Re: NACP III: Differing health needs of states

[Guest guest]

Dear Rajeev, Dr.Ajith and others,

It is very thoughtful of both of you to think about assessing the gaps in NACP

II and think of planning for NACP III. Many of us are in all sorts of

consultations for both and hence this process should

be taken further to engage all sectors in the health and family welfare sector.

Throughout NACP II, many of us within the community based health sector have

realised that though NGOs and CBOs can work furiously and faithfully within

their communities, the efforts are at best a catalyst in kick-starting the

public health sector to deliver on its promises.

There is no alternative to integrating the NACP into the other successful health

programs initiated by the Indian State.

I think one of main reasons for the variant views about the way the NACP has

been executed is that it was isolated from other health programs and went its

own way. Many blame the World Bank and still others the obsessive glamour and

glitter associated with HIV/AIDS.

Both are rendered redundant precisely because of how Rajan Gupta describes the

epidemic so aptly : " HIV/AIDS is going to be a very hard to eradicate. Stigma,

taboos, sexual transmission, and a very long asymptomatic period make it a

unique pandemic " .

And even though Gupta optimistically pays great stress on the private-public

ownership berween the NGO and the government sector, I'm afraid that the

government alone will finally have to " take ownership " for fighting this disease

by integrating it actively into the reproductive and child care programs within

its reasonably successful family welfare programs.

It's going to be difficult as Health is a non-concurrent subject to be

administered and executed by each State within the Union of India;

hence the uneven development of the health sector in india. There are wide

differences in the revenue expenditure on health with the Southern states

leading the charge into the health sector.

Surely, we cannot be expected to penalise Kerala or Tamil Nadu for having spent

so well on the health of their people by denying them more resources just

because the northern states wasted their revenue in getting chief ministers

swindling money from even fodder allocations for cattle during drought years?

A state like Bihar which sends the largest number of IAS officers, has a

flourishing diary industry, a well entrenched education infrastructure and a

highly politicised electorate, must be forced to

spend more on health. And when I say health, I mean starting with ante-natal

care, basic reproductive health care and dealing with male sexuality gone

haywire because of massive migration for employment.

In places like Mumbai, for example, UP and Bihar represent nearly 35 per cent of

migrant labour according to every BSS done since 2000.

So large is this demographic shift that the recent elections saw

the Shiv Sena voted out as the local Marathi population has been reduced to 40

per cent in most city constituencies.

It's also time to review the role of the various SACS which were meant to

short-cirucuit the complicated bureaucratese built by the Left-talking political

class following totally anti-people policies.

For example, before the SACS days, even NGOs in well connected Mumbai had to go

to Thane to collect their cheques as the state treasury was located there- 70

km outside the city centre.

However, instead of creating vibrant centres for an integriated health discourse

and funding for innovative HIV/AIDS prevention programs to dovetail them into

the state's other health programs, nearly all the active SACS have gone their

own way becoming hot beds of politics and didactic discussions within a lack

lustre public health program.

This has also encouraged a totally backward looking intellgentsia with neocon

ideas hiding under various labels of cultural or national chauvinism as recently

happened in a veritable witch hunt against sexual minorities on this list.

The exercise to develop NACP III should begin by looking back at such huge gaps

in NACP II. Without identifying those gaps, it is going to be increasingly

difficult, nay impossible, to give a conscious and well defined direction to

NACP III.

Whether this is being done is the million rupee question.

I think an effort is underway but whether the suggestions will reach concrete

fruition is the bigger question....

Ashok Row Kavi

Humsafar Trust

Mumbai Metro

E-mail: <arowkavi@...>