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Mr. Jaitley’s Unhealthy Calculations For Us This Year

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By Lamya Ibrahim:

Post-independent India has had its share of medical achievements to boast of: it witnessed milestones ranging from a doubling of life expectancy to the eradication of Polio. And it continues to churn out world-class health professionals every year. Yet, the UN reports that 70% of our public health expenditure is concentrated in the urban areas, where less than a third of the population lives.

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For a country that has faced major healthcare issues since its inception, the least-recommended step would be to starve its already-dilapidated system. But that is exactly what we see in the case of the finance minister Arun Jaitley’s otherwise balanced annual budget.

The allocated budget for healthcare in 2015-16 is Rs. 33, 152 crore, a little over last year’s Rs. 30, 645 crore. The total amount spent in the first three years of the 12th Five-Year Plan has been around Rs. 70, 000 crore, which falls way below the Rs. 2, 68, 000 crore allocated for the 5 year period. While the government aims to meet its fiscal deficit target, slashing Rs. 60 billion from the budget sets our frail healthcare industry on a pitiable expedition. Our healthcare sector will be unable to meet the minimum expenses.

Currently, India spends a little over 1% of its GDP on public health, in contrast to China’s 3%, Brazil’s 4.1% and US’ 8.3%.

The intention for building an integrated system for delivering affordable and accessible healthcare for all is clearly there, but it is not reflected in this year’s distribution.

It is impractical to simplify the public healthcare scenario. We have understaffed, overcrowded hospitals and clinics, rife with corruption, absenteeism and inadequate resources. Their facilities are far from meeting the requirements for dealing with basic issues, such as malnutrition, infections, and preventive healthcare.

More children die because of preventable illnesses, such as diarrhea and pneumonia in our country than in the neighbouring countries, such as Bangladesh and Sri Lanka. Adults face no less a challenge, when as many as 80 per cent of those afflicted with dengue every year either never seek medical care, or are turned away from overcrowded hospitals.

We also have a nation with a teeming population, decreasing mortality rates, and rising life expectancy rates. All of these have lead to an increase in instances of non-communicable diseases, such as diabetes, and cardiovascular diseases.

Out-of-pocket expenses on dealing with these healthcare problems push an estimated 39 million Indians to poverty every year. Under addressed mental health issues too paint a tragic picture as India’s suicide rate in the age group of 15-29, arguably the most productive period of an individual’s life, is the highest in the world.

The cutback affects schemes concerning a range of issues including malnutrition, right to education, health, child protection, and support to the disadvantaged groups – the scheduled tribes and castes. While allocations in these areas have always been significantly less, these cuts will push some of the schemes further back and ensure that they can’t be launched at all.

Schemes such as Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM) have been hit hard just as they were beginning to show results. Worse still, the Finance Ministry has ordered a cut in the spending for India’s HIV/AIDS program by about 30 per cent to Rs. 13 billion, an absurd step for a nation that accounts for more than half of all AIDS-related deaths in the Asia-Pacific region.

Another missed opportunity was the lack of incentives for the pharmaceutical industry, which has recently come to the forefront as the leading producer of generic drugs worldwide. Facing stiff competition from China, the dearth of support for its capital investment needs, research and  development investments, or tax exemptions is a major setback. The ‘Make in India’ campaign’s aid to the development of Indian pharmaceuticals and medical devices would have given a boost to the health industry as well as the economy.

On the positive side, the proposition for the extension of health cover and initiatives to boost health insurance will reduce the out-of-pocket spending. Setting up AIIMS in different locations across India, would strengthen the tertiary care infrastructure in these states. However, the need of the hour is to reinforce primary and secondary healthcare facilities, as is evident from the ongoing crisis of Swine flu.

Further, the spotlight on Swacch Bharath Abhiyaan concentrates on sanitation. Moreover, the tax exemption provided under this program is a commendable step; its acceleration and implementation can help keep disastrous diseases, such as Malaria under check.

Nevertheless, the government has a long road to travel if it is to win back the confidence of its people as well as its healthcare providers. Recent tragedies such as the botched sterilizations in Chhattisgarh have alienated even the poorer classes from accessible facilities. Meanwhile, the morale of its healthcare providers remains at an all-time low. With underpaid staff, under-resourced health centres and a neglected medical education system, they need serious attention from the centre.

India needs to raise its public healthcare expenditure to at least 2.5% of the GDP so as to fulfill the promise of universal health coverage. Tackling the issue requires getting to its multiple roots, including hygiene, female empowerment, and literacy.

The government must gear up to accommodate a dual battle against a developing country’s health concerns and a host of developed world disorders. New methods of fund transfer, procurement, and a supply of life saving drugs and diagnostics for the implementing units should be conceived for better healthcare.

Let’s hope that the Centre considers all these aspects and rethinks its budget allocations for subsequent years.

 

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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