their welfare system until now. Doctors usually opt for specialised, post-graduate training and work in groups that are attached to private hospitals. About 60 per cent of citizens pay a premium towards their medical expenses. Health Maintenance Organisations provide this insurance. Besides doctors, HMOs decide the level of treatment, sometimes even the type of tests and procedures, including surgery. Everything depends on the amount of premium paid. Doctors and insurance companies make a killing out of the deal. This has led to a general hostility towards doctors and increasing medical litigation.
In the USA, the government hospitals which serve the non-insured public are fairly well-run and staffed adequately. The USA government spends $5000 per citizen every year on health. Most of it is spent on their hospitals, treatment of defence personnel and administrative work. Yet, three million hospital beds across the country stay empty and one-sixth of the population has no access to satisfactory treatment. A recent study from Harvard shows that two million Americans are driven to bankruptcy every year by medical bills. In India, too, health costs are the single biggest factor in driving people below the poverty line.
Is socialised medicine relevant in today's world? Non-rich Costa Rica is the envy of many developed countries. The working population pays 15 per cent of its salary towards health care. Every citizen is entitled to free treatment without any distinction between the classes. This is possible because a large number of middle-level health workers are trained to treat simple ailments. Private medical care is available for those who wish to pay but only 30 per cent ever opt for it. Costa Ricans live to 78 years and infant mortality is 11 per 1000, much better than our own. And their expenditure on health per person is one-tenth of the USA's.
Nearer home, Sri Lanka and Bangladesh have better health indicators than we have. Communist and socialist countries like China, the erstwhile USSR and Cuba have done much better than India. In Malaysia, government-funded health care is free and of good quality. Primary health centres called 'Klinik Desa' give basic health care in remote areas. Their life expectancy is 79 years and infant mortality nine per 1000. (Ironically, with globalisation there is a move to abandon socialised welfare and follow the failed US system!)
Wide gaps
What are our priorities in India? The training of doctors for rural areas and a cheap health insurance scheme will certainly help the poor. But good planning is needed to ensure that these programmes are free of corruption. The advice of professionals experienced in rural and public health is invaluable. We have several internationally acclaimed doctors working in these areas and they have transformed health in hundreds of villages around the country. Why is their example being ignored? We have some very good centres like the National Institute of Mental Health in Bangalore, AIIMS in Delhi and others but the majority of government hospitals have little to commend them.
The health insurance scheme has started well in a few states, particularly Kerala and Gujarat. My own experience with the much talked-about Yashaswini scheme in Karnataka was otherwise. I first heard of it from a well-to-do farmer who had availed of the benefits, because the scheme stipulates that an individual must own a certain area of land to qualify. It had nothing for the landless who are the poorest among rural folk. So while this owner of a farm underwent heart surgery at no expense, his labourer's wife had to pay for surgery on her fractured hip. Rural hospitals registered to treat insured patients complain that they have to overcome a lot of red tape and long delays before being paid by the government.
In Haryana, in a district which was under the insurance scheme, the number of Caesarean sections increased to 50 per cent of all deliveries. Why not, when the insurance cover for a normal delivery is Rs. 3,000 and for a Caesarean, 25,000?
India has come to a turning point. The government is all set to introduce such far-reaching initiatives and it cannot afford to be short-sighted. The corporate health industry is eager to expand its empire. With its powerful influence in government circles, that may happen soon. However, if we genuinely wish to "revolutionise" health, we must turn our attention towards the prevention of disease through public health measures. The only reason for the indifference towards public health is that unlike curative health care, there is no profit in prevention. No wonder our corporate specialists carefully avoid the issue while expanding their curative facilities.
Preventive health care is simple. Take for example the fact that 47 per cent of our children are malnourished (it is 46 per cent for Bangladesh and 37 per cent for Pakistan) and it kills a million every year.
Many NGOs have proposed ways of overcoming the problem. One group in Pune has developed a ' Nutribar' costing less than a rupee and made of cereals, groundnut and jaggery. If used as a supplement to food, it will provide essential proteins, iron, vitamins and minerals. The government, or a corporate house with a big heart, could produce and market it. If gutka,shampoo, instant coffee and sugary toffees can sell for a rupee, why not the Nutribar which can put millions of children on the road to health?
We say "Prevention is better than cure" but it remains a platitude. If the government, the medical professionals, and the corporate health industry could enlarge their tunnel vision, we may, one day, pride ourselves in being a healthy nation. Merely pumping in money will not transform health. What it takes is empathy, imagination and common sense.
Kavery Nambisan is a surgeon and novelist based in Lonavla.
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by
Ravi Duggal
(Abstract)
For the last five decades, the government has systematically nurtured the private health sector. This unwritten policy of the government runs parallel to the neglect, and now gradual, withdrawal of the state from the responsibility of people's health. Such a consistent support and encouragement to the private health sector are very important reasons for the failure to provide universal basic health care to all people of the country.
Today there are approximately 11,25,000 practitioners of different systems registered with various medical councils in the country. Of them, only 125,000 are in government service (including those in central health services, the armed forces, railways, state insurance etc). That leaves about a million doctors floating around in the private sector, not to mention tens of thousands of additional unqualified and unregistered medical practitioners. Fifty-nine % of all practitioners are concentrated in cities. For instance, 60 % of all medical graduates in Maharashtra are located in Mumbai, where no more than 11 % of the state's population lives! Similarly, 84 % of hospital beds are today located in urban areas, whereas 75 % of the population still resides in villages. This selective concentration of health care providers is a major concern to be addressed, especially since studies have shown that those living in rural areas spend about as much on health care as those in towns.
The State offers subsidies, loans, tax waivers and other benefits for the setting up of private practice, hospitals, diagnostic centres and pharmaceuticals. For instance, the government subsidises the unethical and exploitative private health sector via medical education at the expense of the public exchequer. Assuming that the government spends about Rs. 10 lakhs at current prices on the education and training of each doctor and about 80% of the out-turn of public medical schools either joins the private sector or migrates abroad, the country loses large resources which could have been used for public benefit. The country loses Rs. 4,000-5,000 million as a result of the out – migration of four to five thousand doctors every year. Thus, with such support the private health sector has grown into a giant – it is the largest private health sector in the world. With 60-80 % of health care sought in the private sector, and households contributing 4-6 % of their incomes, there's a whopping Rs. 400-600 billion health care market in India. Its mammoth size notwithstanding, this sector has remained completely unregulated.
While the expansion of the private sector is primarily responsible for high and increasing inequity in access to health care, its internal functioning is riddled with problems and its claim of better efficiency and quality service are yet to be objectively proven. Besides, malpractice is very common, irrational and unnecessary diagnostic tests and surgeries are rampant, and ethics are by and large jettisoned.
Surinder Jindal discusses some of the complexities arising from new trends in health care
Increasing economic liberalisation and privatisation have affected health care as much as they have affected many other social and administrative systems, perhaps even more so. Though the changes are global, in India, the shift seems to have happened overnight, and public health services have been overwhelmed all of a sudden.
This was inevitable. How can one expect proper health care from a state which is unable to guarantee its people clean water, food and housing? Infact, very few countries can afford to provide their citizens comprehensive health care. Wherever state-managed care is free it is nominal – or there are "hidden" costs to the user. Today the majority of us must take care of our own food, clothing, shelter and health needs.
State responsibility in health care
There are three main elements of health care: prevention, treatment and rehabilitation. Prevention of disease is both a personal and a state obligation. In fact, the state has enormous stakes in the maintenance of healthy and relatively disease-free society. It is committed to providing a good and clean environment, water supply, family and social welfare services, vaccination and health advice.
Individuals, on the other hand, may choose to abide by the state's laws and follow general health guidelines, in their own interests. Private and voluntary organistaions have an important role to play, depending on their specific aims and objectives.
It is largely curative and rehabilitative medicine which is getting privatised, and rightly so. Such services are not only costly but highly individualised and time-consuming as well. Recent advances have expanded vistas in health care, raising people's expectations. They can not only stay healthier but also live longer. Body imaging and scanning procedures, endoscopic surgery and screening examinations have helped diagnose diseases earlier and with greater precision. New drugs and interventions have modified the natural histories of most diseases. Both morbidity and mortality have decreased.
Newer methodologies have also helped rehabilitate even the most severely disabled, including those with chronic and systemic diseases. People with gross respiratory, cardiac, renal or cerebral insufficiencies are now able to live more meaningful, useful and enjoyable lives.
Better services, more choices
People are no longer satisfied with general panaceas for their ills. Some patients may want a quick fix if possible, but a large number prefer to have their condition diagnosed and treated with the help of all available technology. Moreover, this is both scientifically and legally required.
Individualised care is obviously easier in private than in government institutions. One can choose both the treating doctor and the time and place of treatment. In certain conditions the patient may want to choose the method of treatment as well. This is especially true for surgery where more than onc eoption is available, such as between endoscopic and open removal of a gall bladder. It can be even more critical when there could be a choice of a life support device such as a pace maker.
A privatised system can also provide better nursing and allied services. It can provide better facilities for attendants and other care-givers. Patients and their relatives are not pushed around, neglected and ignored. Such care may also provide patients with a choice of convenient timings, treatments and costs, though these factors can be limited in both private and public sector settings.
Thus, privatisation has helped improve health services – their type, scope, quality and consequences.
The price of privatisation
Privatisation leads to steep hike in health expenditures, attributable to the increased costs of medical consultations, drugs and devices, medical tests and hospitalisation. Everybody involved has to earn; private medical practice is a profession, not just a public service.
Because of the pressure to make a profit, many private doctors, hospitals and diagnostic centres promote uncalled-for investigations and treatment in order to recover their initial investment. So services with limited value will be popularised and promoted to many people – whether or not they need it.
This is true for the simple ultrasound scanner, endoscopy centre and test laboratory as well as the more costly and sophisticated lithotripsy, CT and MR imaging, balloon angioplasty and transplant. Every test and treatment must be marketed like a commercial consumer product. This is done y individuals as well as big commercial organisations. Newly developed drugs, test kits or instruments are promoted aggressively. All kinds of methods are used to prove that the product at hand is superior to other, and almost indispensable in itself. The strategy succeeds at the cost of rational, ethical practice and patient care.
Points of concern
I will not make value judgements, only raise certain points that concern all of us. The most important is the availability of health care. The economically deprived are bound to suffer in a private health system.
The public sector provides limited services and charity encourages inefficiency and dependency. But knowing this does not help one overcome a feeling of helplessness and guilt when seeing a needy patient with a curable illness suffering because of the absence of a sincere social welfare system.
Privatisation has also encouraged unhealthy competition among the groups involved, since the objective is not only to earn, but to earn more than others.
Privatisation leads to the relative neglect of problems from which there is little to earn. Everyone including the state is interested in setting up commercially viable units. National preventive programmes get neglected.
There is also an undue stress on procedure-oriented medicine. Well-considered, comprehensive advice is bypassed for a computerised laboratory test, resulting in the loss of the human touch.
Effect on medical education
The general decline in standards of medical education and research in most Indian medical colleges can be partly attributed to privatisation. Busy clinicians and hospitals see little reason to invest their time and money in education.
Running private medical colleges is lucrative, but the standards of education have fallen, especially at the undergraduate level since the primary motive is to make money. The basic MBBS diploma is devalued today. An MBBS doctors is reduced to doing the work of a village level health worker or being a postgraduate-in-waiting.
I believe this is at least partly due to privatisation, because private practitioners and institutions almost always prefer practice to teaching and training.
Research, a high-cost investment with poor or uncertain returns, is largely the domain of a few institutions and pharmaceutical companies. Most medical research in India is unoriginal, rarely resulting in improved techniques or therapies.
Privatisation has undoubtedly improved the quality of health care, and widened its scope and availability. And private health services will continue to flourish, since they provide curative and rehabilitative services that the state does not provide. But privatisation has resulted in a number of problems hitherto alien to Indian society. Promoting health care as a consumer service and product is both unhealthy and risky.
It is high time we ponder this worsening situation and take remedial steps.
S K Jindal, additional professor and head of the department of pulmonary medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160012
Healthcare in India
From Wikipedia, the free encyclopedia
 | This article may be confusing or unclear to readers. Please help clarify the article; suggestions may be found on the talk page. (September 2009) |
Healthcare in India is the responsibility of constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.[1]
The art of Health Care in India can be traced back nearly 3500 years. From the early days of Indian history the Ayurvedic tradition of medicine has been practiced. During the rule of Emperor Ashoka Maurya (third century B.C.E.), schools of learning in the healing arts were created. Many valuable herbs and medicinal combinations were created. Even today many of these continue to be used. During his rein there is evidence that Emperor Ashoka was the first leader in world history to attempt to give health care to all of his citizens, thus it was the India of antiquity which was the first state to give it's citizens national health care.
In recent times India has eradicated mass famines however the country still suffers from high levels of malnutrition and disease especially in rural areas. Water supply and sanitation in India is also a major issue in the country and many Indians in rural areas lack access to proper sanitation facilities and safe drinking water. However, at the same time, India's health care system also includes entities that meet or exceed international quality standards. The medical tourism business in India has been growing in recent years and as such India is a popular destination for medical tourists who receive effective medical treatment at lower costs than in developed countries.
[edit] Healthcare Infrastructure
The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2022 [2]. The Indian healthcare market was estimated at US$35 billion in 2007 and is expected to reach over US$70 billion by 2012 and US$145 billion by 2017 [3]. According to the Investment Commission of India the healthcare sector has experienced phenomenal growth of 12 percent per annum in the last 4 years [4]. Rising income levels and a growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery [5].
Even so, the vast majority of the country suffers from a poor standard of healthcare infrastructure which has not kept up with the growing economy. Despite having centers of excellence in healthcare delivery, these facilities are limited and are inadequate in meeting the current healthcare demands. Nearly one million Indians die every year due to inadequate healthcare facilities and 700 million people have no access to specialist care and 80% of specialists live in urban areas. [6]
In order to meet manpower shortages and reach world standards India would require investments of up to $20 billion over the next 5 years [7]. Forty percent of the primary health centers in India are understaffed. According to WHO statistics there are over 250 medical colleges in the modern system of medicine and over 400 in the Indian system of medicine and homeopathy (ISM&H). India produces over 250,000 doctors annually in the modern system of medicine and a similar number of ISM&H practitioners, nurses and para professionals [8]. Better policy regulations and the establishment of public private partnerships are possible solutions to the problem of manpower shortage.
India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population.[9]. Moreover, India faces a shortage of doctors, nurses and paramedics that are needed to propel the growing healthcare industry. India is now looking at establishing academic medical centers (AMCs) for the delivery of higher quality care with leading examples of The Manipal Group & All India Institute of Medical Sciences (AIIMS) already in place.
As incomes rise and the number of available financing options in terms of health insurance policies increase, consumers become more and more engaged in making informed decisions about their health and are well aware of the costs associated with those decisions. In order to remain competitive, healthcare providers are now not only looking at improving operational efficiency but are also looking at ways of enhancing patient experience overall.[10]
[edit] Central government role
Critics say that the national policy lacks specific measures to achieve broad stated goals. Particular problems include the failure to integrate health services with wider economic and social development, the lack of nutritional support and sanitation, and the poor participatory involvement at the local level.
Central government efforts at influencing public health have focused on the five-year plans, on coordinated planning with the states, and on sponsoring major health programs. Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through central-state government consultations of the Central Council of Health and Family Welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education.
The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983 health care expenditures varied greatly among the states and union territories, from Rs 13 per capita in Bihar to Rs 60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product (GNP) remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private-sector spending on health care was about 1.5 times as much as government spending.
[edit] Expenditure
In the mid-1990s, health spending amounted to 6% of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs 320 per year with the major input from private households (75%). State governments contribute 15.2%, the central government 5.2%, third-party insurance and employers 3.3%, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study. Of these proportions, 58.7% goes toward primary health care (curative, preventive, and promotive) and 38.8% is spent on secondary and tertiary inpatient care. The rest goes for nonservice costs.
The fifth and sixth five-year plans (FY 1974-78 and FY 1980-84, respectively) included programs to assist delivery of preventive medicine and improve the health status of the rural population. Supplemental nutrition programs and increasing the supply of safe drinking water were high priorities. The sixth plan aimed at training more community health workers and increasing efforts to control communicable diseases. There were also efforts to improve regional imbalances in the distribution of health care resources.
The Seventh Five-Year Plan (FY 1985-89) budgeted Rs 33.9 billion for health, an amount roughly double the outlay of the sixth plan. Health spending as a portion of total plan outlays, however, had declined over the years since the first plan in 1951, from a high of 3.3% of the total plan spending in FY 1951-55 to 1.9% of the total for the seventh plan. Mid-way through the Eighth Five-Year Plan (FY 1992-96), however, health and family welfare was budgeted at Rs 20 billion, or 4.3% of the total plan spending for FY 1994, with an additional Rs 3.6 billion in the nonplan budget.
[edit] Primary services
Health care facilities and personnel increased substantially between the early 1950s and early 1980s, but because of fast population growth, the number of licensed medical practitioners per 10,000 individuals had fallen by the late 1980s to three per 10,000 from the 1981 level of four per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. However for comparison, the in China for comparison there are 1.4 doctors per 1000 people.
Primary health centers are the cornerstone of the rural health care system. By 1991, India had about 22,400 primary health centers, 11,200 hospitals, and 27,400 clinics. These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centers and subcenters rely on trained paramedics to meet most of their needs. The main problems affecting the success of primary health centers are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. In addition, the integration of health services with family planning programs often causes the local population to perceive the primary health centers as hostile to their traditional preference for large families. Therefore, primary health centers often play an adversarial role in local efforts to implement national health policies.
According to data provided in 1989 by the Ministry of Health and Family Welfare, the total number of civilian hospitals for all states and union territories combined was 10,157. In 1991 there was a total of 811,000 hospital and health care facilities beds. The geographical distribution of hospitals varied according to local socio-economic conditions. In India's most populous state, Uttar Pradesh, with a 1991 population of more than 139 million, there were 735 hospitals as of 1990. In Kerala, with a 1991 population of 29 million occupying an area only one-seventh the size of Uttar Pradesh, there were 2,053 hospitals.
Although central government has set a goal of health care for all by 2000, hospitals are distributed unevenly. Private studies of India's total number of hospitals in the early 1990s were more conservative than official Indian data, estimating that in 1992 there were 7,300 hospitals. Of this total, nearly 4,000 were owned and managed by central, state, or local governments. Another 2,000, owned and managed by charitable trusts, received partial support from the government, and the remaining 1,300 hospitals, many of which were relatively small facilities, were owned and managed by the private sector. The use of state-of-the-art medical equipment was primarily limited to urban centers in the early 1990s. A network of regional cancer diagnostic and treatment facilities was being established in the early 1990s in major hospitals that were part of government medical colleges. By 1992 twenty-two such centers were in operation. Most of the 1,300 private hospitals lacked sophisticated medical facilities, although in 1992 approximately 12% possessed state-of-the-art equipment for diagnosis and treatment of all major diseases, including cancer. The fast pace of development of the private medical sector and the burgeoning middle class in the 1990s have led to the emergence of the new concept in India of establishing hospitals and health care facilities on a for-profit basis.
By the late 1980s, there were approximately 128 medical colleges - roughly three times more than in 1950. These medical colleges in 1987 accepted a combined annual class of 14,166 students. Data for 1987 show that there were 320,000 registered medical practitioners and 219,300 registered nurses. Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centers.
Indigenous or traditional medical practitioners continue to practice throughout the country. The two main forms of traditional medicine practised are the ayurvedic system, which deals with mental and spiritual as well as physical well-being, and the unani (or Galenic) herbal medical practice. A vaidya is a practitioner of the ayurvedic tradition, and a hakim is a practitioner of the unani or Greek tradition. These professions are frequently hereditary. A variety of institutions offer training in indigenous medical practice. Only in the late 1970s did official health policy refer to any form of integration between European-trained medical personnel and indigenous medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in both the governmental and non-governmental sectors.
[edit] Health Insurance
The majority of the Indian population is unable to access high quality healthcare provided by private players as a result of high costs. Many are now looking towards insurance companies for providing alternative financing options so that they too may seek better quality healthcare. The opportunity remains huge for insurance providers entering into the Indian healthcare market since75% of expenditure on healthcare in India is still being met by 'out-of-pocket' consumers [11].Even though only 10% of the Indian population today has health insurance coverage, this industry is expected to face tremendous growth over the next few years as a result of several private players that have entered into the market. Health insurance coverage among urban, middle- and upper-class Indians, however, is significantly higher and stands at approximately 50% [12].
The Insurance Regulatory and Development Authority (IRDA) is the governing body responsible for promoting insurance business and introducing insurance regulations in India [13]. The share of public sector companies in health insurance premiums was 76% and that of private sector companies was 24% for the period 2005-06. Health insurance premiums collected over 2005-06 registered a growth of 35% over the previous year [11]. In 2001 the IRDA introduced provisions for Third Party Administrators (TPAs) to support the administration and management of health insurance products offered by insurance companies. TPAs are facilitators in the coordination process between the health insurance provider and the hospital. Currently there are 27 TPAs registered under the IRDA [14].
Health insurance has a way of increasing accessibility to quality healthcare delivery especially for private healthcare providers for whom high cost remains a barrier. In order to encourage foreign health insurers to enter the Indian market the government has recently proposed to raise the foreign direct investment (FDI) limit in insurance from 26% to 49% [15]. Increasing health insurance penetration and ensuring affordable premium rates are necessary to drive the health insurance market in India.
[edit] Issues
[edit] Workforce productivity
Random visits by government inspectors showed that 40% of public sector medical workers were not found at the workplace.[16]
[edit] Disease
India suffers from high levels of disease including Malaria[17], and Tuberculosis where one third of the world's tuberculosis cases are in India [18]. In addition, India along with Nigera, Pakistan and Afghanistan is one of the four countries worldwide where polio has not as yet been eradicated.
Ongoing government of India education about HIV has led to decreases in the spread of HIV in recent years. The number of people living with AIDS in India is estimated to be between 2 and 3 million. However in terms of the total population this is a small number. The country has had a sharp decrease in the estimated number of HIV infections; 2005 reports had claimed that there were 5.2 million to 5.7 million people afflicted with the virus. The new figures are supported by the World Health Organization and UNAIDS.[19][20][21]
[edit] Pollution
According to the World Health Organization 900,000 Indians die each year from drinking contaminated water and breathing in polluted air [22]. As India grapples with these basic issues, new challenges are emerging for example there is a rise in chronic adult diseases such as cardiovascular illnesses and diabetes as a consequence of changing lifestyles [23].
[edit] Malnutrition
Half of children in India are underweight, one of the highest rates in the world and nearly same as Sub-Saharan Africa.[24] India contributes to about 5.6 million child deaths every year, more than half the world's total.[25]
[edit] Women
Most Indian women are malnourished. The average female life expectancy today in India is low compared to many countries, but it has shown gradual improvement over the years. In many families, especially rural ones, the girls and women face nutritional discrimination within the family, and are anemic and malnourished.[26]
The maternal mortality in India is the second highest in the world.[27] Only 42% of births in the country are supervised by health professionals. Most women deliver with help from women in the family who often lack the skills and resources to save the mother's life if it is in danger.[26] According to UNDP Human Development Report (1997), 88% of pregnant women (age 15-49) were found to be suffering from anemia.[28]
[edit] Water and sanitation
Water supply and sanitation in India continue to be abysmal, despite longstanding efforts by the various levels of government and communities at improving coverage. The situation is particularly inadequate for sanitation, since only one of three Indians has access to improved sanitation facilities (including improved latrines). While the share of those with access to an improved water source is much higher than for sanitation (86%), the quality of service is poor and most users that are counted as having access receive water of dubious quality and only on an intermittent basis. As of 2003, it was estimated that only 30% of India's wastewater was being treated, with the remainder flowing into rivers or groundwater.[29] The lack of toilet facilities in many areas also presents a major health risk; open defecation is widespread even in urban areas of India,[30][31] and it was estimated in 2002 by the World Health Organisation that around 700,000 Indians die each year from diarrhoea.[29] No city in India has full-day water supply. Most cities supply water only a few hours a day.[32] In towns and rural areas the situation is even worse.
[edit] Medical Tourism
India is quickly becoming a hub for medical tourists seeking quality healthcare at an affordable cost. Nearly 4,50,000 foreigners sought medical treatment in India last year with Singapore not too far behind and Thailand in the lead with over a million medical tourists [33]. As the Indian healthcare delivery system strives to match international standards the Indian healthcare industry will be able to tap into a substantial portion of the medical tourism market. Already 13 Indian hospitals have been accredited by the Joint Commission International (JCI). Accreditation and compliance with quality expectations are important since they provide tourists with confidence that the services are meeting international standards. Reduced costs, access to the latest medical technology, growing compliance to international quality standards and ease of communication all work towards India's advantage.
It is not uncommon to see citizens of other nations seek high quality medical care in the US over the past several decades; however in recent times the pattern seems to be reversing. As healthcare costs in the US are rising, price sensitivity is soaring and people are looking at medical value travel as a viable alternative option. In the past the growth potential of the medical travel industry in India has been hindered by capacity and infrastructure constraints but that situation is now changing with strong economic progress in India as well as in other developing nations [34]. With more and more hospitals receiving JCI accreditations outside the US, concerns on safety and quality of care are becoming less of an issue for those choosing to travel for medical treatment at an affordable cost. The combined cost of travel and treatment in India is still a fraction of the amount spent on just medical treatment alone in western countries.
In order to attract foreign patients many Indian hospitals are promoting their international quality of healthcare delivery by turning to international accreditation agencies to standardize their protocols and obtain the required approvals on safety and quality of care [35].
[edit] Rate of growth
India has approximately 600,000 allopathic doctors registered to practice medicine. This number however, is higher than the actual number practicing because it includes doctors who have emigrated to other countries as well as doctors who have died. India licenses 18,000 new doctors a year.[36].
[edit] See also
- Environment of India
- HIV/AIDS in India
- Indian states ranking by institutional delivery
- Poverty in India
[edit] References
- ^ NATIONAL HEALTH POLICY - 2002
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=131&id=168%3AIndian+Healthcare:+The+Growth+Story
- ^ http://www.ibef.org/industry/healthcare.aspx
- ^ http://cii.in/menu_content.php?menu_id=238
- ^ http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4277
- ^ http://economictimes.indiatimes.com/Healthcare/Lacking_healthcare_a_million_Indians_die_every_year_Oxford_University/articleshow/4066183.cms
- ^ http://knowledge.wharton.upenn.edu/india/article.cfm;jsessionid=a830ad0556799af14ed03640274d5d3a1b70?articleid=4277
- ^ http://searo.who.int/EN/Section313/Section1519_10852.htm
- ^ http://www.technopak.com/tkc/index.asp?ol=5
- ^ http://www.technopak.com/tkc/index.asp?ol=6
- ^ a b http://www.technopak.com/tkc/index.asp?ol=8
- ^ "Healthcare in India". Boston Analytics. http://bostonanalytics.com/india_watch/Healthcare%20in%20India%20Executive%20Summary.pdf.
- ^ http://www.irdaindia.org/
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=121&id=170
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=39:&id=330:MALVINDER,+SHIVINDER+PLAN+TO+ENTER+HEALTH+INSURANCE+BIZ+&Itemid=
- ^ Teachers and Medical Worker Incentives in India by Karthik Muralidharan
- ^ "Status of Malaria in India". http://medind.nic.in/jac/t00/i1/jact00i1p19.pdf.
- ^ [1]
- ^ "2.5 million people in India living with Aids, according to new estimates". New York Times. http://data.unaids.org/pub/PressRelease/2007/070706_indiapressrelease_en.pdf. Retrieved 2007-06-08.
- ^ 'Sharp drop' in India Aids levels, BBC
- ^ "2.5 million people in India living with HIV, according to new estimates". World Heath Organization. http://www.who.int/mediacentre/news/releases/2007/pr37/en/index.html. Retrieved 2007-06-08.
- ^ http://www.time.com/time/nation/article/0,8599,1736516,00.html
- ^ http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:21461167~pagePK:141137~piPK:141127~theSitePK:295584,00.html
- ^ "India: Undernourished Children: A Call for Reform and Action". World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html.
- ^ "'Hunger critical' in South Asia". BBC. 2006-10-13. http://news.bbc.co.uk/2/hi/south_asia/6046718.stm. Retrieved 2010-01-05.
- ^ a b Kalyani Menon-Sen, A. K. Shiva Kumar (2001). "Women in India: How Free? How Equal?". United Nations. http://www.un.org.in/wii.htm. Retrieved 2006-12-24.
- ^ "InfoChange women: Background & Perspective". http://www.infochangeindia.org/WomenIbp.jsp. Retrieved 2006-12-24.
- ^ "Asia's women in agriculture, environment and rural production: India". http://www.fao.org/sd/wpdirect/WPre0108.htm. Retrieved 2006-12-24.
- ^ a b Using shame to change sanitary habits, Los Angeles Times, 6 September 2007
- ^ The Politics of Toilets, Boloji
- ^ Mumbai Slum: Dharavi, National Geographic, May 2007
- ^ "Development Policy Review". World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20980493~pagePK:146736~piPK:146830~theSitePK:223547,00.html.
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=39%3A&id=327%3AINDIA+TURNING+AFFORDABLE,+QUALITY+OPTION+FOR+MEDICAL+TOURISTS&Itemid=
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=131&id=168&start=2
- ^ http://www.indianhealthcare.in/index.php?option=com_content&view=article&catid=122&id=173
- ^ http://202.131.96.59:8080/dspace/bitstream/123456789/113/1/Medical+Tourism-Pheba+Chacko.pdf
This article incorporates public domain material from websites or documents of the Library of Congress Country Studies.
[edit] External links
- Washington Post correspondent Amar Bakshi explores why clinical research in India outpaces the U.S.
- Healthcare in India Presentation
- Ayurvedic Colleges in India
- HRC/Eldis Health Resource Guide - new research and other resources on health in developing countries
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"Too much representation, too little democracy"
Narayan Lakshman| Democracy and free market have fused into single predatory organism: Arundhati Roy |
MoUs with transnational firms resulted in tribals moving out of their lands: Arundhati Roy
The problem of market externality posed systemic risks: Chomsky
Washington DC: "What happens, now that democracy and the free market have fused into a single predatory organism with a thin constricted imagination that revolves almost entirely around the idea of maximising profit," asked author Arundhati Roy at a discussion with Noam Chomsky, professor of Linguistics and Philosophy, at the Massachusetts Institute of Technology.
In the discussion, which focussed on the threats to democracy in the United States, India, and worldwide, Ms. Roy said asking such questions about "life after democracy" did not mean we should lapse into earlier discredited models of authoritarian or totalitarian forms of governance. "It is meant to say that in the system of representative democracy too much representation with too little democracy needs some structural adjustment."
Environmental concerns
As an example of some of the inherent risks within democratic systems, Ms. Roy touched upon environmental concerns. She asked the audience: "Could it be that democracy is such a hit with modern humans precisely because it mirrors our greatest folly, our near-sightedness, our inability to live entirely in the present, like most animals do, combined with our inability to see very far into the future, makes us strange in-between creatures, neither beast nor prophet?"
Ms. Roy also touched upon the institutionalised nature of repressive tendencies in India. "Something about the cunning, Brahmanical, intricate, bureaucratic, file-bound, applied-through-proper-channels nature of governance and subjugation in India seems to have made a clerk out of me." She said her only excuse was to say that it took "odd twos to uncover the maze of subterfuge and hypocrisy that cloaks the callousness and the cold calculated violence of the world's favourite new superpower."
Ms. Roy described her recent visit to areas controlled by groups portrayed in the mainstream media as "violent Maoist rebels" that need to be "wiped out." In exchange for giving such groups the right to vote, democracy "has snatched away their right to livelihoods, to forest produce and to traditional ways of life," she said.
Ms. Roy pointed out that Chhattisgarh, Jharkhand, Orissa and West Bengal had signed hundreds of Memoranda of Understanding worth billions of dollars with large transnational companies and this inevitably led to moving tribal people from their lands. "We refer to such areas not as the Maoist corridor but the MoU-ist corridor," she quipped.
Financial crisis
Corroborating some of her comments with points regarding risks in global financial markets, Mr. Chomsky said even senior officers at the Bank of England and the International Monetary Fund recently alluded the high likelihood of a crisis in the global financial system.
Arguing that the problem of market externality posed systemic risks, he said: "If Goldman Sachs sells complex financial instruments which it knows are no good, it will insure itself against loss by betting that they will fail, but it will not take into account systemic risk — the effect on the whole system — if its transactions go bad."
Perverse incentives
In addition, perverse incentives resulted from the "enormous" power of the financial institutions over the state with the U.S. now changed from a manufacturing to financial economy. This power over the state led to "all kinds of guarantees that if something goes wrong they will have no problem. The most famous of them is the government insurance policy called 'too big to fail' — if you are too big, the taxpayer will bail you out," Mr. Chomsky said.
As senior financial regulators had admitted, "the combination of market inefficiencies and perverse incentives virtually guarantees a doomsday cycle," he argued.
http://www.thehindu.com/2010/04/04/stories/2010040455031100.htmMao vs. Gandhi in Chhattisgarh
A naïve admiration for the Maoists is emblematic of the tendency in some among the Indian intellectual class toward left-wing utopianism.
By SALIL TRIPATHI
Maoist insurgents ambushed Indian security forces in the dense forest region of Chhattisgarh state in central India on Tuesday, killing over 70 troops of the Central Reserve Police Force. Analysts are calling it the worst single-day loss in fighting domestic insurgencies.
But despite such massacres, not everyone in India regards the Maoists with horror. One such apologist is the talented and articulate novelist Arundhati Roy who has, since her Booker Prize-winning 1997 novel "The God of Small Things," focused on bigger things, such as attacking Indian economic reforms, foreign investment, free markets, the United States and Israel.
In a rambling 19,500-word essay published a week ago in Outlook magazine in India and the Guardian newspaper, Ms. Roy writes of recent experiences following the Maoists in the Dandakaranya forest, near where the security forces were ambushed this week. The piece was headlined "Gandhi, but with guns."
The comparison is obscene. Not only does it suggest an amoral nihilism, it also represents a rewriting of history. A Gandhian with a gun is as absurd as a Maoist pacifist. India's founding father Mohandas Gandhi may not have been as perfect as some would make him out, but he did believe that only the right means could be used to reach an end, however noble. In 1922 he suspended a nationwide civil disobedience movement, when some Congress followers burned a police station in Chauri Chaura, killing over a dozen policemen and officers. Maoist ideology is precisely the opposite: The ends justify the means.
Ms. Roy herself notes that when she mentioned Mohandas Gandhi's non-violent struggle to the Maoists, they laughed hysterically. Despite her best efforts to portray a bucolic image of Maoists and tribals living harmoniously, their tranquility disturbed by forest officers, loggers, mining companies, and security forces, the truth still comes through. The Maoists show off an impressive arsenal of weapons, and their teenage recruits watch hours of reruns of violent ambush videos. The kids tell her they want to implement Mao's vision in India.
Ms. Roy's naïve admiration for the Maoists is emblematic of the tendency in some among the Indian intellectual class toward left-wing utopianism. In "Radical Chic & Mau-Mauing the Flak Catchers," Tom Wolfe lampooned the Park Avenue elite sucking up to the Black Panther terrorists who were killing cops in 1960s America. Is history repeating itself in India?
Nevertheless, just as in America three decades ago, the tide may be turning as ordinary voters become fed up with the violence. Maoists have been fighting the Indian state for over four decades under various names, including Naxalites, the name the movement got because of its origins in the town Naxalbari in West Bengal, where peasants revolted against landlords in the 1960s.
Like Maoists elsewhere, they are brutal. They conduct show-trials, sometimes executing the people they find guilty; they use improvised explosive devices and land mines; and they appear to use child soldiers. Since 2006, their attacks have become audacious, targeting police stations, power lines, schools and trains. They have not spared civilians and other "class enemies" who in their view collaborate with the state.
Even India's Communist Parties have distanced themselves from Maoists, and condemned their practices. The opposition Bharatiya Janata Party strongly supports the government in its battle. For his part, Prime Minister Manmohan Singh has called the Maoists' threat the gravest national security crisis the country faces.
To be sure, Indians living in forests have legitimate grievances. Their rights are routinely violated. Successive governments have failed them. Large companies, Indian and foreign, want the mineral wealth in those forests. The state hasn't built schools, nor equipped the few that are built. There are few primary health care centers, and the administration neglects remote areas. The rapidly modernizing and prospering parts of urban India ignores the region, its poverty, and its problems.
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Coffins of slain Indian Central Reserve Police Force (CRPF) officials are kept at a District Police camp in Jagdalpur around 300kms from Raipur.
But the Maoists offer no solution. Their collectivist authoritarianism is culturally alien in an India where spiritual acceptance of fate prevails, and where, despite feudal structures, inequities and rigidities, there is social and economic mobility. With all its flaws, it is a real democracy. Maoists know they would never win power through the ballot box.
They can only win through force, by shocking the state, by spreading terror, and by scaring away the administration so that they can reach their end. Which is power, not the removal of poverty.
Maoists want an articulate messenger, and Ms Roy fulfils that role. Her poetic eloquence clothes their naked ambition of power, offering it respectability. Her fame helps make their struggle known to audiences abroad, where people with limited knowledge of India accept the romanticized image of warriors in the jungle fighting for justice that she writes about. In early April, while the Maoists were preparing to ambush the troops in the forest, Ms Roy was in Cambridge, Massachusetts, in a public forum with Noam Chomsky.
Ms Roy has explained Maoist violence as a response to the repressive state, suggesting that the tribal groups are rising against the state, getting even—an eye for an eye. But as Gandhi said, an eye for an eye leaves the world blind.
Mr. Tripathi, a writer based in London, is the author of "Offense: The Hindu Case" (Seagull, 2009).
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