Let our children, including those at the margins of territory, identity, services, social and economic interventions, find themselves future-ready
Infants and children — naked, hungry, crying, sleeping in overcrowded trucks, on the shoulders of their tired parents and caretakers. These were some of the heart-breaking pictures that emerged as everyday lives were disrupted following the Covid lockdown put in place in March across India. The multiple fault lines of our societal order were more visible than ever as migrant workers and their families were seen out on the roads across major cities, while the rest of us took to working from home. This was not “a long walk to freedom”. It was a walk back home through a terrain that was as indifferent as it was strange. It was reverse migration, a story of lost livelihoods and ever-increasing struggles. For some, it was a walk to their deaths.
As we battle the Coronavirus and its varied impacts on our lives, it is important that we do not lose sight of these fault lines. It has especially hit the families of workers in the unorganised sector, who do not have adequate social protection, support and additionally find it hard to provide adequate care to their children.
One of the casualties of the lockdown was the slew of programmes tackling malnutrition. As per the National Family Health Survey-4 (2015-16), 21 per cent children below the age of five in India were undernourished, 91.4 per cent of the children aged six to 23 months did not receive an adequate diet, one in three (38 per cent) of children under five years of age was stunted, one in five (21 per cent) of the children was wasted, 36 per cent were underweight. The lockdown resulted in a more dire situation where the resulting socio-economic impacts, the closing down of anganwadi centres and the resource crunch minimised the likelihood of availability of food to counter malnutrition.
These intersecting impacts of poverty, gender discrimination, caste and class differences, violence, issues of availability and accessibility of services to the young child and lack of professionalisation of childcare workers are brought to the fore in the State of the Young Child in India (SOYC) report, that Mobile Creches, an organisation working for early childhood development (ECD), released recently. While the report was finalised before the pandemic hit the world, it nevertheless offers important insights into the status of India’s children under six years of age — who form over 13 per cent of the country’s population — in addition to a critical examination of legislative frameworks designed to address their needs. The report also goes beyond a homogenising understanding of the child, as it emphasises various disadvantaged categories within this age group and the dire situation they are in. It calls for specific interventions for each vulnerable category, otherwise it results in a risk of lifelong consequences of deprivation.
The results emerging from the indexing can be used to draw out good practices from top performers like Kerala and Goa and turning more attention towards the poor-performing regions and States like Jharkhand, Uttar Pradesh, Bihar and Madhya Pradesh. With recommendations stemming from exhaustive analysis, it can also enable in envisioning a post-pandemic world where the issues of marginalisation and neglect receive due attention and policy intervention.
The Integrated Child Development Services scheme (ICDS), the world’s largest programme catering to children, requires recalibration for it suffers from design and capacity deficits, does not adequately address the components of care and early education and is still a long way from reaching the most marginalised in an effective and equitable manner.
The youngest child is often the most invisible and exceptionally vulnerable. This calls for tapping development opportunities in this young age that can set a healthy foundation for life. Investment in ECD not only has the potential to enhance individual capacity and economic growth, it also provides an opening for women empowerment by recognising the overlapping rights of women and children and bringing in State interventions and increased budgetary allocations.
The SOYC report recognises the biological role in care-giving yet questions the gendered stereotypes that result in an undue burden on the mother. In the unorganised sector especially, women are bogged down by a triple burden — the responsibility of childcare, work outside the home that mostly entails unequal access to the market, longer working hours, unhealthy working environment and lesser wages, and the household work as well. Often, young children are seen lying or roaming around these unsafe work sites since these women are deprived of maternity or childcare benefits. This weak support system compromises their ability to provide quality care to the infant/child. Therefore, it is important that where families are unable to provide due childcare, compounded by their multiple issues, the State steps in as an enabler. As the sole scheme to cater to the needs of children of women engaged in the informal sector, the Government-sponsored National Créche Scheme has actually seen a reduction in the number of creches, with only 7,930 of them functional across the country in 2019, which translates into one creche per 21,000 children. The scheme needs to be re-imagined and strengthened with serious revision of the budget, and this can also be supplemented by a phased conversion of anganwadis into anganwadi-cum-creches.
The pandemic-induced lockdown witnessed a rare visibility of anganwadi and ASHA(Accredited Social Health Activist) workers as they emerged to be the first line of defence in dealing with the contagion. However, as the SOYC report notes, they are otherwise marginalised — not seen as a professional cadre, treated as part-time workers, paid well below the minimum wages in most States. There is a pressing need for their critical role in the childcare ecosystem to be recognised, acknowledged, professionalised and for their remuneration to be in line with their responsibilities. The professionalisation of this service will also mean adequate training of these workers and can strengthen the Early Childhood Care and Education (ECCE) component, which remains a weak focus of the ICDS.
All children in the ages of three to six should have a right to quality ECCE, irrespective of whether they are located at anganwadi centres, pre-primary sections of Government, private schools or any other pre-school centres.
For the country, prioritising ECD can translate into fulfilment of Sustainable Development Goals and its international commitment towards child rights. While data paucity on multiple dimensions of child well-being hampered the indexing process and a more accurate insight in certain areas, the budgetary analysis through national-level data and allocations to States brings forth issues of inadequate allocation, under-utilisation, lack of management capacity to cater to the needs of children.
The per child expenditure in the country for 2018-19 was an abysmally low figure of Rs 1,723. This must be enhanced to Rs 1.25 trillion annually to cover funding gaps and ensure holistic interventions. This approach has the potential to bring in returns that would exceed budgetary spends on any alternative welfare programme.
Coronavirus has significantly altered the way we thought of our lives, our work and our very support systems. It has taught us lessons, tragic ones at that.
Yet, it is in this moment that we must recognise the deprivations, neglect and exclusion that mar equitable access of various vulnerable groups, including children, to essential services. Let our children, including those at the margins of territory, identity, services, social and economic interventions, find themselves capable for the future.
(The writer is Executive Director at Mobile Creches and an early childhood development activist)
It would be a very big deal if the US started distributing a vaccine that has not been properly tested. Yet the signs are that this is just what is going to happen
Nine of the world’s biggest pharmaceutical companies have just promised not to apply for regulatory approval for any new Covid-19 vaccine before it has gone through all three phases of clinical study. Why would they do such a thing? You’d be surprised if brain surgeons got together and promised not to operate while drunk, or if the bus drivers’ union publicly pledged that its members will not drive recklessly. They don’t do that because operating sober and driving carefully are just part of the job. So is ensuring that new vaccines are safe and effective. Yet nine major players in the international pharmaceutics market — AstraZeneca (UK-Sweden), BioNTech (Germany), GlaxoSmithKline (UK), Johnson & Johnson (US), Merck (Germany), Moderna (US), Novavax (US), Pfizer (US) and Sanofi (France) — all felt obliged to reassure the public that they won’t cheat. What’s up? Obviously, it’s the perception that other players in the same market may indeed be cutting corners. We’re not talking here about Russia and China, both of which have begun inoculating some key workers with vaccines that are still listed by the World Health Organisation (WHO) as being in clinical trials. No surprise here: Everybody knows that those regimes break the rules whenever they feel like it.
Usually the Donald Trump Administration’s actions are viewed with weary resignation by the rest of the world, but it would still be a very big deal if the US started distributing a vaccine that had not been properly tested. Yet the signs are that this is just what is going to happen. Last month at the Republican national convention, the US President told the delegates and the country: “We are developing life-saving therapies and will produce a vaccine before the end of the year, or maybe even sooner.” On September 4, the US Government’s Center for Disease Control and Prevention (CDC) told American health officials that “limited Covid-19 vaccine doses may be available by early November 2020.”
More specifically, the CDC urged State authorities to consider “waiving requirements” and grant permits to McKesson Corporation so they can start distributing a vaccine by November 1. You don’t need a weatherman to know which way the wind blows. The presidential election is on November 3, two days later: That’s long enough for the glad news to get around and floating voters to be swayed in favour of Trump, but too short for any defects in the rushed vaccine to come to light. Donald Trump is going to liberate Americans from the curse of Covid in a little less than two months. If the vaccine’s miraculous properties subsequently fade, even if it turns out to kill large numbers of people, that won’t matter. The votes will have been counted and Trump will be back in office for another four years. That, at least, is the scenario that is currently envisaged by the people around Trump.
It is a plausible one, especially if the race has tightened by then. Just 1,00,000 votes in three States, mostly from people who had previously voted Democratic, put Trump in the White House in 2016. A miracle vaccine could certainly swing that many votes again.
The nine pharmaceutical majors, who felt the need to issue a “historic pledge” to uphold scientific and ethical standards, were doubtless driven by this scenario. Even if there really has been an American breakthrough, they would still have to cope with the public’s suspicion that Trump is cheating — and the mistrust that will also attach to any other early vaccines. It is possible that the vaccine or vaccines that Trump is about to unleash on the American public really do work and are safe. It would be a historic first in the development of vaccines — having a Covid vaccine ready for general use by next June or July would normally be seen as a remarkable achievement — but miracles do happen. The problem is that they don’t happen often, and if the full testing regime is not followed, you don’t know if this is one of those times.
It’s only because the AstraZeneca/Oxford University vaccine was going through the full third phase of tests, involving tens of thousands of individuals and many months of testing, that they spotted a bad reaction requiring hospitalisation and paused the tests. Now they have resumed them again. The American miracle vaccine will only start third-stage tests at the same time that it is made generally available. Pauses like AstraZeneca/Oxford University’s happen often in the development of a vaccine. And the pause was temporary because one person in the UK had a side effect but later it was deemed safe to continue with the testing. But even a very low-frequency bad reaction can be a mass killer when tens of millions of people are being vaccinated, and these are not desperately sick people willing to risk anything for a cure. They are people in good health, and you mustn’t kill them.
(Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy and Work.’)
Due to the efforts of AIH, UNICEF and intrepid SHG workers, an entire village in Dantewada is free of its fears of immunisation
If interaction paves the way to heart-touching subjects, the person feels contentment and automatically ventilates with inner thoughts and feelings.” This quote of Elton Mayo, the father of human relations, got justification when the team of Alliance for Immunisation Health (AIH) interacted with Laxmi Kunjam, a Self-Help Group (SHG) member, who shared her diligent efforts for ensuring the immunisation of every child in her village at Koriras in Dantewada district, a project village affected by Maoists. The village posed a challenge to the Rural Health Organiser (RHO) because many new mothers were reluctant to get their infants immunised despite counselling. The reluctance was due to the prevailing myths and misconceptions that a child gets fever and develops other health issues after immunisation. However, this situation is changing slowly but surely as Kunjam, who was oriented and mobilised by the district coordinator during AIH interventions, has been actively engaged in tracking the children, sensitising the people on COVID-19, supporting the RHO during Village Health and Nutrition Day (VHND) sessions and coordinating with other SHG groups in the village on various activities.
Kunjam was encouraged by her husband, a school teacher, to get involved in the village developmental efforts. After getting orientation on Routine Immunisation (RI), hand-washing and COVID-19 from Babita, the district coordinator of AIH, Kunjam was motivated and started associating with the RHO in every VHND session and helped the ASHAs (Accredited Social Health Activists) in bringing the children to the session for immunisation. She was linked with the Panchayati Raj Institution (PRI) and RHO by Babita and allowed to participate in the training programmes. The AIH interventions, that are being handled by Babita, aim at ensuring immunisation and hand-washing at 24 hard-to-reach villages of Dantewada and Bijapur districts, by engaging local institutions such as women SHGs and panchayat-level institutions. One of the attempts of AIH includes the community engagement process where it links the PRI members, SHGs, stakeholders such as traditional leaders, teachers, ASHAs, AWWs (Anganwadi Workers), ANMs (Auxiliary nurse midwife), elected representatives and so on. Women SHGs serve as the main platform at villages for initiating activities and they are reaping constructive results due to their close proximity with the communities.
It is in this drive that Kunjam, as a group member, was trained by the AIH team, extensively on all the sections of immunisation, COVID-19 and hand-washing. She has been associated with the project since the beginning and started working for children in order to save them from diseases. The immunisation programme is fulfilling her objectives as it is the best preventive measure for a child.
The routine immunisation process was thoroughly internalised by Kunjam and she started following every instruction given by Babita seriously. Kunjam motivated her fellow group members and started working on extra miles. Her group visits every household of the village, who has a child to be immunised and informs the family on the programme. Once, she met a mother and found that the infant was not immunised because the woman feared that the baby would fall sick after getting the shots and drops. However, the child was immunised after Kunjam convinced the mother and the family that it was needed for his foundational health.
The system of tracking children, introduced by the AIH team, is being updated with the help of the Rural Health Officer and ASHA workers with necessary pre-alert, counselling, sensitisation and peripheral support. When Kunjam started updating the register and the tracking system, she realised that many children were vulnerable because of their mother’s misplaced fears. She felt that counselling them and clarifying their doubts was the need of the hour and she began an outreach programme.
Initially, she faced resistance from the villagers, who thought that she was getting monetary incentives for getting the children immunised. To convince them otherwise, Kunjam had to take the help of other SHG members, PRI members and the Mahila Panch to make home-visits and counsel women on the importance of routine immunisation. She visited every house with children below the age of 23 months and clarified their doubts. Today, due to Kunjam’s efforts, the entire village is free of its myths and fears about immunisation and new mothers have become conscious about the advantages of getting the children their shots. The Health Department has noticed this and Kunjam’s efforts are being cited by it as an example of how a group with progressive thoughts can cause positive change.
(The writer is State Coordinator of AIH in Chhattisgarh and his work is supported by UNICEF, India.)
The desi variant of regulation has many unique characteristics, namely observing the format even if the content sounds silly
The last six months have seen exponential growth in the use of internet-enabled platforms for communication purposes. More webinars have been, perhaps, held per week than were seminars held per month, in each of the preceding years, with any month being taken as an example. This is understandable because after the initial severity of the lockdown began wearing off and the overenthusiasm of regulations without back-ups created its own long-term damages, gradually a greater sense of realism became a part of the scene. Dealing with a pandemic where — at the best — mitigation was the only strategy (and inexorable personal disaster a real possibility), there was little option but to allow life to begin limping towards the so-called “new normal.” If in the process infection multiplied and unmanageable risks erupted, it was a price which could not be avoided.
The eateries started opening up and public transport was back on the wheels. Those who could not do without air travel went back to flying. The standards were more of a lip-service, than being implemented seriously. Reports had it that two twin airports, called “sister airports” and managed by identical agencies, manpower and serviced by identical airlines, at least on September 10, offered two diametrically opposite scenes. Long queues at Jammu airport, more organised systems at the Srinagar airport. At the Jammu airport, people were reconciled to standing shoulder to shoulder. If in the process they contracted or passed on the virus, how could it be helped? The system wanted to know personal details, including the mobile number. How could one know whether this was a genuine mobile number?
The Indian variant of regulation has many unique characteristics, namely the form must be observed even if the content sounds silly. This is truly an understandable approach because the circumstances demanded that procedures be shown to be observed. Once in a while somebody talks of increasing medical literacy in the extension mode and somebody else notches up a point by talking of public healthcare systems. Once in a while, somebody even talks of some modifications in the medical education curriculum. Truly speaking, nothing much seems to have been seriously attempted. At the time of writing this column, guidelines were being issued for re-opening of higher educational institutions: “Staggering of classroom activities to be done with separate time slots to allow for adequate physical distancing and disinfection of classroom premises…and so on.” It has been directed that a distance of six feet would be observed between desks. It is mandated that academic scheduling should have an intermix of regular classroom teaching and online teaching and assessments. What has been missing is a back-up calculation to assess how many square metres of space does an average educational institution have? The smugness of powers that be is touching. It is duly leavened by people willing to sing praises to it in the hope of some compensating privileges coming their way. The guideline document is a delight to read: “Institutions conducting skill or entrepreneurship training, higher educational institutions conducting doctoral courses and postgraduate studies shall specifically ensure online and distance learning….’’ The document even goes on to suggest the “utilisation of any outdoor space by relocating equipment outside like in veranda, courtyard, shed and so on.” This kind of wisdom eludes comment.
The truth of the situation is, in the absence of any standards of prevention, in a verifiable sense, one cannot sense what the future would look like. The efforts seem to measure up only to a format. It is little wonder then that on September 9, India had the highest number of cases in a single day of any country on this planet. The official response was swift, pointing to “the low percentages of fatalities.” This debate should not even have begun. In reality, no real teaching has begun in many places. There is much drumming up of the “hybrid approach” but the contents of the curriculum have not even been touched.
Education as a domain is not a fallow field where anyone can walk all over with command and confidence. It is management of an expert system and the identification of genuine experts in sufficient numbers to plan, develop and execute is an important pre-requisite. The powers that be claim that the education policy had comments from over two lakh individuals. This is fabulous. Who were the core group of people — with what expertise — to screen their reactions? Nevertheless a good aspirational document has emerged. What is now required is its conversion to an operational level. A rebirth is possible provided the envisioning is clear and process issues clarified.
(The writer is an internationally-acclaimed management consultant)
With over 4.66 million cases and 77,472 deaths, India has overtaken Brazil to become the second worst Corona-hit country. This is not all, there are around 95,000 cases reported daily. Is India witnessing a second wave of the virus? MUSBA HASHMI speaks with doctors to tell you more
Just when we thought that India is getting a respite from the Coronavirus and the Capital is on its path to recovery, the second wave of the virus is about to grip the nation. So much so that the country started to recording not less than 80,000 cases per day and went on to overtake Brazil to become the second worst-hit country by the virus.
Having said that, what seems like a silver lining in the clouds is the recovery rate which has soared to 77.77 per cent.
Dr Ajay Kaul, Chairman & HOD — CTVS, BLK Super Speciality Hospital, tells you that with over a billion population, lack of hygiene and overcrowding there is a good chance of having a second wave of COVID-19 and that India is prepared to handle that.
“This pandemic has prepared us very well for the second wave or any other outbreak of a major pandemic in future. The rise of technologies like telemedicine and teleconsultation, proved to be beneficial during this time because it has minimised the doctor-patient contact. This technology has been there for years, but was not being used frequently. Also the use of 3D-printing to make various equipments like ventilator, mask, PPE kits and other disposable items at a very short notice and custom made according to the needs of the medical staff, has equipped us to lead the fight. Not only this, but with the help of various apps which can be installed on mobile phones, we were able to trace the infected people. An example of a country that made the best use of technology for curb the disease is China,” Kaul says.
He adds that in order to slow down the falling economy many shops, metros and shopping malls are opened up and a lot of people are already flocking to these places. This along with the lack of discipline and preventive measures is definitely going to bring a second wave of COVID-19. But, fortunately this time we are better prepared to handle the problem. In hospitals too, we are well prepared to segregate the patient right from the emergency unit to the ward, the whole hospital is geared up to manage an infective patient without contaminating the other routine patients.
We should learn from the countries which has reduced the infection rate and are back going to normal, he says. “The countries like Germany, Italy, Spain, UK, France and other European countries where despite of an early rise in the number of cases, implementing strict measures are able to reduce the number of infected patients. This is an example that it is not to impossible to curb or at least slow down the spread of the virus,” he tells you.
There are reports that claim that winters can prove to be worse in terms of the virus spread. However, Kaul says it can be the other way round. “Since, very little is known about this virus, we still don’t know what is the effect of weather and climate on this virus. Normally, viruses multiply rapidly in cold atmosphere and a decline is seen in summers, but this was not true about coronavirus where even during the peak summer months in India the virus continue to spread very fast and in fact during the months of June and July it was a peak time. So contrary to the normal belief that in winters there may be an increase in the number of patients, it may be the other way around. But, we shouldn’t forget that in the months of October and November there is a sharp increase in the number of patients with other viral illness. So, we have to be very careful and should perform hand hygiene frequently. Social distancing and face masks are the preliminary shields in fighting the virus,” he says.
He adds that the number of cases may see a decline from October onwards, when the case load rate gets lesser than the recovery rate, there after COVID-19 patients would start to see a decline.
Dr Shiba Kalyan Biswal, Consultant, Pulmonary and Sleep Medicine, Narayana Hospital, Gurugram, says that one can’t speculate about whether the country will see a second wave or not.
“While witnessing an alarming rise in the number of infected cases it is understood to be sceptical about the situation. Considering population, congestion, infrastructure and lack of proper use of mask and social distancing norms in a section of society in the country are adding to the problem of rising cases, but it cannot be considered as a second wave, and it cannot be speculated whether our country will see one or not,” he tells you.
The reason behind the increased number of cases, he says, is lockdown being lifted with guidelines and restricted movement is almost free. “People are now coming out of their confined places for economic reasons. And once you step out of your house risk is there. Lesser education, poor awareness and lesser understanding about the precautions related to COVID infection are adding to the problem. The situation is such that it is hard to identify whether the person standing next to you is infected or not, because there are asymptomatic cases as well. Hence, the person may be feeling totally fine, but still can be the carrier of the virus. To curb this, the crowd in public places needs to be managed,” Biswal says.
Our healthcare workers, doctors and frontline warriors are fighting this battle day in and out. Hence, we are more prepared to fight the virus, he says. “A number of steps have been taken by the Central and State Governments. We have private and Government COVID care centers. Every required step is being taken as per the need. Now that we all are aware about the infrastructure and lack of availability of proper medication in certain areas of the country, we need to work on that as well. As far as the treatment is concerned, even developed countries are working hard to prepare a vaccine and medical trials are being done. This virus and its mutation is making the situation more complicated,” Biswal says.
As for the cases of reinfection that India has seen in the past few days, Biswal says that it can prove to be a setback.
“Without any doubt it may prove to be a setback because this means a COVID-19 survivor is equally at the risk of getting infected again. Developing antibodies may help to fight the infection but it is not a guarantee that one cannot be infected again. Back in time we had witnessed the same with dengue. In some areas, people were repeatedly getting infected with the same disease again. Hence, precaution is the key for everybody. Follow a healthy lifestyle, work on your overall wellbeing and consult a doctor if needed,” he asserts.
Dr Shuchin Bajaj, Founder-Director, Ujala Cygnus Healthcare Services tells you that the high number of cases that are recorded every day can be a result of the second wave. “It looks like the second wave of COVID-19 has already started. And with more States opening up for business purposes, we can say that this wave will be severe and more widespread. Because usually the second wave of any disease is more severe with higher fatality rates. Take for example the Spanish flu, the second wave of which was started in winter season was deadly. For COVID-19, it may not be deadly because we have better healthcare infrastructure and facilities and certainly have more knowledge about this virus. But having said that, the number of cases are expected to rise in the second wave for sure,” Bajaj explains.
To protect ourselves in the second wave, he says, people need to be more vigilant than ever. “Proper sanitisation is must. Follow the rule of SMS — Sanitisation, Mask and Social Distancing. As the virus is relatively new, we don’t know the post infection complications. Hence, it is all the more important to follow proper hygiene practices. We have seen some young patients who got cured but months later they came back to us with breathing problems. The only solution is to take as much precautions as possible,” he says.
He adds that with winter approaching we have to be more careful. “The Spanish flu’s second wave was seen in the winter months. The viruses are known to thrive in cold conditions and the infection rate is high in cold weather,” Bajaj says.
‘Following a centralised crisis management approach is key’
At a time when the world is fighting to curb the raging virus, Praja Foundation released its report on the Importance of Local Governance in Crisis Management in Mumbai on September 8, 2020. The report is based on Praja's COVID-19 response study of 29 cities across all 28 States and NCT of Delhi in the initial phases of lockdown during the months of May and June, 2020.
Nitai Mehta, Founder and Managing Trustee, Praja Foundation, says that the country followed a strongly centralised approach during the initial phase of the lockdown.
“Cities across the country have become hotspots of the COVID-19 virus. City level crisis management is of paramount importance in the wake of such crises. However, it was observed that the COVID crisis management in the country followed a strongly centralised approach during the initial and extremely vital period of the lockdowns before June 2020,” Mehta tells you.
Under such circumstances, it is important to understand how city Governments across the country were handling the COVID crisis in the cities. Hence, Praja reached out to stakeholders i.e., elected representatives, administrators of City Governments and CSOs in 29 cities across 28 states and NCT of Delhi.
“To start with, Praja's COVID response study highlights that eight cities (Vijayawada, Itanagar, Guwahati, Bhopal, Shillong, Kohima, Bhubaneswar, Coimbatore) out of the 29, do not have an active functioning City Government council as municipal elections are yet to be held,” Mehta says.
The report also covers key data points on the involvement of City Governments and Councillors in the COVID crisis management interventions, City Governments that undertook ward level actions, and on distribution of control over delivery of public health service in the cities.
“The decentralised and efficient delivery of public health services have always been very important, especially in this pandemic. In line with this, The Twelfth Schedule in the 74th Constitutional Amendment Act has provisions on the need for State Government to devolve Public Health function to the City Government. However, it was noted that out of the 29 cities covered in the study, the control of delivery of public health services lies with multiple agencies in 20 cities, and only in four cities, the City Government has control over the delivery of public health service whereas rest of the five cities have public health service delivery under the complete control of the State Governments,” he tells you.
The report also covers the case studies of Agartala, Aizawl, Guwahati and Kochi, which have set examples of localised management of COVID crisis through decentralised citizen engagement in the city.
In Agartala, The Agartala Municipal Corporation (AMC) utilised the ward committees led by the Mayor and respective councillors across the city for discharging quick relief measures as a result of the COVID crisis. Localised monitoring and enforcement of COVID-19 norms were issued at each ward. The AMC also used shelter home kitchens for supply of cooked food to the migrant workers.
We must call out all instances where the rule of law is being compromised to suit an agenda. Given the state of TV news, there’s a lot of damage to be undone
In 1958, Peter Yarrow wrote a song called “Puff the Magic Dragon” before he formed the popular band, Peter, Paul and Mary. The song gained widespread notoriety even years after its release because it was rumoured to be about celebrating drugs, particularly marijuana. Singapore and Hong Kong even went so far as to ban the song, fearing that it would promote drug abuse. In reality, the song (which is a classic), was included by the band in its album, Moving, as it thought it would be a good idea to include a children’s song. That assumption came easy as the song was written in 1958, when Yarrow didn’t even know what “pot” was. The lyrics are about the loss of childhood innocence and are actually inspired by an Ogden Nash poem that has nothing to do with marijuana.
On a completely unrelated note, in this past week, Rhea Chakraborty has been arrested by the Narcotics Control Bureau (NCB) apparently on the allegation that she procured marijuana for Sushant Singh Rajput and might have even consumed it herself. The arrest came after Ms Chakraborty was being grilled for close to eight hours for three days straight and without any contraband actually being recovered. The inspiration behind the arrests appears to be the WhatsApp messages that allegedly referred to the procurement and consumption of marijuana. Before the arrest, certain “news” channels had already declared her guilty with hashtags like #ArrestRhea, were displaying WhatsApp conversations and extrapolating conspiracy theories on national television from morning till late night as “political analysts” gave their non-expert commentary. After seeing the steep fall in standards of TV journalism over the past few years, it may be naïve for us to expect such channels to follow rigorous (or even lax) journalistic standards but it was amusing and a bit surprising to see viewers tuning in and even supporting such on-air antics. I say surprising because if Rhea Chakraborty can be arrested in the manner she has been, parents should be seriously worried about their college-going children and even themselves and should ponder on when the State and its informal agents may turn their glance on them. The charges against Rhea Chakraborty seem to (on the face of it) lack any weight and will be rightly examined by a court of law but the trial in all respects has already been played out on our television screens. The only real consequence, I suspect, will be that officials will now be able to scare individuals by just talking about this entire episode and extracting a larger bribe.
You, dear reader, might say you have nothing to fear and will, therefore, welcome scrutiny of my WhatsApp messages or that of your children. Maybe you have nothing to worry about when it comes to marijuana but are you sure that the State and these news channels cannot find something else to pin you on? Again on a completely separate note, let us talk about pornography. There is technically a ban on pornography in India. However, as per statistics, India is a world leader in the consumption of pornographic material with close to 89 per cent consuming it on their phones. If you enjoyed watching another person’s intimate texts displayed all over national television, I wonder if you would feel the same about your internet search history. What is especially interesting about the instances highlighted above is that rarely are the rulers governed by the same rules as the ruled.
Just look at the example of the Laxman Savadi and CC Patil, BJP Ministers who were caught watching porn inside the State Assembly.
In the case of drugs too, it is hardly ever the powerful who are punished. Most drug arrests are on charges of consumption of marijuana by watchmen, students and hardly ever well-connected politicians or media moguls. In a study by the think tank Vidhi, data from Mumbai revealed that though cannabis constituted just Rs 6.2 crore of the Rs 60.6 crore worth of drugs seized in Maharashtra in 2016, it accounted for 87 per cent of arrests and convictions. This means that more serious drug consumption, like that of heroin, opium and so on, easily slips through the cracks while minor marijuana charges are picked up to show better statistics. The nexus of politicians with dangerous drugs like heroin is well documented and this is with respect to not merely consumption but of widespread sale. However, all our attention has been on this 28-year-old woman for allegedly smoking pot, while a Bill to regulate the use of cannabis is pending in Parliament.
Even assuming the best of intent, that the Government is serious about drug consumption, it would do well to note that one of the primary reasons young people are pushed to drug consumption is unemployment. Statistics on employment generation are abysmal with the Mint reporting that India is witnessing its weakest hiring sentiment in 15 years. The media would do a great service reporting on this root cause rather than spending most of its time on what can only be called voyeuristic entertainment.
At its core, all of these episodes show that we as Indians have slowly but surely descended to a state where political agenda trumps rule of law. This cuts both ways. For example, though Kangana Ranaut’s statements on Mumbai being Pakistan-occupied Kashmir are ridiculous and would lead to sedition and NSA charges in a State like Uttar Pradesh (going by how Kafeel Khan was treated), she is seen as a “nationalist.” However, the demolition of a part of her office by the Bombay Municipal Corporation “smacks of mala fide” as noted by the High Court of Bombay and is another instance of how the rule of law has been treated as an inconvenience. The only way forward, in my humble opinion, is to course-correct and to call out all instances where the rule of law is being compromised to suit an agenda. Sadly though with the state of TV news as it is today, there is a lot of damage to be undone and this goal may be a long time coming. So till then, please make sure that you are not listening to “Puff the Magic Dragon” in your car stereo or in public. Who knows what may follow?
(The writer is a former IPS officer, a former MP and currently a member of AAP)
Celebrities make news but we need to map the extent of drug abuse among young Indians and address systemic flaws in curbing it
For the large consumers of salacious news and celebrity scandals, there may be a sense of comeuppance about Rhea Chakraborty’s arrest for supplying drugs to late actor Sushant Singh Rajput. The conspiracy theory that she might have pushed him to addiction, swindled him, could have diverted funds and in the process pushed him over the edge by entrapping him in a world of debt and drug cartels, has become a credible story that the nation is devouring hungrily. Simply because legal evidence and cold facts of the actor’s mysterious death are too dry to be juiced out for news cycles. Simply because a glamorous starlet allows the masses to project their sinful obsessions, aspirations and high crimes to a certain societal strata and claim moral righteousness by exclusion. So Rhea going to jail becomes a visual that is more satisfying as a portrait of instant justice. Just as the arrest and subsequent police custody of Karnataka actor Ragini Dwivedi in relation to a drug bust is representative of how the State film industry is addicted. Or actor Kangana Ranaut’s campaign to clean up the Hindi film industry of narcotics, as she challenged its youth icons to take the drug test, made substance abuse a headline point. Fact is, film industries everywhere have had celebrity drug users for years, the likes of lysergic acid diethylamide (LSD) and methylenedioxy-methamphetamine (MDMA) common in the circuit. Many film personalities have been involved in the drug racket either in the capacity of a consumer or supplier. That by no means should normalise their behaviour or exempt them from punishment. But a top-notch arrest makes a seething urban sub-culture a sensational discovery. The fact is the drug menace exists in the corporate sector, among high fliers, students and the next door neighbour in Indian cities. Rave parties, often funded by drug syndicates themselves, have not left any of our cities untouched. Still, urban India justifies its self-denial by projecting its ills on to others and condemning them.
So nobody talks of this year’s biggest drug seizure by the Narcotics Control Bureau (NCB) in July when its officials recovered 234 kg of opium in Rajasthan. It seemed some legal cultivators, especially those in Mandsaur, Neemuch and Ratlam districts of Madhya Pradesh and Chittorgarh and Jhalawar districts of Rajasthan, diverted opium through illegal channels and sold it to intermediaries for profit. Drugs have become a societal epidemic, affecting generations and percolating through all strata, presenting a much larger problem than the faces we might try to attach to it. According to an AIIMS report, Magnitude of Substance Use in India, which it submitted to the Ministry of Social Justice and Empowerment in February 2019, around five crore Indians had used cannabis and opioids at the time of survey. About 8.5 lakh people injected drugs. About 60 lakh people were estimated to need help for their opioid use problems. More than half of these numbers came from Punjab, Assam, Delhi, Haryana, Manipur, Mizoram, Sikkim and Uttar Pradesh. But the most shocking discovery was that of alcohol being the most abused substance in India. Disturbingly, more and more children are taking to alcohol consumption and the highest percentage has been reported from Punjab followed by West Bengal and Uttar Pradesh. Even more disturbing is the fact that students, particularly those in harshly competitive disciplines like medicine and engineering, are routinising drugs as a stress-buster. So drugs, more than an aberration, have now become the commonest relaxant among the young. Ignoring their destructive aspect, students see them as a coping strategy as they battle performance pressures. Then there are the usual triggers like peer pressure, which make drug consumption almost like a rite of passage. People in the lower income group or the jobless seek the same kind of escapism. And the police system has failed to plug the loopholes that allow for easy availability of drugs. With smuggling rampant among porous border States, it is indeed difficult to track every consignment that moves rapidly along a well-established traffickers’ network.
There is a need to strictly implement the Narcotic Drugs and Psychotropic Substances (NDPS) Act, which provides for care and legal rights of the drug user. But our de-addiction and rehabilitation centres are ill-equipped to rescue the youth. Counselling should be institutionalised in schools and colleges, with physicians and psychologists holding workshops from time to time. Community-level interventions through self-help groups, that are at the forefront of many corrective campaigns, should be prioritised. Also, there is a need to define addiction strictly in the Act. Otherwise, it equalises hardcore addicts with recreational users, the former diseased by dependency and helplessness, the latter making a conscious choice by design. Drug users are a vulnerable lot and we shouldn’t stigmatise them as criminals. That defeats the purpose. Similarly, many experts have suggested legalising the use of cannabis as that would lead to a regulated economy and use. You can certainly punish Rhea Chakraborty for smoking weed but how many young people will we put into jail by that logic? So let us get off our high hobby horse, effect systemic changes and stop looking for scapegoats to expiate our collective guilt.
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Kangana has become Bollywood’s bete noire but the Y-plus security makes her a pawn in a larger political game
Several years ago, the fiery Kangana Ranaut appeared on the cult Bollywood talk show called Koffee with Karan hosted by producer Karan Johar. To paraphrase from that outing of hers, she said that if a film was ever to be made about her life, Johar would be the antagonist. Over the past few years, we have seen how that has played out. First, there was the story about nepotism and how Bollywood promotes its own, and while the Indian film industry epitomises nepotism, it really is not very unique in that regard. Anywhere in the world or in India, nepotism is a byword in politics and industry. So when popular Bihari actor Sushant Singh Rajput allegedly committed suicide, Kangana was one of the first to climb onto the bandwagon to accuse the nepotism of Bollywood of pushing a young actor over the edge before quickly jumping on to the murder conspiracy theory. And then from a crusader, she appeared more and more like a headline-grabber. She has written utterly shameful tweets against mental health, questioning the very concepts of psychology, and taken on the Shiv Sena, a partner in the Maharashtra alliance government, with several party spokespersons attacking her. There is no doubt that with little to no formal media training and reverting to type, Shiv Sena leaders come across as uncouth, sexist goons while attacking Kangana, who is playing her pro-BJP card well and using it to give ammunition to the Central party’s relentless attack on its one-time ally. So she has been given Y plus category security by the Central Government to make a point, never mind the costs this will involve or the purpose it will serve. That possibly will not save her office from being demolished by the Brihanmumbai Municipal Corporation (BMC) which is controlled by the Shiv Sena, an act that, if the Sena goes ahead with, will allow the once-plucky Kangana to play the victim yet again.
While the actor is entitled to her opinions, it would be prudent for her to remember that the past can come back to haunt you. Her actions today, that make her look like a pawn, will be judged by many in the future and while she has in the past raised some very valid points against the extreme nepotism in the film industry, where a talentless child of a superstar gets breaks that others would not, that model itself is being broken by new streaming platforms and more choices. Bollywood itself will not survive the Coronavirus pandemic in any recognisable shape or form. The actions of the television media in amplifying some of the wilder allegations raised by Kangana and others of her ilk have also been shameful and must be questioned. This entire affair will leave India, the Indian media and Bollywood scarred for years to come.
With cases spiralling in rural districts, the pandemic could just about be felt like never before. We have a long haul
There is no denying that we are racing to be the next epicentre of the pandemic. What the series of early lockdowns did was to slow the virus down and give us enough time to ramp up our medical infrastructure and get a grip on disease management protocols. But it could not contain the pathogen’s infectivity or trajectory as it has ultimately trickled down the trellis of megacities, their hinterland and has found its way in the countryside. And now that lockdowns have been eased to grease the economy and restore its operability, it is coursing through with an all-consuming rage. If the super-spreader dhabas at Haryana’s Murthal are any indication, which reportedly infected around 10,000 people, then it isn’t difficult to understand why we are taking lesser and lesser days of doubling time and why we may overtake Brazil soon and the US in a month in terms of caseload. And these nations are nowhere as populous as us. Unlike the US and Brazil, India’s caseload is still accelerating seven months after our first Coronavirus case was reported on January 30. New infections are plateauing out in these two severely-hit countries even without restrictive protocols while they are spiralling here. Given the poor public health infrastructure in rural India, and the fatigue and strain that the existing one has been put through over the last few months, we could be standing at a tipping point of either reining the virus in or keeling over. The next month is our real test and would show if we can really flatten the curve. Testing, though increased much, continues to be a challenge, given our huge population and we are far behind Brazil in terms of the sample ratio covered. This is evidenced by the latest antibody studies in New Delhi and other cities, which show that the number of people who have signs of being infected is multiple times bigger than the official caseload. If this is true, then the extent of community spread is far bigger than what the official case tracker shows us. Worse, it would be difficult to assess how much testing is enough to map the trajectory of the disease. In fact, the Indian Council of Medical Research (ICMR) has issued a new advisory on testing strategy, allowing “testing on demand” for individuals rather than waiting for the doctor’s prescription. It also advised “testing on demand” for “all individuals undertaking travel to countries or Indian States mandating a negative Covid-19 test at the point of entry.” Worryingly, the current scenario could also put pressure on keeping mortality figures down as early detection and treatment may not be as efficacious in rural India and many fatalities could go unaccounted. We still have to rely on conventional testing, considering rapid antigen tests are throwing up too many false negatives and, therefore, cannot be relied upon at this critical juncture. But RT-PCR labs are currently located in big cities or district headquarters, so what does one do in smaller towns and villages?
Infrastructure and response protocols pose a big challenge in rural India and can no way be seen through the prism of urban preparedness. Even though the swamp has not happened yet, there are reports of dismal conditions at district hospitals. Compounding problems is the lack of trained medical personnel, response teams who can sense the signs and emergency equipment like pulse oximeters and chest X-Ray facilities. Then there is the issue of more at-risk patients, the indices not too encouraging among a population that doesn’t meet basic parameters of nutrition and physical well-being, particularly women and children. Of course, some of the rural areas are not as densely clotted as cities and business hubs are, which should make surveillance and tracking a key component in chasing the virus. In fact, the Dharavi model could well work here. Mumbai’s slum cluster showed how resource-deprived and under-served zones can fight the virus, too, provided there is community engagement and it is here that panchayats and self-help groups can be made aware and skilled to arrest the spread. In Dharavi, community volunteers fanned out among seven lakh people, tracking signs and symptoms and tracing contacts of the infected. They got in mobile testing vans, thus supplementing the work of overworked health centres and ran fever clinics to let people get themselves checked without fear. Volunteers checked people’s oxygen saturation levels and if they were below 95 per cent, rushed them to quarantine centres. Local clubs and schools were converted into quarantine facilities, leaving hospitals for the critically-ill. In short, they had a ground-up connected chain of warning and response system that saved lives. The bigger problem with the spread in rural India is that it could be a slow-burner and continue longer. And with people moving inter-State in the new normal, cities could look at a second wave from returnees. With the vaccine trials reporting a 50 per cent success rate till now, India could have to battle a winter of discontent.
Although the Govt has taken a positive step to introduce a standard policy for battling Coronavirus, hospitalisation and other medical costs, it should also make it easier for the claims to be settled
T he outbreak of the Novel Coronavirus in the city of Wuhan in China towards the end of last year became a major health emergency and a global pandemic. Over the last 10 months or so, different parts of the world have been the epicentres of this contagion. Governments around the world have reacted to this unprecedented situation by taking extreme measures like closing international borders and air space, imposing restrictions on domestic travel, prohibiting huge gatherings like sporting or religious events, shutting down entertainment hubs and educational institutes. The toll of the virus on both personal and economic aspects has been tremendous with the huge loss of human lives and slowdown of economies around the world impacting several industries and the financial markets. Governments have responded by providing a slew of measures to aid the ailing industry by providing liquidity and slashing interest rates, among others.
The insurance industry is one such industry that had to react quickly to this situation to develop new products in the face of the growing spread of the Coronavirus and the socio-economic uncertainties it brought in its wake. Lack of education and awareness have been the main reasons for India being largely under-insured, particularly in the area of health insurance, with only 18 per cent of the urban and 14 per cent of the rural population availing protective schemes. The Insurance Regulatory and Development Authority (IRDA) recently made the availability of the standard health policy, Corona Kavach, mandatory. Though it can’t replace the normal mediclaim policy, and all standard indemnity policies are covering Coronavirus in India, if people don’t have a health insurance, or if they are not adequately covered by their health insurance, it would make a lot of sense to buy this special policy. Especially given the fact that India now has nearly 37,69,523 confirmed cases of Covid-19, the third-highest in the world after the US and Brazil. There are no drugs as yet to fully cure patients and work on the vaccines for the virus is still in the trial stages.
While most people with mild symptoms recover with the medicines prescribed by doctors, in extreme cases, infected people require hospitalisation and ventilator support. That is where the bills go up exponentially and this is where a person who does not have health insurance or whose cover is not adequate will be most vulnerable as the out of pocket expense will be huge. The features of Corona Kavach are very standard and cover both individuals and families, and it is available in one basic mandatory cover offered on indemnity basis and one optional cover available on benefit basis. Corona Kavach is a single premium plan where the sum insured is in the multiples of Rs 50,000 where the maximum sum insured is Rs 5 lakh, minimum being Rs 50,000. Not only is the Corona Kavach a standardised policy, which is uniform across all the insurers, it is also very comprehensive, covering homecare and Ayurvedic, Unani, Siddha and Homeopathic treatment, PPE and treatment of co-morbidities when hospitalised, including any ventilator and ICU charges, ambulance cost upto Rs 2,000, pre and post-hospitalisation care upto a certain number of days and daily cash allowance of 0.5 per cent of the sum insured for a certain number of days. Some insurers do not have a cap on the room rent as long as the room availed is a single private one.
Then there is the Corona Rakshak which is an optional benefit-based cover that can be issued by life insurance companies also in addition to health and general insurance firms. The maximum sum insured is Rs 2.5 lakh, which is offered as lumpsum and can be used at will, especially during home quarantine, on treatment, medicines and for nursing charges. The tenure of the policy and waiting period remains the same as that of Corona Kavach. The requirement for claim in the Corona Kavach policy is a positive diagnosis of Coronavirus from a Government-authorised centre and hospitalisation for 24 hours. For Corona Rakshak, other things being same, the hospitalisation requirement is for 72 hours. One is also unsure of the amount of additional cover required if an health insurance policy is a part of the portfolio. An individual should have a health insurance cover of Rs 8-10 lakh, so depending on this, an additional coverage of Corona Kavach can be taken, to top up your existing health policy. But remember to choose a top-up Corona Kavach policy from the same company as your basic health policy to claim cashless benefits for both. In most of the cases, co-morbidities will also be covered during the claims. The premium may vary from as low as Rs 127 per month to as high as Rs 14,927, based on the sum insured, availing family cover, age of the insured and so on. The IRDA has given a go-ahead to 29 general and health insurance companies, both State-owned and private, to market the Corona Kavach policy. Some of the prominent State-owned insurers marketing this policy are SBI General Insurance, National Insurance, New India Assurance, Oriental Insurance and United India Insurance. Other renowned private players include Acko General Insurance, ICICI Lombard General Insurance, HDFC ERGO General Insurance and Star Health and Allied Insurance among others. So how do you choose the insurance company? There are some factors, among others, that can help you make a wise decision.
Affordability: Choose an insurance company that can provide these policies at an affordable premium.
Choose family coverage: It is also important to cover your entire family and, therefore, choose an insurance company that offers coverage to family.
Network: A health emergency can strike you, anytime and anywhere. Therefore, choose an insurance company that has a wide network of hospitals around the world.
Healthy claim settlement ratio: Choose an insurer who has a high claim settlement ratio, which means it settles more claims than others when compared to the total claims received.
Although the Corona Kavach is very comprehensive, there are still circumstances which are not covered. First, if the diagnosis is negative or not from a Government-approved centre. Second, if hospitalisation is not required and the patient undergoes only day care procedures. Third, if medicines are bought without proper prescription; fourth, if the treatment is availed outside India and fifth any vaccination, inoculation expenses used for prevention of the condition are not covered in the policy. So we have to be careful about different situations under which our claims may not be processed. One of the reasons a claim may not be approved is the choice of the line of treatment. It is a grey area as only treatments, which are approved by the Indian Government, are recognised by the health insurers. For example, the recently-tried plasma therapy is not officially recognised by the Government. The insurance companies are claiming that they have eased their norms to make it easier for their customers to settle claims, like accepting email submissions and in some cases, on meeting certain conditions, without policy documents. The LIC settled more than 561 Covid-19 death claims amounting to nearly Rs 27 crore till the last week of July. Although this data looks impressive, there are a number of cases where the kin of Corona warriors like doctors and nurses, who died of Coronavirus, are battling to claim the insurance money. Red tapism is making their lives hell and the families of the deceased health workers are struggling to prove that they contracted the deadly infection in the line of duty to claim the Rs 50 lakh insurance provided by the Government.
In some cases, insurance claims were not approved of doctors and nurses who laid down their lives in taking care of patients as they were not Central Government employees. Although the Government has provided an insurance scheme for frontline workers like sanitation workers, ASHA workers, ward boys, paramedics, doctors, nurses and specialists, it fails to cover their treatment and is limited to their death. Even after months into this pandemic, several claims are rejected due to the confusion about the eligibility and other requirements buried within the fine print of policy guidelines of the insurance companies.
Although, the Government has taken a positive step to introduce a standard policy for battling Coronavirus, hospitalisation and other medical costs associated with it, it should also make it easier for the claims to be settled. Though the insurance money can never replace our loved ones, the bereaved family members can at least hope to pick up the remaining threads of their lives with it.
(The writer is Associate Professor, Amity University, Noida)
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