SUGGESTIONS
FOR
NEEDED REFORMS IN
HEALTH
CARE SECTOR FOR
MARGINALIZATION OF
CORRUPTION AT ALL LEVELS
AND
MEASURES
FOR ACHIEVING
“HEALTH CARE FOR
ALL”
THROUGH COLLECTIVE
RESPONSIBILITY OF VARIOUS
MINISTRIES
OF GOVERNMENT
BUSINESS ESTABLISHMENTS &
RESPONSIBILITY OF PEOPLE
PRADEEP
KUMAR KUNCHE
Think Social Engineering Think Me
kunchepk@gmail.com, pradeepkunche.blogspot.com
INTRODUCTION
MEDICAL EDUCATION INFRASTRUCTURE
NEED FOR MORE HOSPITAL INFRASTRUCTURE
REGULATION OF HEALTH CARE SECTOR
FIXED UNIFORM COSTS FOR MEDICAL SERVICES
DIAGNOSTIC TESTS
HOSPITAL SERVICE CHARGES
NEED FOR MEDICAL TOURISM
CATEGORY WISE
CHARGES
DOCTORS CONSULTATION FEE, SALARY
MANDATORY DUTY FOR ALL DOCTORS TO SERVE IN
RURAL AREAS
LATERAL ENTRY FOR DOCTORS TO GOVERNMENT
SERVICE
SUPPORTING STAFF
MANDATORY PROCEDURES IN HOSPITALS
REGULATING DOCTORS PRESCRIPTION
ROLE OF PHARMACY RETAILERS
DOCTORS MAINTAINING PATENT DATA
MANDATORY DOCTORS SERVICE
MEASURES
TO BOOST DOCTORS MORALE FOR ETHICAL PRACTICE
TAX CONCESSIONS
ALLOTMENT OF SPACE FOR MEDICAL PRIVATE
PRACTICE
PREFERENTIAL TREATMENT FOR DOCTORS
MUNICIPAL
TRANSPORT
MEDICAL REIMBURSEMENT
SOCIAL OBLIGATION ON BUSINESS ENTERPRISES
TO CREATE HEALTH CARE INFRASTRUCTURE FOR THEIR EMPLOYEES
MEDICAL INSURANCE
REGULATION OF
GOVERNMENT HOSPITALS
REGULATION OF PHARMACEUTICAL
MANUFACTURING
REGULATION OF DRUG PRICES
MEASURES FOR MONITORING DRUG SALE AT PHARMACY
RETAILERS
NEED TO ENCOURAGE R&D, SSI UNITS
METHODS OF DRUG DISTRIBUTION
DETAILS OF PATENTS
HEALTH CARE FOR GOVERNMENT EMPLOYEES AND
EMPLOYEES OF BUSINESS ENTERPRISES
TELEMEDICINE
NEED FOR MANUFACTURING OF ESSENTIAL MEDICAL
CONSUMABLES BY GOVERNMENT
HEATH CARE IN HIGHWAYS
ROLE OF PUBLIC REPRESENTATIVES
EMERGENCY AMBULANCE
CHILDREN HOSPITALS
NEED FOR SPECIALITY
HOSPITALS
HOSPITAL NORMS
REFORMS IN OTHER SECTORS WHICH HAS
SUBSTANTIAL INFLUENCE ON HEALTH OF INDIVIDUALS
HEALTH EDUCATION
FOR SCHOOL CHILDREN
FOR COLLEGE, UNIVERSITY STUDENTS
FOR EMPLOYEES AT WORK PLACE
OCCUPATIONAL DISEASES
RECREATION FACILITIES FOR EMPLOYEES
MEASURES FOR GOOD
HEALTH PRACTICES
SAFE DRINKING WATER
HEALTH AWARENESS
RESTRICTION ON SALE OF TOBACCO PRODUCTS,
BAN ON TOBACCO CULTIVATION IN INDIAN SOIL
RESTRICTION OF SALE OF ALCOHOLIC PRODUCTS,
BAN OF SALE OF CHEAP LIQUOR
REGULATING SALE OF IMFL
BAN OF LIQUOR SALE
REGULATION OF SALE OF LIQUOR
ALCOHOL DE ADDICTION CENTRES
REGULATION OF MANUFACTURING OF LIQUOR BY
DISTILLERIES
TRANSPORT SECTOR
SAFETY IN PASSENGER TRANSPORT
MANDATORY MEDICAL TESTS FOR PEOPLE WHO ARE
DRIVING VEHICLES
UN ORGANISED WORKERS CONVERSION TO
ORGANISED WORKERS FOR SAFETY, SECURITY, PROVIDING HEALTH CARE
DRIVERS
SERVANTS/DOMESTIC HELP
HEALTH CARE FOR SEMI SKILLED WORKERS,
PROFESSIONALS IN UNORGANISED SECTORS
HEALTH CARE FOR FARMERS
HEALTH FOR ELDERLY AGED PEOPLE
HEALTH CARE FOR ORPHANS
CLEANLINESS OF SURROUNDINGS
ENVIRONMENT POLLUTION CONTROL FOR BETTER
HEALTH OF INDIVIDUALS
REGULATING OF RADIO SIGNALS RADIATION OF
MOBILE PHONES IN EDUCATION PLACES, IN WORK PLACES.
VEHICULAR POLLUTION, URBAN DEVELOPMENT
PLANNING
INDUSTRIAL POLLUTION
MINING POLLUTION
FOOD ADULTERATION
MILK ADULTERATION, PREVENTION MEASURES,
SUPPLY OF PURE MILK TO CHILDREN IN ANGANWADIES, WELFARE HOSTELS
FRUIT ADULTERATION
HYGIENIC READY MEADE FOOD AT RESTAURANTS,
FOOD COURTS, CANTEENS ETC
REGULATION OF FOOD STORAGE, SUPPLY
STORAGE INFRASTRUCTURE CREATION
REGULATION OF FOOD PRICES, CONTROLLING AGRICULTURE
INPUTS LIKE FERTILIZERS, SEEDS, PESTICIDES, WATER SUPPLY
SAFE DRINKING WATER SUPPLY
CONTROL OF SEXUALLY
TRANSMITTED DISEASES
NEED FOR MARGINALISATION OF FLUSH TRADE IN
INDIA
PREVENTION OF ADVERTISEMENT OF SELF
MEDICATION
REGULATION OF BLOOD BANKS AND ORGAN BANKS
ROLE OF PUBLIC REPRESENTATIVES AND PUBLIC
SERVANTS IN BLOOD DONATION
ROLE OF POLITICAL PARTIES IN BLOOD DONATION
PROPAGANDA OF BELIEF IN SELF FOR SPEEDY
RECOVERY
CONCLUSION
-------------
INTRODUCTION
As we all knew that population of India has
crossed 1.2 billion with a GDP of Rs 43,59,762 Cr (2010-11 at 2004-05 pricing) and
the per capital income is Rs 53,331 (2010-11
at 2004-05 pricing). Even though India has a rapid growth in the GDP and per capta
income in the recent couple of decades, the conditions of poor did not changed
much, still people below the poverty line accounts to 28.8 % of the total
population, still majority of people lack basic needs like balanced diet,
drinking water, sanitation, and ‘health care’ is far reach for them. It is due
to the fact that health care in government sector not increased at the rate GDP
has increased, which lead public to send for health care at private hospitals.
It is a fact that over 75 % of the
medical services (hospitals & diagnostic centres) are under private
operators and the total drug (medicine) supply, 85 % are sold through pharmacy
retail outlets and only 15 % is distributed by the institutions. It is a fact
that lack of social insurance in the health care sector forcing the poor to spend
70 % of their medical expenditure in cash for purchase of drugs. The economic surveys
indicates due to medical expenditure alone 2 % of the population of the country
are slipping below poverty line. It is mainly due to failure on the part of
governments to create mandatory social health care, create social obligation to
all stake holders i.e the government, the business establishments, and the
income earning people, to be part in the process of creation of primary needs
like health care, drinking water and sanitation, which is very necessary, as it
is a fact that raise in per capta income is not the real purchase power of the
majority population in India, the rise of per capta income is only due to rise of billionaires and milliners
due to the rapid rise of trade and industrialisation in the last 20 years due
to economic liberalisation. It is fact that the top 10% of India’s population enjoys 31.1% of the country’s income;
the lowest 10% suffers with merely 3.6% only. It is also evident from Gini Index
which is widely used for measuring the Income Inequality which shows India at
36.8 (2004), the higher rate of index the more the disparity.
It is indeed a shame on our part that we
being the emerging global super power nation but very low power as far as health
care of people is concerned, the statistics speaks itself, as our country has
only 0.95 hospital beds per 1000 population and 0.34 hospitals per very 1000
population. Also it is a fact even though near about 30,000 MBBS doctors are
Graduating every year, it is really most unfortunate and a “real national
shame” that only around 26,000 doctors working in rural India, which accounts
over over 80 crore population of the country. (i.e 68% as per 2011 census population). The poor condition of health
care is mainly due to lack of systematic planning and lack of far sightedness by
the governments, because as early as in 1948 Sir Joseph Bhore Committee or Health Survey and Development Committee
recommend that proper planning needed to achieve 5.67 beds per 1000 population
in 30 to 40 years from the position of 0.24 beds per 1000 population in 1946. However it's been 64 years since and we still
haven't been able to reach the target of even 1 bed per 1000 population. Public health spending as a percentage of GDP is
minuscule. Due to this India is being overly dependent on private sector. With
lowest insurance penetration people are forced to spend out of their resources,
the
ratio of public health to private health investment is 1:4, in India the economic growth index is moving forward, the
wellness index is dipping, our governments ignoring the fact that “health is
wealth” and “health of the citizen is the wealth of the nation”. India’s public spending on health as a proportion of GDP
is among the lowest in the world. All these factors leading India ranks among the top 10 countries for
communicable disease, it is today, world leader of chronic diseases like
diabetes, hypertension and coronary artery disease. As such he health care in India is become a premium for many
sections due to lack of existence of adequate health care facilities, high cost
of the services due to lack of systemic accountability, checks and balances,
transparency in the system of governance the in health care sector.
It is a fact to
admit, appreciate that after UPA under Congress leadership came to power in
2004, realising the need of propriety of health care, boosted the pace of setting
of health care infrastructure like medical colleges, nursing colleges,
hospitals, and also providing health care schemes like National Rural Health
Mission (NRHM), Jan Swasth Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSY), promotion of generic medicine to provide low cost medicine through “Jan
Aushadi” and also the social insurance scheme Rashtriya Swasthya Bima Yojana (RSBY) to provide medical insurance for the BPL
and low income group etc with an annual allocation of over Rs 90,000 Cr
(2010-11) in the budget for health care which is 1.4% of GDP increased to 2.5 %
of the GDP in the plan (2012-2017).
Also to admit, still
due the lack of control on pricing of the drugs, leads to high cost of medicine
of life saving drugs leads to poor health care in India. It is really shocking,
that the people was dying due to lack of medical facilities, unable to afford
medicine due to their poorness, the pharmaceutical companies are earning huge
profit margins, with difference in manufacturing cost and retail selling price
ranges from 200% to over 1000% due to lack price control of government control
on many drugs (only 74 drugs out of 348 drugs are under government price
control). It is a great surprise to many people that how come many public representatives and media are
ignorant of the real pain of common
people due to the “day light robbery” by some of the private hospitals, nursing
homes who are squeezing the money once entered such hospitals and nursing homes
are performing all sorts of un necessary tests (irrational treatment) even
though they knew the issue is very minor, which can be resolved with simple
treatment and charging heavily which earn them huge profit margins. Also a
great surprise to many that how come the so called media with great
investigative journalism, which talks high about corruption, the top political class who constantly raise
their voice for the welfare of down trodden, completely ignoring the “dacoity”
by major pharmacy companies who are earning profits ranging from 200 to over
1000 % in some life saving essential medicines (the difference of cost of
manufacture of the product and the cost of the product at the retail store) unfortunately
some of them show in account books for taxation the shrinked margins..
It is high time for
the UPA government under the congress leadership who are constantly advocating
for and also dedicatedly extending the support for the welfare of the
downtrodden sections of the people of the country should immediately need
address the issues and bring more confidence to them, by regulating the pricing
of services in the hospitals in a systematic way to ensure affordability for
treatment all sections of people in all the hospitals across the country and
also to regulate the pricing of the medicine to get within the reach of the
common man by getting control of pricing of the drugs in uniform manner in the
light of judgement, direction of Supreme Court division bench comprising Justices G S Singhvi and Justice S J
Mukhopadhaya
in November 2011, also
adhering to the commitment by the government to Supreme court to control the
prices of all 348 drugs in the National List of Essential Medicine (NLEM) from by
bring balance 274 which are not under government price control (at present only
74 drugs are under the government control). In addition governments must fix uniform
pricing for diagnostics and medical tests and also to bringing the mandatory health
care education and mandatory health care obligation on the part of business
establishments in the country. In order to achieve the desired results of the most
magnificent welfare schemes of UPA government like NRHM, JSR, Jan Auahadi,
RSBY, etc, government should mandatory regulate health care sector in all
possible angles. Also to emphasise that the health care for all should be the
collective responsibility of the governments and business establishments,
government should make it mandatory that all business establishments to
contribute from their side appropriately as decided by government to maintain
equal treatment of business establishments of same nature. As business
establishments are grown o the hardship of the employees, some of the
industrial business establishments are directly or indirectly responsible for
deterioration of health of millions of population due to the pollution of the
air, water and land and also in many other ways.
It is true, some state
governments who are the implementing agencies understands the the potential
need of health care , extents the free medical services to the BPL families to
obtain multiple gains out of this. One is that all the BPL families will remain
as their vote banks; second the free medical service in the form of
reimbursement to the treatment is to be paid by the government to the some
select, private hospitals due to shortage of government hospitals. To our shame
majority of the selected private hospitals who are extending the medical
services on the government reimbursement keeping the motto of the hospital i.e
to “service to the sick” at the gravest level are becoming more or less like “leeches”,
“vultures” squeezing the tax payers money that was extended to BPL families by
performing Numerous unwanted tests (mostly irrational) for simple diseases,
performing unwanted surgeries even in minor cases. It is a fact that this booty
is shared among some of the public representatives, some public servants and
some medical professionals and touts. It is a fact this is happing mainly due
to lack of medical ombudsman system to monitor the prescriptions of the
doctors, to monitor the treatment procedures etc to make them accountable for
wrong diagnosis or over dose or error in dosage etc, ombudsman system will certainly
create the accountability and increases the responsibility of the doctors to
adhere to ethical practice of this noble profession. The medical ombudsman
should a three tire system from the district level to the state level to the
national level, with more number of panels at the district level working in the
lines of judiciary to determine the correctness of the diagnosis and issue of
medicine, treatment procedure etc, with option for either parties i.e the
victim patent or the doctor to appeal in the next higher level if the patent is
not satisfactory at one level. Also to ensure speedy justice to the sick
patents the delivery of judgements should be done in a fixed time frame say
less than 30 days in normal cases, for all emergency cases in less than 24
hours.
It is nothing to
degrade or de moralise the doctors / medical professionals or the hospital
managements but it is necessary to keep the system clean and ensure justice to
the people to build confidence in them towards professional ethics of this
noble profession, as it is a fact to admit that some hospitals, nursing homes
and some doctors are too much greedy, self centred and only motto is to earn
money, totally ignoring the professional ethics of this noble profession and
due to these few black sheep’s the entire profession is being doubted by common
people who are under the peril to visit even a private hospital leaving apart
the government hospitals, as majority of which always lack of facilities and in
most cases government hospital atmosphere itself makes the people sick?. Even
though majority of the times the doctors want to be straight forward still they
have to act under compulsion according to the hospital management as they are
paying fancy salaries to them. It is more happing because the doctors and
specialist doctors have to recover their money invested in their education. As
it is an open secret that government colleges for medical education are limited
in number, as such limited number of seats to study in government medical
colleges, the admission into MMBS doctor seats in private medical colleges are not
less than 25 lack rupees with maximum up to Rs 60 lakh and for the post
graduation course in medicine for specialisation in any discipline in the
medicine is not less than 40 lack rupees and ranges as high as Rs 1.5 crores.
All the corporate hospitals and the hospitals and the nursing homes, especially
in the cities expect the doctors with PG or specialisation. As such government
should regulate the fee structure immediately making it at as low as possible
with uniform fee structure throughout country.
MEDICAL EDUCATION INFRASTRUCTURE
The primary focus
of the governments is to create infrastructure and facilities to the medical education
especially the PG courses, it is most ideal that PPP mode is the best option.
The private corporate make investment for the infrastructure and facility for
the creation of the necessary infrastructure and facilities for the study,
where government allocate land, soon after the construction is completed the
management and administration is done by government with partnership to the
private investor for some period till the investment of the private partner is
recovered. The main motto of PPP is to provide more number of free seats to the
study of MBBS course. As such there should be uniform procedure for calculating
the percentage of seats to be given for the PPP private partner to collect the
fees for recovering the investment and the rest of the seats to be given on
merit to the students as per the reservation policy by the government at
nominal price. The ideal ration of seats to government and private PPP should
be 60:40 till the investment is recovered by the private partner in a fixed
number of years say 10 or 12 years after which the entire infrastructure and
authority on the 100 % seats should be with government. The numbers of years
the private partner entitled to collect the fee is determined based on the
investment made in the infrastructure and on maximum fee to be collected from
the private student, (also there should be sealing on fee from private student).
It will be ideal that all cities and towns above 10 lakhs population should
have at least 3 medical colleges in PPP with not less than 600 seats at degree
level having all the courses at adequate number in all levels and disciplines,
more importantly in the PG courses.
Also it will be
more ideal to bring a change in the
curriculum of the medical education to introduce 4 year medical course that
will be allowed only to practice issue of general medicine and not eligible to
go for operation theatres or specialisation. This is necessary as in order to increase the
ration of doctors to population on par with the developed nations it may take
over few decades, creating infrastructure in that pace will take several
decades. As such all the existing private universities and select engineering
colleges who are ready with necessary adequate constructed space, financial ability
to create facilities for medical education as per the MCI standards should be
given permission to operate the 4 year medical course, the teaching in all the
4 year course medicine should be ideal to adopt the e-learning on the interactive
learning methods, the basic practical’s can be made through tie-up with nearby
hospitals and full-fledged medical colleges at the nearest place to the
colleges.
NEED FOR MORE HOSPITAL INFRASTRUCTURE
Also it is
necessary that government to set up hospitals to increase the ratio of hospital
beds to the population. As per the WHO the total additional beds required in
India are around 4,50,000 Since government alone cannot built such
infrastructure in such a fast pace, government must involve private investors
to add to the capacity building in the heath care infrastructure through PPP
mode. In order ensure government and private investment have equal
representation the government should provide land for the construction of the
hospital infrastructure at prime localities in the districts and cities and
towns to ensure that the value of the land is almost equal to the value of
financial investment by the private for the construction of the hospital and
setting up of necessary infrastructure. This will ensure that equal share for
government and and private. All these hospitals should mandatorily cater the
free treatment in beds as for the percentage as per the government share, the
private percentage beds can charge the rates as per the pre fixed rates as
normal as in the case of private hospitals.
Also it should be
most ideal and necessary that governments should set up super speciality
hospitals in every discipline like heart care, cancer treatment, etc in every
district in the country. More focus should be on establishing hospital
exclusively for the heart care is very necessary, as there are several lacks of
patents are suffering from heart issues of which majority of them belonging to
down trodden and low income group without any treatment due to un affordable,
high costs in private hospitals. As the studies shows out of the total
population in India 3-4 % population in rural areas and 7-8% population in
urban areas are suffering with Coronary Artery Disease (CAD) which is a serious
heart disease which requires heart care and surgeries. Moreover, majority of the people prone for CAD in India are at younger
ages (35-64 years old), during an individual’s working years, and as a result,
there is an extremely high loss of potentially productive years of life in
India. As per World Health Organisation data, 16.7 million people die each year
owing to heart attacks in India. The figure is one-third of the number of
deaths worldwide. The estimates shows that at the current facilities for
treatment of heart care, Among working-age adults (35-64 years old), nearly 18
million productive years of life are expected to be lost from CAD by 2030, as
the estimates show likely there will be
65 million people in India by 2015 suffering with CAD. At present there
are over 500 centres with facilities for heart care treatment i.e coronary angiography
and coronary angioplasty in the country and mostly in cities and and to some
extent in towns. But the treatment costs are very high not within the reach of
even middle middle class leaving apart the BPL and low Income group people,
which is a major hurdle for the economically deprived sections they have to
depend on the government hospitals mostly situated in cities and due to lack of
exclusive heart care treatment centres in government causing much un wanted
delay in treatment causing the deaths.
Similarly there should be government hospitals for exclusively for the
treatment of cancer, as the study shows that more than 5,56,000
cancer deaths occurred in India in 2010 and 71.1 per cent of those who died
were aged between 30 and 69 years, of which most of the men are more likely to
die of oral cancers followed by stomach and lung cancers, the most fatal
cancers in women are cervical, stomach, breast and oral. The number of cancer deaths in India are due to
tobacco consumption, around men (84,000) and women (35,700) died of
tobacco-related cancer in 2010 of the total cancer deaths in India, several
millions of people are suffering from respiratory problems, chest infections
etc. As such there should be a ban on cultivating tobacco, tobacco production
and restricted sale of tobacco finished products with heavy excise duty to the
tune of 1000 % to 5000 % on the finished tobacco products (there should not be
any hesitation in levying such high tax on these dangerous products, when the
governments allowed the pharmacy companies levy mark-up’s ranging from 1000 %
to 5000% on basic manufacturing cost of essential life saving drugs by private
pharmacy manufacturers), also governments much think that in the case of any death
occurred in any accent even due to technical failure (most ideal example rail
accidents) government announces few lacks of rupees compensation, in case of
major accident causing death of few tens of numbers of people the cabinet
minister is bound to resign ; then in the case of these tobacco cancer deaths
crossing lacks in numbers how come government not compensate them, which cabinet
ministers will resign, how many times they have to resign? Should be given very
serious thought on this issue as the tobacco deaths are more or less equivalent
to state sponsored deaths as governments are fully aware that there will be
deaths due to tobacco cancer still it being allowed to sale just for the tax
collection at the cost of life’s of few lacks population in the potential working
group (the deaths of potential working group will lead to loss of production,
which may be several times more than the revenue collection of the government,
apart from governments expenditure on the health care), just providing a
statutory warning on the pack of cigarettes does not control the cancer cases
as long as it is available at affordable prices people will buy and get
victimised, in case not available at affordable costs most of the urban smokers
switches to the local tobacco cigarettes i.e “Beedi’s” and raw tobacco as in
the case of rural population, as such complete ban on tobacco farming from
production of tobacco on Indian soil is needed which is fully justified. It is
true that the common people in India who are good hearted will not consciously
accept the better infrastructure or welfare schemes at the cost of deaths of lacks
of fellow citizens leaving utmost sorrow and misery for their family members, there
are some crooks even in the common people who are self centred will agree that at
any cost they should need all facilities. Apart from this also needed is construction
of speciality cancer treat hospitals in every district with adequate number of
beds. Also needed is to establish adequate number of tobacco de addiction
centres offering free de-addiction treatment. The UPA government’s allocation
of Rs 125 Cr in 2011-2012 budget for the National Programme for Prevention
and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is
a welcoming step to begin with but need huge allocation and investment as the
budget allocation is very meagre compared to the magnitude of the diseases. As
per the WHO reports India may lose 5 % GDP on account of deaths due to lack of
health care.
REGULATION OF HEALTH CARE SECTOR
In order to
regulate the medical sector it is the mandatory duty of the government to must create
& maintain the data bank of the all hospitals and nursing homes and
diagnostic centres with each and every detail of the facilities, doctors etc,
by making it mandatory to register with government to get registration number
on applying online along with the required details. Also government must maintain the data base/
data bank of all medical professionals like doctors, nursing staff, lab
technicians etc, by making it mandatory for all the medical education
institutes to submit the data of their pass-outs and also the individual
doctors to apply online to ensure that every one provided with a valid
professional ID card. All the medical data bank should be permitted to access
by all the hospitals and nursing homes for asserting the authenticity of the
job seeking medical professionals etc. Also it should be made mandatory that
the hospitals and nursing homes should up-load the date regarding the medical
professionals working with them (both permanent and visiting regularly). Also
should mandatorily submit the details of current equipment, its fitness status,
any maintenance and repairs done. Also it should be made mandatory that all
hospitals and nursing homes submit e-retunes on the details of number of
patients treated, billing information day wise, income and expenditure break up
statement every month. The data base will ensure that the hospitals and nursing
homes provide the authentic services through authentic, trained professionals
the income and expenditure break up etc. Also this will help in preventing the
falls medical claims at the insurance companies and also all the medical
reimbursements by the employees both in government and private.
Also it is the
mandatory duty of the government to determine the cost of medical services at
all hospitals and nursing homes, which should be fixed, uniform for all medical
tests and services based on the cost of the equipment, and the grade of the
city i.e metro, city, town, and also based on the number of medical staff in
the hospital/ nursing home. Also it should be ideal that government must mandatorily
fix the doctor to supporting staff ration in every hospital/nursing home. Also
it should be made mandatory that all hospitals and nursing homes maintain computerised
system for billing and accounting in a standard uniform pattern as suggested by
the government. Also government should
made it mandatory that audit for all the hospitals and nursing homes is
necessary for issue of licence and renewal of licence to run the hospital by
asserting the accuracy of the data submitted by the hospitals and nursing homes.
The audit should cover the details of number of doctors, their qualification,
working hours, their official payment details, the supporting staff like
nursing, lab technicians, helpers etc, the computerisation of hospital billing
and more specifically the available equipment, the date of manufacture, the
accuracy of results, the depreciation value etc. Also the audit should look
into necessary external factors like adequate parking space for the visitors to
the hospital / nursing home, also the fire safety, availability of water
facility, hygenity of the sanitation facility, waste disposal system etc should
be taken into account while extending the licence to run the hospital/nursing
home. Also the all the costs of various diagnostic tests should be determined
based on the cost of the equipment, the operational costs of the machine.
Also it should be
made mandatory that all the data of the patents treatment should be
computerises and kept a record at the hospital for future reference, in
addition copy of the data should be provided to the patent in a computer memory
card in addition to printed paper reports. All the test reports should
mandatorily contain details of the the machine on which the tests are
conducted, the date of manufacture of the machine, date of installation at the
hospital /nursing home, number of conducted on the machine till date, the life
span of the equipment, the technicians name and details. All the machines that
were depreciated should be withdrawn from operating and scrapped (either as per
the books of accounts or as per the maximum life of the equipment), or
alternatively if the equipment and machinery has still has the life span even
after the depreciation can be allowed to be in operational, but the cost of the
tests should be just restricted to the cost of consumables and operational
charges (as the value of the machine is zero financially) that were pre
determined by the Government, which will be far less than the tests on the new
machines. Also strictly withdraw from the operations those machines and
equipment which has been exceed the life cycle even before natural deprecation
due to excessive use in short time. In order to provide clarity to the public
regarding the difference in costs for similar tests made on the new and
depreciated equipment which are still having working life span in the same
hospital or different hospitals, it should be made mandatory the equipment details
and the cost of services should be made available on the website of the
hospital and nursing home for public knowledge. This will ensure that the
public will go for the lesser cost hospitals for tests in case they want at a
cheaper cost else the hospitals will scrap the equipment and purchase the new
once the depreciation value of the equipment is zero. Also it should be made
mandatory that all hospitals and nursing homes both in government and private
should mandatory e-file the details of equipment
and manpower periodically i.e every three months which will ensure that no were
in the country the scrapped or depreciated machine will be used again.
Also it should be
made mandatory that all hospitals and nursing homes should maintain a web site
and put the details of the building, the facilities in the hospital etc and the
doctors list both resident doctors and visiting doctors with their timings, the
details of number of beds available, the details of availability of the
operation theatre up dated on daily bases etc. All these details should be
supported by photographs taken in the actual location in the hospital. Also it
will be more ideal to take a video of the installations and facilities both
external and internal should be made available in the web.
FIXED UNIFORM COSTS FOR MEDICAL SERVICES
DIAGNOSTIC TESTS
Also it is a fact
that all the tests like blood test with a single sample can get number of
details can be extracted by a single titration or analyses details like sugar
level, RBC, WBC, plasma etc but most of the hospitals/nursing homes and
diagnostic centers are charging extra as per the number of parameters in the
blood test as per the prescription. In fact the cost of test for one blood
sample takes only 2 Rs if you add the cost of consumables and the operational
cost, but unfortunately the hospitals/ nursing homes/ diagnostic centres are charging
100 rs to 2000 rs for the same just to provide the detailed analysis report, like
wise all tests are charged much higher than the actual cost of the tests, which
is nothing but “extortion”, As such the government need to fix the uniform cost
for the blood tests, ECG, X-RAY etc. The costs of diagnostic tests will come
down to affordable level on having a ceiling of the costs at a fixed rate, as per
the cost of the equipment and the value of depreciation. All the tests should
have uniform pricing whether it is in a super speciality corporate hospital or
the nursing home or a diagnostic centre in a small town, Also most of the
diagnostic centres are usually getting their breakeven in few years, and the
depreciation value of the equipment is zero, in these cases the cost of the
tests should be based on the operational and material should be charged only
they should be barred from loading the cost of equipment etc.
HOSPITAL SERVICE CHARGES
Also it should be
mandatory that the private hospitals and nursing homes should have a four tire
service charge for their services rendered instead of uniform service charge,
the first category should be for the BPL families with 30 % of the beds for
treatment should be allocated to this category, the second category low income
group & low middle and middle middle income group 40 % of the beds should
be reserved for them, third category should be upper middle income group and
20% beds should be reserved for them and the forth category should be upper
income group and 10 % of the beds for the upper income group. The fees should
be decided based on the financial strength of population of these groups as
well as keeping in view of the number of patents, and the breakeven of the
investments made etc (In Business Financial Management, C- Class items are more
in volume say 70 % but total costs only 25% of the total cost the unit, the
B-Class items are moderate in volume say 20 % with total cost around 30% but the A Class items are 10% but
costs 50 %; the business principles has universal acceptability and
applicability, as such it should be applied to the health care in the larger
interest of the people, as the economic disparities are so high in India due to
several reasons), charging uniform rates for all is nothing but criminal,
people who has large income should be able to pay for their health as they have
adequate food, good shelter, and have all facilities in possession. Also the
cost of the service charges should take into account of the depreciation value
of the fixed assets like building, the permanent equipment like beds etc and
the depreciation value of the backup power generator, fixtures, and other
movable assets like ambulances etc, and most importantly the cost of land, as
many corporate hospitals got land at very low price from the government, this procedure of determination of costs will
certainly lead to reduction in the service charges of all the private hospitals,
nursing homes throughout the country. As such basic cost of the treatment plus
mark up profits should be very minimum (2% profit) for BPL, moderate (5 %) for
Low Income, normal (10% to 15%) for middle income and high (20%-25%) for higher
income group. Also the government should make it mandatory that in no case the
percentage of allocation of beds should change for the upper classes, with
exceptional that to real emergency; however if BPL/Low income group has more
patents then their reserved % of beds they can allocate bed in the next higher
class quota. The violation should be treated stringently.
NEED FOR MEDICAL TOURISM
Also it should be
ideal that government should select private hospitals in metros and major
cities for medical tourism, which are adhere to the international standards in
the entire hospital i.e all beds in the hospital, all diagnostics, all staff
etc (there should not be any discrimination either in facilities or treatment
to local Indian patent and foreign medical treatment patent). All these
selected hospitals in various specialities should be allowed to have 20 % of
the total beds to the foreign patents under medical tourism category. The
charges to the patents in the medical tourism category will be based on the
average cost of treatment in those countries; it should be fixed at less than 50
to 70 % of the cost average cost of treatment in that country, added the cost
of travel and the stay along with one attendant. (for example a Herat surgery
in USA costs 1,50,000 dollers (i.e around Rs 80, lacks) where as in super
speciality hospital with international standards in India costs maximum of Rs 4
lacks (all profit margins loaded), add to this travel in business class air
fare for two people i.e patent and attendant and the stay for 10 days in five
star hotel will cost maximum of Rs 10 lacks, if
the cost of medical tourism patent from the USA is charged at 70 %less
than of the cost of surgery in their country i.e 30% of 80 lacks is 24 lacks,
even after recovery of the cost of surgery, travel, stay cost of Rs 14 lacks
still the hospital makes Rs 10 lacks from a single patent of USA. Likewise each
country specific rates should be fixed) It will certainly boost the revenues of
the the so called corporate hospitals to recover their capital expenditure and
the operational costs that may go down due to the slab system accommodating
majority of the BPL &low income group which the cost of services should be
basic costs of tests without any profit margin plus 5 % of the mark up. The
medical tourism is a great boon to the corporate hospitals, at the same time
doing great service and favour to the foreign nationals as the medical services
are many fold higher than our Indian corporate hospitals and also the best of
the doctors availability in India. The medical tourism will also be useful in
revenue generation for the travel, and hospitality industry also.
CATEGORY WISE
CHARGES
Also it should be
ideal that all the BPL families since government is reimbursing their medical
bill the cost of services to them should be determined at very minimum profit
margin to the basic costs of the services of both diagnostic tests as well as
the service charges of the hospitals and nursing homes plus a profit margin of
5 % only, as the exchequer money is being paid for the BPL families in case the
governments are extending free medical aid facility to them, and also otherwise
keeping in view of large number of persons using the service. Also the
government must make it mandatory that the category of service chargers should
also be in accordance to the facilities in the hospital / nursing homes. All
the hospitals and nursing homes of same category should uniform service charge
structure based on the parameters like the built-up area, the available
equipment, available man power, experience of the doctors etc and the location
of the hospital/ nursing home. As such all the hospitals and nursing homes
should be divided into 3 categories 1,2,3. It should be mandatory that all
hospitals in that category should not charge more than the price fixed by the
government. Without having service
charges as per the classification of income group, without reserving the beds
appropriately as per the income group of the population, expecting health care
for all will forever remain as a myth.
DOCTORS CONSULTATION FEE, SALARY
Also it should be
mandatory to regulate the doctors fee, make it a uniform structured fee
according to the qualification of the doctor, experience of the doctor,
location of the doctor (city, town, or village) and the income group of the
patents, it is not for the individual doctors or the hospitals and nursing
homes to determine the consultation fee/ salary of the doctor even in the super
speciality hospital or the small nursing
home or the private practice the fee should be same for all doctors with same
qualifications, experience throughout the country. All the doctors working in
the government and private with same qualifications and same experience should
get the same salary. The doctors working
in rural areas in government and private should get more salary than doctors
who are working in city to encourage more doctors’ work in rural areas. Also
for all the private doctors who are practicing independently, (not working, not
receiving any salary, any consultation fee from private hospitals) in rural
areas should be allowed to charge only Rs 10 Per patent, but to encourage them,
the government should compensate the fee difference on par with doctors in
metro based on the total number of prescriptions (the private doctors
practicing independent should be provided with 1+1 carbon copy enabled bar
coded prescription pads to retain doctors copy for claim from the government),
which are subjected to the scrutiny by the authorities with the data of the prescriptions
obtained through drug authorities sale
of medicine on reading the bar coded prescription by retail pharmacy stores,
also subjected to the ombudsman. This necessary as it is a fact even though
near about 30,000 MBBS doctors are graduating every year, only around 26,000
doctors working in rural India
MANDATORY DUTY FOR ALL DOCTORS TO SERVE IN
RURAL AREAS
Also it should be
made mandatory that all doctors should be categorised in the four brackets as
per their working experience category-A 1-5 years of experience, category–B
5-10 years of experience, category-C 10-20 years of experience and the
category–D experience 21-30 or more years. It should be made mandatory that all categories
should mandatorily serve in the rural areas in government hospitals, category-A
should serve 6 weeks at a stretch or 8 weeks in three intervals, like wise
category-B should serve 4 weeks at a stretch or 6 weeks in three intervals,
like wise category-C should serve 3 weeks at a stretch or 4 weeks in three
intervals and the category-D should serve 2 weeks at a stretch or 3 weeks in
three intervals, during a calendar year to get their medical registration
validity extension for one more year for practicing the medical profession irrespective
of their working government or private. (in the lines of mandatory election
duty for the government employees). Also there should be some relaxations to
the surgeons in this regard due to non availability of the facilities for
surgery in the rural areas. However if the facilities exists they also should
be brought into the mandatory category to serve in the rural areas. To enable
this and more transparency in the allocation of work in the rural areas the
government must have a web registration and the allocation should be as per the
state of preference or as per the voter list the state belongs, the other than
the native district, any district of the state, the mandal / village PHC,
should be allocated randomly by the computer itself to avoid any bias or favour
to individuals to work at choice place. All the doctors should be provided the
working space in the PHC, or a pota cabin built for them, Also since as per the
NRHM so far has trained 2.55 lack ASHA’s (Accredited Social Health Activists)
out of total 8.09 lack selected people and the ANM (Auxiliary Nurse Midwife)
and AWW (Anganwadi Worker) who can assist the doctors on rural duty. All the
doctors should be provided with temporary accommodation made for their stay
built on the fast construction method of structural steel and foam concrete panels
pre fabricated buildings which can be constructed in less than couple of days
with a plinth area of 300 Sq Feet with provisions for kitchen, bathroom, visitors
area and the bed room with solar power for light and fan with less than 2 lack
rupees which has a life of over 30 years. Also to encourage doctors to work in
government at any point of their carrier, lateral entry should be created to
switch from private to government.
LATERAL ENTRY FOR DOCTORS TO GOVERNMENT SERVICE
Also there should
be provision for lateral entry for the doctors working in the private to enter
into government hospitals, as both government and private doctors with same
qualifications and experience have the same salary both in government and
private. Also government should make the
later entry encouraging by providing the pension benefits to them with eligibility
for all the doctors who served in the government through lateral entry for more
than 12 years in any two categories (i.e category A,B C D) at a stretch or in intervals, with at least 3
full years of service in rural area should be eligible to pension benefits on
par with the normal government doctors. Also all the private doctors are allowed to
get a percentage of treatment from the private hospitals and nursing homes as
an incentive for better treatment. However the percentage of the incentive
should not be more than 1% of the total revenues earned by the hospital divided
equally to all the doctors working in those private hospitals, with maximum
amount of incentive given should be less than 50 % of the basic salary per
annum of the doctor. To compensate the doctors working in the government should
provided subsidized canteen facility for getting food, beverages, accessories
etc at a subsidized cost like military canteens. Also government must provide housing
plot in that rural free of cost to all doctors who served in the rural area
after serving a minimum of 10 years in any category either in the direct entry
government service or through lateral entry. Also for all those doctors who
wish to serve throughout there carrier under the bond to the government in
rural areas , the government must provide free constructed house to the
doctors, which will be transferred to the individual doctor after 20 years of
service in that rural area at the choice place in any mandal of a rural area. This
will ensure that fair treatment of all doctors, which will enable them to work
more dedicatedly with more focus on the treatment and recovery of the patent
whether they are serving in the government or private.
SUPPORTING STAFF
In order to get
better cooperation to the doctors from the supporting staff i.e the nursing
staff, assistants, etc it should be mandatory to that all staff with equal
experience, qualifications should get equal salary in both government and
private hospitals and nursing homes. Also it should be ideal that these staff
should be paid 0.5 % of the turnover in the private hospitals as incentives, in
government the subsidized canteen facility should be extended to the supporting
staff of the doctors.
MANDATORY PROCEDURES IN HOSPITALS
Also it should be
made mandatory that all the hospitals/×nursing homes/ diagnostic centres
should conduct tests only on the reference of a registered medical practicenor
only. All pharmacy retailers must issues medicine mandatorily only on the
prescription of the registered doctor. In no case any single test should be
conducted without the reference of the doctors through the bar coded
prescription and no single medicine should be issued by the pharmacy.
Also that the
doctor/s’ fees and the referral doctor’s fee should be clearly mentioned in the
medical bills provided to the patents, all these details should be submitted to
the government in quarterly e-filing return. It should be mandatory that all
the hospitals and nursing homes submit the details of their income and
expenditure should be submitted in the standard format online to the government
every month. The details should contain the doctor, referral doctor, patent,
the equipment the amount charged for the consumables the total cost of the
tests, the cost of the services etc, if the tests were made in the other
hospital/ nursing homes/ diagnostic centre the details should be extracted from
the patents from the details given in memory card of the tests regarding the
test details and the hospital/nursing home details containing the charges they
have collected from the patents, the equipment details, the details of the
technicians etc.
Also it should be
necessary to formulate stringent laws to ensure that all hospitals and doctors
adhere to the ethical norms and strictly follow the fee structure and the
procedures in prescribing the medicine and the test and the dosage by the
doctors (to prevent the irrational prescriptions); the allocation of beds as
per the income group, the charging of the bills as per the directions as per
the classification etc by the hospitals and nursing homes. All violations
should be made non-bail able offences and the punishments should be rigorous,
apart from suspending the registration to practice as doctor, and for the
hospitals heavy fine, in addition to rigorous imprisonment for the all members
of the hospital management.
REGULATING DOCTORS PRESCRIPTION
It is fact that
doctor profession is a noble profession; every one rich or poor, strong or weak
has to visit on the doctor for treatment. As such we have to give utmost social
respect to the doctors who are in the profession of service to the people. However
there should be some system in place to control the corruption in the medical
field, as doctors play a Vital key role, it will be more appropriate and ideal
to control other factors in the health care through the doctors, also it is a
fact that some crook elements exists in every profession with no exception to
medical profession, as such the reforms in the medical profession is very
necessary. SINCE DOCTORS PRESCRIPTION IS THE ORIGINATING MOTHER DOCUMENT FOR
ALL HEALTH CARE INDUSTRY, ANY DIAGNOSTIC TESTS OR ISSUE OF MEDICINE DEPENDS ON
THE PRESCRIPTION ONLY, AS SUCH IT WILL MORE IDEAL, NECESSARY AND APPROPRIATE TO
REGULATE THE DOCTOR’S PRESCRIPTION WHICH IS THE MAJOR BASE FOR OTHER ACTIVITIES
IN THE PROCESS OF TREATMENT, WHICH WILL CERTAINLY PROVIDE THE REQUIRED THRUST
IN THE PROCESS OF CONTROLLING CORRUPTION IN THE MEDICAL PROFESSION WHICH
INCLUDES THE PHARMACY RETAILERS, PHARMACY MANUFACTURERS, DIAGNOSTIC CENTRES’,
HOSPITALS ETC.
AS SUCH IN ORDER TO
ENSURE THE AUTHENTICITY OF THE PRESCRIPTION GOVERNMENT SHOULD PROVIDE BAR CODED
PRESCRIPTION PADS AND MAKE IT MANDATORY THAT ALL DOCTORS SHOULD USE THE BAR
CODED PRESCRIPTION PADS, WHICH WERE SUPPLIED BY GOVERNMENT ON THE REQUEST OF
INDIVIDUAL DOCTORS WHO ARE REGISTERED FOR MEDICAL PRACTICE. THE BAR CODED
LETTER PAD HAS EACH PRESCRIPTION PAPER WITH DIFFERENT BAR CODE WITH CERTAIN
INBUILT SECURITY CODES FOR EACH DOCTOR, SO THAT NO ONE CAN TAMPER OR CAN
GENERATE THE SAME PAD PHOTOCOPY, EACH PAGE HAS A DIFFERENT CODE INBUILT IN IT
FOR USE.
All the registered doctors should apply online to the government to obtain the
same. All the doctors should apply in the prescribed format online mentioning
their degrees, sizes of pads (should have only two standard sizes), number of
booklets, address for delivery, the DD amount towards the charges for printing,
stationary and delivery etc. The entire letter pad booklets will be mailed to
the doctors mailing address, in case of non delivery at the address will be
directed to the concerned district medical and health office, the concerned
Doctor has to go and collect the same. The bar coded prescription pads is it
not only for the betterment of the individual doctor but for several people,
which has multiple advantages of its own, it is necessary since the doctors are
dealing with individuals health i.e life as a whole, as we all knew that if money
is lost can regain but if health is lost
it is difficult to regain, since the bar coded prescription pads increase the
responsibility of the doctors in dealing with patents and patents recovery will
be more faster, of course the responsibility on the part of the patient to
administer the medicine prescribed by the doctor. Also all the hospitals and
nursing homes can apply for the doctors working with them on obtaining an
affidavit from the doctors. This will ensure that all the prescriptions are
authentic and mostly rational. The doctors who are net savvy can download the
bar coded prescriptions permission codes free of cost, to be printed by
themselves by providing the registration ID card number.
ROLE OF PHARMACY RETAILERS
ALSO MOST IMPORTANT
ASPECT IN MAKING BAR CODED PRESCRIPTION PADS MANDATORY IS TO REGULATE THE ISSUE
OF MEDICINES IN THE PHARMACY RETAIL STORES, AS SUCH IT SHOULD BE MADE MANDATORY
THAT ALL MEDICINE SHOULD BE ISSUED AGAINST THE BAR CODING PRESCRIPTION ONLY
AFTER DUE READING OF THE BAR CODE BY THE BAR CODE READER ELECTRONIC EQUIPMENT
WHICH WAS CONNECTED TO THE BILLING COMPUTER SYSTEM IN THE PHARMACY RETAILER
STORE. As such all the prescriptions which were made
by fake doctors will not have any scope here after the introduction of bar
coded prescription, as the system will
not allow without bar coding prescription issue of medicine, and also the issue
of prescriptions should be only made by the government of verifying the
authenticity of the degree of the doctor. All fake bar coded prescription, can be
detected by the system itself as all authentically issued bar coding are in the
server of the system, also hardly any chance to tamper the prescription pads
with bar coding and duplicate bar coding cannot be possible, in case of patent
visits with duplicate of the original pad (colour photocopy of the same
original or any fake doctor name) which was already medicine was issued, can be
recognised as system will indicate that the prescription paper was already used,
and such cases the retailer should immediately complain to the local police for
further action. It is the responsibility of the doctor to preserve and use the
pad carefully appropriately, the loss of blank original pad is the
responsibility of the doctor. Also this will
ensure that doctors cannot deny the prescription of medicine, tests were not
recommended by them, over dosage of medicine or, unnecessary treatment of the
patent is not possible. As the surveys reveals that in some places irrational
prescriptions by doctors are as high as 69 % of the total prescriptions,
leading to waste of money on the medicine, over charging of the patents will
not happen as the prescription was written in the doctor in their own hand
writing. Also it should be mandatory that all the pharmacy stores in the
government hospitals and inside the private hospitals and nursing homes also should
issue medicine based on the doctor’s prescription only. This will ensure that
doctors will not prescribe un wanted medicine, all the medicine sold is original
excise duty paid. Also this will curtail
the government doctors from private practice. (the government doctors can use
the pads in emergency for private purposes, all government doctors should be
relaxed for 10 % use of the pads for private use, the use of the prescriptions
of the government doctors can be identified from the pharmacy issue and the
diagnostic tests, whether in government or in private a record of the
prescriptions with the government) All the pharmacy retailers should mandatorily
use the same computer format for generating the sale data. In case the
prescription holder wishes to take part of the prescribed medicine for what so
ever reason, the same should be allowed with an entry on the system as well as
a rubber stamp mark on the prescription clearly mentions the remaining quantity
of medicine to be issued. It is the mandatory responsibility of the pharmacy
retailer to stamp the prescription pad for part issue. All the pharmacy should
issue only the remaining part of the medicine in the prescription which was
already used/issue; once the course prescribed in the prescription is fully
issued the validity of the prescription should be nullified by providing the
rubber stamp by the pharmacy retailer that the full course issued, further
medicine only after obtaining the new prescription. The data of sale, stock in
store should be submitted in the e-form on daily bases through online else on
daily bases (as in the case of banking each branch that at the end of the day
tally the account with withdrawal and deposits) to the district drug inspection
authorities to integrate the data of all the pharmacy retailers in that
district as per the doctor wise and prescription wise date wise which will
certainly reveal if any excess of medicine issued either without prescription
or with prescription. Violation should be seriously punished with stringent and
quick punishment. Also the e-data of districts should be integrated to get the
state data. It will more ideal that formation of national integrated pharmacy grid
(Central Pharmacy Network) to issue medicine online every time with the
information of sale on real time as patents can travel from one place to other
and obtain medicine at any pharmacy retail outlet in any part of the country.
The above method
will certainly prevent the sale of under invoiced medicine, non excise duty
paid medicine, sub standard, unauthorised and spurious medicine as every batch
of the medicine issued is recorded in the bill and the national data integration
will certainly identify any duplication excess manufacture of same batch number
distributed to different states or wrong batch number or dis continued batch
number of the medicine from the manufacturers end also, as per the revelations of
comprehensive examination of Drug regulatory issues of DPCO, Ministry of Health
Government of India shows that out of the total sale of medicine in the
country 0.24% to 0.47 % medicine are
spurious and 8.19% to 10.64 % are sub standard. The spurious and sub standard medicines
cause extensive damage to health of the people who consume them. As such in
this method there is hardly any scope for manipulation of what so ever manner. All
the pharmacy stores should mandatorily issue the bills for the purchase
containing printed details of the doctor who prescribed the details of the
qualified pharmacist, the details of the licence to run the pharmacy, the batch
number of the medicine, date of manufacture, date of expiry etc. This will
ensure that all the pharmacy stores should have a dedicated qualified
pharmacist all the times. All the pharmacy stores should maintain the records
and submit on monthly bases the e- filing of the monthly sales of the medicine
as per the doctor wise. This will ensure that doctors prescription is not mis utilised
which can be easily found.
DOCTORS MAINTAINING PATENT DATA
Also it should be
mandatory for the doctor to maintain the details of the patents and the
prescription pad number and date and time of issue of prescription, the amount
of fee collected in a log book (like books of accounts in any business
organisation). All the doctors should be restricted to collect the fee to a
maximum amount of Rs 10 from all the BPL families if the patient claims that he
belong to BPL family on the production of the BPL card or the MNREGA card as
this will certainly benefit over 5.49 crores people who are covered under the
MNREGA scheme. All the doctors while issuing the bill should clearly mention
the name of the patent, in case minor/dependent the guardian name, age of the
patent, the place of their ward/village or any ID card number, contact number
of patent/guardian. This system will be more transparency, more accountability
of the doctors certainly encourage them to practice more ethically. Also it is
the responsibility of the doctor to keep the prescription pads under his own
custody to prevent any mis-utilisation and the individual doctor is responsible
/accountable for the prescriptions.
The issue of
medicine mandatorily on the prescription will certainly boost the respect of
the doctors in the public, also income of the doctors will be on raise as
patents have to visit the doctor every time to obtain the medicine, as it is
fact that majority of the patents do not visit the doctor for most of times,
also in case visited one time never consult second time after the course of
medicine completed as prescribed in the prescription. Also most of the patents
living in slums in cities, in towns, and villages visit the pharmacy store and
consult the pharmacist or the helpers in the pharmacy store and get the
medicine, which may give temporary relief for them. This practice is dangerous
and the bar coded prescription will certainly curtail/marginalize the issue of
medicine unauthorised by the pharmacy retailer. As all the pharmacy retailers
have to read the bar coded prescription by the bar coding reader which will
verify the authenticity of the prescription by automatic online verification or
otherwise has checks and balances by daily submission of sale and stock
position in the prescribed format to the district drug authorities by the
pharmacy retailer.
MANDATORY DOCTORS SERVICE
All the public
places like bus stations, rail stations where large foot print is happing
should compulsorily maintain a general physician round the clock. Also all the
important pilgrim places and tourist places should have at least one general
physician at all times.
Also all the
offices, factories and industries having more than 300 employees should have
one doctor on regular bases visit for few hours. All factories and industries
having more than 300-1000 employees working at a single place should maintain
one doctor visit the office/factory/industry at least few hours daily. Offices
and factories, industries having more than 1000 employees should mandatorily
maintain one permanent doctor working in the organisation placed in the
premises. The doctor should be preferably specialist in the general medicine.
MEASURES TO BOOST DOCTORS MORALE FOR
ETHICAL PRACTICE
TAX CONCESSIONS
In order to boost
the morale of the all the doctors towards practice of ethical professional
skills( as it is a fact that the un ethical practise of some doctors are
curtailed to a maximum extent by the bar coded prescription, the slab system of
consultation fee, salary); the income earned from their professional practice
only should be subjected to minimum level of income tax, should be fixed at 50 % of the current income tax slabs charged
for generally for all people, the concession on income tax should not be applicable
to the income earned by doctors from other business other than the professional
earning. All the doctors should maintain portable/handheld billing machine or
computer billing machine for issue of bills to the consultation fee received
from the patents to record their professional income. All the consultation fee
of 10 Rs and above should be provided the bill, the doctors who maintain the
assistant should pay the salary through banker’s cheque and the 50 % of the
amount of salary paid to the assistant should be exempted from the tax. The
salary amount should not be more than Rs 1,20,00 or 50 % of the earning of earning whichever is the lower or a maximum
of Rs 60,000 should be exempted from the income tax payable by the doctor for
the payment towards the assistant.
ALLOTMENT OF SPACE FOR MEDICAL PRIVATE
PRACTICE
Also it is more
ideal that government must provide all the private individual doctors (who are
not employed either at government or private hospitals) for self employed
consultancy with subsidized space (a shop) for individual private practice at
the rural areas and semi urban areas. Also the government should make it
mandatory that at least one shop in each market yard at all places both urban
and rural, and one shop in each shopping complex in the villages, small towns
and semi urban areas should be allocated to doctors with minimum infrastructure
required for the doctors to practice their regularly. Also it is a pre
condition that doctors will charge minimum consultation fee i.e Rs 10 only or
less than that from all the visiting patents in these subsidized places. Also
it should be made mandatory that all the large private housing societies and
building complexes and government housing societies and housing complexes
should have mandatory provision of adequate space for the doctors, all private
societies should mandatorily surrender the space designated for the doctors to
the government. The government should invite the doctors in the nearby vicinity
(as per the address in the voter ID card) to allocate the space on subsidized rent
with required minimum infrastructure like table, chair, electricity, provision
for running tap water etc. The selection should be purely on the bases of
lottery in case more than two doctors wish to serve in the same place. It
should be on the pre condition that the doctor visits the clinic regularly with
at least 20 working days per month.
PREFERENTIAL TREATMENT FOR DOCTORS
Also in order to
extend more respect and honour to doctors it is ideal that the governments should
extend the special preferential treatment to doctors, starting from the free
vehicle parking, concession on the travel, preference to the admission in the
schools and colleges with 1 % of the total seats should be given to the
children of the doctors, free admission for doctors children in the welfare
hostels run by the government with a pre condition that doctor visit and spend
a day with the child at least monthly once and also look at the health
condition of all other children in that hostel etc, preferential treatment for
the doctors in the religious worship places based on their religious practices
etc, concession on property registration, concession on the interest rates for
the doctors who avails vehicle loan or housing loan (this concession should be
restricted to onetime lone only),apart from concession in the income tax. This will ensure that
doctors are not neglected or targeted; they will certainly work with more
enthusiasm, and more dedicatedly maintain the true professional ethics that is
the motto is to serve the people, speedy recovery at minimum burden to the
patent.
MUNICIPAL
Also it will be
ideal that state municipal authorities should issue free parking pass/ card for
one vehicle either two wheeler or four wheeler applicable in any part of the
state at all points whether it is private property like malls, shopping
complexes or railway stations, bus stations etc. This will ensure that doctors
get preferential treatment to the doctor’s vehicle. All the doctors’ vehicles
should clearly display that doctor symbol on the vehicle, and all the doctors
should at all times help the patents in emergency at all places. As such it
should be mandatory that all the doctors should carry first aid kits with them
at all times in their vehicles.
TRANSPORT
Also all the
doctors travelling in the road transport vehicles either government or private
operated should provide 25 % concession on the fare charges, all the doctors
who wish to avail this facility should provide the registered practiser number while
reserving/purchasing the ticket for travel. Similarly Indian Railways should
provide 25 % concession on the fare for the doctors travelling in the train, to
avail these doctors should mention the registration number while reserving the
ticket. By getting the concession on travel either by road or rail will
automatically binding obligation on the doctors to serve the people in
emergency situation if any arises during the journey, also all doctors availing
should mandatorily carry a personal emergency medical kit along with them
during the travel. It will be very ideal that in emergencies the first aid by
the qualified professionals in the first few minutes of the accident which are
more crucial moments for the survival of the accident victim.
MEDICAL REIMBURSEMENT
As we all knew and
its is an open secret that majority of the claims of the medical reimbursement
are falls, and simply the employees claim the reimbursement money by giving
falls declarations and medical bills
without actually purchasing the medicine. Actually medical reimbursement is
meant for taking care of the employee and their family and dependents. The bar
coded prescription, the bill from the doctor, the bill from the pharmacy
retailer based on the prescription will marginalise the scope for falls claims
by the employees and need for verification also minimised. In order to ensure
all the claims of the medical reimbursements are genuine government must make
it mandatory that all organisations must pay the medical reimbursement charges
only on the verification of details submitted by their employees with data
available at the government through the pharmacy retail sales data, the data of
patents through the e- returns of the hospitals. For this government must
create a medical reimbursement verification department in the government to
provide information online to the required organisations.
SOCIAL OBLIGATION ON BUSINESS ENTERPRISES
TO CREATE HEALTH CARE INFRASTRUCTURE FOR THEIR EMPLOYEES
Since the
companies/ business establishments are earning profit apart from their capital
investment, mostly due the hard ship of the employees it should be mandatory
primary responsibility of the employees to take care of the health care of the
individual employee as well as their family.
As such it will be most ideal to make it mandatory that all the business
establishments/organisations and industries, factories having more than 1000
employees in a single organisation/industry or in the same business group/industrial
group of the same management, should have its own hospital setup to cater the
health care of their employees, alternatively a group of different industries
with different managements can club together to form a super speciality
hospitals for their employees for providing free treatment. The hospitals can
be either at the place of choice of the organisation, either in the cities for
their corporate office employees or at the place of the factory or industry or
near their employees residential places.
Also it should be mandatory for all the industries whose turnover more
than 500 crores or the industries having profit margin above 50cr which ever is
applicable has to establish hospitals with all modern amenities like cathe labs
operation theatres etc for their employees for providing free medical treatment.
(all normal surgeries should be made at the company hospital only, for any major
complicated surgeries should be shifted to other nearby government/ private
corporate hospitals) The governments may allocate the land at a concessional
rate for this purpose. This will be far better than the medical reimbursements
put together and have also catering the social responsibility obligation on the
part of the business people. Also it will be ideal that government to provide
tax concessions on the total operational cost of these hospitals only, not on the
capital investment as it is mandatory social obligation contribution, since these
hospitals have expenditure on doctors salaries, consumables, electricity,
manpower, medicine cost. Also it should be mandatory that all such hospitals
exclusively built for their employees should be barred for commercial purposes.
However in case of emergencies they should treat the local residents other then
employees at nominal cost. Also make it mandatory that all the BPL card
families residing in the vicinity of such hospitals should be given free
treatment whenever there are vacancies of hospital beds. Also these business
establishments should mandatorily maintain the emergency ambulances (minimum
two vans, one to pick up normal patents, one to pick up patents in emergency
equipped with emergency treatment machinery) to pick up the family members of
the employees, it is ideal that they donate the van, integrate with the 108
service for better care, Also it is very ideal since most of the factories are
in small towns and rural areas that these vans can be integrated with already
existing Mobile Medical Units (MMU) of NRHM which has over 1031 number units in
operation at present spread all over the county. Also this system will
certainly reduce the load on the government and private hospitals.
Alternatively those business houses who are not interested in setting up or
maintenance of the hospitals on their own due to the fact that their employees
are spread in small number throughout the country; even though their turnover
has crosses 500 cr or having employees more than 1000 like banks and
construction companies etc has to built the hospitals or contribute the fund
equivalent to the capital cost, mandatorily. Also should contribute for the maintenance
and operations to NGO’s or the government or they should contribute onetime 2%
of their turnover or the total turnover divided by 500 which will be number of single
hospital to be constructed in their name (ex 10 Cr for a single standard hospital
construction) should be contributed to government towards the building of
hospitals and 0.5 % of the turnover thereafter for maintenance and operation.
Also it is ideal that for every 1000 employees in every single district should
have the hospital facility, in case of less than 1000 employees and more than
500 Cr turnover one single hospital in any district where maximum employees are
working and the total turnover divided by 500 should be contributed for
construction of hospitals in any choice district or the same amount should be
contributed to government. Also for all those companies who contributed the
fund yet their employees are placed not at the place of construction of the
hospital can be adjusted for free medical service on par with other employees
in their company through establishment of inter corporate adjustment system,
which allows them to use other nearby similar
free corporate hospitals. Also all other private business establishments who does not
fall under the above criteria / category should mandatorily deduct 2.5 % of the
salary amount of the employees and add 5 % of the salary equivalent from the employer’s
side to pay to insurance companies for creating the medical insurance for their
employees.
MEDICAL INSURANCE
Also the medical
insurance is the sector government needs more focus. It is a known fact that
there exists criminal nexus between some medical insurance companies and some
hospitals, as a result soon the patent with medical insurance admits the
hospitals the hospital authorities will ensure that all irrational tests are
being performed on the patent, calling unnecessarily expert specialist doctors
or only on billing statement the consultation fees for the experts, inflate the
bill to an extent which crosses the limit of the medical claim, or just touches
the claim limit. This is really a loss to the insurance company, especially the
public sector insurance companies, it is happening due the corruption of the
middle level executives in the insurance companies and the hospital
administration greed, and also some doctors in those hospitals. This can be
eliminated to a maximum extent by the bar coded prescription, and ombudsman
system. Also it should ideal that the integration of data of the subscribers of
all insurance companies is needed to ensure that each individual person should
have only one company policy only. Also it should be made mandatory that have a insurance portability of the service
provider, all individuals who are subscribers of one company insurance policy can have the option to switch to other companies
with the protection of the amount of money paid by that individual client to
the existing company, which should be transferred to the new company. Also it
should be made mandatory that in case the client discontinues paying the amount
of insurance, such amounts should be kept under suspense account, once the
client resumes to pay for the same insurance company or the client subscribes
to another companies policy after some period of dis continuation of the
previous policy, the amount in the suspended account should be transferred to
the new account of the other insurance company. The mis use of claim/
corruption, mal practices in the insurance claims can be marginalised by
transparent billing due to bar coded prescriptions, rational treatment due to
bar coded prescription, all tests to be conducted on prescription, and medicine
issued under the bar coded prescription by the pharmacy retailer, with the bar
coded prescription the individual doctor is accountable for the treatment. Also the insurance companies can pay a fixed
fee to the medical ombudsman to examine the cases and provide their opinion.
REGULATION OF GOVERNMENT HOSPITALS
Also It should be
mandatory that all government hospitals should issue biometric attendance
system on entry and exit, also to install the CC cameras at the entrance and
exit points of the all the government hospitals, all the the bio metric card
readers and the CC camera feeds should be integrated to computer system, which
should be transmitted to the district health office for monitoring all the
hospitals in the district. This system will certainly improve the attendance in
the government doctors. Also it should be the duty of the hospital
superintendent to keep the hospital premises and the surroundings in hygienic
condition at all times. In order to do achieve the DMHO should issues order to
take a video of the hospital premises for assessing the hygenicness and
cleanness of the surroundings, maintenance of the hazardous waste disposal
methods etc instantly one day in every week. The hospital in-charge or the
superintendent ensure that the video is made instantly on receiving the
instruction, made through 3G camera mobile phone or through Video camera (which
shall be provided by government to all the hospitals) and upload the same
instantly to the DMHO office website, time of call from DMHO, the time of start
of recording Video should not be more than 5 minutes otherwise the office
superintendent should be liable for disciplinary action. Also sent the same
through any messenger to the DMHO office or store it for record future
observation. In order to ensure the video shooting made on the instructions of
the DMHO, there should be a security code which has to be displayed throughout
the recording of the video, Also it is more ideal that the surprise calls to
every hospital by the DMHO every week on any random date and random time. In addition also there should be periodic
inspection for the hygienicness at least once in a week by the the DMHO
officials or local authority, most ideal the revenue authority (MRO and above) and
submit the report to the DHMO. This method will ensure that the hospital
atmosphere most of the times in hygienic condition. Also it should be ideal
that the toll free number service installed (at least three points) in every
government hospital to be operational at all times available to the patents to
report / register a complaint against the staff or the doctor in case of the
doctor don’t attend the duty on time or leaves the duty before time in spite of
the bio metric system of attendance and the CC camera, also any misbehaviour by
the staff or in case of seeking bribery by any staff. The complaint will soon
be transmitted to the superintendent of the hospital, the DMHO on their mobile
phone and also a fax message to their office regarding the issue, and also
recorded at the state office, all this automatically by the call centre, this
will ensure that hierarchy will respond automatically in order to avoid the
disciplinary action. This will keep the doctors and the staff on alert all the
time. Keeping the toll free phone in the working condition is the
responsibility of the hospital superintendent, one responsible official should
call to the call enter every day at least three times to ensure that the toll
free number is working condition, also from the end of the service provider can
identify the non working phones and ensure the repair takes place in less than
24 Hr service. Also the toll free phone should have just one button to be
pressed to activate and contained in a tamper proof box with speaker phones in
built in it. Even in government hospitals the issue of medicine should be
purely on the bar coded prescription which will ensure that accountability.
REGULATION OF PHARMACEUTICAL MANUFACTURING
REGULATION OF DRUG PRICES
Also the government
must urgently focus on getting the prices of drugs under the control of
government, to be available to the people at affordable price. Also should ensure
the prevention of dacoity of some of the pharmacy manufacturers who are earning
profit margins as high as 1000 % i.e 10 times the cost of manufacture of the
medicine. In addition the government must fix the cost of a particular medical
formula at a uniform price by all manufacturers. All this in the light of
direction of the Supreme Court division bench of Hon’ble Judges, Justice G S Singhvi and Justice S J Mukhopadhaya in November 2011,
and the commitment by the government to Supreme Court to bring all 348 drugs in
the National List of Essential Medicine (NLEM) to be under government price
control from the present position of 74 drugs which are under the government
control. As it is a fact that estimates
shows that the expenditure on medicine per annum in India touches over Rs
30,000 Crores i.e every citizen is spending on an average of Rs 1500 per year
on medicine alone apart from the cost of the services in the hospitals and
nursing homes towards doctors fee, diagnostic tests, hospital service charges
etc. As of now “free market” is
prevailing as far as 2/3rds of the essential drugs, with the prices of these
drugs are merely at the wish, mercy and greed of the manufacturers as
government does not have control over majority of the drugs. The price should
be uniform for all the manufactures who are manufacturing the same formula in
different names. The cost of the end sale price of drug product should not be
more 100 % of the basic manufacturing cost at the ex-factory, also should fix
the margin a maximum of 20 % profit to the manufacturer. As of now government
has 74 drugs under its control , which allowed to add 100 % mark up price to
the original manufacturing cost of the product to cater the expenses
towards packaging, distributor margin,
retailer margin and the transport expenses; even this mark up i.e 100 % also should be reviewed to bring down the % of
mark up and thus bring down the cost of medicine; government must act
immediately in bring all the 348 drugs under government price control with
restricting the manufacturers of these 348 drugs to add mark ups less than 100 % of the cost of manufacture of
the product while delivering it to retail sale. The costing of these essential
medicine which will certainly come down, which will reduce the burden on common
man, and also reduction of burden on the government where ever it is supplying
free medicine. In addition Since Government is promoting “Jan Aushadi” i.e
generic medicine which is much cheaper (many times less than price even in
medicine with 100 % mark up’s), it should bring much more medicine whichever is
possible to bring “generic”, “generic-generic” version of medicine to be
available to people, also should expand the “Jan Aushadi” stores to a maximum
extent. It is a fact that the
institution supply of medicine is only 15 % of the total production of the
medicine and the retail sale accounts for the 85 % of the total medicine in
India. Also it is a fact that still 81 % of the expenditure on medical care in
rural areas in low income group and BPL is for medicine spending cash for
medicines and where as in urban areas it is 71% towards medicine alone. Also it
is a fact that a study by National Commission on Macroeconomics reveals that
the there exists a huge variation of whole sale price to bulk purchaser through
tenders to institutions mostly government and the retail price the price
variation ranges from 100 % mar up for whole sale institutional supply to 5600
% mark ups for retail price for the same drug in some cases. It is a fact that
even in 100 % mark ups to the basic manufacturing cost the manufacturer earns decent
profit margins ranging from 17% to 21 %, due to the reason that as per the (Drug
Price Control Orders) DPCO 1995 the whole sellers margins are fixed at maximum
8 % and the retailer margin of 16 %, 4% VAT (zero VAT in some states) but it is
happening only on the 74 drugs which are under price control of
government. In the case of remaining
drugs in the total list of 348 drugs the free market prevails with mark-ups
exceeding over 1000 % than the original manufacturing cost of the drug, which
is evident from the recent study of “Cost Audit Branch” of the Ministry of
Corporate Affairs which has found the essential life saving drugs are sold in
the market at 10 times the manufacturing cost, suggested for regularisation of
the prices of these products. As such it is learned that Shri Veerappa Moily, Minister
Corporate Affairs, advised the Minister Chemicals & Fertilizers under whom
the Department of Pharmaceuticals function and also the Minister Health seeking
appropriate action on these pharmacy companies for curbing this practice to
regularize the price control of these products by regularizing the profit
margins of these companies to adhere to ethical practises). Since the profit
margins are as high as 1000% these manufacturers are providing more margins to
the pharmacy companies to promote their products , also providing the gifts and
percentages to the doctors to prescribe these high cost medicine even though similar
formula manufactured by other companies, their generis are available for lower
cost. It is nothing but decoity by these pharmacy companies squeezing the blood
and hard earned money of the people. It is more ideal and appropriate that
government must review even the basic cost of the drugs by reviewing the cost
of inputs, methods of manufacture etc to fix a uniform basic manufacturing cost
of the products. Also to reduce the prices of medicine there should not be any
tax from the state government side on the sale of the medicine should be
exempted from the VAT preview.
Even though the
free market drugs are enjoying the huge margins with the difference of
manufacturing and retails as high as 1000 % it appears while coming to the
account books for taxation the margins are shrinking, causing a huge loss to the
ex-chequer. As such there should be a
closed monitoring and analysis of data of the inputs of the raw material
produced in India/ imported has to have record and the utilisation of the raw
material by various companies, the cost of raw material i.e Bulk drugs (
maximum margin of 14 % fixed for bulk drugs by the DPCO to ensure drug prices
are under control) and the final product
of the company produced, the wastage, left over stock should tally online at
every time, also to ascertain that the production is fully duty paid and no
under invoicing is happening. Also it will be ideal that the electricity
department should submit the energy audit report every month in order to ensure
that the machinery is operated in the shifts that were recorded by the company.
In addition to note that any generators were in operation during anytime and
the duration of generators operation. This will eliminate completely all
unauthorised manufacture and sale of finished pharmacy products. There will be
great scope to control the non standard, non approved products in the pharmacy
sales counters. Also it should be mandatory that all pharmacy companies whose
turnover exceeds over 50 Cr should have two excise official and two drug officials
24/7 on three shifts on weekly rotation in the manufacturing premises of the
pharmacy company, it may be very negligible cost for the government but have
great advantages. Also should have weekly surprise visits by all other pharmacy
companies. Also there should be a vigilance task force for over all monitoring
to ensure the officials and the manufactures on alert all times.
MEASURES FOR MONITORING DRUG SALE AT
PHARMACY RETAILERS
In order to ensure
that the pharmacy retailers sell the medicine as per the prescription, prevent
unauthorised sale of drugs there should be regular inspections from the district
drug authorities once in three months every retailer to be inspected and
audited. Also there should be taskforce teams in appropriate number at the district,
state and central level in the drugs department to conduct the audit of the
stock at the pharmacy retailers and the distributors, a double check on a
regular and random bases which were under periodic checks by the local drug
authorities, the retail outlets should be selected randomly every time just
before the reach of the teams in that particular area. The message should be
sent through wireless to check the shops randomly selected by the district drug
authorities in that particular locality to tally the stock present, the stock
sold, the reflection of stock in the account books as per the official records
and the stock is a legitimate stock, all sales are recorded in accordance to
the guidelines, whether medicine sold strictly on the bases of the prescription
of the registered doctor, which will be reflected in the bills strictly. In
order to ensure that everything in order it should be made mandatory that all
the drug manufacturers should send on daily bases the details of the manufactured
goods, the batch number, the destination of dispatch of the batch i.e to
various distributors across the country, and also the final destination of the
batch of the product to the retailer to all the central drug authorities. The
central drug authorities should send the details of the drugs with the batch
number with date of manufacture and date of expiry of each company product to
each state drug authorities as the records. The state authorities should in
turn forward the details to district authorities as the location of the
retailers the batch number of all the 348 drugs. The district drug authorities
have the information of the batch, stock at each retailer. This method will
certainly provide better results on periodic surprise inspections at the retail
pharmacy outlets to ascertain the sale is as per the prescription, the stock is
as per the books, no un authorised batch numbers or products without batch
number or under invoiced products etc can be easily found, stringent action
should be on the retailer immediately and investigation should be conducted to
ascertain the culprits and drought to justice.
Also to inspect for
the storage facilities for the medicine storage at the retail out lets as some
require to store in refrigerators, some at controlled temperatures less than
normal room temperature so air conditioner is provided and generator to run the
air conditioner and refrigerator is available and in working condition etc. In
case the refrigerator, air conditioner is not there in the retail shop especially
in rural areas only such medicine who don’t require special storage conditions
only to be allowed to be sold by the retailer, to ensure that everything in
order all the pharmacy manufactures and distributors are given instructions to
stop supply to these special storage products to retailers and also the
medicine issued on the prescription of the doctor, the bill of sale clearly
ensures that such stock will not be sold in these outlets
Also there should
be special cell at each district level drug authorities to collect the near to
expiry drugs from the distributors and the retailers to destroy them. Also it
should be made mandatory that all the distributors and retailers should
surrender the medicine one week prior to the expiry date to the drug authorities.
Failure to surrender the expired medicine either in the position of the
distributor or the retailer should attract the non-bail-able offence with
stringent punishment, with suspension of the licence to trade the medicine. As
these expiries medicine may cause damage to the people who consume them.
Also needed is to
formulate stringent punishments for violation of any provision by the
manufacturer or the retail pharmacy; the existing laws are so weak that these
pharmacy manufacturers and retails never bother for action on them due to
violation; as DPCO has not having any enforcement agencies except through state
drug departments to monitor and control the system under the Essential
Commodities Act. The law should be made in such a manner the violations of the
drug act should lead to non bail able offence, with punishments ranging from
rigorous imprisonment to life term in the case of the spurious medicine sale.
Also the manufactures of the spurious medicine and sub standard medicine should
be charged with attempt to murder case and punishments not less than life term
rigorous imprisonment.
Since UPA
Government under the Congress Party is committed to the welfare of the all
sections of people of the country, especially the common people and the down
trodden it is necessary on the part of our government to regulate the prices of
the pharmacy product and keep a sealing cap on the profit margins of the
product manufacturing cost and product purchase cost. As such always the profit
margins should be restricted to 15% maximum in all pharmacy raw material (bulk
drugs),and pharmacy finished products 20 % maximum for all the 348 drugs. Also
should create strict, transparent accountability and checks and balances in the
supply of raw material for the manufacture of bulk drugs and the total
production of the bulk drugs and the distribution of the bulk drugs to the
pharmacy manufacturers, Also to regulate the pharmacy pricing of finished
products i.e 348 drugs under the National List of Essential Medicine (NLEM) of
different companies, restricting the mark up to a maximum of 100 % on the original manufacturing cost towards the
cost of packing, distribution margins, retail margin and the transport costs, Also should restrict the promotional
and advertisement expenditure to 5 % of the total turnover (to ensue un due
favours to doctors in the form of gifts etc to make irrational prescriptions
and promote only a particular company) by bringing National Pharmacy Policy
(NPP). In addition to these English medicine, also the AYUSH products also should
be brought under the DPCO mechanism and regulate the prices of all the
Aurvedic, Unanani Medicine.
NEED TO ENCOURAGE R&D, SSI UNITS
Also government
should encourage indigenous R&D by contributing to the companies by providing
reduced excise tax for all companies having R&D facilities, the difference
of the regular tax and the concessional tax should be mandatorily utilised by
the pharmacy manufacturer exclusively for the R&D only. Also the FDI in the
pharmacy should be reviewed to ensure proper protection to the generic
medicines while allowing the FDI, as the MNC’s partners may pursue/pressurise Indian
Partners to restrict, restrain or discontinue the existing Indian companies
producing the “Generic” medicine, “Generic-Generic” medicines which are
available at low cost compared to the products of other MNC manufacturers. The
generic version of the majority of the 74 drugs who are under price control of
government (only 100 % mark up)are much cheaper than the price of the drugs in
the branded companies as such generics are real low cost life saving drugs
needs to be promoted in large scale. Also
the government should encourage the SSI units in the pharmacy sectors to
produce generic medicines, Also should ensure their products are purchased by
the institutions, government machineries mandatorily by amending the existing
bulk procurement procedures rather than discouraging, since majority of the existing
bulk procurement procedures are in such a manner which automatically disqualify
the SSI’s from participating and automatically favouring the high cost MNC
products.
METHODS OF DRUG DISTRIBUTION
Also it is
necessary all governments should to bring a model like which the State of Tamil
Nadu following for pharmacy procurement and distribution through its state PSU
Tamil Nadu Medical Services Corporation (TNMSC) which developed a unique drug
distribution system (DDMS) with centralised procurement of medicine at the
state headquarters and distribution to institutions at each district through
district warehouses whose receipts and issues are recorded in computers and all
the district warehouses are connected to state computer system for better
monitoring and distribution of drugs, with the computerised distribution which
will instantly reflect the flow of medicine, need of a particular medicine, the
quantity from every mandal to district to the state centre is known. At present
central government as well as most of the state governments are having de
centralised procurement of the medicine
by different institutions of working under it, which is certainly losing the
advantage of bulk purchase and also the accountability of the flow of medicine.
Also it is a fact the institutional distribution of medicine is about 15 % of the
total manufactured medicine in the country. As such there a need to have a
mechanism to monitor, regularise the distribution and sale of medicine. It is more
ideal to extended monitoring of DDMS from warehousing to each government
hospital and to the reach to individual patent for more transparency and to
prevent misuse and corruption along with issue of medicine mandatorily on the
prescription of the doctor with the bar coded prescription with scanning and
storing the prescription copy in the computer system for record which will
marginalise corruption to a maximum extent as far as distribution of medicine
is concerned, also should make it mandatory that each other state follow more
or less similar model, in addition all the drug manufacturers should follow the
same till the retailer through a governing body at the central as there are
many manufacturers distributing drugs at various states) as mentioned in my
paper “Simple and effective reforms for controlling corruption, black money and
delivering good governance with existing anti corruption mechanisms”.
DETAILS OF PATENTS
Also it should be
made mandatory all the hospitals and nursing homes should maintain the data of
the patents admitted, patents discharged, the treatment details and the bill
payment details. All the details of the number of in patents occupied the rooms
and the operation theatres availability etc should be made online to the Cntral
Health Administrative Authority (CHAA) which will be up loaded to the system of
CHAA website, and people can view on the web site the details of the available
number of beds and the available dates for in-patent admission and operation
etc (like the railway reservation online showing the details of number of
available berths on different trains in different dates) the details of the
hospitals should be as per the mandal, district, state wise after feeding the
basic details of the patents in the website site CHAA.
The above measure
is very necessary since some of the state governments are extending free medical health care for
all which will make the private hospitals and the nursing homes are also be
part of the system due to acute shortage of beads in the government run
hospitals. It should be mandatory to know the available beds, the dates and the
patents who undergone the treatment, especially the BPL card and government
reimbursement patents.
HEALTH CARE FOR GOVERNMENT EMPLOYEES AND
EMPLOYEES OF BUSINESS ENTERPRISES
Also it should be
made mandatory that 2.5 % of the salary should be mandatorily deducted from
annual salary from all the employees both government and private to create a
compulsory health insurance for the employee and the dependents., who don’t
fall under the category of 1000 employees or 500 cr annual turnover or 50 cr
annual profit, for whom a dedicated hospital run by their respective
managements is mandatory. This will ensure that all working class heath care
needs should be taken care. All the employees should be provided with health
cards that can be used in all the hospitals and nursing homes for treatment of
their illness. Since medical ombudsman system is in existence, lot of checks
and balances from the doctor’s prescription to the issue of medicine in the
pharmacy to the online information of the patents and beds details to the CHAA
and the quarterly report of the income statement of the hospitals and the
nursing homes will certainly marginalise the scope for misuse by the hospital /
nursing home. All the card holders
should mandatorily use the card for obtaining the treatment. In case the
employees and their family members are so healthy that no need for use of the
health insurance card, once in every 7 years the money collected from the
employee will be returned to them as a bonus to them for maintain the good
health. The bonus should be cash reward or the gift coupons to the individual
employee to provide it to their relatives, friends, etc who are not employees
of government or private sector for certain period of time. The medical
treatments that are under the cover should be specified. This will ensure that
confidence in the employees’ families’ especially low income and middle income
group that their health care needs will be taken care and in case they don’t
utilise the facility their money will be returned to them after some time. The money collected should be utilised to
upgrade the facilities in the existing hospitals and also act as the corpus
fund for creation of infrastructure in the PPP mode, as it is necessary to
increase the population to availability of hospitals, the hospital beds, the
population to the doctors ration uniform in all parts of the country at all
cities, districts and in the mandals.
TELEMEDICINE
Also it is very
necessary and ideal at this stage to encourage the tele-medicine as it takes
only few months to establish the telemedicine facility in each state to cater
the needs of the rural, remote villages where the access to doctors is either
not possible due to the shortage of doctors or due to the geographical location
difficulties in transportation etc. As such the telemedicine is an excellent
way to provide health care for the people living in remote habitations. What
all to needed is to provide training to the nursing staff or the ASHA’s, ANM’s
and AWW in the villages to operate the facility of video conferencing, also to
issue the medicine as per the directions of the doctor or where the doctor
sends a fax or computer operated prescription, Also the patents can buy
themselves at the nearby pharmacy retail store with the prescription. Also it
is very ideal that basic essential medicine should be kept at post offices in
the villages and Gram Panchayats, also the drugs which are not available at the
post office or with the ASHA’s which are needed to be administered by the
patents should be immediately delivered by post from the nearest town post
office to that particular village post office of the patent to get
delivered. Also it is ideal that the
post office premises should be used for creating the telemedicine centre in the
villages and Gram panchayats. With fixed timing, but in case of emergencies the
post master/ postal official can open the facility and do the teleconference.
The telemedicine centres should be acting like a call centres having video
conference facility, having adequate number of doctor’s mostly general
physicians, also paediatricians, gynaecologists and orthopedicins, with
appropriate number from all the states of the country with all languages. Also
since the major diseases in the rural area are tuberculosis, asthama, jaundice
and malaria and other viral fevers; all the ASHA’s and other activists should
be thought about the basic identification of these diseases and calling the
doctor is very ideal way. Also the drugs related to cure of these diseases
should be kept available at the Post office or nearby pharmacy retailer and
issued to the patents on the prescription of the doctor only. Also the
telemedicine centre should have the Video conference (VC) facility with the
specialists to get their opinion in case required to determine the emergency
and urgency to get admitted in the hospital. Also it is very ideal to have
mobile laboratories to conduct the blood test, urine test, ECG, etc. These
mobile laboratories fitted in the vans with trained staff to take samples and
conduct the tests and deliver the reports, to the patent as well as the doctor
referred. All these mobile vans are
stationed at mandal head quarters with GPRS to know the location and movement
must visit the villages as and when required. Also it is ideal the 108 vehicles
or MMU vehicles of NRHM to use for this purpose. All the doctors who are in
contact with patents through telemedicine should do the follow up action with
the ASHAS and the individual patents or their representatives to ensure the
patent is recovered.
NEED FOR MANUFACTURING OF ESSENTIAL MEDICAL
CONSUMABLES BY GOVERNMENT
Also most import
that the government should set up manufacturing units for the manufacture of essential
consumables in the hospitals for the supply to all government hospitals. All the
basic daily hospital consumables such as
needles, syringes, cotton, gloves, anti septic lotions, spirits, IV fluids like
glucose water, cleaning agents like phenol, nebulizers etc and basic fixed hard ware items like IV
fluid stands, hospital beds, etc. at various strategic locations in the country
to be distribute to all states which will save lot of government expenditure.
Also it should more ideal and very necessary that government should manufacture
oxygen in each and every district in the government with appropriate capacity
of the plant as per the population, consumption in the hospitals in that
district based on the previous records towards the expenditure on oxygen
cylinders. It is a fact due to non availability of oxygen cylinders due to
short supply by the private manufacturer there are many incidents that infants
and patents are died due to lack of emergency oxygen). As the manufacture of
oxygen to have supply of own oxygen cylinders is more cheap than buying from
private manufacturer, in addition her will not be any break in supply of oxygen
cylinders as the oxygen cylinders are manufactured in advance in accordance to
the data of consumption in the hospitals. For example the setting up of oxygen
plant with a capacity of 100 m3/hr which costs around Rs 60 lacks can provide
24 cylinders per hour number of cylinders per day will be 576, the cost
variation is around 30 % less than purchase cost from private supplier (average
cost of cubic meter of oxygen supplied by private supplier is around Rs 35
including the transport cost, whereas own manufacturing cost per cubic meter of
oxygen is Rs 23 including the transport cost). Alternatively all big hospitals can have
individual Liquefied Oxygen Plants in the hospital compound itself and can
supply oxygen in pipes which will reduce the capital cost by 70 %. Like this in
very other consumable in the hospital will have a substantial savings if
manufactured and supplied by the government. Also the excess manufactured
oxygen cylinders can be commercially traded to the private hospitals with
pricing of the cylinders slightly less than the market price in that area,
which should be strictly after due verification that the sufficient stock at
all government hospitals exists as per the online stock position and the demand
for the cylinders from the government hospitals is less than 50 % of the total
production; in addition buffer stock should be maintained at the manufacturing
unit. Also it is ideal to revive IDPL and other drug manufacturing units and
also to set up drug manufacturing by government itself regarding certain
essential drugs which are of mass perennial consumption like drugs related to
the diabetics, heart care which required to be consumed by the patents for
several years and in some cases the whole life time; As it is a fact that as
many as over 50 % of the population in India is prone for Diabetics.
HEATH CARE IN HIGHWAYS
Also it should be
the duty of the state governments to provide the facilities for the people on the
move i.e to create the emergency hospitals along the highways preferably
adjacent to the cluster of small towns/ villages. Also all state should provide
the facilities for creation of emergency ambulances operating on the GPRS like
108 services existing in some states.
ROLE OF PUBLIC REPRESENTATIVES
As stated in my
earlier documents regarding the moral responsibility of the elected
representatives both MP/MLA to contribute to the welfare schemes; also it
should be ideal that all MP/MLA should mandatorily contribute 25 % of their
MPLAD/MLALAD fund towards creation of medical facilities in their constituency
like 108 emergency response teams, for creation of medical infrastructure in
the rural areas and small towns etc. It
will be more ideal and appropriate that MPLAD/MLALAD to create permanent assets
for the health care in the constituency rather than spending on the roads,
which are having short life because of lack quality construction leaving a
remark on the MP/MLA even though they may not have much role in the
construction of the road except sanction of the fund.
EMERGENCY AMBULANCE
Also the government
must make it mandatory for the private hospitals and nursing homes to contribute
1 % of their turnover to create and operate the unified 108 facilities in the
cities and towns and villages and also the facilities at highways (both state
and national) in the territory of the respective state. Also it should be ideal
that all the highway hospitals and
the hospitals and nursing homes should
have a permanent police post within the premises of the hospital with
appropriate police personal to register the medico legal cases and ensuring
quick medical treatment. Also these police personals should be provided with VC
facility (or mobile video conference and record the statement of the injured)
with the local judges to record the statement in emergency situations.
CHILDREN HOSPITALS
Also the
infrastructure for health care for the children should be built proportionately
and All the government hospitals should have the required staff and the
equipment for paediatric health care, as in recent times many children are
dying due to lack of oxygen supply sue to shortage of cylinders and also due to
lack of child care specialists. Also it will be ideal that the inventory in the
hospitals should be made online on daily bases to ensure this kind of shortage
does not arise. This will certainly help the patents in need especially in the
ICU patents and child patents. Also all the hospitals should have the RO plants
for purification of water to supply pure water at all times free of cost to
patents in all government as well as private hospitals. All nursing homes
should have the safe drinking water sully like water filters or bottled
purified water supply.
NEED FOR SPECIALITY HOSPITALS
Also
it is ideal government should built,
maintain exclusive hospitals at least 3
hospitals in each discipline per every 5 lack population in cities, towns, and
semi urban areas for exclusively discipline wise like dental care and eye care,
and diabetic care and also AYUSH hospitals with appropriate number of doctors
and supporting staff. As the statistics of the International Diabetes Federation (IDF) shows India has the largest number
of people 50.8 million suffering from diabetes in the world. India continues to
be the “diabetes capital” of the world, and by 2030, nearly 9 per cent of the
country’s population is likely to be affected from the disease, warns the
fourth edition of the World Diabetes Atlas launched by the IDF at the 20th
World Diabetes Congress in Montreal, Canada. “This trend will continue till the
next 20 years unless significant efforts are made to curb this disease. “In
India, the poorest people with diabetes spend an average of 25% of their income
on private care. Most of this money is used to stay alive by avoiding fatally
high blood sugar levels,” All these statistics stress the necessity of
exclusive diabetic care hospitals in government sector.
HOSPITAL NORMS
Also it should be
made mandatory that all hospitals and nursing homes should mandatorily adopt
“green building” norms. All existence buildings should be renovated where ever
possible should be converted to green buildings for more ventilation, free flow
of air, air circulation, saving on energy due to lights. All the hospitals
should mandatorily have power backup for all the equipment and operation
theatres and ICU through inverters and generators. All the hospitals should use
solar power panels on the terrace for lighting the surroundings, corridors, and
the rooms and for water heating. Also
all the hospitals, nursing homes both government and private in rural areas should
have the complete backup of power by solar energy or wind energy. Also it
should be ideal that the hospitals surroundings should have plants and trees
with medicinal values like neem trees, eucalyptus trees. Also ensure that all
the surroundings of the hospitals are clean all the time.
REFORMS IN OTHER SECTORS WHICH HAS
SUBSTANTIAL INFLUENCE ON HEALTH OF INDIVIDUALS
Also it is a fact
that health care for all is possible if and only if the elements that are the
primary root cause of illness/ decline of health/ case of deceases are
controlled. Otherwise what so ever the government’s efforts in bringing the
health care for all is next to impossible, which will remain as just cosmetic
in nature or more or less symbolic, vote bank tactics, in fact it is nothing
but “keeping the garbage in the house and spraying the perfumes and air
fresheners” which is purely a temporary phenomena and the investment in the
money is will not yield the desired results. What all needed is a permanent
cost effective solution, As such the collective efforts of other departments of
the government is necessary after all governments are running for the well
being of the people as such the excise policy should be stringent, the complete
ban on cheap liquor, regulated sale of IMFL, complete ban on tobacco
production, restricted sale of tobacco finished products, encouragement of use
of bio fertilizers and bio pesticides in the agriculture providing subsidies
for such production, coupled with liberal bank loans for formers for bio
farming. Also in order to reduce the use of pesticides and for more production
of the agriculture, the ideal solution to encourage “Hydroponics” (soil less
culture) which uses the less water, less space more output as all the process
is done in a controlled atmosphere especially for the vegetables and other
spices production, may be initial capital expenditure is slightly on the upper
side but has enormous benefits and most cost effective agriculture techniques
which is a grand success in the countries like
“Israel” and other places. Also to extensively promote the production of
paddy in (SRI) System Of Rice Intensification method of cultivation which the
paddy is grown in with 90 % less seeds, 50 % less water, higher yields, less
labour, more income to the tune of 60 % more than conventional yield income.
Also needed is to extend the National Food Security Mission (NFSM) programme
for more production. Also use of drip irrigation etc, as it is know that
agriculture production mainly depend on water either through the river water or
ground water, river water is at the mercy of nature due to monsoon, and the
ground water at the mercy of state electricity department due to acute shortage
of power due to various factors. The food produced from SRI, drip irrigation, hydroponics
and the use of bio fertilizers and bio pesticides is really good for health as
it does not contain any harmful substances in it.
HEALTH EDUCATION
FOR SCHOOL CHILDREN
Also it is not only
the responsibility of the government or the doctors but also more
responsibility on the people to adopt the preventive measures rather than cure.
As such the education of better health care should start from the school stage
itself. As such health care should be thought in the school at least two
periods in a week about basic foods to eat, personal care etc according to the
class of the students. Also it should be mandatory that all schools to make
periodic health check-up by qualified doctors of all the students once in 3
months and record the parameters like height, weight, BMI , eye site etc for analysis and necessary further steps. Also
all the school children from class seven should be thought about the adult
health care as it is the period of transaction from child to adult, all girl
children should be thought about food intake, hygienic maintenance, skin care,
care for protection of seasonal anomalies etc. Also it should be mandatory that
all schools should make it mandatory that every day yoga as a subject for all
students to perform for at least 30 minutes. Also sports should be a subject in
the school as every day activity.
FOR COLLEGE, UNIVERSITY STUDENTS
Also all the
college going students should be thought about the foods and supplements needed
for maintain the bone growth, the memory power increase, maintenance of the
body, stress management, skin care, seasonal health problems, issues in long
run due to smoking, consumption of alcohol, consumption of narcotics,, pre
marital sex, etc all college going children especially 10+2 or intermediate and
the professional degree students yoga should be made mandatorily, a daily
activity for at least 30 minutes, which will certainly help them to get reduce
the stress factor as well as increase in concentration on the subject etc. All the college canteens should mandatorily
serve only health foods like salads, sprouts, coconut water, green tea, coffee,
milk/flavoured milk, lassi, buttermilk, fruits, fruit juices, vegetable juices etc
Also there should be ban of sale of soft drinks, pre packed food like potato
chips, and fast foods like burgers, pizzas etc. Also the breakfast,
lunch/dinner served in the canteens should have balanced nutritional values
certified by the nutritional experts only. All the canteens should display the
food chart and calories chart at all times covering the entire walls of the
canteen. All the canteens should sell the food at minimum margin which should
fit into every student’s pocket money, it will be ideal to run the canteens by
the university / college managements or by NGO organisations. Also all the
canteens should serve only RO water. Also it should be mandatory that all
universities and colleges should have adequate facility for the sports and
recreation facilities. Also it should be made mandatory that all the colleges
and university students to spend every month on day for social service, not all
at once but in batches as per their class of study. Government should create a
website to register for social service with various kinds of service to be
rendered by the schools and colleges to allocate the place, area of service for
the choice of voluntary service in the district to avoid any confusion. Also it
should be mandatory that all students above intermediate should be taken to
villages once in three months to knew them about the hard ship& ground
realities of different profession like pot making, agriculture, coconut
plucking, food processing, different
handicrafts making, nursery raising, dairy farms, sericulture, poultry,
traditional weaving, traditional games, dances, etc Also ideal to have the visits where ever
possible, or presentation of documentaries big screen regarding production
of cement, steel, power, pharmacy, etc and
construction works of dams, buildings, roads, etc and have interaction with the
workers and management etc. Also all students should be thought of power
production, power distribution, power savings etc.
FOR EMPLOYEES AT WORK PLACE
All the government
and private establishments, factories, industrial shop floors should
mandatorily conduct health education time three hours in a week, one hour at a
time every alternative day. The subject should be nutritional values required,
how to preserve nutritional values while preparation of the food, the child
rise, the issues of child care, the common illness/ deceases that occur like
diabetics, hepatitis, heart attacks, obesity, adultery problems, issues due to
smoking, consumption of alcohol, problems for the women like breast cancer,
issues of 40+ women etc. Also it should be mandatory that all the employers in
the government, PSU, Private sectors should provide the details of the
occupational hazards and the preventive health care. A calendar chart should be
prepared and provided a copy to them and thought them periodically. Also it
should be mandatory that there should be health clubs in each office with basic
equipment like the tread mill, cycles etc in appropriate number and allow the
office staff to utilise at appropriate time 30 minutes every day during the
office hours. Also it should be mandatory that the office canteens serve the
health foods like salads, sprouts, coconut water, green tea, coffee,
milk/flavoured milk, lassi, buttermilk, fruits, apart from the traditional
foods, certainly ban the sale of soft drinks, potato chips or any other
chips, pizzas, burgers and other deep
oil fry foods like samosas, etc etc. Also the breakfast, lunch/dinner served in
the canteens should have balanced nutritional values certified by the
nutritional experts only. All the office canteens should serve the food
subsidized, to encourage the employees to have the breakfast, lunch and tea in
the office/factory premises only to ensure that certain nutritional values are provided
by the employer in the form of coupons to be utilised by them equal number to
all the employees irrespective of status of employee. All the canteens should display the food chart
and calories chart at all times covering the entire walls of the canteen. All
the establishments both government, PSU, private should organize the yoga camps
and provide yoga training with mandatory condition that yoga certificate is
must for getting the promotion, in addition all the employees who got training
certificate should be given one single increment, single time as bonus. Also it
is very ideal to make it a pre condition for promotion, that employee should
obtain the fitness certificate from the doctor for maintaining their health in
perfect condition, maintain the height to weight ratio, maintaining the body in
perfect shape and conditions as per the normal standards in addition to
providing of yearly incentive with a bonus of one single increment. All the employees working in the hazardous
areas should be thought about the cleanliness’ and the personal health care.
OCCUPATIONAL DISEASES
Also it should be
ideal that all the people in the occupations like sales persons, police persons
in traffic duty, postal persons, courier persons on delivery duty and other service
persons like municipal people, all security persons etc who are on the constant
exposure to sun radiation and vehicular pollution should be provided with nasal
masks, UV filter eye care glasses etc better protection for the heath care. Also it should be more ideal and mandatory
that all the offices should provide to its employees doing the desk duties with
the “ergonomic tables and chairs”, mostly the soft ware professionals,
administrative jobs etc. All the
employees doing the desk job should be provided with adequate working space as
per the standards maintaining the ratio of employees per the floor area of the
room space. All the employees in the factories should be provided the rest
period periodically in regular intervals 10 minutes to relax and refresh in
accordance with the International Labour Organisation (ILO) Work-Study methods,
which will reduce the stress element and increases the production output. Also
all the offices should have adequate lighting facility more preferably the
natural sun light by converting the existing office buildings to “green
building” and also maintain the “Lux” levels (the measurement of light, Lux
levels of 500 is ideal for working atmosphere with minimum levels of eye stress)
for safety of the eyes even after long exposure and working, and also facility
for fresh air by providing the “electronic air purifiers” in all closed room
offices. Similarly all the factories should maintain fresh air and green
buildings and also should maintain the “oxygen bars” in the factory for getting
refreshment for the workers by providing the fresh oxygen, this facility should
be mandatory in the factories exposed to the pollution within the shop floor.
RECREATION FACILITIES FOR EMPLOYEES
Also there should
be adequate recreational facilities in each office space and the factories to
get the workers relax and get engaged in sports like table tennis, chess,
caroms, shuttle, volleyball, basket ball, squash, etc, all multi stories
offices should have at least some indoor activity at each floor. In case the offices
do not have enough space to provide the recreations it should facilitate in the
open Terries of the office buildings, in addition should hire/ acquire space in
nearby area to the office for facilitation of the recreations to their
employees. This will certainly help the employees to get certain physical
activities other than routine which will certainly reduce the mental stress, as
it is a fact that majority of the employees spent half of their active life
time in the office space or the factor premises only. Also it is ideal that the
parking of the vehicles should be far from the main building and all employees
should be made to walk few yards, similarly the lift facility in the multi
stored buildings should start and stop at the second floor only, (Only those
physically handicapped and not in a position and extremely sick should be
allowed from the ground floor) this will ensure that all employees will walk
through the steps to get some physical exercise. Also it should be made mandatory
that offices maintain the office buses for pickup and drop of the employees,
and make it mandatory that all the office staff should use the office bus only,
instead of bring personal vehicles. This will reduce traffic congestion,
traffic pollution to some extent, reduction of tediousness due to driving, increase
in interpersonal relations among employees leading to better cooperation coordination
in work area, and also all employees in general maintain standard working hours
as office bus will has fixed timings leading to more productive work.
MEASURES FOR GOOD HEALTH PRACTICES
Also it should be
ideal to advise all the employees to raise a pet animal at home, preferably the
dogs which are really lovable and are true stress busters as they express
“unconditional love” towards the master and other family members. As such not
only employees but all the families in the country should be advised to raise a
pet at home. Also everyone should be advised to raise garden at the homes, in
case of apartments the terrace/balcony gardening. Also it should be ideal that
all the, school, college, university and office compounds should be planted
with neem, eucuplitus and other medicinal plants, also should have walk ways
around the compound wall to make a habit
for the students, employees to have brisk walk for good health.
Also it should be
ideal to make it mandatory that all colonies, gated communities, apartments
should have walk ways inside their compound to make provision for its residents
to walk a mile every day for good health. Also it should be mandatory that all
the students from intermediate onwards and all employees in the government and
private mandatorily have one day every month to have compulsory social service
in the public like cleaning of roads, cleaning of lakes, water bodies, planting
of trees, visiting the old age homes, visiting the orphan homes, visiting the
welfare hostels, crating awareness in their area about the achieving good
health, saving energy, water, awareness to reduce environment pollution,
awareness towards reduction of use of
plastic, polyethylene bags, reduction of
paper waste, segregation of waste disposal on bio degradable and non bio
degradable etc, which has multiple advantages on they are remained of social
responsibility, also it creates freshness in the mind to serve in the open,
also considerable exercise for them. Government should create a website to
register for social service with various kinds of service to be rendered by
various government and private organisations allocate the place, area of
voluntary service for the choice of service in the district to avoid any
confusion
Also it should be
mandatory that all the schools, colleges, universities, and office
establishments both government, PSU and private, should provide RO water all
the times and also to provide, maintain hygienic toilets with separate
provision for females. As it is fact that majority of the deceases are water
born, most of the health risks are occurring due to lack of toilets irrespective
of gender with more health risks in the females.
SAFE DRINKING WATER
Also all the public
places should mandatorily have the RO and toilet facility in areas like rail
stations, bus stations, shopping complexes, shopping areas, market places,
hotels, restaurants where there is lot of frequency of peoples movement,
gathering happens, should mandatorily have the RO drinking facility at the cost
price Rs 1 for 500 ml. Also it should be mandatory that all the restaurants and
food courts and canteens should have power back up either inverter or generator
to preserve through refrigeration its essentials like milk, yogurt, cheese,
pinner etc for having the shelf life without getting soiled by bacteria. In
addition there should be toilet facility maintained hygienic at all times, by
the local government authorities offered free of cost or with a donation box to
leave it to the wisdom of the user to donate. Also should ensure that RO water
and the hygienic toilet maintenance, lack of provision, lack of hygienic
maintenance should be heavily penalised. All the NGO’s and volunteers services
should be taken for periodic inspection of all the public areas, schools, and
colleges universities. For this there should be a public health registered
voluntaries group formed by inviting individuals to register for free for free
service. All the volunteers should be
given a day or two for formal training for the inspection and reporting to the
authorities. The volunteers should be mostly the retired employees, NGO’s as it
will be ideal that the retired employees should get involved in some social
activity which will give them more satisfaction, time pass, and help for the
public. Also the volunteers should inspect the toilet facilities in all the 4.9
lack villages throughout the country where ever possible for them, as NRHM has
issued an amount of Rs 10,000 to 4.9 lakh villages till date towards the fund
for the construction of community
toilets in the village under the total sanitation programme.
HEALTH AWARENESS
Also the government
should conduct awareness meetings and camps starting from villages to cities
periodically regarding the health care issues like diabetic care, heart care,
issues related to consumption of alcohol, smoking of tobacco, consumption of
tobacco products, cancers, food adulteration, issues arise due to food
adulteration, etc.
RESTRICTION ON SALE OF TOBACCO PRODUCTS,
BAN ON TOBACCO CULTIVATION IN INDIAN SOIL
Also it should be
mandatory duty of the government to ban tobacco cultivation in Indian soil,
especially state governments to ensure that there farmers should not rise tobacco
crop, all the farmers raising the tobacco should be thought of alternative farm
production that suits the soil conditions of the tobacco farms should be made
and encourage them with more subsidies for non tobacco product raising in the
farm. Also all the workers who are working in the allied industry’s using the
tobacco products like cigarette, gutaka etc may have the apprehension that
tobacco production ban may reduce the employment due to limited production of
the manufacturers through import of the raw material or no production, all
those ex-workers of the tobacco industry should be given skill training in eco
friendly paper bags making, paper boxes i.e corrugated box manufacturing, and
other handicrafts etc. Also there should be ban on import of finished products
of tobacco like cigarettes, gutka, cigar etc, only raw tobacco import should be
allowed with heavy duty on the raw material as well as on the manufactured
product. Also it should be mandatory that the state governments should ban the
sale of tobacco products in the vicinity of schools, colleges, universities,
government office complexes, private office complexes, in the vicinity of
hospitals and in bus stations, railway stations, all pilgrim places, all
religious places and all public places in the villages and towns adjoining the
state highways and national highways, in the rest areas and daabas in the
highways and also near to bus stations, railway stations. All the hucca centres
in the cities and towns should be banned to operate, as it becomes an
increasing fashion for the urban youth to get hucca and addicted to it, which
is leading to the other anti social activities by the youth and completely
spoiling the health and the future of the youth. The sale of tobacco products should be like
the sale of liquor in exclusive shops only. Also it is very necessary to have
tobacco de addiction centres in all important places in the city and town to
ensure that all those people who are under indirect forced control will get to
the normal stage. All the tobacco de addiction centres should be operated by
the government / NGO and operate without any monitory benefit, deliver free
service to the people who joins the de addiction centres. Also to this there
should be extensive advertisements regarding the de addiction process in the
print and visual media.
RESTRICTION OF SALE OF ALCOHOLIC PRODUCTS,
BAN OF SALE OF CHEAP LIQUOR
Also the governments
should completely ban sale of cheap liquor/ country liquor, as it is an open
secret that the quantity of natural cheap liquor available is very low as it
has to be collected from the trees and brewed, or from the extracts of
molasses, un refined distilled spirit as
such in order to make huge money at the cost of the life of the down trodden,
all the cheap liquor suppliers, sellers are using dangerous drugs like “ dizopharm” ,
or illicit liquor which is made of industrial methylatde which will provide the
required drowsiness and the kick to the consumers of this liquor, but it will
spoil the health very rapidly, impact on the brain, kidneys and all other
organs thereafter, much faster depletion of health than any other liquor
consumption As we all knew that majority of the people living in the rural
areas consume cheap liquor and the tobacco which will spoil their health faster
as majority of them belong to BPL families and whose food intake dose not contain sufficient
nutrient values, as such does not possess the normal body resistance.
REGULATING SALE OF IMFL
Also it is very
necessary and more ideal that governments regulate the sale of IMFL liquor or
completely ban sale of liquor by adopting alternative revenue earnings rather
than depending upon the cheap liquor, liquor sale for gathering funds for
implement the welfare schemes. The governments should not think of loss of
revenue as compared to the bad effects of the liquor consumption of the
majority of the BPL, low income and middle middle income group spoiling their
personal health, added financial crunch in the family as up to 45 % of the
earnings are spent for drinking liquor, Also 85 % of the domestic violence
cases are due to liquor consumption, the
children education is suffering, the family health care is suffering, there is
acute mal-nutrition, under-nutrition in their children, families due to
financial crunch, all the females in their families are prone to anaemia, all
these leading to backwardness in education of their children, again the entire
family, their children in future are living in poverty and again depend on the
welfare schemes of the government, how far the present governments run this
vicious circles? As such If the governments have real intention of the welfare
of the down trodden they should completely ban the cheap liquor, in addition
levy heavy duty on the finished product, the excise duty ranging from 1000 % to 5000 % ensuring
the cost of liquor is not within the reach of majority of the people i.e BPL,
low income group, it should made that liquor consumption is a luxury only for
the BPL and low income and low middle income group, in addition regulating the
sale by restricting the sale points is the only solution. The higher rate of excise
duties will certainly bring down the sale quantity but will provide the same revenues
as earlier; Also there should be uniform duty structure in all states otherwise
smuggling activities will take place due the rate difference; “Now people
especially the female family members of the families of liquor consumer are
able to understand the negative impacts of the liquor on the entire family,
future of their children they are of the opinion that state governments not
banning liquor and collecting large amount of
revenue and providing soaps of welfare schemes is nothing but giving a
penny from one hand and swindling booty from the other hand and pretending as
if governments are for the welfare of all especially the down trodden, but in
reality for the welfare of select section
of the people who are elite, belong to the upper echelons of the society many
be a political class or the business class or the touts”. As majority of the
liquor lobbies, shop owners are either local elite in the village, mandal or
the city and also have the strong nexus/ partnership with the politicians and
bureaucrats. In some cases all the liquor business is operated by the political
class irrespective of party, in their kin and kith name. This opinion of the
women towards governments will have great impact in the electoral politics, as
women play a decisive role in the election mandate.
BAN OF LIQUOR SALE
As such all the
governments must either follow the four states namely Gujarat, Manipur, Mizoram
and Nagaland where ban on sale of liquor is in existence or at least control
the sale of IMFL liquor and completely ban cheap liquor, it may lead to some
loss of revenue but the state governments must adjust their budgets accordingly
in the larger interest of long term welfare of the people of that state. For
example if there is a shortage of available electric power in the state due
shortage of production either due to shortage of coal or gas or due lack of
water in the dams etc the governments are adjusting with the available power,
people are also adjusting to it even though there is some protest, likewise
government should adjust the shortcomings of revenue, also should find
alternative sources of revenue rather than depending on the blood money of the
downtrodden, since our country is the birth place of great economists like
“kautalya” and our country does not have dearth for economists, all our
economists are of top class in the world, the governments should entrust the
job to these economists to find alternative ways of getting the revenues which
was deficient due to the ban of cheap liquor, restricted sale of liquor.
REGULATION OF SALE OF LIQUOR
As mentioned above
regarding the restricted sale of liquor, it is most ideal and mandatory that
government should ban the sale of even liquor in villages and towns with less
than 10 lack population. Also mandatory ban of sale of liquor near the vicinity
of the hospitals, factories, industrial zones and slum dwellings should be
banned at least 3 kilo meters from the outer radius of these establishments. Also
governments should ensure ban of liquor in the villages and towns adjoining the
state highways and national highways and also near to bus stations, railway
stations. Also to down size the number of sale points and restriction of sale
timings, Also it will be ideal to fix the timing of sale of liquor between 10
am to 5 pm in the evening during the working days (Monday to Friday) only, Also
the sale of liquor should be banned on Saturday, Sunday and all other state
government and central government holidays and during the festivals. As it will ensure that the working class will
be mostly restricted to access the shops, also it will restrict the college
going youth to access the liquor as the studies indicate the average age of
consumption of liquor in India is 19 years in some cities it is much less than
this average age. Also the sale of liquor below 25 years should be banned. This
will help that youth will not be addicted to liquor and will consume on their own
personal earning. Also the sale of
liquor should be banned locally during the big possessions and rallies and
darnas within the mandal /block during that particular day. Most important the
sale of liquor should be banned during the election period soon the election
dates are announced till the election results are declared. This will certainly
help in electing the right candidate. Also at all times the sale of liquor
should be mandatorily through bio metric finger print of the purchaser, and not
more than two bottles or 1000 ml of liquor should be given to any individual at
a time and not more than 3000 ml in a month, for this all the liquor shops
should be computerised and the sale of liquor should be integrated district
wise in that state. Also it should be mandatory that the bars will not be
permitted in towns less than 10,00,000 population and the number of bar permits
also should be restricted, the maximum number of bars should be less than 50 %
of the number of licences wine shops in that district/city/town. Also the
minimum age for entry to bars should be 25 years. All the bars should operate
only during evening hours between 7 pm to 10 pm, on all working days with
relaxation on Sundays to open from 10 am to 10 pm, with exemption on restriction
of timing to in house bars in the hotels. In-house bars should be permitted only
in 3 stars and above hotels.
ALCOHOL DE ADDICTION CENTRES
Also it is very
necessary to have alcohol de addiction centres in all important places in the
city and town to ensure that all those people who are under indirect forced
control will get to the normal stage. All the alcohol de addiction centres
should be operated by the government / NGO and operate without any monitory
benefit, extend free service to the people who joins the de addiction centres.
Also to this there should be extensive advertisements regarding the de
addiction process in the print and visual media.
REGULATION OF MANUFACTURING OF LIQUOR BY
DISTILLERIES
The ban alone is not sufficient unless
there is tight control on the production of the IMFL in the distilleries and
breweries, the first step is to restrict
the number of licences to production by heavily increasing the licence fee,
second to have tight monitoring of the production and distribution by
exclusively dedicating couple of excise officers on all the three shifts on
weekly rotation bases preferably from other far way districts; third to make it
mandatory all the bottles are bar coded; and the entire chain from the
manufacturer to distributor to the retailer to sale to the individual consumer
should be computerised with online status of data, all sale should be only on
the production of ID card, the name of the customer as in the ID must be
entered along with bio metric fingerprint of the customer to issue the liquor
with the bill, fourth there should be
straight vigilance and enforcement wing to ensure all rules are strictly
followed, in addition imposing heavy penalty with rigorous imprisonment and for
violating the rule. All the offences of
violation of any rule should be a non bail able offence with rigorous
imprisonment for the offender; in case the officials are involved or there is a
negligence on the part of the official the punishments for the officials in the
entire hierarchy should be not less than the suspension from the present
position for not less than 5 years and in serious cases dismissal from the
service. Also there should be punishments equal to life imprisonment for
illegal manufacture, distribution, sale of either IMFL or the cheap liquor, All
the cases related to this should be non bail able offence. All these on
implementation will improve the overall family health of millions of people.
TRANSPORT SECTOR
SAFETY IN PASSENGER TRANSPORT
Also the
governments should make it mandatory duty of the public passenger transporters
both government and private to carry the emergency medicine kits like emergency
medicine, emergency oxygen with nebulizers both adult and child in appropriate
number and other consumables. There should be periodic certification of the
existence of the medical kits, and the content in it, by the concerned
authorities otherwise the medical kits will be more symbolic and namesake. Also
it should be mandatory that all driving licence holders should obtain the
fitness certificate once in every 6 months from the medical doctors after
undergoing the body checks like Eyes sight, hearing ears, physical stamina/
grip of the hands, legs, spine, and complete blood test etc, more or less like vehicle
fitness certificate). It should be mandatory to undergo once in 3 months for
all the drivers of the public transport from rail, to buses to Lorries to
taxies. It should be mandatory duty of the employer (Government, PSU or
Private) of the driver to get the medical tests in order to continue him to
drive the vehicle. In order to prevent the fake fitness certification without
having proper check up, lack of fitness of the candidate, strict action should
be taken with punishment equivalent to death sentence in case of death due
accident because of lack of fitness of the driver both on the driver and the
issuing doctor. Also it should be mandatory that passenger travel vehicles like
cars, taxies, vans etc should carry the emergency first aid medical kits with
them at all times. All the taxi operators and drivers should be given mandatory
training by the doctors in the presence of the police to act in the emergency
situations, all the taxi drivers who attended should be given certificate, and
all taxi drivers should carry the certificate with them at all times. Not
having the certificate should be penalised heavily apart from seizing the
vehicle, as such all persons driving any vehicle should mandatorily carry the
fitness certificate with them all the times.
MANDATORY MEDICAL TESTS FOR PEOPLE WHO ARE
DRIVING VEHICLES
It should be ideal
that professional drivers of the private vehicles should undergo the mandatory
medical fitness certification once in 6 months at the cost of the employer
whether the owner of the vehicle is an individual or business enterprise, the
fitness certificate must be obtained from the medical doctor after undergoing
the body checks like Eye site, hearing ears, physical stamina/ grip of the hands,
legs, spine, complete blood test etc.
UN ORGANISED WORKERS CONVERSION TO
ORGANISED WORKERS FOR SAFETY, SECURITY, PROVIDING HEALTH CARE
DRIVERS
Also in order to bring the unorganised
professions to organised professions is the primary task of the government.
People who are working as professional driver, house made/ domestic help,
watchmen, ayas, sweepers etc are low income unorganised sector. They might have
migrated from different parts of the country. Their income is not sufficient to
take care of the daily needs, so it is really a great difficulty for them in
case of medical emergencies. In order to bring them under one cover the
government must make it mandatory that all the people who employed these
category people has to register with the government and the local police (more
ideal) for verifying the credentials and also to issue an identity card and a
bank account. It should be made mandatory that all salary payment should be
bank payment (by cheque or cash deposit). As majority of the drivers working in
passenger transport and goods transport other than the government and PSU are
totally un-organised, does not have uniform salary, uniform working hours, no
health care, and no track record of the drivers, as such in order bring them
into some sort of organised sector with more social security it should be made
mandatory that state RTA should have a special cell to register the private professional
drivers i.e other than the employees of government & PSU. All the drivers
have to register them self with their driving licence, bank account, local
address proof/affidavit (all three are mandatory) in RTA office near the place
of work, all such drivers will be conducted a driving test by the local RTA and
on passing the test will issue a private professional driver licence. Also
there should be uniform fixed salaries throughout the country for all drivers
based on the years of experience, their age, the vehicle type, type of duty i.e
public taxi, private taxi, passenger transport or goods transport etc. All private
employers (other than government) should provide job to registered private
drivers only. To employ a private driver the employer should registration with
the RTA for along with the details of the owner of the vehicle and the details of the local RTA
registration copy of the private driver, then the RTA should issue a permit to
the owner of the vehicle on agreement duly signature by the employer or owner
of the vehicle, and the driver in presence of RTA officials regarding the
minimum salary as per the standard fixed as per the guidelines, salary to be
paid through bank and the number of working hours, number of working days in
month, the mandatory responsibility of the owner for medical check up condition
of driver once in 6 months as pre conditions of employment. A copy of the
agreement should be forward by the RTA to the local police for record. It has
multiple advantages in the security angle as well as prevention of accidents,
having resting period, adequate timely salary to cater the family needs; health
check up of the individual is the duty of the employer. It should be applicable
not only to the four wheels and above vehicle drivers but also to the three
wheelers if the three wheel vehicle owners employ the driver to run the
vehicle. This facility will help several lacks of people in the country as
majority of the four wheels have drivers and the three wheel owners are third
party. If the vehicle either four wheeler or three wheeler run by other than
the owner should be treated as driver. The driver not registered by the owner
should be treated as violation should seize the vehicle with heavy
penalty.
SERVANTS/DOMESTIC HELP
Also there is a
need to bring the All the maid servants/ domestic help who are un–organized to
organised sector in the similar lines of the drivers by registering mandatorily
at the local labour department with a special cell at labour department to
resister the domestic help/servants with them on the production of a valid ID
proof and bank account to obtain the registration certificate with a number.
All the households who wish to employ maid servants/ domestic help should
employ only the registered maid servant or domestic help, by getting the agreement
with the special cell of labour department regarding the place of work,
address, the owner, the working time, number of working hours and the salary,
on obtaining the agreement with the owner the labour department should send the
same to the local police for record. All
the salary payment should be decided per hour minimum 30 Rs/hour, i.e with
daily one hour per month salary is 900 Rs per month with Sunday holiday, with
extra payment for Sundays. (5 hours per day work will get them a salary of Rs
4500.) The maid servants are at the liberty to serve at as many houses as
possible based on their stamina after the fixed working hours of the agreed
house is completed. If the work performance is not satisfied the employer can
make a registered remark at the local labour department special cell and remove
them with payment of full salary if they work for more than 15 days and half
salary if they work for more than one week, less than that only for those days.
Also it should be the responsibility of the employer to deduct 10 % of the
salary every month and pay to the insurance account at the labour department
towards the family insurance of the domestic help. The government must
contribute equal amount for them to issue health card for them, which can be
used anywhere in India for themselves and their family members. This will have
multiple advantages, one the security angle, second the domestic help will get
security of the health care, the responsibility of the individual and
government ensures that part of the reduction of burden on the government. This will certainly cater the needs of urban
poor in the unorganized sector.
HEALTH CARE FOR SEMI SKILLED WORKERS,
PROFESSIONALS IN UNORGANIZED SECTORS
Like the above all
unorganized semi skilled and skilled work force can be brought to the semi organised
work force. This includes the private electricians, private plumbers, private
vehicle mechanics etc, who are not working under the government or PSU, should
get registered mandatorily with the labour department of the government, they
should be given registration card after testing them for their basic skills in
their respective profession ( the testing of the skills should be recorded in
camera, otherwise there will be a huge chance for mal practice, corruption,
allowing every other individual to get a profession card) , a copy of the
registration details will be sent to the local police for record. Also they
should be given training for a day or two for the skill up gradation/ skill
perfection and also safety measures need in performing their work. Also it
should be ideal that there should be a
mandatory cess of 1 % on the manufacturers of the products related to the
respective professions like all electrical manufacturers like bulbs, chokes,
fans, electric cables etc, and all motor vehicle manufacturers and spare part
manufacturers should mandatorily contribute for the skill development, up
gradation of people in these sectors and also for the government will
contribute from the fund for their social health insurance to all the semi
skilled persons who are not employed in any of the private establishment and
who are either not running any individual private business. As for the entire
people employed in private establishments it is the responsibility of the employer
to take care of the health of their employees. Also government should decide
the minimum remuneration for the private employees based on the grading of the
skill and experience if they are passed out from any ITI or any recognised
skill training centre, and also for the individual private self employees the
fixed uniform service charge throughout the country and all the individuals who
own a shop has some source of income, in case the income of the self employed
is below 60,000 Rs per month as per annum as per record, the government should
contribute from the part fund collected from the manufacturers. For all unemployed
trained semi skilled labour government should contribute from the fund
collected from the manufacturers related to that profession.
Also in the similar
lines of the above unorganised category, few more categories can be included to
bring more semi skilled people in un organised sector to semi organized sector.
The gold Smiths, black smiths, cobblers who are practicing independently, also
who are having small establishment under loan from SC finance corporation, tailors
who are practicing independently and all the weavers in textile looms who owns
small looms, etc Also it is ideal to bring the un organised professionals like
qualified priests who has no income or low income as most religious places are
run privately has very meagre income, qualified teachers/tutors in rural areas
and slums not working in any school etc. Also it will be more ideal to bring
all the hawkers selling in the streets, news paper boys, the milk deliver boys,
the street fruit and vegetable hawkers selling on non motored carts, etc.
HEALTH CARE FOR FARMERS
Also in order to
provide health security to the farming community which are over 116 million in
number, out of the total farmers majority of them lack financial ability to
take care of their family needs, certainly health care is far reach for them,
as over 61 % of the framers are small farmers with less than 1 hector of
cultivatable land with a total cultivated land by these small farmers is around
18% of the total cultivated land in India. As such in-order to provide health
care security to these small and marginal farmers, it should be made mandatory
on the part of the fertiliser companies, the pesticide companies should
contribute 2 % of their annual sale turnover to the farmers’ welfare fund,
similarly all other companies related to agriculture and farming should
contribute 1% of the turnover. The fund should be used to create the family health
cards for all the farmers in the country especially small and marginal framers.
This is necessary as by administering the fertilizers, the pesticides, and long
working hours in open skies leads to lot of health issues. All the agriculture labour should get
registered with the labour organisations in their respective
village/mandal/district to obtain the job card; all the labour in the
unorganised sector should be given healthcare by the government free of
cost.
HEALTH FOR ELDERLY AGED PEOPLE
Also government must
mandatorily take the welfare of all the people who are either retired, aged
above 65 years, all senior citizens to take care of the medical needs. It is
necessary because the health insurance for all senior citizens is at high
premium. Even though government providing old age pension, unfortunately the
old age people getting only Rs 200 which is not at all sufficient to take care
of their monthly needs, of-course it is certainly helping them to some extent.
It is a fact to admit that due to urbanisation majority of the people are
having nucleus families, very rarely seen joint families. Also it is a fact to
admit that due to the high cost of living majority of the children after grown
up are self centred and completely neglecting the aged parents leaving them to
be taken care by themselves or by the almighty. Also it is a fact that due to
geographical location. As such government must provide free medicine /
subsidized medicine for the aged people. Also government must construct
appropriate number of old aged homes in the rural areas in village’s mandals to
take care of the old aged people who wish to leave their home and take shelter
there. The old age homes should be like ashrams having lot of space, greenery,
gardening etc all the buildings are only ground floor only. The ashrams should
have one doctor 24/7 available. Also for all those who wish to stay at their
home or their children’s home they should be provided with the health card. All
the medical expenses should be borne by the government only. In order to create
the responsibility & respect, in the children towards their aged parents, and
pay their gratitude towards the elderly parents, because of the parents they
are in the current position of what so ever earning the bread and shelter, the
government must collect 2% of the income of all the employees both in
government and private sector deducted from the salary. Government, private
business establishments should mandatorily contribute 2% from their side to
create the old age homes, maintenance of the old aged homes and also providing
the free medical treatment for the old aged. This will certainly improve the
work output of the employees as majority of the employees has the concern for
their parents at least to some extent but they are enable to take care of them
due to the indifference attitude of one of the spouse (mostly non employed), or
due to their busyness in the work being workaholic, in these cases they are
totally relived of the stress due to the worry of not taking care of the
parents. To ensure this the government
must get a declaration on stamp paper from the employers about the details of
parents, whether they are alive, their where about, their source of income, the
chronic diseases if any, etc and all falls deceleration should lead to suspension
from the position, and at least 6 months imprisonment. Also if the old aged people who are getting
pension due to retirement from any government service, if they wish to
contribute should be taken for the welfare fund of the old aged. Also government
must form a trust to get any donations from the corporate or individuals to
contribute other than mandatory contribution. Also if the Corporate come
forward to create the facilities government should allot the land free of cost
for such a noble purpose. Also government must involve NGO’ and all the old
aged persons who still have the ability to work to get involved in the process
of managing the individual old age homes at the mandals and small towns. Since
majority of the old aged are from the villages only, they feel that they are
back to their child hood got freedom from the concrete jungles. If government
does not make this happen majority of the elderly old people will certainly
think that the people in the governments do not have the respect for their own
parents. As such since UPA Government is supporting for the well being of the
elderly by providing old age pension, should take a step further in this and
ensure the old aged elderly people has been taken care properly, which will
certainly get appreciation from all the people and also government will get
lots of blessings from these elderly soles.
HEALTH CARE FOR ORPHANS
Also government
must maintain the hostels for the child orphans and the ensure all the child
orphans are given good education and the health care of the orphans is the
mandatory responsibility of the government alone, government must provide free
medical service to all the orphans who are not having the appropriate income by
providing the free medical insurance card.
CLEANLINESS OF SURROUNDINGS
Also it should be
the duty of the state to have adequate manpower to ensure cleanliness of the
city, town and the village at all times by ensuring no blockages of drains, all
drains should be closed, adequate hygienically maintained public toilets,
adequate disposal of garbage, adequate provisions for recycling of municipal
waste, generation of power from the municipal waste etc with regular periodic cleanliness
of the lakes, water bodies in the vicinity of the residential areas especially
in the villages, small towns, slums.
ENVIRONMENT POLLUTION CONTROL FOR BETTER HEALTH OF INDIVIDUALS
REGULATING OF RADIO SIGNALS RADIATION OF
MOBILE PHONES IN EDUCATION PLACES, IN WORK PLACES
Also it is ideal to prevent the side
effects long exposure ration emission from the mobile phone towers and mobile
phone instruments. The mobile phones are crossed over 65 crores in India, still
does not enforcing the implementation of international standards of instruments
for radiation emission norms. As only very few percentage of the 65 crore
mobile instruments adhere to international radiation emission norms. Also need
to enforce the cell towers radiation norms strictly. The government must make
it mandatory to install mobile phone jammers in all schools, colleges,
universities, office establishments both in government and private, in
factories and in the hospitals, auditoriums, movie theatres, restaurants etc as these places does not deserve the
mobile phone, unnecessarily emitting radiation from so many phones in the
closed area. As mobile phone is meant for communication on the move, where as
schools, colleges and university campuses does not require mobile phones till
the students are in campus and similarly all the offices the employees are
performing the desk job which has land
phone does not require a mobile phone, like wise in the hospitals, restaurants,
etc. Also it will be ideal to keep cell phone storage racks in the class rooms
in the schools colleges and universities to make the students in the class
deposit their cell phones in the safe racks allotted to them in the class room
itself, this will ensure that the students will switch off the mobile phones
during the class hours and also lake the scope for playing games, viewing the pictures
and videos etc. In offices also there should be safe racks for cell phone
storage where each employee should deposit in switch off mode and take back at
the end of the office hours. Also in hospitals, in offices certain staff where
ever required they can use the wireless phones / HAM radio phones with short
frequency within the compound for the staff in urgent duty.
Also government
must make it mandatory that all mobile operators to have the provision for
minor phone and major phone in the system to be self declared by the phone
users to declare the phone is for self or for the minor i.e students. Also
alternatively all the parents wish to provide mobile phone should provide
mobile phone to their children below 18 years under declaration the phone is
for minor use. All the minor use mobiles should be basic phones without
internet. Alternatively all the minor phones should be barred from mobile
internet surfing. Also it should be made mandatory all the parents should
submit declaration to the school / college that the phone was presented to
their children for use by them and they will be responsible for any misuse. All
the children bringing phone to the school/ college without parental declaration
should be confiscated and the number should be forwarded to the mobile operator
to de activate immediately. It should be made that all non registration of
mobile number for child use should be suspended for holding a mobile from any
operator for one year and fine of Rs 10,000. Also all the schools, colleges
should collect the numbers from the children bringing the phone to the school /
college to allocate the safe rack in the class room for the storage of the
mobile phone based on the mobile number and name of the student. I t should be
the duty of the schools to forward these numbers to the mobile operators to
completely block the internet surfing facility for the numbers submitted by the
school/ college. The children can surf the internet at their home or any place
in the computer system but not on the mobile phone. Also the schools should
advice the parents to provide the basic instruments without camera for the
school children, as they require only communication if any. Also government
must make it mandatory that all the mobile numbers used by minors below 18
years of age should have a maximum length of permissible talk period of two
minutes only (both incoming and outgoing calls), after two minutes the phone should
automatically must get disconnected, not more than two consecutive calls at a
time. Also the total talk time in day should be fixed for 30 minutes only. This
will ensure that students and children must use the phone only for few minutes
only, it has multiple advantages, the children exposed to cell radiation will
be minimal, concentration on studies, they are prevented from mobile addiction,
which is very dangerous addition than any other narcotics ( it completely
distracts their concentration, as even if ring tone somewhere heard they are
searching for their mobiles, it is becoming
an integral part of the body, every time checking for messages, get
depressed when they don’t receive any call etc which will have long term
neurological and psychological diseases,). Also it will be ideal that schools,
colleges, universities, office establishments and factories should have EPBX
phone system with more lines connected. The number should be provided to the
parents of the students to provide any urgent message to the students only
during emergencies. Similarly the office establishments should provide the EPBX
number to the employees to be passed on to their family members to pass on any
emergency messages. This will ensure all flow of communication will occur as
and when required. The above installation of jammers, child lock for surfing
the internet on mobile phones of children will certainly improve the results in
education as students will have more concentration on the lessons thought by
the teachers, also in case of the office establishments improve the work output
as there is no disturbance, scope for unnecessary chit chatting, wasting the
productive working time. Also this will improve the physical and mental health
of the people to a great extent.
Also government
must make it mandatory that mobile phone tariff charges are fixed based on the
time of use. The more the mobile use at a time whether incoming call or
outgoing call after 2 minutes of use the special user charges to be applicable.
All the mobile phones should be allowed first two minutes of talk at normal
rate, from third minute on wads the tariff should be doubled every minute (from
third minute the incoming call should also be charged), this will ensure that
the reduction in use of mobile phone by all individuals. Also the maximum usage
of mobile should be 10 minutes continusally. Also the maximum talk times for
any individual mobile both incoming and outgoing should fix at 90 minutes per
day. All this will lead to good health of all the people.
VEHICULAR POLLUTION, URBAN DEVELOPMENT
PLANNING
As we all knew
vehicular pollution cases acute health hazards mostly causing respiratory
diseases like bronchitis, asthma etc. It is mainly due to the high content of
carbon monoxide, sulphur dioxide and lead residues in the air, which is due to
abnormally high vehicular traffic in the cities and bigger towns. It is mainly
due to lack of multi modal mass transport systems, also due to the predominant
older vehicles, maximum share of two stroke two wheelers, lack of maintenance
of vehicles, maximum number of diesel vehicles etc leading to maximum pollution
in the cities and big towns caused by vehicles as the statistics indicate out
of the total pollution in cities as high as 72% is due to vehicular emissions,
20 % due to industrial pollution and 8 % due to domestic pollution. Also the
statistics indicate out of the total traffic of vehicles and maximum number of
trips of vehicles is for education and work purpose. As such we have to reduce the vehicular
traffic in the cities in order to preserve health of the people living in the
cities and big towns. As such the first step is government must make it
mandatory that all schools, colleges mostly in the private have to mandatorily
provide bus transport to the students, ban students from coming in individual
vehicles, they have to plan the school/college bus stops at places they can
gather maximum number of students. Also the government must make it mandatory
that all business establishments having more than 100 employees should maintain
the employee pick up bus. Also all the office complexes having various business
establishments in less than 100 employees should have a bus pooling and engage
bus to maximum possible employees. Also the private business establishments
should get some concession from the governments for encouraging their employees
to use mass road transport. Also all the government offices must mandatorily
either maintain the bus for the employees or should have a tie up with the
state road transport bus services to operate exclusive buses during the office
timings. In order to reduce the traffic density both the schools, colleges and
universities should have different timings for different schools in the same
area, different timing for different levels of students, this will reduce the
traffic congestion. Also the government
must make it mandatory that the office establishment’s timings should be
variable from 6 am in the morning to 9 pm in the evening, for business
establishments in the same location for reducing the traffic density. In order
to ensure that the business is not disturbed, government must ensure that all
the banks will operate from 6 am in the morning to 9 pm in the evening,
otherwise make all the business banking transitions online to be operating 24/7.
Also the government must keep a ban on the number of vehicles per individual,
family. All the individuals should be charged heavy tax for the second vehicle.
The government must make it mandatory that al the vehicle whose age is above 10
years should be scrapped, else has to pay huge tax to keep the vehicle in
operation. Also the government must permit vehicles as per the registration
number of the vehicle, all even and odd number vehicles should be permitted on
alternative days. Also government must lift all the subsidies on the fuel both
petrol and diesel to the passenger vehicles and the same should be passed on to
the public transport, mass transport
vehicles. This will ensure that people will prefer to travel by mass transport
provided by the school/college/ business office etc, or will prefer to travel
by public transport. This will certainly reduce the vehicular traffic in the
cities. Also need to implement transport sector reforms. (Refer Transport
sector reforms in my paper “Simple and effective reforms...). Also government
must ensure the density of the roads is increased by expanding the roads or
construction of flyovers at the major junctions and also make multi-modal
transport system is available. The estimates of population in the urban in
India is around 31.8% at present will rise to over 50 % in next 3 decades. The
government must plan the urban development keeping in view of the density of
the pollution migration from the rural India to urban cities. (Unlike health
care infrastructure from 0.24 hospital beds per 1000 in 1946 still 0.95
hospital beds per 1000 population in 2011 when required at least 3 per 1000).
All this is very necessary in order to have a good health and also ensuring the
future generations are safe, as the vehicular emissions are the major cause of
global warming, which has very adverse effect on the entire mankind due to the
rise in temperature by 1 degree centigrade will lead to rise in sea level, as
in the globe is surrendered by 2/3 water which will submerge the coasts, having
terrible impact on the habitations. Also the rise in temperatures causes,
variation in food production as certain foods are grown in certain temperatures
only, also causes many diseases to the humans especially skin, many species
will vanish from the sea etc. This will have great negative impact in the
entire mankind.
REDUCTION OF FUEL ADULTERATION TO REDUCE
POLLUTION
As we all knew that even though the
vehicles are maintained periodically for the fitness, large extent of pollution
is caused by the adulterated fuel use. As it is a fact the some of the oil is
adulterated from the stage of the transport from the oil companies to the
retailer’s en-route the so called oil mafias who are well organised and
established are pilfering the oil from the tankers and filling the adulterated
fuels like kerosene and other cheap oils to maintain the quantities at the
delivery points. In addition some of the retailers are also adulteration of the
fuel either them self or they are hand in glove with the oil mafias. There are
many incidences of death of honest government officials who try to prevent
these oil mafias. As such government must plan like completely automation of
the transport of the oil, with electronic locking system and GPRS enabled
system with hiring of the private security personal from the retired army
people to accompany the transport lorries, along with and regular periodic
checks at stressed points during the transport for ensuring the seal is
maintained un tampered, also ensuring the electronic lock of the tanker is
decoded only on the delivery point by ensuring the reach of the vehicle at the
delivery point through the GPRS and confirmation by the delivery point
officials, the regular online updates from the delivery
points for the quality checks and also mandatory for the delivery points to
daily do the quality analysis till the stock is lost in the presence of
customers randomly at random timings and up load to the system. Also government must completely ban the loose
sale of fuel on the streets, ensuring that all fuel stations dispense fuel only
in the vehicle, in case loose for emergency can be issued on taking the written
declaration that the vehicle was stranded in so an so place due to lack of
fuel, the minim quantity of fuel required to reach the nearest fuel station is
so and so quantity. It will more ideal, necessary to follow the suggestions
made for creation of National Petro Fuel Network Authority (NPFNA) for better
issue of fuels and ensuring mandatory maintenance of vehicles(as per by views
suggested in Simple and Effective Reforms for controlling corruption and
delivering good governance) In addition government must frame stringent laws
for fuel adulteration and implement it very strictly, making the offence of
fuel adulteration a non bail bale offence and make it life imprisonment for
fuel adulteration, which will certainly reduce the fuel adulteration leading
reduced pollution leading to reduced health hazards due to vehicular pollution.
INDUSTRIAL POLLUTION
As we all knew that
pollution cases lot of health problems from respiratory issues, to skin diseases,
to eye site to neurological issues, polluted water consumption has much more
negative impact on the health. A survey conducted by IIT Delhi and the Central
Pollution Control Board (CPCB) for ranking of selected 88 industrial clusters
across the country for Comprehensive Pollution Ranking based on the level of
water, land and air pollution on ranking based on the environment sensitivity
revels the shocking truth, as out of the 88 industrial clusters 33 clusters are
critically pollutant, 32
clusters are seriously polluted and 10 clusters are under warning zone. The
results of the sample can be extended to all the industrial clusters, which
means that majority of the industrial zones are emitting dangerous pollutants. As
such it should be the most priority duty of state government to have adequate
manpower in the state pollution control departments to have a periodic
inspection of the industries which are causing huge health hazards for the
people in the vicinity as many industries which are emitting untreated
effluents to the nearby open areas, or in drains, or in the water bodies and
lakes some times in rivers. Polluting the ground water table, polluting the
water supply lakes, polluting the species like fish in the lakes and rivers,(consumption
of such polluted fish leading to health illness), apart from this enormous air
pollution due to industrial emission release which has the adverse affect to
several kilometres in the vicinity of the factory causing acute respiratory and
neurological health issues. All these
can be controlled to tolerable extent by enforcing stringent laws, to ensure
the industries will treat the pollutants to become neutral and release them at
safe, designated places which are far from the habitations, this is possible
through periodic inspection for which recruiting adequate number of pollution
control staff is necessary along with proper checks and balances to ensure all
industries follow the proper treatment procedures, also to prevent the
undergoing corruption practices to regulate the factories and industries
strictly implement the pollution control norms also needed is adopting the
stringent punishments for the officials who are corrupt who let off the
factories to act causing environment pollution coupled with stringent
punishments to the top managements of the industries and factories who are
causing the pollution. Also CPCB identified 17 major pollutant industries such
as Aluminium, Caustic Soda, Cement, Copper Smelter, Distilleries, Drugs & Intermediaries,
Fertilisers, Integrated Iron & Steel, Tanneries, Petro chemicals, Drugs
& Pharmaceuticals, Pulp & Paper, Oil refineries, Sugar, Thermal Power
Plants and Zinc Smelting majority of them are located in the mostly in
critically polluted industrial clusters in the country. As such the government
must mandatorily levy 2 % General environment protection tax (GEPT) on the
turnover of these companies and should be used small portion of the fund (10 %
of the total tax collected) for creating necessary infrastructure for pollution
control boards, and also sizable portion (30 % of the total GEPT ) for
neutralizing the already effected water bodies, etc and the major portion of GEPT
fund i.e 60 % of the total collected should be used for creating the health
care, medical infrastructure like hospitals, etc for the people living in the vicinity of these
industrial clusters. For all these industries operating their own hospitals in
the category of 500 cr turnover or 1000 employees also should mandatorily pay
the pollution tax. Also it should be ideal and mandatory that government must
classify industries and factories as per the emission of pollution, also in
each category the quantity of pollution as per the capacity of the factory /
industry. All the industries and factories are charged with Special Specific
Pollution Tax (SSPT) as per the category of harm of pollution can cause to the
public, and the quantity of emission, the effect of extent of the territory and
the quantity of people in that vicinity that are victims of these harmful
pollutants. The taxes should be in addition to GEPT. The SSPT should range from
minimum 1 % to maximum of 5 % on the total turnover. Also it should be ideal
that pollution control board should make it mandatory that all the industries
and factories causing pollution should keep on the website the nature of the
effluents, emissions, the treatment process, procedure, the efforts for the
processing of effluents to neutralise the side effects of effluents causing the
pollution, etc. Also government should have strict vigilance and enforcement to
have periodic checks on the factories and also in the surroundings pollution
levels should be checked and certified by the pollution control authorities and
also it will be ideal that all the pollution inspections should be conducted in
the presence of the local people, local elected representatives, leaders from
all parties and the NGO representatives to ensure transparency in the
inspection process.
MINING POLLUTION
Also all the mining
activities should pay the environment degradation tax of 15 % on the turnover.
As it is an open secret that more than the turnover they extract the material
and sell under invoiced, so it is ideal to put on the turnover minimum of 15 %
environment tax in addition to regular taxes. Also it is a fact that mining
causes lot of pollution in the nearby areas where the habitants have serious
health problems due to environment pollution, also pollution due to the
transport of the excavated mining material, As it is open secret that mining
industry is known for its unaccountability, also the royalties levied by the
governments are very nominal compared to the profit margins earning by the
private mining operators, as such there should not be any hesitation in putting
the tax. Also this environment tax should be applicable for the captive mining
too as mining activity is mining activity causes environmental degradation. All
the taxes should be on the turnover only
and certainly not on the profit margins, as even though they are making
losses the industry / factory are causing environment pollution health hazards by
emitting hazardous pollutants in the atmosphere, and also degrading the
environment in case of mining.
FOOD ADULTERATION
Also it is a fact
that food adulteration causes serious long term health problems in millions of
people. As such it should be the duty of the state health department to control
the adulteration of the food items both raw and cooked food. The recent reports
show that over 70 % of the milk supplies in the cities and towns are
adulterated. Some of the common adulterated
foods are milk and milk products, atta, edible oils, cereals, condiments (whole
and ground), pulses, coffee, tea, confectionary, baking powder, non-alcoholic
beverages, vinegar, besan and curry powder which needed to be controlled. Also need
to prevent the adulteration in fruits. Also in most of the restaurants and food
courts , canteens in the colleges, hostels, offices, factories in many cities
and towns the hygienic conditions dose not prevail, most of the food are stored
for more than its shelf life most of them are preparing from the rotten raw
materials, especially the non vegetarian, the oils are being re used multiple
number of times, also lack of the hygienic conditions of the cooks, the people
serving etc causing illness in the urban and semi urban people who are
consumers of food prepared under these conditions. The condition can be improved
if there are stringent laws coupled with periodic inspections as such state
governments should recruit adequate number of food inspection teams and control
this situation apart from these framing strict laws with stringent punishments
for food adulteration.
MILK ADULTERATION, PREVENTION MEASURES,
SUPPLY OF PURE MILK TO CHILDREN IN ANGANWADIES, WELFARE HOSTELS
As mentioned above
milk is being adulterated mainly due huge variation in the demand supply gap.
The demand is increasing and the supply is not increasing at the pace of
demand. The adulterated milk is mainly made of UREA and other vegetable oils.
Consuming them will have an effect long term on the entire function of the body
metabolism due to the accumulation of urea in the kidneys. In order to prevent
this adulteration the strict vigilance and monitoring alone is not sufficient,
in addition to it to ensure safe milk is available through the strict vigilance
and monitoring also need to increase the milk production to a great extent by
bringing the milk revolution. Since milk is the primary requirement in the food that will provide the vitamin A’ useful
in the better eye care, calcium deposit in the bones and the cured provides the
pro biotic bacteria useful in the digestive system in the body and many more
uses of milk. As such it will be ideal
for the government to bring in more In Vetro Fertilisation (IVF) and In Vitro
Production (IVP) centres that cater embryo technologies to produce more milking
cows through test tube. The government must at first phase provide the set of
few cows in appropriate number to all the welfare hostels, to the anganwadi Kendra’s,
and the old aged homes to provide the milk for the children in the welfare
hostels of SC,ST and BC, children in the anganwadi and the elderly old aged
people.. Also the community cow centres should deliver the milk to the
anganwadies. As such all the children will get the required nutrients at least
through adequate fresh milk. Also in
future to provide milk to the old age homes those were built in the select
villages.
In order to ensure
that the supply of milk will take place for the welfare hostels, anganwadi Kendra’s
and the old age homes the milking cows should be supplied by the government in
appropriate number based on the strength of the children, old aged people,
which are to be maintained at the community cow centres to be operated by the
gram panchayat. It should be the duty of the Gram Panchayat to maintain the Rural
Community Cow Centres (RCCC) and provide the milk and the accountability of the
milk supply etc. It the responsibility of the Village revenue official (VRO)
and Mandal Revenue officer (MRO) to monitor the supply of the milk to the
welfare hostels, anganwadi Kendra’s and the old aged homes, also ensure the
RCCC is maintained hygienically etc. Also the government must provide free veterinary
service for all the community cow centres. There should be proper
accountability of the milk collected and supplied by creating accountability to
the Gram panchayat and with proper checks and balances.
Also the government
must ensure milk production at all the places are improved substantially. In
order to ensure the milk supplied is genuine and original and pure, government
must make it mandatory that all the milking supplying units to get the registered
with the government Milking Cattle Information
Centre (MCIC), through the help of the animal husbandry department at each and
every village and the dairy farms. Government must maintain mandatorily the cow
census to arrive the population of the milking cows and the total natural milk
production in the country based on the average milk production of each cow, in
order to achieve this cattle should be given a specific number tagged with
Radio Frequency Identification Device (RFID) tag which cannot be duplicated
locally as each tag has unique number which can be read only by the electronic
reader (this will help the cattle owners to identify their cattle when it is missed), All the cattle owners (more than 12 million) shall be
given a electronic card to be swiped at
the village dairy cooperative societies (over 1,10,000) while delivering the
milk to record the milk provided by the individual owner of the cattle. All the data of the milking cows should be
separated and the average milk production can be arrived. All the dairy milk
suppliers should mandatorily supply the milk in the packs only. All the milk
supply should be registered in the MCIC about the collection details from the
individual cattle owners and the dairy from. This will ensure that over production
of the milk supply is natural, safe pure milk is supplied to the consumers.
Also this will ensure fair price for the milk is paid to the owner of the cattle.
Also this will ensure that the milk production enhancement by artificially by injections
of banned oxytocin (The Prevention of Cruelty to Animals- PCA Act of 1960 has
made indiscriminate use of oxytocin, a punishable offence of Rs 1000 fine, 2
years jail) to the milking Cowes will be drastically reduced as the original
data of the cow is known to the MCIC and will asses that which breed of cow
will give what quantity in normal circumstances on an average. Also due to mandatory
prescription of the doctor to deliver the medicine at the pharmacy centres will
ensure such medical drug injections which will boost the milk production temporarily
will be curtailed totally. Also government must bring stringent law for the
adulteration of milk in what so ever manner. Also government must make a long
plan to achieve the milking cattle at each BPL population, can be achieved with
providing the milking cattle to each BPL family in the villages to be
maintained in the Rural community cow centres (RCCC). In order to provide the cattle
with nutritious feed to yield good milk production the government must provide
the free seeds of high nutrient grass like Napier etc which has posses high
nutrient values and resistant to pests (there is an acute shortage of green
fodder over 60% and dry crop residues over 20%, as such the government must
mandatorily allocate / reserve over 100 acres of land in every village for the
cultivation of fodder to the cattle.) to the CCC to be maintained by the Gram
Panchayat. The cow ruminants (cow dung) should be used to produce the gober gas
and the slurry can be used as a fertilizer to the nearby fields. As far as the
urban poor is concerned the government must form the Urban Community Cow Centres
(UCCC) in the villages adjacent to the towns and cities. All these UCCC should
cater the needs of the children in the slum dwellings and the anganwadi Kendra’s
in the towns and cities. The maintenance of these UCCC should be the municipal
administration as well as the group of the slum dwellers on rotation bases.
FRUIT ADULTERATION
As we all knew that fruits are excellent nutritional
values and indeed many people consume fruits daily. The main fruit is banana as
it is all season fruit and also poor people’s meals, since the ripe bananas has
short shelf life due to the transportation, storage and other reason the fruits
are plucked when it is raw, much before it is about ripen naturally, this will
forcing the traders to ripen artificially by using the chemicals like calcium
carbide, similarly traders/vendors are ripening other fruits like mangoes,
papaya, apples etc which are regularly consumed by people, apart from seasonal
fruits like checkoo/sapota etc. These artificial ripened fruits have chemicals,
though used in small amounts;
the chemicals used for artificial ripening contain carcinogens, arsenic and
phosphorus which
cause cancer. As such governments must enforce the “Food Safety and Standards
Act 2006 (Rules 2011) which imposed ban of artificial repining of fruits. By
keep a regular monitoring of market yards and all the fruit vendors. Also
should ban sale of calcium carbide in open market as it is an industrial raw
material used in production of acetylene gas which is used for welding and many
other purposes. Also to bring public awareness about the artificial ripening,
the appearance of the fruits (will be shiny, flawless in appearance) and Symptoms of poisoning include vomiting, diarrhoea,
burning or tingling sensation, numbness, headache and dizziness etc.
NON-VEGETARIAN RAW FOOD (LIKE MEAT) ADULTERATION
As we all knew that majority of the Indians are non-vegetarian consumers majority of them consume either goat or lamb, chicken or other birds like duck, eemu, etc. Since there is no specific standards for the meat sellers, majority of the meat sellers do not follow standards and sell the meat in un-hygienic conditions, some of them sell the meat mixed with other animal meats. Also majority of the restaurants are serving the stored bacteria generated non vegetarian food. As such government must issue the mandatory hygienic conditions to be maintained, measures for containing the non-vegetarian food adulteration, as it causes acute health disorders
HYGIENIC READY MEADE FOOD AT RESTAURANTS, FOOD COURTS, CANTEENS ETC
Also it should be
made mandatory that all the restaurants and canteens the food preparation areas
should be installed the CC camera and should be integrated to the website of
the food adulteration prevention department for the public view and the
scrutiny by the officials. Like the traffic police observing the CC footage remotely
and acting on violations, the food inspection officials will monitor all the
food preparations from the start of the preparation to the cleaning of the food
preparation area in the closing time should be observed closely. This method
will certainly help in achieving the better results.
Also the
governments should give more focus on the maintenance of hygienic of street
foods preparation & serving, as many of them are causes of health
disorders. To regulate the street food sale it should be mandatory for the the
street food sells to get registered locally with the food authorities to obtain
the licence card. Also there should be mobile teams to have regular and periodic
inspection of street food vendors for the quality, preparation in hygienic
atmosphere, use of water filtered water, use of standard edible oil etc and
more important about the health condition of the perpetrators and the server of
the street food should be observed for skin deceases, any communicable deceases
etc and all unhygienic outlets should be seize immediately and allow them to
continue after maintain the standards.
Also most important
is that the governments should control the food stalls in the public places
like bus stations, rail stations and more specifically at the pilgrim places of
all religions where mass movement is existence and short stay or eat and move,
which are the main centres where substandard, unhygienic conditions of the food
preparations are in existence. This has long run impact on the health of the
people who are consuming food at such places, such food consumption leads to
gastro entities, hepatitis. The CC cameras should be made available in these
places of food preparation and service in all the public places mentioned
above.
The governments has
to realise the fact that small expenditure in the other sectors with straight
implementation of law, rules and regulations in other sector will certainly
help in a great extent towards the achievement of health care for all. Also the
state governments should prepare a white paper on number staff in the pollution
control board, the periodic inspection chart, the staff is adequate
proportionate to the existing industries and factories, also the municipal
staff adequate to the amount of garbage, drainage, sewage facility maintenance,
are the food inspectors adequate proportionate to the restaurants and canteens
and food processing industries and to
prevent the adulteration in the food products, what are the steps taken for
containing the adulteration of food products, what are the checks and balances
and accountability of the officials involved in the above process etc.
REGULATION OF FOOD STORAGE, SUPPLY
STORAGE INFRASTRUCTURE CREATION
Health care for all
can be achieved if every person has proper affordable nutrient diet; this can
be achieved if and if the food grains are available at affordable, relatively
cheaper prices. This is possible only through proper long term storage of the
farm production. It is indeed shame on our part that many children, BPL
families are dying with hunger and malnutrition, at the same time the food in
the godowns is rotten due to in-adequate facilities or due to non existence of
covered godowns for the storage of food grains. Also it is due to failure on
the part of governments to identify the places of mass agriculture production
of crops like onion, potato, tomato, ginger, turmeric, garlic etc and construct
the cold storages and also encourage the food processing industries in that
areas, instead the food processing industries are far away from the places of
mass agriculture produce. In order to ensure that proper supply of food grains,
vegetables, etc at normal price at all times even during the draught or other
natural calamities which are beyond human control, the government has to
construct the proper storage facilities for the food grains. As such large food
silo bins should be constructed as per the international standard to preserve
the food grains in the controlled atmosphere and cold storages for the
vegetables for long storage. The
construction of godown and “Silo Bins” (Most ideal for food storage as long
storage without deterioration or loss, no access to insects and rodents,
occupies 1/5 area of the conventional godown) should be made in the PPP mode
with the tri-party agreement of the government, private investor and the local
farmers association (not the middle men) to get operated on WIN-WIN bases. Also
should build the food processing industries in the vicinity of the mass agriculture
production areas to ensure that the farmers will get the minimum support price
for their produce. Also should have the railway lines near to the godowns for
easy transportation. It should be mandatory that minimum support prises for
agriculture produce should be determined as per the local conditions in that district;
however the price difference should not me much more compared to other parts of
the state or the country as different climate conditions, different soils
conditions and different methods of agriculture prices determine the yield. This
will ensure that justice to the farmers as uniform pricing is leading the formers
in debts due to non recovery of even capital expenditure made. Also it is ideal
that government should procure the perishable agriculture produce i.e
vegetables and fruits from the farmers directly at the villages, add mark up
for transportation and handling and a little margin for the operation cost, sell
to the people in the cities, towns through exclusive stores operated in each
ward at least one such store, along with adequate number of mobile vegetable
stores. (Where ever farmers are willing to setup own agriculture markets in
nearby cities and towns government must provide space and also subsidized transport).
This will provide fair price for the farmer as well as the consumers; in
addition this will generate employment for the youth also. To ensure this
system operate successfully there should be proper supply chain management, all
the farmers village wise should be identified and enter agreement with them for
supply at the appropriate fair price depending on the local conditions, this
will ensure adequate supply of the material produce is assured, then all the
collection from the villages should be brought to mandal headquarters, from
there to the towns and cities, as per the pre requirement ascertained through
automation of supply chain management system. The logistics should utilise the
Operations Research methods to optimize the transport distances, save time and
maximum delivery in most efficient cost effective manner. Then there should be
warehouses in the mandal head quarters / cities at important locations and the
shopping areas at the each ward in the city / town. The vehicles which are
carrying the vegetables to the city/town should be used as mobile vegetable
shops in the city and towns in the large colonies. This will save the
expenditure on the vehicles and maximum output can be drawn from the investment
in the vehicles. Also from the purchase of vegetables from the farmers stage to
the sale of vegetables to the individual consumers, the entire process should
be computerised with online, this will record the movement of the stock, the
procurement and the storage etc, also brings the required transparency in the
system. A little investment from the government on this will give permanent
solution for better food, better health of the people.
REGULATION OF FOOD PRICES, CONTROLLING
AGRICULTURE INPUTS LIKE FERTILIZERS, SEEDS, PESTICIDES, WATER SUPPLY
Also in addition to
this the primary need is to regulate the pricing of the inputs of the farming
like seeds, fertilizers and the pesticides, also to ensure the fair supply of
the seeds and fertilizers a totally automated supply chain management system
should be adopted from the manufacturer to the local retailer in the villages
with online recording of the movement of
the stock, material i.e seeds and fertilizer, as many places the seeds are not
available in required quantity and duplicate seeds are in circulation which
does not yield as per the normal standards causing huge loss due to crop
failure, also the required fertilizers to boost the yield are not available to
the farmers most of the time not at the actual cost price of the product at the
retailer end, most of the time farmers buy on premium price in black market due
to the creation of artificial deficiency of stock by the local dealers and the
retailers to gain more profit, this can be completely eliminated by the total
automation of the supply chain management and very pack of the seed/ every bag of the fertilizer sale should be against the
entry of farmer name as in the the kissan card. Also most important is the
water supply to irrigation, since most of the rivers are passing through
several states, the is always water disputes to be shared by the farmers of
different areas. The governments must act in the large interest of the nation
and the farmers to resolve the issues related to irrigated water supply in all
the states. Also government must make the removal of the silt in the water
cannels, creation of more water pits to conserve the rain water, maintain the
tanks in clan environment by preventing the industrial effluents mixing in the
tanks and river irrigation (to make it possible all the governments must
maintain the data of water bodies, lacks, their capacity, removal of silt data,
nearby industries which can cause pollution etc and appropriate action plan
should be implemented). This will ensure that the farmer will produce the
agriculture output at more less price, then the sale price will be less, the
elimination of the few middle men and direct purchase by the government from
the farmers will ensure the agriculture produce is sold at very reasonable,
affordable, economic price to the consumer. This will enable all income group
people have the access to the nutritional diet, thus improvement of health of
all the citizens. All This will ensure that food prices are stable
all the time, and thus the inflation under control.
SAFE DRINKING WATER SUPPLY
Also since majority
of the diseases are water born, it is the duty of the government to supply the
portable drinking water to all the people. In urban areas and towns the water
supply is through the water supply boards mostly presumed to be treated to some
extent, but on reaching the individual consumers sometimes it is contaminated
due to leakages in the main supply lines and mixing of drainage water etc. As
such all water supply boards ensure that pure drinking water is supplied, they
should use the Supervisory Control and Data Acquisition (SCADA) technology to
find out the flow parameters of the water in the pipeline system to detect any
leakages. Also since the cast iron/ iron/ steel pipes are prone to corrosion,
scaling and formation of blue green algae etc causes long run health diseases
to the consumers, as such all the piping at the entry of the colony to each
house should use the ” Multi Layered Flexible Piping System” which are made of
Poly Ethylene and Aluminium layers has the properties of non corrosion, non
scaling, no bacteria formation in the flow system, which will certainly help to
a great extent for healthy water. In order to ensure that adequate portable
drinking water is supplied to the rural areas, all two lack gram panchayats
should have mass RO system running on the solar power (as power supply is a
major issue in rural India) to achieve this the help of the CSR, MPLAD/MLALAD
and also by the government should be made starting from the villages having
acute water problems due to salinity, alkalinity, and fluoride affected areas and
also areas where water table is far deep in the ground. Also all slums in the
urban areas should have the mass RO system for supply of water for drinking at
nominal price for the cost of operation. The cost of operation is as low as 20
Pisa per litre. Which will be affordable for the families in the slum dwellings
to consume the RO purified water rather than suffering with diseases.
CONTROL OF SEXUALLY
TRANSMITTED DISEASES
Also it is most
important that due to the lack of sex education in upper primary schools and
colleges in India, major percentage of youth is including in pre mature sexual
acts (mostly un protected) which has long term affects on their health
affecting their future life. It is mainly due to the physical and metabolic
changes among them during the transaction period from becoming adult leads
to natural curiosity towards sex, added
to it the influence of the cinema films (which are supposed to be either a social
message carrier or provide entertainment to get relaxed from the stress, but
strangely the kind of semi nude exposure
of artists irrespective of gender and the way of picturisation of the present
cinemas irrespective of sensor certification, are more or less acting as
stimulants to the youth) and added to the cinemas free access to prone sites in
internet, mobile downloads and also due to the negligence of parents. As such it
should be ideal that safe sex education should be part of curriculum from (most
ideal from 8th standard on
wards) the intermediate or the 10+2 stage as it is very necessary as the recent
reports of surveys shows that the average of sex in boys 17.4 and girls at 18.2
years as per the National Institute of Health
and Family Welfare, a quarter to a third of
India’s young people indulge in premarital-sex with 17% among them
schoolchildren; 33% among young working class in Indian-population, With 60% of
them had sex rarely or sometimes; 14% frequently with 3-4% had multiple
partners and 50% of females and 45% males never used a condom. Also it should be
mandatory that all colleges and universities for students of intermediate, 10+2
and the graduation students a uniform decent dress-code on all working days and
the PG students should be allowed to have casual dressing. As it is a fact that
the casual dressing in the ultra modern outfits will distract the section of students
as all are not economically sound to wear the branded and expensive clothes
like few elite children do, also some sections are wearing very voluptuous
dressing irrespective of gender which will certainly distract the concentration
on studies and leads to un-wanted things. Also all the schools (above 7th
standard ), colleges and universities permit only basic mobile phones having
only receiving and making calls and sending SMS only, should make complete ban of
students carrying mobile phones with advanced features like with camera,
internet facility in the campus. Also the class rooms/ college compound should
be fixed with mobile jammers. As the advanced mobiles has more radiation effect
than the basic phones as the advanced phones to receive more data which will
emit more radiation, also due to surfing mobile internet for watching the
pornography or through the memory card, possible only in advanced phones, which
will certainly affect the child psychology, lead to bad health. All the above
guidelines are certainly not the “
talibanisation “ as was termed by the media for inculcating the good manners,
but very necessary in the context of safe sex education in the 10 +2 students
and to keep the children grow under disciplined atmosphere. All the children
should be given freedom in the controlled atmosphere as the age of transition
from teenage to adult will have lot of distractive thoughts, if directed
properly will lead to good health, constructive and bright future of the child.
The parents should be thought about the negative implications of more freedom,
as these children are in the transition period needs more concentration on education
then the gossips and un-wanted stuff surfing the internet on the mobile phones.
The children should be given access to internet at home in the PC or Laptop
computer with pornography filters and regular observation of the parents.
NEED FOR MARGINALISATION OF FLUSH TRADE IN
INDIA
Also the safe sex education should be
thoroughly thought to the youth. Also the STD awareness should be created among
the public, especially at the rest areas of the transport Lorries etc. The
governments should give utmost priority to marginalize the flush trade in Indian
soil. Also the government should ensure that all the “redlight” areas and the
prostitution should be brought to closure. As many females and young girls in
millions are under this flesh trade and getting spoiled their health to the
gravest level being caught in the bondage of sex racks, sex mafia and also acts
as agents of carriers of STD and AIDS. The Ministry of Home Affairs (MHA) Government
of India reports says yearly as many as 3 lacks girl children in India are
every year forcibly entering in to this trade by the organised mafia. In order
to provide justice to the girl child and women victims and to bring a change in
the society to have good health for all it is necessary to bring stringent non
bail-able offence with laws equivalent to the murder case to keep the culprits
who are forcing the women to flush trade. Also since it is evident from the MHA
reports that police are unable to tackle this serious issue, the flush trade in
the “redlight” areas should be dismantled by engaging the army to rescue the
victims to conduct raid on the red-light areas in the states. It is really and
indeed should be treated as a “national shame” since over 3.5 million Indian
women are in this forced flush trade as per the MHA report, majority of the victims of this heinous trade belong to
the downtrodden sections of the society belonging to SC,ST, and Minority (over
50 % SC, ST and 27% BC). Also it is real surprise for many to see that open
advertisements for flush trade is happening in cities, towns appearing in the
news papers even in leading national dailies with captions “relax your body and
mind”, full body massage, and the friendship clubs with caption” join today to “date
with & enjoy” with high class female, entry for joining free for all
females“ it’s a naked truth that 9 out of 10 advertisements are meant for flush
trade, prostitution? All this un stoppable continually happening flush trade in
India leaving doubt for many about system of governance due the inaction of
governments, callousness of law enforcement agencies, disability of media investigative
journalism and the lack of real zeal and commitment of women rights
organisations ? Also many people are of the the thought that it may be part and
parcel of cosmopolitan culture, useful in boost of tourism?. In order to ensure
confidence to all people about the system of governance the government must act
quickly on dis mantling the redlight areas, ensure that such advertisements which
are meant for the flush will not appear in the news papers and also at the same
should ensure the web sites promoting the flush trade in Indian soil should be
blocked, and also to ensure that such flush trade will not take place through
social media, ensure stringent laws for enacted and enforced to curb the flush
trade, Its is high time government to completely
dismantle of all the red-light clusters across the country by deploying the
army as many state police are enable to fight against this mafia’s in the red
light areas. Also to achieve total marginalisation of flush trade the governments
must form special department Anti Flush
Trade Task Force (AFTTF) like ACB / CBI in each state with at least 10% of the total
police force at all levels should be
working round the clock for crushing flush trade, to free the flush trade
victims and do justice to them, provide appropriate free medical support,
coupled with psychological counselling to build confidence in them, and the
government must provide some sort of lively hood for them This is certainly
bring the desired results in public health as the cases of STD, AIDS will be
drastically come down, as many of the public sex workers are major carriers of
many diseases causing a huge health damage to themselves and the temporary partner,
their family of the temporary partner. The budget allocation for AIDS
prevention is Rs 1700 crore for the
National Aids Control Programme with the objective of halting and reversing the
HIV epidemic in the country by integrating programmes for prevention, care,
support and treatment. Even 50 % of the amount spent on the dismantle of the
redlight areas and creating the re-habitation of the sex workers will not only
save the budget allocation on the AIDS in future decrease the expenditure of
many in the for the treatment and medicine, but also decreases the number of
deaths in the AIDS cases, also increase the productivity due to increase in the
work force as most people who effected AIDS are in the working age group.
The above steps are
very necessary to inculcate the confidence to the public that governments have
real intention in the protection, safety, security and dignity and welfare of
the women especially females belonging to downtrodden. Otherwise governments should
legalise the prostitution with mandatory pre conditions of health check-up both
the partners’ i.e both female and male in this unholy heinous flush trade activity
on daily bases, In the larger interest of health care for all.
PREVENTION OF ADVERTISEMENT OF SELF
MEDICATION,
MAGIC CURE IN PRINT AND ELECTRONIC MEDIA
Also It is very
unfortunate that the government allowing the media to air the advertisements
for the health care products which are not certified for the authenticity of
the claims and the product standards, their usefulness in the health care, for
example many products with claims “grow hair”, “grow height”, “get slim in few
minutes”, “get fitness in few minutes”, “reduce fat in few minutes”, “increase
your chest dimensions”, “get endurance and vitality stimulants” etc, does not
possess the necessary health care certification from appropriate government regulatory
body like Food and Drug Administration (FDA), Indian Standards Institute (ISI).It
is a fact that these advertisements tend to
cause the ignorant and unwary consumer to resort to self-medication or to
resort to quacks who indulge in such advertisements for treatments, which cause
great harm. It was therefore found necessary in the public interest to put a
stop to such undesirable advertisements. As such It appears mostly all these
advertisements are violation of spirit of the “Drugs and Magic Remedies (Objectionable Advertisements) Rules, 1955”. As The main object and purpose of the Act
is to prevent people from self-medicating
with regard to various diseases. Self medication in respect of diseases of
serious nature mentioned in the Act and the Rules has a deleterious effect on
the health of the community and is likely to affect the well being of the
people, by
using such products people health may deteriorate due to side effects, just the
testimonials of some few who might have benefited due to what so ever reason cannot
be universalised unless it is scientifically proven for its universal
applicable principle, as such airing/publishing of such advertisements should not be
entertained. Giving media self regulation is very much in need and very much acceptable
as far as the presenting of news and views are concerned to keep the public
informed and also to keep the executive and legislature alert at all times. It is
not appropriate that media airing / printing this kind of objectionable advertisements
of such un-standard products just putting the statutory warning message that
the claims of the product are not endorsed by the media is not at all sufficient.
Government must restrict all advertisements related to health care and fitness
to obtain necessary approval from the appropriate department for the claims,
especially all products of food, fitness and health care mostly from FDA of
government. All these product advertisements should be aired/printed only on
production of certification from the appropriate government authority for the
quality and the claims of the company product are genuine on conducting
appropriate scientific tests, also the products are not having any side effects
on the health and the product is as per the international/Indian health
standards. All such test reports regarding the claims of the products should be
kept in the website of the government for more detailed view by the public.
REGULATION OF BLOOD BANKS AND ORGAN BANKS
ROLE OF PUBLIC REPRESENTATIVES, PUBLIC
SERVANTS IN BLOOD DONATION
Also government
should focus on blood banks and organ banks. As blood is required in heart surgeries,
cancer therapy, talasima treatment and also in major accent cases where blood loss
occurred, needed same group blood to be transuded to the patent to ensure the
proper function of the brain and body metabolism. It is fact that awareness
about blood donation is still needed as "People still believe that they will become weak and anaemic if they
donate blood. People should know that anybody aged 18-65 years can donate
blood. A healthy person can donate blood once every three months." As stated by many
elders that charity should start from home, lip service will not serve any
purpose unless set an example for others. Keeping in view of the precious words
of the elders, as such all public representatives (Netas) and public servants
(Babus) should be made to contribute to the blood donation and organ donation
mandatory. All the employees of Government, PSU especially male employees especially
the IAS, IPS, allied services, Group-A, Group–B and Group-C only, should donate
blood at least once in two years, all Group-D employees should be exempted from
mandatory donation, but if they wish they can voluntarily donate the blood, organs.
Since most of the Group-D employees are either mal nutritional or under nutritional
due the limited financials. Likewise in armed forces should donate blood at
least once in two years, certainly making the real meaning of ”Civil Service”.
Also it should be ideal to make it mandatory all elected representatives, government
employees and personal in armed forces should to make organ donation
compulsorily. Also it should be mandatory criteria in the electoral system;
people who wish to contest the election to be a public representative should
mandatorily have contributed the blood donation camp least once during the last
two previous years before the nomination, in addition a declaration on court
stamp paper for organ donation agreed and witnessed by their spouse or parents, both the copy of the blood
donation certificate and the self declaration for organ donation should be
attached to the nomination form, without which the nomination of the candidate
should be invalid. since all prospective candidates are willing to represent
the people to serve them, work for their betterment, if the candidate does not
have the heart to donate 350 ml of blood in 2 years, their organs after their
death, how can he claim that he will
work for the welfare of the people in the territory, their speeches or
statements or lip service saying that
their life is for peoples service, they wish to bring change in the system
which is not alone sufficient but their
real contribution is necessary?, all persons who wish to contest local body elections should have donate blood at
least one time in last 2 years before nomination, all MLA candidates at least 2
times in last two years before nomination, all MP candidates at least 3 times
in last 2 years before the nomination, which reflects the “TRUE SPIRIT OF
SERVICE TO THE PUBLIC”, which will set example for many followers of these
leaders and common public.) Also it should be mandatory that all public
representatives both elected and nominated on election should donate the blood
at least twice during their tenure as a member at what so ever level may be (a
Gram Panchayat member, to Member of Parliament) it will be the mandatory
criteria for re-nomination in the next general elections, Also it should be
made mandatory that organ donation of the diseased public representative is the
criteria for consideration of the family members for future nomination in the
elections (either bye-election or general election). Also it should be
mandatory criteria for nomination in next elections and also for obtaining any
nominated position in the government. Similarly it should be made mandatory for all
the civil servants/ government employees at least 2 times blood donation is the
minimum mandatory criteria for considering the promotion of the civil servant /
government servant. Also this should be applied to the private sector. This
will certainly help all sections of the people in emergencies, also improves
the respect for the public representatives and public servants.
ROLE OF POLITICAL PARTIES IN BLOOD DONATION
Also all the
recognised political parties should make it mandatory that all the party office
bearers at all level from ward/village to the mandal level should donate blood at
least once in two years. It will be more ideal that all ruling parties should
set an example for others by making an initiative in this regard. Also it
should be the duty of the government to establish blood banks at all districts
in the state covering all major cities and towns having more than one lacks
population. The statistics shows India
has around 2545 bloods banks of which 996 are operated by government and 1549
are operated by private, NGO, Charitable trusts. There is a need to increase more
blood banks under government covering all districts and placing the blood banks
at strategic locations. Also government must review the re frame rules
regarding the setting up of the blood banks by the private, and also regarding
maintenance of the blood banks (government & private) by appropriately
amending the Drugs Rules of D&C Act (1940)( “DandC Act”) as all
the blood banks are governed due to advancement in transfusion science and new
practices coming into the routine blood bank management, and Central Drugs Standard Control Organization
(CDSCO) which is the government of India regulatory body of blood banks headed by the Drugs Controller General
(India) to ensure safe blood available in all corners of the
country, whatever blood and components are issued out of any blood bank,
whether government, NGO or corporate, it should be made safe by implementing
quality standards. Also ideal to computerise the data of stock at each blood
bank and integrate the data district wise and make it available on the web to
be accessible to all hospitals and nursing homes. Also it should be made mandatory that all
the highway health centres and hospitals should have the facility of mini blood
bank and also possess blood of all groups in adequate quantity to cater emergency
needs.
PROPAGANDA OF BELIEF IN SELF FOR SPEEDY
RECOVERY
Also it is more
ideal and advantageous to many if all the schools, colleges, universities,
offices, factory workers should thought about the “ power of sub conscious
mind” and “power of positive thinking” to infuse the ultimate confidence in
them to act right. Also all the hospitals and nursing homes should view/provide
the preaching’s of elders about the power of sub conscious mind and power of
positive thinking for better healing and their seedy recovery from the illness;
as the teachings of the above subjects are universally applicable and do not
contain any religious matter/content in it. This will boost the confidence in
the people as well as in patents, it is fact that they will be perform well in
case of normal people and in case of patents will recovered faster than normal.
As a famous quote” the doctor dresses the wound, but the god heals it”. The god
hears their prayers in their sub conscious mind and favours them with seedy
recovery.
CONCLUSION
The fact even though UPA under Congress
Leadership has already implementing health care schemes like NRHM, JSSY, Jan
Aushadi, RSBY etc which will certainly benefit large section of the population
of the country, also likely bring “Health Care for All” by providing
substantial increase in health care budget, which may not provide the desired
results until unless all the government brings in all the stack holders
directly or indirectly responsible for the health of the people of the country.
It is the fact that health care is not only the responsibility of the
government alone, but also the business establishments who earn profits on the
hardship of the employees, in certain cases the industries are the cause
deterioration of health of large sections of people due to environment
pollution, Also some business establishments causes the food adulteration
directly or indirectly causing deterioration of health, as such it should be
the primary responsibility & duty of all the business establishments to take care of the health of the employee
and their family, either by contributing to health insurance in case of small and
medium business enterprises or by construction of hospitals exclusively for the
employees in all big business establishments, also those business
establishments which spreads pollution
unavoidably causing the deterioration of health of people, has to take care of
the victims through government by contributing the environment pollution tax.
This method will certainly reduce the burden on the government; also reduce the
load on the existing hospitals due to the exclusive hospitals for sizable
population. Also since the governments are extending the facilities like tax
concessions, bank loans etc to the pharmacy industry, the industry is only
surviving on the consumption by the sick, but the pharmacy companies are
mercilessly squeezing the money from the sick and downtrodden by charging over
10 times the manufacturing cost earning huge margins creating inevitable
circumstances, as we know that majority of the population does not have the
real purchasing power even though the per capta income is high, the fact is the
rise in per capta income is only on paper and a mere economical calculation, as
statistics shows still 1/3 of the population is below poverty line, in order to
ensure that every citizen has access to affordable medicine, as such in order
to achieve health care for all the
government to must mandatorily bring the prices of the medicine by regulating
the pharmacy manufacturing cost, profit margins of all drugs manufactured and
sold in India, Also need to regulate the hospitals and nursing homes to collect
the service charges at a limited margin by fixing uniform cost for diagnostic
tests and service charges in hospitals of same standard, also government must
ensure fair treatment of the sick by preventing irrational treatment through
bringing ombudsman mechanism in the health care sector. As we all knew that entire
health care sector is dependent on the doctor, more specifically on the
prescription of doctor. As such government must bring in a system to regulate
the prescription by bringing the introducing mandatory use of the bar coded prescription
paper to prescribe the medicine or tests which the blank bar coded prescription
pads for each doctor are issued by the government will certainly prevent the
irrational prescriptions and also should ensure the delivery of the medicine
mandatorily on prescription of doctors will ensure all pharmacy retailers sale
of medicine is regulated , added to this monitored regularly and the
integration of data of the retailers sale prevent the spurious medicine, non
excise paid medicine etc. Also since the doctors are the core of the health
care to ensure that all doctors work in all places both in urban and rural
areas and ensures practice of professional ethics government must ensure that
all doctors of equal qualification and equal experience will get equal salary/
professional fee in case of independent practice irrespective of their service
in government or private, added to this allowing later entry to government from
private and mandatory service of all the existing doctors for few weeks on
rotation to serve in the rural areas will certainly ensure all people in the
country will get the required health care. It is a fact that health care for
every individual is not possible unless the individual maintains the
disciplined life, and adopt health practices. Like having health care food with
nutritional values as far as possible, regular exercises and also not inclined
for any addictions like smoking and consumption of alcohol and adhere to
legitimate sex. To make the individuals practice discipline government also
ensure that other avenues closed except the fair health practices in all
aspects of life. As such government must ban tobacco farming in India and very
restricted sale of finished tobacco products, also the government must regulate
the sale of the alcohol products and ensue that these products which are the
major health distracters for all people especially the downtrodden, as such the
government must ensure the sale of the tobacco and alcohol is not within the
reach of the common person by restricting the sale points and enhancing the
duties on them to the maximum extent. Also the governments must ensure that maximum
people adhere to legitimate sex in their life by completely dismantling the
flush trade in India. To ensure all the individuals practice good health habits
in life the government should ensure that all stake holders’ i.e the educational
institutions, the business establishments, will compulsorily cater time to
discuss and share thoughts about the good health practices for the benefit of
the individual and their family members. Also government must ensure that the
practices of good health habits are infused in the minds of people living in
villages through regular discussions at the Gram Sabah. All the above suggested
measures on implementation will certainly lead to achieve “Health Care for All”
, will make maximum population in the country are healthy throughout their lifetime, due to
drastic decline of illness of people unnatural deaths will decline sharply,
which increase the working force population of our country for the reason as
per the current census over 2/3 rds of population in India is youth, with our
country being known for natural talent & nature to work hard, our country
will excels in all areas which are needed for betterment of the planet earth, making
India the real “Super Power Nation” in the World.
***
JAI
HIND
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