Should We Laugh Or Cry?

The Prime Minister of India, Narendra Modi, has been given the prestigious "Champion of the Earth" Award for this year by the United Nations Environment Programme jointly with the French President Emmanuel Macron for launching the International Solar Alliance. He has also been nominated for the Nobel Peace Prize by a Bharatiya Janata Party member from Tamil Nadu for launching the world's largest public health insurance programme - Ayushman Bharat. Are these two programmes indeed game changers as claimed to merit such high recognition? Let us find out what the reality is.

The foundation of a successful public health programme is its primary health outreach. Most illnesses start as primary health problems and need to be tackled at the initial stage itself to prevent them from escalating into immediate or chronic health problems of a serious nature. Unfortunately, the government primary health infrastructure and servicese in this country, especially in the rural areas, is woefully inadequate and dysfunctional. Consequently, most people have to rely on quacks and tradtional medicine men for their primary health problems with devastating consequences. Both these categories of health service providers practice irrational medicine and complicate rather than cure people. We try to provide rational health care, which also includes advising people to change their diet to make it more nutritious, but the hold of irrational food intake and healthcare is so strong on the minds of the people, promoted in no small part by the fast food and pharma industry, that we do not make much headway.

One lady who stays just across the road from our field centre in Pandutalab village and who had seen us cure many people, some in her own family, steadfastly refused to follow our advice. She would alternately go to a quack to get intravenous drips and visit the traditional medicine men to shoo away the evil spirits that had allegedly made their home in her. In between, her father in law expired. This gentleman too had disregarded our advice and despite being a diabetic and sufferer of hyperacidity and hypertension, refused to take proper treatment and relied on traditional healers and quacks instead. As the woman's condition deteriorated further, the traditional medicine men said that her late father in law's spirit had entered her and given the fact that she and her father in law had had quite a few tiffs while he as alive, he was now taking vengeance.

Then one day her husband called me saying that the lady was in very bad shape and getting spasms and would have to be admitted to hospital. This is not the first time that we had got such calls from people in dire medical distress and so I told him to bring her to our office in Indore. We took her to a senior general practitioner doctor and after examining her he said that she was suffering from a combination of hyper acidity and anxiety related problems which had become severe due to long neglect and mistreatment. She was given an injection of an anxiety relaxant drug and prescribed a course of anti acidity and anti anxiety treatment. Within a week she was cured of the severity of her illness and has recovered so much that she is able to work. The treatment is continuing because it will take at least three months to clear the ill effects of the long neglect completely.

Her two sisters in law, who live with her in the same house but in different rooms, also are suffering from various ailments and they too practice the same combination of cure from quacks and traditional medicine men. One of these women has recently become ill and she says that since her sister in law has been cured, the father in law's spirit has now moved into her and is causing her problems.

There is not only a need for providing extensive rational primary health care free of cost to the people but also a massive information and education campaign to convince people to follow proper nutritional diets, sanitation and hygiene practice. Innumerable studies have shown that public investment in primary health care is recovered many times through taxes from a population that is much more productive due to being healthy. Yet the "Ayushman Bharat" programme has bypassed this important basic foundation of a public health programme and instead targeted the secondary and tertiary health problems which require hospitalisation. So far the Rashtriya Swasthya Bima Yojana has not been able to adequately provide for even this hospitalisation care as the costs incurred by the people is much more than the insurance cover in most cases. This will plague the new programme also which while making bold to cover the world's largest number of people through insurance has made a financial provision of just Rs 200 per person for this. Which in effect means that those being hospitalised will get very little actual support. So this neglect of primary health care combined with a measly provision for secondary and tertiary health care will result in the Ayushman Bharat programme coming a cropper and belying its Nobel Prize winning rhetoric of being the world's biggest public health programme.

What about the claims of the International Solar Alliance (ISA)? It has been set up primarily to ensure that countries lying within the two tropics, which have greater solar insolation, the "sunshine countries", utilise fully their solar potential and so reduce greenhouse gas emissions. To this end a financial target of 1 trillion dollars has been targeted to be raised from developed countries which are mostly out of the tropical zone but which have both the financial and technical resources to give a big push to solar energy. To this end the ISA has roped in the old warhorse of many such grandiose development plans, the World Bank, to achieve its goals. Specific to India the goal is to have 100 GW of solar power by 2022. Given that the current installed capacity of solar power is only 23 GW this looks a far fetched dream. What is of greater concern however, is that the thrust of the solar policy in India is towards the installation of mega solar parks instead of towards greater decentralised generation through the involvement of communities and individuals. Thus, the subsidies for solar power are going to big corporations which are setting up huge solar parks and not so much to the poor to encourage them to set up rooftop systems. A vast number of households throughout the country in rural areas is without reliable supply of electricity and even today kerosene lamps are being used and post harvest processing is a serious problem. Rural industries are not being able to take off due to lack of electricity. This is to be contrasted with Germany where 90 per cent of the solar energy comes from rooftop decentralised units. Under the circumstances just making grandiose announcements in international fora and then involving the World Bank, which has consistently funded anti-people development, is a well orchestrated farce like the Ayushman Bharat programme.

Often, I have wondered about what I have achieved in all these years, slogging it out in the field to try and bring some people centric sense into development in this country. When I see the ground reality of people living in adverse circumstances due to a combination of ignorance and faulty planning and the grandstanding of policy makers beating their chests about initiating more such faulty planning I don't know whether to laugh or to cry.