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¦¤±¦šÉ ¿òËûþ Õ±÷±Ëðõþ ÷±ï±õÉï± ï±ßÂËùÝ õþ±©†˜ÂóÅ? ÆîÂõþÏ ýõ±õþ ü÷Ëûþ, ÕïÇ±È 1945 ü±ù Ý î±õþ Õ±Ëáõþ ßÂï±õù¿å, ¿õË•«õþ î±õh Îðú&Ëù±õþ Û ¿òËûþ àÅõ ÷±ï±õÉï± ¿åËù± õËù ÷Ëò ýûþ ò±¼ Û¶ï÷ ¿õ•«ûÅËXÂõþ ÂóËõþ ûàò League

of Nations Æî¿õþ ýËBå Îüü÷ûþß±õþ draft-Û ¦¤±¦šÉ Ûß¿é “Forgotten” ¿õø¸ûþ ¿åËù±¼ ÛËßÂõ±Ëõþ Îúø¸ ÷ÅýÓËîÇ Ûús¿éÂõþ Û¶Ëõú âËé¼ Õɱë ýß ¿ö¿MËî United Nations Conference (San Fransisco, 1945) -Û ¦¤±¦šÉËß¿õø¸ûþ ¿ýËüËõ Õ±Ëù±äÂò±ûþ Õ±ò± ýûþ¼ Û îÂËïÉõþ æòÉ ÕËòß õËh± Âó¿`Âî ýõ±õþ Û¶Ëûþ±æò Îòý×¼ MBBS ™¦¸Ëõþõþ Âó±êÂÉõý× Park’s Preventive and Social Medicine (2011, p. 12) ÎðàËùý× äÂùËõ¼ Ûý× “forgotten” ¿õø¸ûþÕ±™LÃæDZ¿îÂß ÂóÅÒ¿æ, ¿õ•«-õ±¿íËæÉõþ ò±ò± é±ò±ËÂó±ËhÂò, Õ±ñÅ¿òß ¿õË•«õþ governance Ý biopolitics-Ûõþ ¿õ¿öÂi§ÕòÅø¸/ Ûõþ ÷±Ëç æÅËh ձËå¼ [ÛßÂéÅÂ౿ò ÷±æÇò± ÎäÂËûþ Îòõ±õþ ÷Ëî± Âó¿õþ¿¦š¿îÂõþ ëÂ×¾õ ýËûþËå¼ Îûüõ ¿õËð¿ú ÂóS-Âó¿Sß±õþ Û¶õËgÂõþ ëÂ×Ë{¡à ßÂËõþ¿å Îü&Ëù± ÕòÅõ±ð ò± ßÂËõþ ý×ÑËõþ¿æËîÂý× ÎõþËà ¿ðËûþ¿å¼ ÕòÅõ±Ëðõþ ¦¤±ñÏòî± Âó±êÂËßÂõþ¼]

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pharmaceutical industry and disease mongering”. Û å±h± ÛßÂ-ý× ÂüÑàɱûþ Peter G. Gotzsche, Com-

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7

Ûõ±õþ Õ±Ëõþ± ü±¥x¿îÂß ¿ßÂåÅ ß±¿ýòÏ õù± û±ß¼ Û¿õþß± ÎäÂß •Erica Check— ¿õàɱî Îòä±õþ Âó¿Sß±õþ Û¶õÏòü±Ñõ±¿ðß¼ Õ±Ë÷¿õþß± ÎïËߠ۶߱¿úî ôÂËõþò Âó¿ù¿ü Âó¿Sß±õþ æÅù±ý×-Õ±áˆÂ 2006 üÑàɱûþ Quest for the Cure

õËù Ûß¿é Û¶õg ¿ùËàËåò¼ ¿î¿ò æ±ò±ËBåò, 1975 ÎïËß 2004-Ûõþ ÷ËñÉ Îû 1556 ¿é ÝøÅ̧ñ Õ±¿õ© Ô̈î ýËûþËåÛõþ ÷±S 1%-Ûõþ õÉõý±õþ ¿õ¿öÂi§ ÕõËý¿ùî õ± ¿é¿õ-õþ ÷Ëî± ÕüÅËàõþ æòɼ ûàò Ûý×ëÂüÄ-Ûõþ ÷Ëî± Îõþ±Ëáõþ æòÉÎß±¿éÂ-Îß±¿é ëÂù±õþ õÉ¿ûþî ýËBå ý±üÂó±î±Ëùõþ ðÔ¿©†Ëß±í ÎïËßÂ, îÂàò Îõþ±áÏõþ õ±™¦¸õ Û¶±ûþ ßÂàËò±Ýý× Õ±÷±Ëðõþ ß±Ëæñõþ± Îðûþ ò±¼ ¿ä¿ßÂÈüËßÂõþ õ±™¦¸õ Õ±õþ ¿ä¿ßÂÈü±õþ õ±™¦¸õ öÂÏø¸í ÂóÔïß ýûþ û±ûþ¼

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from Dying” Û¶õg¿éÂõþ ßÂï± õ¿ù¼ Û¶õgÂß±Ëõþõþ Û¶•Ÿ ßÂËõþËåò, Õ±÷±Ëðõþ ä±õþÂó±Ëú Îõþ±áÏËðõþ õÅçÂËî ¿áËûþ Îûmodel of detachment-Ûõþ ÷ñÉ ¿ðËûþ Õ±÷õþ± û±ý× Îüà±Ëò ¿ä¿ßÂÈüËßÂõþ± “how they can be healers, even

in the face of terminal illness.” ÝÒËðõþ ÷™LÃõÉ, “Unfortunately, the ‘hidden curriculum’ of contem-porary medicine - especially the hurried, disease-centered,impersonal, high-thorough-out clini-cal years - stil tends to undermine the best interests of students and faculty members and thebest interests of patients and families.” •¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò 2005 5 ÎüË›I×Â¥¤õþ, 1313-1315— ÛßÂ-ý× üÑàɱûþ Îõþ¿ò ô' îÒ±õþ “Cultural Competence and the Culture of Medicine”-Û Ã›¶•ŸîÅÂùËåò - ÛõþßÂ÷ Âó±êÂÉ õý×-ê±ü± ¿ä¿ßÂÈü± ¿ú•Â±õþ æáËî ü¿îÂÉ-ý× ¿ß ÷±ò¿õß ýËûþ Ýê±õþ Îß±Ëò± üÅËû±á Õ±Ëå·

‘‘Î÷¿ëÂßÂɱù ¿ýëÂ×÷ɱ¿ò¿éÂü’’ õ± ‘‘òɱ¿õþ¿éÂö Î÷¿ë¿üò’’ -Ûõþ ÷Ëî± Âó±êÂÉS•÷ Æî¿õþ ýËBå¼ ‘Î÷¿ëÂßÂɱù ¿ýëÂ×÷ɱ¿ò¿éÂü’õËù Ûß¿é ձù±ð± Âó¿Sß± ¿òûþ¿÷î Û¶ß±¿úî ýËBå ßÂËûþß õåõþ ñËõþ¼ ÛË•ÂËS Õ±÷±Ëðõþ ÎðËúõþ ¿ú•Â±S•÷ úîÂËû±æòðÅËõþ¼ ÛàËò± Ûà±Ëò Û¶ñ±òî ü±Ëõ¿ß ձ÷Ëùõþ ÂóêÂò-Âó±êÂò ÕòÅüõþí ßÂõþ± ýûþ¼ ôÂùî ÷±ò¿õß ¿ä¿ßÂÈüß ¿ýËüËõûÒ±õþ± Õ±R۶߱ú ßÂËõþò îÒ±õþ± ¿òËæËðõþ Õ±ðúÇáî Õõ¦š±ò õ± õÉ¿M•áî ä¿õþËSõþ &Ëí ßÂËõþò¼ ¿ú•Â±S•Ë÷õþ Îß±Ëò±ßÔ¿îÂQ Õ±¿÷ Õ™LÃî Ûà±Ëò àÅÒËæ Âó±ý× ò±¼ ÛõÑ Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ Õ±öÂÉ™Lÿõþò ß±ê±Ë÷±õþ ÷ËñÉ ÷±ò¿õß ýËûþ Ýê±õþëÂ×Âó±ð±ò Û¶±ûþ Îòý× õùËùý× äÂËù¼

õåõþ ÂóÒ±ËäÂß ձËá ¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò-Û õ±õþõ±õþ± Îæ ÷Éß¿òù Ûß¿é Û¶õg ¿ùËà¿åËùò“Hidden Barriers to the Improvement of Health Care”. Û Ã›¶õg Û¶ßÔÂîÂÂóË•Â 2001-Ûõþ &•QÂóÓíÇõ±Èü¿õþß ‘‘ú±éÂß ÎùßÂä±õþ’’¼ Îü Û¶õËg ¿î¿ò æ±ò±ò, “Uncertainty can be interpreted not only as lackof convincing evidence but also as impaired access to convincing evidence... Uncertainty influ-ences virtually all of medical decision making...The lack of data persists despite enormousefforts to improve clinical decision making... The well-reported underrepresentation of womenin clinical trials similarly limits informed decision making...the results of clinical studies sug-gest that varying perceptions of the same data can lead to different clinical decisions.” üõ ÎúËø¸îÒ±õþ ¿üX±™Là ýù, “Once we know more definitively what to do for our patients and at what cost

(average and marginal), we will have a clearer road map for thinking about priorities...” •õ±õþõ±õþ±Îæ ÷ɱß¿òù, ¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò, 21 òËöÂ¥¤õþ 2001, ÂóÔ 1612-1620—

¿ß ¿ß õùËùò ÷ɱß¿òù· Û¶ï÷îÂ, ¿ä¿ßÂÈü±õþ Û¶±ûþ ü÷™¦¸ ú±à±Ëî տò}Âûþî± Ûß¿é ëÂ×Ë{¡àËû±áÉ ¿õø¸ûþ, ¿ZîÂÏûþîÂ,Õ¿ò}Âûþî±õþ ð•í ü±õÇæòÏòö±Ëõ ü¿êÂß Û¶÷±í ¿òöÇÂõþ Îß±Ëò± ¿ä¿ßÂÈü±õþ ßÂï± õù± Û¶±ûþ ðÅÐü±ñÉ Ûß¿é ß±æ îÔÂîÂÏûþîÂ,¿ä¿ßÂÈüËßÂõþ Îõ±Ëñõþ Âó±ïÇËßÂÉõþ æòÉ ÛßÂ-ý× îÂËïÉõþ ¿öÂi§ ¿öÂi§ õɱàɱ üyÂõ äÂîÅÂïÇîÂ, ¿ù/-Æõø¸Ë÷Éõþ æòÉ Îû üõ îÂïÉ

8

üÑáÔýÏî ýûþ Îü&Ëù± ÂóÅËõþ± ¿òöÇÂõþËû±áÉ òûþ¼ ÛõÑ üõËúËø¸ ¿üX±™Là ¿òËBåò, Îõþ±áÏõþ ¿õËúø¸ Õõ¦š±Ëòõþ ÝÂóõþ ¿òöÇÂõþßÂËõþ ¿ä¿ßÂÈü±õþ Õá豿ñß±õþ ¿êÂß ßÂõþËî ýËõ¼ Û å±h± Õ±Ëõþ± ÕËòß ձËù±äÂò± õþËûþËå Û¶õg¿éÂËî - Îû÷ò, ¿öÂi§Æð¿ýß ÛõÑ æiœáî Õõ¦š±Ëòõþ æòÉ ÛßÂ-ý× ÝøÅ̧Ëñõþ ¿õ¿öÂi§ ôÂù±ôÂù, ¿õ¿öÂi§ ü±Ñ¦Ô̈ ¿îÂß Âó¿õþËõËúõþ æòÉ ¿ä¿ßÂÈü±õþôÂù±ôÂËùõþ ¿õ¿öÂi§î± ý×îÂɱ¿ð¼ ÷ɱß¿òËùõþ ßÂï±õþ üÅS ñËõþ õùËõ± Û¶÷±í ¿òöÇÂõþ ¿ä¿ßÂÈü±õþ Û¶¿î ձ÷±Ëðõþ Îû Õ±Båi§î±Îõ±ñ ß±æ ßÂËõþ î±õþ ÕËòßÂé± ¿õÂóõþÏËî ÷ɱß¿òËùõþ õM•õɼ Û å±h± Âó¿ù¿éÂßÂü Õõ Û¿öÂËëÂk-Îõüë Î÷¿ë¿üò¿òËûþÝ Ã›¶äÅÂõþ Îùà±Ëù¿à ýËBå¼ ôÂËù EBM (Evidence-Based-Medicine)-Ûõþ ¿÷ï Ûàò ÕËòßÂé±ý× ðÅõÇù¼

ÛîÂüõ ¿õ¿öÂi§î±õþ ÷±Ëç ձ÷õþ±, Û¶ï÷ ðÅ¿òûþ±õþ ¿ä™Lñûþ ü÷ÔX ÷±ï± ¿òËûþ ß±æ ßÂõþ± îÔÂîÂÏûþ ðÅ¿òûþ±õþ ¿ä¿ßÂÈüËßÂõþ±ßÂî üýËæ ÛßÂ-ý× Îõþ±Ëáõþ Î|íÏ-öÓÂM• ü÷™¦¸ Îõþ±áÏõþ æòÉ •Ûõþ± ÎßÂëÂ× Õ±÷±Ëðõþ ß±Ëå õÉ¿M• õ± Û¶ßÔÂî ÷±òÅø¸ òûþ,ÎßÂõù÷±S Îõþ±áÏ— áî 150 õåËõþ ¿ä¿ßÂÈü±õþ æáËî Îû Âó¿õþõîÇÂò ýËûþËå î±õþ ÷ËñÉ &•QÂóÓíÇ ýù - õÉ¿M• ¿ä¿ßÂÈüßÂÎõþ±áÏõþ áÔËý ¿áËûþ ¿ä¿ßÂÈü±õþ Îû ð±¿ûþQ ¿òËîÂò î±õþ Âó¿õþõËîÇ Ûß¿é æ¿éÂù, ï±ßÂõXÂ, Û¶ûÅ¿M•-¿òöÇÂõþ, ÎÂóú±ð±õþ¿ä¿ßÂÈüßÂ Ý ¿ä¿ßÂÈü±ßÂ÷ÇÏ-ü÷ÔX ¿ä¿ßÂÈü± õÉõ¦š±¼ •üÓS “Tavistock Group ; A shared statement of ethical

principles for those who shape and give healthcare”, British Medical Journal, 1999; 318 : 249-

51.) Ûüõ ¿ßÂåÅõþ Îû±áôÂËù Îû üõ ÷±òÅø¸ ÛßÂü÷ûþ ¿òËæËðõþ ¿õ¿öÂi§ ú±õþÏ¿õþß ü÷üɱ ¿òËæõþ± ü±÷Ëù ¿òËîÂò î±õþ±Ûàò ÕËòß ÎõúÏ ¿ä¿ßÂÈüßÂËðõþ úõþí±Âói§ ýËBåò - “an unquestioning media and drug companies turn

everything into a ‘disease’ in need of treatment.” Û ÷™LÃõÉ Õ±÷±õþ òûþ, Õõü±öDZõþ Âó¿Sß±õþ ò±÷Ï ü±Ñõ±¿ðßÂÕɱKé¿ò õè±ëÂ×Ëòõþ¼ •Observer, Sunday, April 14 2002). Û å±h± Õ±Ëá Õ±Ëù±¿äÂî õþûþ ÷ûþ¿òý±Ëòõþ Îùà±Õ±Ëõþß¿é &•QÂóÓíÇ Ã›¶õg “The making of a disease : female sexual dysfunction” ÎïËß ÛßÂéÅÂ౿ò ëÂ×Ë{¡àß¿õþ, “ The corporate sponsored creation of a disease is not a new phenomenon, but the making

of female sexual dysfuction is the freshest, clearest example we have.” •¿õè¿éÂú Î÷¿ëÂßÂɱù æ±òDZù,4 æ±òÅûþ±¿õþ 2003, 45-47—¼ 1998 ü±Ëù ö±ûþ±áè± õËù ÂóÅ•ø¸Ëðõþ æòÉ ¿õËúø¸ Ýø¸Åñ¿é ձ¿õ©¨±õþ ýõ±õþ Âóõþ ÎïËßÂ2003 ÂóûÇ™Là 1 Îß±¿é 70 ù•Â ÂóÅ•Ëø¸õþ æòÉ Û Ýø¸Åñ Îùà± ýËûþËå - ôÂù±ôÂù û± Îý±ß ò± ÎßÂò¼ ÛËî ô±ý×æ±õþÎß±¥ó±òÏ-õþ 2001 ü±Ëùõþ ¿õS•Ïõþ Âó¿õþ÷±í 150 Îß±¿é Âó±ëÂ×̀ ¼

ÛõþßÂ÷ ôÂù±ôÂËù ëÂ×Èü±¿ýî ýËûþ ÝøÅ̧ñ Îß±¥ó±òÏ&Ëù±õþ Ûõ±õþ Û¶Ëûþ±æò “To build similar markets for

drugs among women, companies first require a clearly defined medical diagnosis with measur-

able characteristics to facilitate credible clinical trails. Over the past six years the pharmaceu-

tical industry has funded, and its representatives have in some cases attended, a series of

meetings to come up with just such a definition.” ôÂËù Îß±¿é Îß±¿é é±ß±õþ ß±õþõ±¿õþ Õ¿îÂ-õÔýÈ ÝøÅ̧ñÎß±¥ó±òÏ&Ëù±õþ ÂóË•Â female sexual dysfunction-Ûõþ ÷Ëî± Ûß¿é ÕüÅËàõþ æiœ Îðûþ± ¿òî±™Là æ•õþÏ ýËûþÂóËh¼ Û Ã›¶üË/ Õ±õ±õþ Ûß¿é ëÂ×XÔ¿îÂ, î±-Ý Õ±ËõþßÂõ±õþ ý×ÑËõþ¿æËîÂ, Îðõ±õþ Îù±ö ü±÷ù±Ëî Âó±õþ¿åò± •Âó±êÂËßÂõþ± ÷±ôÂßÂõþËõò Õ±ú± õþ±¿à—, “The potential risk, in a process so heavily sponsored by drug companies, is

that the complex social, personal, and physical causes of sexual difficulties and the range of

solutions to them will be swept away in the rush to diagnose, lavel, and prescribe. Perhaps the

greatest concern comes from the flip side of inflated estimates of disease prevalence the

ever-narrowing definitions of ‘normal’ which help turn the complaints of the healthy into the

9

conditions of the sick.” ¿ä¿ßÂÈü± ÛõÑ ¿ä¿ßÂÈüËßÂõþ ý±î ñËõþ ÷ÅËå ÎûËî q• ßÂËõþ healthy ÛõÑ sick-Ûõþ÷ËñÉß±õþ üÏ÷±Ëõþà±¼ ÛæòÉ normal-Îß òîÅÂò ÎäÂý±õþ±ûþ ü/±¿ûþî õ± ¿òñDZõþí ßÂËõþ Îòõ±õþ Û¶Ëûþ±æò ÂóËh¼ Õ±õþ ÂóÅËõþ±Ã›¶¿S•ûþ±¿éÂËî ÷ñɦšî±ß±õþÏ ¿ýËüËõ ï±Ëß տîÂ-õÔýÈ ÝøÅ̧ñ Îß±¥ó±¿ò&Ëù±¼

Healthy ÛõÑ sick, Ûý× ðÅý× binary-õþ ÷±Ëç ¦¤±¦šÉ õ± health-Ûõþ Õõ¦š±ò - Îß±ò ¦¤ûþÑ-ü¥óÓíÇ üM± ¿ýËüËõòûþ, ¿õ¿öÂi§-÷ÅàÏ ¦¤±ËïÇõþ é±ò±ËÂó±ËhÂò Ûõþ ÎäÂý±õþ± ¿òXDZ¿õþî ýûþ¼

¦¤±¦šÉ Ý õþ±æòÏ¿î

Õ÷îÇÂÉ ÎüËòõþ ü±¥x¿îÂß õM•õÉ Îõ±ñ ß¿õþ ÕËòß ¿ú¿•Âî ÷±òÅø¸Ëß ö±¿õî ßÂËõþËå¼ îÒ±õþ õM•õÉ ÕòÅû±ûþÏ ¦¤±¦šÉÛ¶ßÔÂîÂÂóË•Â Ûß¿é õþ±æËò¿îÂß ÎÛ¶±áè±Ë÷õþ ÷ËñÉ ÂóËh¼ ßÂﱿé àÅõ òîÅÂò òûþ¼ ¿õàɱî æ±÷DZò Âóɱïù¿æˆÂ, Æõ:±¿òßÂÛõÑ õþ±æÍò¿îÂß õÉ¿M•Q •ëÂùô ¿öÂõþßÂ±Ý õ± ¿öÂõþËú± •Rodolf Virchow— 1848 ü±Ëù æ±÷DZ¿òõþ Õ±Âó±õþ ü±ý×Ëù¿üûþ±Õ=ÁËù é±ý×ô±ü Îõþ±Ëáõþ ß±õþí ÕòÅüg±ò ßÂËõþ 4¿é àËG “Report on the Typhus Epidemic in Upper

Silesia” ۶߱ú ßÂËõþò¼ Îü ¿õþËÂó±ËéÇ ¿î¿ò õËùò – “Medicine is a social science, and politics is

nothing but medicine on a large scale.” ÕïDZÈ, ÛßÂéÅ òæõþ ßÂõþËù õÅçÂËõ±, Û¶±ûþ 165 õåõþ ýËù± Î÷¿ë¿üòÛõÑ ¦¤±¦šÉËß õþ±æòÏ¿îÂõþ ÕÑú ¿ýËüËõ ñõþ± ýËBå¼ Õ±÷õþ± ò± ýûþ ÛßÂéÅ ÎÂóåËò ýÒ±éÂ¿å¼ î±õþ ÷±Ëò Îî± Ûé± òûþ Îû¿õø¸ûþ¿é ¿ú¿•Âî æáËîÂõþ äÂäDZõþ ÷ËñÉ Îòý×¼ Û¶ü/î ëÂ×Ë{¡àËû±áÉ, Journal of Epidemiology and Community

Health-Ûõþ Õ±™LÃæDZ¿îÂß Âó¿Sß±õþ Õ±áˆÂ 2011-õþ üÑàɱ¿éÂõþ ¿õø¸ûþ ýËù± – Politics, primary healthacre

and health : was Virchow right ?

Ûõ±õþ Õ±÷õþ± ö±õþËîÂõþ æò¦¤±Ë¦šÉ üõþ±ü¿õþ Û¶Ëõú ß¿õþ¼

ö±õþËî æò¦¤±Ë¦šÉõþ ÕîÂÏîÂ Ý õîÇÂ÷±òÂ

æò¦¤±¦šÉ ús¿é ðÅ¿é úËsõþ ÎûÌáÂóð - ÛËî± üõ±õþ æ±ò± ßÂï±¼ ÛéÂ±Ý üõ±õþ æ±ò± Îû Û ús¿é ձ÷õþ± áèýí ßÂËõþ¿åý×ÑËõþ¿æ public health -Ûõþ Û¶¿îÂús ¿ýËüËõ¼ áèýí ò± ßÂËõþ ëÂ×Âó±ûþ Îòý×¼ Õ±õ±õþ áèýí ßÂõþ±õþ ÷±ËçÂÝ ¿ßÂåÅ ü÷üɱùÅ¿ßÂËûþ Õ±Ëå¼ Û ¿òËûþ ÛßÂéÅÂ౿ò ßÂï± õËù ÷Óù Õ±Ëù±äÂò±ûþ Û¶Ëõú ßÂõþ± ýËõ¼ 27Ëú æ±òÅûþ±¿õþ 2011-Îî Û¶ß±¿úîÂÛ ÷ÅýÓËîÇ ÂóÔ¿ïõÏõþ üõËäÂËûþ ÷±òÉ Î÷¿ë¿üËòõþ æ±òDZù New England Journal of Medicine-Û Ã›¶ß±¿úî Û¶õg“Public Health in Haiti - Challenges and Progress”-Û õù± ýËBå - Nevertheless, long-standingpublic health problems remain. Efforts to improve roads to reduce traffic injuries, providelifesaving community and obstetrical services, and repair, upgrade, or build safe water andsanitation systems are just beginning to be scaled up. Û¶õËgÂõþ ÎúËø¸ ÂóûÇËõ•Âí¿é ÛõþßÂ÷ “Politicalstability will be essential, and a central challenge will be to train and employ an adequate publichealth workforce to carry on the work of the small cadre of public health leaders...”

ëÂ×ÂóËõþõþ Õ±Ëù±äÂò± ÎïËß üýæËõ±ñÉ Îû public health-Ûõþ ü±Ëï æ¿hÂËûþ Õ±Ëå õþ±™¦¸±-â±ËéÂõþ Õõ¦š± ÎïËßÂÂó±íÏûþ æù, üɱ¿ò鱿õþ õÉõ¦š± ÎïËß õþ±æÍò¿îÂß üÅ¿¦šõþî± ý×îÂɱ¿ð üõ¿ßÂåÅý× Õ™LÃáÇî ýËûþ Õ±Ëå æò¦¤±Ë¦šÉõþ õ±™¦¸õ±ûþËòõþ÷±Ëç¼ Ûõþ ÕïÇ ýù æÏõËòõþ Û¶¿î¿é ΕÂS Õ±ò±äÂ-ß±ò±ä Î÷¿ë¿üËòõþ òæõþð±¿õþõþ ÷ËñÉ äÂËù ÛËù±, û±Ëß õù± ýûþ‘‘Î÷¿ëÂßÂɱù±ý×Ëæúò Õõ ù±ý×ôÂ’’¼ ßÂùß±î± Õ±ñÅ¿òß ëÂ×Âó¿òËõ¿úß òáõþ ýËûþ áËh Ýê±õþ ûÅËá æòæÏõòËß ý±üÂó±î±ùÝ Î÷¿ë¿üËòõþ òæõþÂóËï ¿òËûþ Õ±ü±õþ æòÉ Ã›¶õ¿îÇÂî ‘‘öÂõâÅËõþ Õ±ý×ò’’, “Lunacy Act” ý×îÂɱ¿ðõþ ßÂï± Õ±÷±Ëðõþ¦œõþËí Õ±üËõ Õ±ú± ß¿õþ¼ õþ±©†˜ Ý ¦¤±Ë¦šÉõþ Õ¿òõ±ûÇ ü¥óßÇ Îõ±ç±Ëî 1779 ü±Ëùý× æ±÷Ç±í ¿ä¿ßÂÈüß Îû±ý±ò ¿Âóé±õþ

10

ô豩¨ õÉõý±õþ ßÂËõþ¿åËùò ¿õàɱî Îü ús¿éÂ-õg¿é Medical Police, îÒ±õþ A System of Complete Medical

Police áèËLš¼ 9¿é àË` ¿õöÂM• Û áèËLšõþ 4ïÇ ÕÑËúõþ îÔÂîÂÏûþ ÕñɱËûþ ô豩¨ õùËåò - In dealing with thisimportant subject of Medical Police, I must refer to all that I have said elsewhere aboutnecessary cleanliness of the air... of large towns, etc.. so that now I can lecture on pertinentmatters... public health cure is necessary. (A System of Complete Medical Police : Selectionsfrom Johann Peter Frank, ed., Erna Lesky, Johns Hopkins University Press, Baltimore, Mary-land, 1976, p. 183)

ÛËßÂõ±Ëõþ ¿öÂi§ Ûß¿é ¿õø¸Ëûþõþ Õõî±õþí± ß¿õþ Ûàò¼ ý×ÑËõþ¿æËî û±Ëß ձ÷õþ± áè±÷±õþ õ¿ù õ±Ñù±ûþ Îüé± õɱßÂõþí¼ðÅËé± ¿ß Ûß· ýõþÛ¶ü±ð ú±¦aÏ õËù¿åËùò - üѦÔ̈î õɱßÂõþí úËsõþ ÕïÇ õɱ¿S•ûþË™Là õÅÉÈÂóðË™Là ús± Õ±Ëòò - ÕïDZÈý׿éÂûþù¿æ - Îë¿õþËöÂúò¼ õ±™¦¸¿õßÂý× ÷Å*Ëõ±ñ±¿ðËî Âóð¿é ÆîÂûþ±õþ ß¿õþûþ± ÎðÝûþ± ÂóûÇ™Là õɱßÂõþËíõþ ß±ûÇ... õɱßÂõþí qXÂAetiology ÷±S Îüý× õɱßÂõþíËß grammar-Ûõþ ù•ÂËí ù¿•Âî ßÂõþ± ëÂ׿äÂî ¿ß ò±, üýËæý× Îõ±ñ ßÂõþ± û±ý×ËîÂÂó±Ëõþ¼ •Ùí ¦¤Ïß±õþ Âó¿õS üõþß±õþ - õɱßÂõþí ÷±Ëò ¿ßÂ, Û¶ü/ õ±Ñù± õɱßÂõþí 2, Âó¿}Â÷õ/ õ±Ñù± ձ߱Ëð¿÷, 2006—ÕïÇ±È üѦÔ̈î ÎïËß ձý¿õþî õ±Ñù± õɱßÂõþí ús¿éÂËß ý×ÑËõþ¿æ áè±÷±õþ ús¿é ¿òËæõþ ÷Ëî± ßÂËõþ ÂóÅòáÇ¿êÂî ßÂËõþ¿òËûþËå¼ Û•ÂËS ÷Óù õɱßÂõþí úËsõþ Õ±öÂÉ™LÃõþÏò õÉ?ò± õðËù Îáù¼ õɱßÂõþËíõþ õ±ý×Ëõþ Û¶±ßÔ¿îÂß æáËî ձ¿ü¼ ÷ÓùüѦԨËî æ±/ù ús¿é õÉõý+î ýËûþËå Û÷ò Ûß Õ=Áù Îûà±Ëò öÓ¿÷ ••Â, &{œ õ± ß񱎱 æ±îÂÏûþ ëÂ׿¾ð æiœ±ûþ¼ Ûõþ¿õÂóõþÏËî õþËûËå ÕòÓÂó ús¿é û±õþ ÕïÇ æù±öÓ¿÷¼ ÷¿òËûþõþ-ëÂ×ý׿ùûþ±÷Ëüõþ üѦÔ̈îÂ-ý×ÑËõþ¿æ Õ¿öÂñ±ò æ±ò±ËBå æ±/ùúËsõþ ÕïÇ - arid, sparingly grown with trees and plants (though not unfertile)¼ Õ±÷õþ± Îðà¿å Ûús¿é ¿ßÂö±Ëõ õòöÓ¿÷ õ± ôÂËõþˆÂ-Ûõþ ü÷±ïÇß ýËûþ ëÂ×êÂËù±¼ Õ'Ëô±ëÇ ý×Ñ¿ùú ¿ëÂßÂúò±¿õþ õùËå - The changein Anglo-Indian use may be compared to that in the historical meaning of the word forest inits passage from a waste or unenclosed tract to one covered with wild wood. In the transferredsense of jungle there is apparently a tendency to associate it with tangle. Û ¿õø¸Ëûþ äÂ÷Èß±õþÕ±Ëù±äÂò± ßÂËõþËåò ôè±ò¿üü ¿æ÷±õþ÷ɱò îÒ±õþ The Jungle and the Aroma of Meats (Motilal Banarsidass,

1999) áèËLš¼ ¿î¿ò ÷™LÃõÉ ßÂõþËåò - The Hindi name terai (“marshy lands”) - the exact semanticequivalent of the Sanskrit anupa - now becomes the aberrant synonym of jungle. (Ibid, p. 15)

Õ±Ëõþß¿é ús û± Õ±÷±Ëðõþ Õ±Ëù±äÂò±õþ Û¶ñ±ò ¿õø¸ûþ î± ýù ¦¤±¦šÉ¼ Õ±ûþÅËõÇËðõþ õ±ý×ËõþÝ õþ±÷±ûþí ÷ý±ö±õþî üýÛ¶±ûþ ü÷™¦¸ üѦÔ̈î áèËLš ¦¤±¦šÉ Ý ¦¤¦š úËsõþ õÉõý±õþ Âó±Ýûþ± û±ûþ¼ ¦¤±¦šÉ-õþ üѦԨî ÕïÇ ýù ¦¤-Îî ¿¦šî ýÝûþ± õ± ¿ôÂËõþÕ±ü±¼ ¿÷Ëõþ±• ý±õþ± îÒ±õþ “A Note on the Sanskrit Word Svastha” (European Journal of Ayurvedic

Society 4, 1995, pp. 53-87) Û¶õËgÂ Û ¿õø¸Ëûþ ¿õúËð ÕîÂÉ™Là ÷Ëò±: Õ±Ëù±äÂò± ßÂËõþËåò¼ îÒ±õþ ßÂï±ûþ - Itimplies not only a healthy physical condition, but also a serene state of mind The usage,however, is not limited to the state and condition of individual human beings, but is extendedto those of the state and government.

Û ü÷™¦¸ Õ±Ëù±äÂò± ÎïËß ՙLÃî Ûß¿é Û¶±ï¿÷ß Îõ±Ëñ ÎÂóÌÒåËò± ÎûËî Âó±Ëõþ Îû Alma Ata üË¥œùËòõþ ÷ñÉ¿ðËûþ æiœ ÎòÝûþ± health-Ûõþ ¿õ•«æòÏò ñ±õþí±õþ ü±Ëï ö±õþîÂÏûþ ¦¤±Ë¦šÉõþ ñ±õþí±õþ Ûß¿é ÷Óùáî տ÷ù Õ±Ëå¼ û¿ðÝõù±õþ ÕËÂó•Â± õþ±Ëà ò±, ¦¤±¦šÉ Ý health ü÷±ïÇß ýËûþ ÂóËhÂËå¼ Õ±Ëõþß¿é Û¶ü/ ëÂ×O±Âóò ßÂËõþ Û Ã›¶±ï¿÷ß ձËù±äÂò±ûþû¿î é±ò± ÎûËî Âó±Ëõþ¼ Õ±÷±Ëðõþ ü±ñ±õþí Îõ±ñ-õÅ¿XÂËî õÅ¿çÂ, Õ±ûþÅËõÇË𠦤±¦šÉ ¿òËûþ üõËäÂËûþ ÎõúÏ Õ±Ëù±äÂò± ýõ±õþßÂï±¼ ÛõÑ õ±™¦¸Ëõ î± ýËûþËåݼ Õ±ûþÅËõÇð ¿ßÂcà Û¶ßÔÂî ÕËïÇ Îß±ò ¿ä¿ßÂÈü± ¿õ:±ò òûþ¼ ÛßÂæò ÷±òÅËø¸õþ Õ±ûþÅ ÕïDZÈ

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ðÏâÇæÏ¿õî± ¿òËûþ Õ±Ëù±äÂò± ýËûþËå Û ú±Ë¦a¼ Û¶îÂɱ¿úîÂö±Ëõý× Õ±ûþÅËõÇð ú±Ë¦aõþ Õ±Ëù±äÂò±õþ Û¶ñ±ò ÕÑú õÉ¿ûþî ýËûþËå÷±òÅËø¸õþ ¿ä¿ßÂÈü± üÑS•±™Là ¿õø¸Ëûþ¼ Õ±ûþÅËõÇËðõþ ý׿îÂý±ü Û¶±ûþ 2500 õåËõþõþ¼ ôÂËù õÔ¿éÂú ú±üËòõþ 200 õåõþ õ±ð¿ðËù ÂóÅËõþ± ü÷ûþß±ù æÅËh ձûþÅËõÇËð Õ±Ëù±¿äÂî æÏõò±äÂõþËíõþ Îõ±ñ ¿ò÷DZí ßÂËõþËå ö±õþîÂÏûþ üM± õ± subjectivity¼ÕËòËßÂõþ æ±ò± äÂõþßÂ-üÑ¿ýî±õþ Âó¿õþ¿äÂî Ε-±ß - ¿ýýîÂÑ üÅàÑ ðÅ à÷±ûþÅ™¦¸üÉ ¿ýýîÂ÷÷ “ ÷±ò=ÁîÂBä ûËS±S•÷±ûþÅËõÇð ü ëÂ×BäÂËî •üÓS¦š±ò - 1¼41— Ûõþ ÕïÇ - Õ±ûþÅ ä±õþ ۶߱õþ¼ ¿ýî±ûþÅ , Õ¿ýî±ûþÅ , üÅà±ûþÅ Ý ðÅ à±ûþż ÕïDZÈ, üýæ ßÂËõþõùËù, Õ±ûþÅ üÑS•±™Là Îû üõ ¿õø¸ûþ ÛõÑ î±õþ Âó¿õþ÷±í Ý ¦¤õþ+Âó ¿òíÇûþ Îû ú±Ë¦a Õ±Ëå î±Ëß ձûþÅËõÇð õËù¼ Û Ã›¶üË/ÛËüËå ÙîÅÂ, ¿ðò Ý æÏõËòõþ ¿õ¿öÂi§ ÂóûDZËûþ ÛßÂæò ÷±òÅø¸ ¿ßÂö±Ëõ æÏõò û±Âóò ßÂõþËõ •¿õõ±¿ýî ÎûÌò æÏõòüý—, ü™Lñò ñ±õþí Ý Ã›¶¿îÂÂó±ùò ßÂõþËõ, Û¶ßÔ¿îÂõþ ü±Ëï ö±õþü±÷É ÎõþËà Û¶ßÔ¿îÂËß ùãâò ò± ßÂËõþ äÂùËõ, ¿ú•Â±õþ ñõþòÎßÂ÷ò ýËõ ý×îÂɱ¿ð ü÷™¦¸ Æò¿îÂßÂ, Û¶±îÂÉ¿ýßÂ, Âó±õþËùÌ¿ßÂß ¿õø¸ûþ Ûõþ ÷±Ëç ՙLÃöÇÓÂM• ýËûþËå¼ üõÇæò÷±òÉ Âó¿`Âî ÝÕ±ûþÅËõÇð: ¿Âó ¿ö ú÷DZ Ûß ßÂï±ûþ õùËåò - In fact Ayurveda is not a system of medicine but a dynamicphilosophy of life by which one can attain healthy individual and social life so as to performthe functions efficiently and blissfully, at the end to attain perfect bliss of liberation. (Essentialsof Ayurveda, Motilal Banarsidass, 1998, p. xliv)

Õ±õ±õþ äÂõþßÂ-üÑ¿ýð± - Û¶±Ííø¸í± ñÍòø¸í± ÂóõþËù±ÍßÂø¸Ëí¿î “ •üÓS¦š±ò - 11¼3— Õ±ËßÂî ¦š±Ëò ëÂ×Ë{¡¿àî -۶±íÂó¿õþîÂɱËá ¿ý üõTÇîÂÉ±á ¼ îÂüɱòÅÂó±ùòÑ ¦¤¦šüÉ ¦¤¦šõÔ¿Mõþ±îÅÂüÉ ¿õß±õþÛ¶ú÷Ëò ýÛ¶÷±ð “ •üÓS - 11¼4— Ûõþ üõþùÕïÇ ýù - ÎßÂò ò± Û¶±íîÂɱËáý× üõÇîÂɱἠüõDZËáè Û¶±í±òÅÂó±ùò ßÂõþ± ¿õËúø¸ ßÂîÇÂõɼ üŦš Õõ¦š±ûþ ¦¤±¦šÉõþ•Â± Z±õþ± ÛõÑÕüŦš ýËù ëÂ×ËÂó•Â± ò± ßÂËõþ Îõþ±á ú±¿™Là Z±õþ± Û¶±í±òÅÂó±ùò ßÂõþ± ýûþ¼ Îõ±ç± û±ËBå, Û¶±í, ñò Ý ÂóõþËù±ËßÂõþ ü±ËïÎõþ±á ÛõÑ ¿ä¿ßÂÈü± ûÅM• ýËûþ Æî¿õþ ýù Õ±ûþÅËõÇËðõþ Âó¿õþüõþ Ý Âó±ËêÂõþ ß±ê±Ë÷±¼ qñÅ î±ý× òûþ¼ Û ú±¦a Õ±Ëù±äÂò±õþü±Ëï æ¿hÂËûþ Õ±Ëå õþ±æñ÷Ç, ü±÷™L¸ Ý ßÔ¿ø¸-󦕱 ¿òöÂÇõþ Ûß ü÷±æËõ±Ëñõþ ¿ö¿MöÓ¿÷¼ ÛõÑ üËõDZÂó¿õþ, Õ±ûþÅËõÇð ÕîÂÉ™LÃðÔìÂÿö±Ëõ ÂóÅ•ø¸î±¿Laß òæõþð±¿õþõþ ¿òöÇÅÂù ÎðɱîÂß¼ Û üõ üËQÝ Û ¿õø¸ûþ¿é ¿òËûþ ßÂï± àõþä ßÂõþ±õþ ß±õþí ýù, Û¿ä¿ßÂÈü± õÉõ¦š± Û¶±ßÂ-õÔ¿éÂú ö±õþËîÂõþ ¦¤±¦šÉ Ý æÏõò Îõ±ñËß Û¶õùö±Ëõ ¿òûþLaí ßÂËõþËå¼ ÛËß ¦š±òäÓÂÉî ßÂËõþý× q•ýËûþËå Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ ÕË÷±â û±S±¼ äÂõþßÂ- ÛõÑ üÅ|ÅîÂ-üÑ¿ýî±ûþ Û÷ò ¿ß Û¶±ï¿÷ß ™¦¸Ëõþõþ ý±üÂó±î±Ëùõþ ßÂï±Ýõù± Õ±Ëå¼ äÂõþßÂ-üÑ¿ýî±ûþ õù± ýËBå - ÎðËýõþ üÑËú±ñËòõþ æòÉ ÝøÅ̧ñ ÎüõËòõþ Õ±Ëáý× Ûß¿é áÔý ¿ò÷DZí ßÂõþËîÂýËõ¼ áÔý¿é ðÔìÂÿ Ý õ±ûþÅõ±¿ýî ýËõ¼ ÛËî ¿õäÂõþí ßÂõþËî Îûò Îß±ò ß©† ò± ýûþ¼ Õ¿ò©†ßÂõþ Îß±ò õd Îû÷ò, ñÓ÷,ÎõþÌ^, ñÓù± Û¶Ëõú ßÂõþËî ò± Âó±Ëõþ¼ áÔý¿é Îûò Õ¿ò©†ßÂõþ ús, ¦óúÇ, õþ+Âó, õþü Ý áËgÂõþ Õá÷É ýûþ¼ Îüà±Ëò ÎûòÎü±Âó±ò, ëÂ×ðÓàù, ÷Óø¸ù, ÷ùîÂɱËáõþ ¦š±ò, ¦§±òöÓ¿÷ Ý õþgÂòú±ù± ï±Ëß¼ •üÅS¦š±ò - 15¼6— Û ßÂï±Ý õù± ýËBå ÎûÎüà±Ëò Îûò àõþËá±ú, ý¿õþí, ßÔÂø•ü±õþ ÷Ôá, Î÷ø¸, òÏËõþ±á æÏõõÈü± ðÅ*õîÂÏ á±öÂÏüßÂù ý×îÂɱ¿ð ï±Ëß¼ Îõþ±áÏõþüÅ|Åø¸±ß±õþÏ Ý Þø¸ñËÂóø¸Ëí ü÷ïÇ Âó¿õþä±õþßÂõÔj ï±Ëß¼ •üÅS¦š±ò - 15¼7— Ûõþ ü±Ëï ûÅM• ýËûþËå õUùüÑàÉß ÎöÂø¸æÝ ÎöÂø¸æ ëÂ×Âó±ð±Ëòõþ ò±÷ Îû&Ëù± Û ñõþËíõþ áÔËý õþ±àËî ýËõ¼ õÅçÂËî ÕüÅ¿õËñ ýûþ ò±, ü±ñ±õþí ÷±òÅËø¸õþ ¿ä¿ßÂÈü±õþÛß¿é Û¶ßÂõþí Ý ÂóX¿î üõùö±Ëõ ä±ùÅ ¿åËù±¼ Ûõþ ü±÷±¿æß áèýíËû±áÉîÂ±Ý ¿åËù± ¿ò}Âûþ-ý×¼

¿ßÂcà ü±÷±¿æß õ± õîÇÂ÷±ò Âó¿õþö±ø¸±ûþ æò¦¤±Ë¦šÉõþ Û ¿ä™Lñõþ ÷±Ëç ÎðËýõþ Îû ñ±õþí±¿é ¿åËù± î± Îß±ò Õɱò±é¿÷ß±ùÎðý òûþ, Ûß¿é Îðý ß±ê±Ë÷± û±õþ ÷ñÉ ¿ðËûþ Îð±ø¸, ñ±îÅÂ Ý ÷ù Û¶õ±¿ýî ýûþ ÛõÑ, ¿õËúø¸ ßÂËõþ, ÎðËýõþ õ±ý×Ëõþõþ õÔýÈ¿õË•«õþ ÷±Ëç ¿¦šî Ûß¿é Û¶±í ÛõþßÂ÷ Ûß¿é Îõ±ñ¼ Û ß±õþËí Û¶±ßÔ¿îÂß æÏõËòõþ Î÷é±ôÂõþ õÉõý+î ýûþ ÎðËýõþ¿ô¿æÝù¿æ Îõ±ç±Ëò±õþ æòɼ üÅ|nîÂ-üÑ¿ýî±-ÎîÂ Û ¿õø¸ûþ¿é ¿ò¿ðÇ©†ö±Ëõ Õ±Ëù±¿äÂî ýËûþËå - ¿õüáÇð±ò¿õË•ÂÂó Îü±÷üÓûÉDZ¿òù± ûï± ““ ñ±õþûþ¿™Là æáËVýÑ ßÂô¿ÂóM±¿òù±™¦¸ï± ““ •üÓS¦š±ò - 21¼8— õ±Ñù± ÕïÇ ßÂõþËù - Îû÷ò

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äÂf, üÓûÇÉ Ý Õ¿òù - ¿õüáÇ, Õ±ð±ò Ý ¿õË•ÂËÂó Ûý× ¿îÂò ¿S•ûþ± Z±õþ± æáÈËß ñ±õþí ßÂõþ - Îüö±Ëõ ßÂôÂ, ¿ÂóM Ýõ±ûþÅÝ ¿îÂò۶߱õþ ¿S•ûþ± Z±õþ± úõþÏõþËß ñ±õþí ßÂËõþ¼ [éÂÏß± ß±Ëõþõþ üÑËû±æò, ¿õüáÇ úËsõþ ÕïÇ ÎüÌ÷É-&í ¿õîÂõþí,Õ±ð±ò úËsõþ ÕïÇ Îú±ø¸í ÛõÑ ¿õË•ÂÂó úËsõþ ÕïÇ ÎÛ¶õþí¼] üýËæý× Îõ±ç± û±ûþ, äÂËfõþ ßÂ±æ ¿õüáÇ, üÓËûÇÉõþ ß±æÕ±ð±ò ÛõÑ Õ¿òËùõþ ß±æ ÎÛ¶õþí¼ Ã›¶±ßÔ¿îÂß õþ+Âóߊ ñÔî ýËûþ ï±ßÂËù± ÎðËýõþ ß±Ëæõþ õɱàɱûþ¼

Õ±Ëõþß¿é Û¶üÑá ÎöÂËõ Îðà±õþ ÷Ëî±¼ ÎðËýõþ õ± microsm-Ûõþ Îû Âó¿õþüõþ Ûà±Ëò Õ±Ëù±¿äÂî ýËûþËå Îüé±Û¶ßÔÂîÂÂó˕ Û¶ßÔ¿î õ± macrocosm-Ûõþ üÏ÷±¿ûþî õþ+Âó¼ Ûà±Ëò ¿ä¿ßÂÈü±õþ Õ¿öÂ÷Åà ýËBå Û¶ßÔ¿îÂõþ ü±Ëï ö±õþü±÷ɦš±Âóò ßÂõþ±, Û¶ßÔ¿îÂËß ¿òûþLaí õ± ÂóÅòáÇ¿êÂî ßÂõþ± òûþ¼ Û ßÂï± qñÅ Õ±ûþÅËõÇËðõþ æòÉ òûþ, Û¶±äÂÏò Îû Îß±ò ¿ä¿ßÂÈü±ÂóX¿î Îû÷ò ü÷ü÷Ëûþ Õ¿î ëÂ×i§î áèÏß ¿ä¿ßÂÈü±õþ ÷±ËçÂÝ Õ±÷õþ± ÛßÂý× ñ±õþí± ÎðàËî Âó±Ëõ±¼ ¿ßÂcà ÛËî±é±ö±õò±ü¥ói§ ¿ä¿ßÂÈü± õÉõ¦š± Ý æò¦¤±Ë¦šÉõþ ñ±õþí± ¿ßÂö±Ëõ Û¶±ûþ ÕõùÅl ýËûþ ÂóÂóÅù±õþ Î÷¿ë¿üò Ý Õ¿ú¿•Âî ÷±òÅËø¸õþ¿ò榤 ¿õ•«±ü ¿òöÇÂõþ ý±îÅÂËh ¿ä¿ßÂÈü± ýËûþ ÎáËù±, î± Û Õ±Ëù±äÂò±õþ Âó¿õþ¿ñõþ õ±ý×Ëõþ ýËùÝ Ûß¿é &•QÂóÓíÇ ÂóûÇËõ•ÂíÛà±Ëò ëÂ×Ë{¡à ßÂõþ± ðõþß±õþ¼ ülðú úsõþ ¿õàɱî ôÂõþ±¿ü ÂóûÇéÂß õ±¿òÇËûþõþ ÎðËà¿åËùò – It should be notedthat in all the countries we have just passed through, both in the Kingdom of Carnatic and theKingdoms of Golkonda and Bijapur, there are hardly any physicians except those in the servicesof the Kings and Princes. ¿î¿ò ÛéÂ±Ý ù•ÂÉ ßÂËõþ¿åËùò – when the rains have fallen and it is seasonfor collecting plants, mothers of families may be seen going out in the mornings from the townsand villages to collect samples which they know to specifics for domestic diseases... It is truethat in good towns there are generally one or two men who have some knowledge of medicine...They first feel the pulse, and when giving medicine, for which they take only the value of twofarthings, they mumble some words between their teeth. (Francois Bernier, Travels in the MughalEmpire, trans., lrving Brock, Vol. II, London, William Pickering, 1826. p. 240. òæõþé±ò Û¶õgÂß±Ëõþõþ¼—

Õ±ñÅ¿òß æò¦¤±¦šÉ - ëÂ×Âó¿òËõ¿úßÂ Ý ëÂ×Âó¿òËõËú±Mõþ ö±õþî - ÛõÑ Õ±÷õþ±

ô豂 ÎïËß q• ßÂËõþ äÂɱëëÂ×ý×ß õ± æò Φ§± ûÒ±Ëðõþ ý±î ñËõþ Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ üÓäÂò± îÒ±Ëðõþ Û¶ËîÂÉËßÂõþÕ±Ëù±äÂò± Ý Îõ±Ëñõþ Ûß¿é üÅ¿ò¿ðÇ©† ß±ê±Ë÷± Õ±Ëå¼ ÛõÑ î± ýù, æò¦¤±¦šÉ Û÷ò ÛßÂé± Õ=Áù Îûà±Ëò ÎðËýõþÕɱò±é¿÷ß±ù Φóú-Îû ÕÑú Îû÷ò QßÂ, ÷ÅàáýWõþ ý×îÂɱ¿ð üɱ¿ò鱿õþ ü±ûþ±k-Ûõþ Õ™LÃöÓÇÂM• ýù¼ Ûõþ Õ±Ëá ¿ßv¿òßÂɱùÎ÷¿ë¿üò Ý ýü¿Âóé±ù Î÷¿ë¿üËòõþ üÓäÂò± âËéÂËå¼ ÎðýËß Îõþ±áÏõþ ÎäÂò± Âó¿õþ¿äÂî Âó¿õþüõþ ÎïËß ü¿õþËûþ ¿òËûþ ý±üÂó±î±Ëùõþnoise-free ÛõÑ Ã›¶±ßÔ¿îÂß ¿õ:±Ëòõþ Âóõþϕ±-¿òõþϕ±õþ ÷Ëî± ëÂ×ÂóûÅM• ý±üÂó±î±Ëùõþ Âó¿õþüËõþ ¿¦šî ßÂõþ± ýËûþËå¼Îüà±Ëò ÷ÔîÅÂÉõþ ÂóËõþ •ÛõÑ Õ±ËáÝ— Îðý ò±÷ß ¿S-÷±¿Sß Õɱò±é¿÷ß±ù Φóü-Îß úõ-õÉõËBåËðõþ ü±ý±ËûÉ ß±é±-ßÅ¿é ßÂËõþ ÂóÓíÇî ÎæËò ÎôÂù± û±ûþ ÛõþßÂ÷ :±ò Ý Ã›¶îÂÉûþ Õ¿æÇî ýËûþËå¼ Îü :±ò ¿ú•Â± ¿ðËBå õ±ý×Ëõþõþ Âó¿õþËõúÎðËýõþ ÕöÂÉ™LÃõþ Ý õ¿ýõþ±ÑúËß ձS•±™LÃ Ý ßÂùÅ¿ø¸î ßÂõþËî Âó±Ëõþ¼ üÅîÂõþ±Ñ üɱ¿ò鱿õþ ü±ûþ±k-Ûõþ ß±æ ýËõ •Â¿îÂßÂõþÛ¶±ßÔ¿îÂß Âó¿õþËõËú ý™¦¸Ë•ÂÂó ßÂõþ± Ý ÂóÅòáÇ¿êÂî ßÂËõþ ÎòÝûþ±¼ Õ™LÃî ¿îÂò¿é ΕÂËS Û¶±ßÂ-Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ ñ±õþí±õþü±Ëï Û ñ±õþí±õþ ÷Óùáî Âó±ïÇßÂÉ âËé ÎáËù± - •1— ÎðËýõþ Õɱò±é¿÷ß±ù Φóü Ý Âó¿õþËõúáî Φóü-Ûõþ üŦ󩆿õö±æò, Ý •2— Û¶±ßÔ¿îÂß Âó¿õþËõËú ý™¦¸Ë•ÂÂó ßÂõþ± Ý ¿òËæõþ ëÂ×ÂóËû±áÏ ßÂËõþ ÂóÅòáÇ¿êÂî ßÂËõþ ÎòÝûþ±õþ Õ±áè±üÏÎäÂîÂò±¼ Ûà±Ëò Û¶±ßÔ¿îÂß ö±õþü±Ë÷Éõþ Îß±ò õþßÂ÷ Îõ±ñ ÕòÅÂ󿦚îÂ, Û¶ßÔ¿î Ûà±Ëò ÷±òÅËø¸õþ öÔÂîÂÉ, Ûß¿é Õ-ÎðýÏÕ=Áù Îûé±Ëß Îû÷ò àÅ¿ú ÷±òõ ÎðËýõþ ÷Ëî±ý× ß±é±-ÎåÒh± ßÂõþ± û±ûþ, ÛõÑ üËõDZÂó¿õþ, •3— Û ß±Ëæõþ Û¶ñ±ò ð±¿ûþQýù õþ±Ë©†˜õþ¼ õþ±©†˜ Ý õÉ¿M•õþ ÷±Ëç Ûß ñõþËíõþ òæõþð±¿õþ õ± surveillance Î÷¿ë¿üò-Ý õËé¼ Îë¿öÂë ձ÷Ǧ†˜Ñ-Ûõþñ±õþí±ûþ òîÅÂò ñõþËíõþ æò¦¤±¦šÉ Âó¿õþߊò±ûþ ‘‘Âó¿õþËõú õ±gÂõ’’ õþ±æÍò¿îÂß ß±ûÇS•Ë÷õþ Û¶Ëûþ±æò ÂóËh ÛõÑ “it calls

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for an ecological approach to health; and, for the individual, it requires an extension fromconcerns with body boundaries or individual psychology to examination of ‘lifestyle’. In itsnew guise of health promotion, public health is now concerned with generating and monitoring‘political awareness’ in its widest sense.” (David Armstrong, “Public Health Spaces and theFabrication of Identity”, Sociology 1993, 27 (3), pp. 393-410.)

Õ±÷Ç̂ ÂÑ-Ûõþ ñ±õþí±õþ Ûß üÅjõþ ëÂ×ð±ýõþí ¿÷ùËõ ¿÷Œò Îõþ±÷±õþ-Ûõþ õM•Ëõɼ 1965 ü±Ëù ßÂɱ¿ùËô±¿íÇûþ±õþ Watts

Õ=ÁËù &•îÂõþ ¿ýÑü±Rß âéÂò± âé±õþ ÂóËõþ Îõþ±÷±õþ-Îß Âó±ê±Ëò± ýËûþ¿åù üËõþæ¿÷ò îÂðË™LÃõþ ß±Ëæ¼ îÒ±õþ õM•õÉÕòÅû±ûþÏ - among other things, recommended the establishment of three or four general ambu-latory health care at “locations of greatest poverty” in the riot area. (Milton I. Romer, “Resis-tance to Innovation : The Case of the Community Health Center”, American Journal of publicHealth 1988, 78, 9, pp. 1234-1239)

æò¦¤±Ë¦šÉõþ ÛõþßÂ÷ Ûß ÎÛ¶¿•Âî ëÂ×Ëiœ±¿äÂî ýõ±õþ ÂóËõþ Õ±÷õþ± Û¶Ëõú ßÂõþËî Âó±¿õþ ö±õþËîÂõþ ¿ò¿ðÇ©† ÂóéÂöÓ¿÷Ëî ¿ßÂö±Ëõ Ûõþ ¿õß±ú Ý ¿õ™¦¸±õþ ýù î± õÅçÂËî¼ Îë¿öÂë ձòÇ‹ ÛËß Ûß ßÂï±ûþ õËùËåò “enclave medicine” ÎïËß“public health”- Û û±S± (David Arnold, Colonizing the Body, California University Press, 1993)

ö±õþËî õüõ±üß±õþÏ õÔ¿éÂú ÆüòÉõ±¿ýòÏ Ý ý×ÝÎõþ±ÂóÏûþ æòî±õþ ¦¤±¦šÉËß ö±õþîÂÏûþ ßÂùÅø¸ Ý •Â¿îÂßÂõþ æùõ±ûþÅ ÎïËßÂõÒ±ä±Ëò±õþ æòÉ ¿õ¿öÂi§ ñõþËòõþ ßÂ÷ÇüÓäÂÏ ÎòÝûþ± ýËûþËå Îû÷ò, éÂÏß±ßÂõþí ý×îÂɱ¿ð¼ ÎÛ-á ð±/±õþ ßÂï± Îî± ý׿îÂý±ËüüÅ¿õ¿ðî¼ ëÂ׿òú úîÂËßÂõþ ¿îÂò-äÂîÅÂïDZÑú ü÷ûþ æÅËh æò¦¤±¦šÉ õ± õÔ¿éÂú ÆüËòÉõþ ¦¤±¦šÉõþ•Â±õþ æòÉ ÕüÑàÉ õý× ÛËßÂõþÂóËõþ Îùà± ýËûþËå¼ Ûß¿é ëÂ×ð±ýõþí ýù Edmund A. Parkes-Ûõþ 1866 ü±Ëù Îùà± A Manual of Practical

Hygiene Prepared Especially for Use in the Medical Service of the Army¼ ÛõþßÂ÷ Îùà±Ëù¿àõþüÓSÂó±î թ†±ðú úîÂËßÂõþ Îúø¸ ö±á ÎïËß¼ 1830-Ûõþ ðúËß ö±õþËî Î÷±é ÆüòÉ ¿åËù± 2,50,000¼ Ûõþ ÷ËñÉ÷±S 40,000-Ûõþ ß±å±ß±¿å ¿åËù± õÔ¿éÂú Æüòɼ ÆüòÉõ±¿ýòÏõþ æòÉ Indian Medical Service (IMS) Æî¿õþýËûþËå¼ 1920-1930-Ûõþ ü÷ûþß±ù ¿ðËûþ ö±õþËî Î÷¿ë¿üËòõþ õþ±¿©†˜ûþ òÏ¿îÂËî ¿ßÂåÅ Âó¿õþõîÇÂò Õ±üËî q• ßÂËõþ“away from the old enclavism and towards a more Indian oriented sytem of public health.Nonetheless, the change was more a shift of emphasis than a complete transformation.”(DavidArnold, “The rise of wsetern medicine in India”, Lancet 1998, 348, pp. 1075-78)

Û¶ñ±òî Îû ¿õø¸ûþ&Ëù±õþ ÝÂóËõþ Îæ±õþ ÎðÝûþ± ýûþ Îü&Ëù± ýù - éÂÏß±ßÂõþí, üɱ¿òËéÂúò, ý±ý׿æò ÛõÑ, Õ¿ñßÂ&•QÂóÓíÇ, Õ±ñÅ¿òßÂî± Ý Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ëÂ×ÂóËû±áÏ æÏõòËõ±ñ Æî¿õþ ßÂõþ±¼ Îúø¸ ¿õø¸ûþ¿éÂõþ õ±™¦¸õ ¿ö¿M ýËBå Îûö±õþîÂõø¸Ç ßÂàËò±ý× ü¥óÓíÇö±Ëõ îÂï±ß¿ïî ÕɱËù±Âóɱ¿ïß ¿ä¿ßÂÈü±Ëß áèýí ßÂËõþ ¿ò¼ Îû Îß±ò ü÷Ëûþ Ûà±ËòÕ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ÎäÂËûþ ÕËòß Îõ¿ú Âó¿õþ÷±Ëí ß¿õõþ±¿æ õ± ÕòÉ ñõþËòõþ ¿ä¿ßÂÈü± ä±ùÅ ¿åËù±, ÛàËò± Õ±Ëå¼1864 ü±Ëù üÓûÇÉ &¿ëÂö äÂS•õîÇÂÏ õÔ¿éÂú Î÷¿ëÂßÂɱù æ±òDZù-Û Ã›¶ß±¿úî îÒ±õþ Ûß ¿õþËÂó±ËéÇ ÛßÂæò ß¿õõþ±Ëæõþ ëÂ×Ë{¡àßÂõþËåò ûÒ±õþ ð¿•Âí± ÛõÑ ü¥œ±ò ý×ëÂ×Ëõþ±ÂóÏûþ ¿ä¿ßÂÈüßÂËðõþ ÎäÂËûþ Îõ¿ú ¿åËù±¼ 1907 ü±Ëù ¿ä¿ßÂÈü±-ü¿¥œùòÏÂó¿Sß±ûþ ‘‘ÎðúÏûþ ¦¤±¦šÉ-¿õ:±Ëòõþ Ûß±ù Ý Îüß±ù’’ úÏø¸Çß Û¶õËg Îùà± ýËBå - Ü¿îÂý±¿üß ß±Ëùõþ ßÂï± ò± ñ¿õþËùÝ,áî Øò¿õÑú úî±sÏõþ ÷ñÉö±á ýý×Ëî õ±/±¿ù汿îÂõþ ú±õþÏ¿õþß Õõ¦š±õþ ¿òî±™Là Îú±äÂòÏûþ Âó¿õþõîÇÂò Îðà± û±ý×ËîÂËå¼Ûõþ ß±õþí ¿ß· ü±÷±¿æßÂö±Ëõ Ûî¿ðò ñËõþ Âó±¿ùîÂ Ý Ã›¶¿î¿‡Âî ձä±õþ-õÉõý±Ëõþõþ Âó¿õþõîÇÂò ýËûþËå - ¿ýjÅñ÷Ç õ±ü÷±æ ü¥¤Ëg Îû üßÂù õþÏ¿îÂòÏ¿î õ± Õ±ä±õþõÉõý±õþ Û¶ä¿ùî ձËå, îÂÈü÷™¦¸ý× Ã›¶±ûþú ÛîÂËVúÏûþ æòáËòõþ úõþÏËõþõþÂóË•Â Ûß±™Là ÕòÅßÓÂù... ¿õñ±î±õþ ¿õhÂ¥¤ò±ûþ ¿ýjÅü÷±æúõþÏõþ ò±ò±¿õñ Îõþ±Ëá Õ±S•±™LÃ Ý ¿òî±™Là æÏíÇ-úÏíÇ ýý×ûþ±

14

Âó¿hÂûþ±Ëå... òîÅÂò æù±úûþ Û¶¿î‡± ýÝûþ± ðÓËõþ ï±ßÅÂßÂ, Û¶±äÂÏò&¿ùÝ S•÷ú q©¨ ýý×ûþ± û±ý×ËîÂËå, ÕËòß áè±Ë÷ ÛËßÂõ±Ëõþý×qß±ý×ûþ± ¿áûþ±Ëå¼ •¿ä¿ßÂÈü±-ü¿¥œùòÏ, òîÅÂò ձ߱Ëõþ 2ûþ à`Â, 5÷ Ý 6‡Â üÑàɱ— Û Âó¿Sß±õþ 1888 ü±Ëù ۶߱¿úîÂ2ûþ àË` ‘‘Õ±ûþÅËõÇð Æõ:±¿òß ¿ß ÕÍõ:±¿òß·’’ ¿úËõþ±ò±Ë÷ Û¶õg Îùà± ýËBå¼

û± Îý±ßÂ, ÛõþßÂ÷ ÎÛ¶•Â±ÂóËéÂ, æ±îÂÏûþî±õ±ðÏ Õ±Ëj±ùËòõþ ü÷Ëûþ ÎðúÏûþ æòî±õþ Õ±Ëõá Ý ü÷ïÇò-ÂóÅ©† Õ±ûþÅËõÇðÝ Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ÷ËñÉß±õþ üÑâ±î äÂõþ÷ õþ+Âó Îòûþ¼ üõ¿ßÂåÅõþ Õ¿öÂâ±Ëî 1946 ü±Ëù Æî¿õþ ýù Îö±õþ •Bhore—ß¿÷úò¼ Primary Health Care õ± Û¶±ï¿÷ß ¦¤±¦šÉ õÉõ¦š±õþ üÓSÂó±î ýûþ Û ü÷ûþ ÎïËß¼ Ûý× ß¿÷úò Îû üõüÅÂó±¿õþú ßÂËõþ î±õþ ßÂîÂßÂ&Ëù± ýù - Û¶ï÷, Û¶ú±ü¿òß ÂóûDZËûþ preventive ÛõÑ curative Âó¿õþËø¸õ±Ëß Î÷ù±Ëî ýËõ¿ZîÂÏûþ ¦¤Šß±ùÏòö±Ëõ 40,000 æòüÑàɱõþ æòÉ 1¿é Û¶±ï¿÷ß ¦¤±¦šÉ-ÎßÂf Æî¿õþ ýËõ ÛõÑ ðÏâÇË÷ûþ±ðÏ ¿ýËüËõ Û¶¿îÂ10,000-20,000 æòüÑàɱõþ æòÉ 75 úûɱ-¿õ¿ú©† Û¶±ï¿÷ß ¦¤±¦šÉ-ÎßÂf Æî¿õþ ýËõ îÔÂîÂÏûþ, áè±÷Ïí ¦¤±¦šÉ ß¿÷¿éÂÆî¿õþ ßÂõþËî ýËõ ý×îÂɱ¿ð¼ Û÷ò ¿ß 1937 ü±ËùÝ ßÂÑËáèü ûàò Û¶ï÷ Û¶Ëðú&¿ùõþ •Â÷î± ù±ö ßÂËõþ îÂàËò±ö±õþËîÂõþ ‘骱¿ëÂúò±ù’ ¿ä¿ßÂÈü± ÂóX¿î õþ±Ë©†˜õþ üý±ûþî± ù±ö ßÂËõþËå¼ Îö±õþ ß¿÷¿é Ûß¿é õUQÂóÓíÇ ü±÷±¿æß ¿ä¿ßÂÈü±õÉõ¦š±õþ ÷±Ëç Âó±}±îÂÉ ¿ä¿ßÂÈü± õÉõ¦š±õþ Û¶±ñ±òÉËß õþ±Ë©†˜õþ îÂõþËô ÕòÅË÷±ðò ¿ðËù±¼ Îë¿öÂë ձòÇ‹ Ûß¿é &•QÂóÓíÇ÷™LÃõÉ ßÂËõþËåò - The Bhore Committee presented a Beveridge-style blueprint that no colonialgovernment of India would ever have put into practice. Its ambitious and idealistic public-healthprogramme could only begin to be realised under an independent regime. Western medicine wasnever so powerful in India as when it shed its colonial identity. (Arnold, “The rise of westernmedicine”.òæõþé±ò Û¶õgÂß±Ëõþõþ¼—

Ûà±Ëò ßÂËûþß¿é ¿õø¸ûþ Õ±÷±Ëðõþ ¿ä™Lñõþ Âó¿õþ¿ñõþ ÷±Ëç ï±Ëß ðõþß±õþ¼ õþõÏfò±Ëïõþ ü±Ëï îÂÈß±ùÏò æ±îÂÏûþî±õ±ðÏÎòîÔÂËQõþ Û¶ñ±ò üÑâ±ËîÂõþ ÕòÉîÂ÷ æ±ûþá± ¿åËù± Ûß¿ðËßÂ, ö±õþîÂõø¸ÇÏûþ ü÷±Ëæõþ áè±÷Ïí üö±&Ëù± ëÂ×ÂóûÅM• &•QÂó±Ëõ ¿ß ò±, ÕòÉ¿ðËßÂ, Õ±Ëj±ùËòõþ Õ¿öÂ÷Åà õþ±©†˜÷ÅàÏ ýËõ õ± ü÷±æ÷ÅàÏ ýËõ¼ Îö±õþ ß¿÷úËòõþ ÷Óù ÎçұߠÂóhÂËù±ü¥óÓíÇö±Ëõ õþ±©†˜-¿òûþ¿Laî Âó±}±îÂÉ ¿ä¿ßÂÈü±õþ ÝÂóËõþ¼ ö±õþîÂõËø¸Çõþ ÷Ëî± ¿õÂóÅù æòüÑàɱõþ ÂóõþËî ÂóõþËî õUQæh±Ëò± ÎðËú ÎßÂõù Âó±}±îÂÉ ¿ä¿ßÂÈü± ¿ðËûþ ü÷±ñ±ò ýËõ ò± õËù áè±÷Ïí ¦¤±¦šÉ ß¿÷¿éÂ-õþ ÷Ëî± ¿õø¸ûþ&Ëù±õþ Û¶™¦¸±õò±ÛËüËå¼ ÛËðËú öÂûþÑßÂõþ Õ±áè±üÏ ëÂ×Âó¿òËõ¿úß õÉõ¦š±õþ Û¶¿îÂôÂùò âËéÂËå Ûõþ õþ±æÍò¿îÂßÂ, ü±÷¿õþßÂ, ü±÷±¿æßÂ,ü±Ñ¦Ô¨¿îÂßÂ, Û¶ú±ü¿òß ý×îÂɱ¿ð ü÷™¦¸ ß±ûÇS•Ë÷¼ Îß±ò ü÷Ëûþý× ¿õߊ Îß±ò ñ±õþí±Ëß •û¿ð Îüé± ü±÷±¿æß •Â÷î±üÔ¿©†õþ ÷ñÉ ¿ðËûþ õþ±Ë©†˜õþ ßÂîÇÔÂQËß äÂɱËù? æ±ò±ûþ— ÕòÅË÷±ðò ßÂËõþ¿ò, ¿õÂóõþÏËî ð÷ò ßÂËõþËå¼ Î÷¿ë¿üËòõþ æáËîÂÝÛé± ü¿õËúø¸ ü¿îÂɼ Î÷¿ë¿üò Ý æò¦¤±Ë¦šÉõþ Û ÷î±ðúÇ Îö±õþ ß¿÷¿éÂõþ ÷±ñÉË÷ Æõñî± Âó±ûþ •ÕòÉ ß¿÷¿éÂõþ ÷±ñÉË÷ÝÎÂóËî Âó±õþËî±—¼ ¿õò±ûþß ÎüËòõþ âéÂò± æò-¦¤±Ë¦šÉõþ Û Ã›¶ü/¿éÂËß Îä±Ëà Õ±/Åù ¿ðËûþ Õ±ËõþßÂõ±õþ òîÅÂò ßÂËõþ Îð¿àËûþÎðûþ¼ ¿î¿ò Âó±}±îÂÉ Î÷¿ë¿üËòõþ Ûß¿é ¿öÂi§ ñõþËòõþ Û¶Ëûþ±á ÂóX¿îÂõþ õ±™¦¸õ±ûþò ßÂËõþ¿åËùò¼ Û õ±™¦¸õ±ûþËòõþ ôÂËùü±ñ±õþí ÷±òÅËø¸õþ ¦¤õþ ú¿M•ú±ùÏ ýËûþ ëÂ×Ëê¿åËù±, ¦š±òÏûþö±Ëõ Âó±Ýûþ± üyÂõ ÛõþßÂ÷ ÷±òõ ú¿M• Ý ü±÷ËïÇÉõþ õÉõý±Ëõþõþõ±™¦¸õ ÎäÂý±õþ± ÆîÂõþÏ ý¿Båù¼ Ûß ßÂï±ûþ õþ±Ë©†˜õþ ¿òûþLaí Õ¿îÂS•÷ ßÂËõþ Î÷¿ë¿üò ýËûþ ëÂ×Ëê¿åËù± ÷±òÅËø¸õþ ¦¤±¦šÉõþ•Â±õþ¿ò榤 ý±¿îÂûþ±õþ¼ ëÂ×Âó¿òËõ¿úß ðúÇò-æ±î ձáè±üÏ õþ±Ë©†˜õþ ÂóË•Â ÛËß Îõ¿ú ¿ðò ñËõþ ÕòÅË÷±ðò ßÂõþ± üyÂõ òûþ - û±ßÂõþ±õþ õþ±©†˜ ßÂõþËõ¼ ÛæòÉ ¿õò±ûþßÂËß ß±õþ±™LÃõþ±Ëù ÎûËî ýûþ¼ Û¶ä¿ùî æò¦¤±Ë¦šÉõþ Û ¿ðß¿é ձæ ÷Ëò±Ëû±á ¿ðËûþö±õ±õþ ¿õËúø¸ Û¶Ëûþ±æò¼ æò¦¤±Ë¦šÉõþ Ûß¿é Îß±ò ÷ËëÂù Îá±é± ÂóÔ¿ïõÏ æÅËh Îòý×¼ ö±õþËî ձñÅ¿òß æò¦¤±Ë¦šÉõþ üÓäÂò±Ý ¿õß±ú âËéÂËå ö±õþîÂõËø¸Çõþ ÷±òÅËø¸õþ, ¿õËúø¸î úUËõþ ¿ú¿•Âî ü¥xð±Ëûþõþ, ¿ä¿ßÂÈü± Ý ¦¤±¦šÉ-üÑS•±™Là ¿ò榤 Îõ±ñËßÂÂóÅòáÇ¿êÂî ßÂËõþ¼ Õ±õ±õþ, Îü æò¦¤±Ë¦šÉõþ ÷ËëÂùËß õ±Ëõþ õ±Ëõþ ¿ôÂËõþ î±ß±Ëî ýËBå ¦š±¿òß տöÂ:î± Ý ÷±òõ ü¥óËðõþ

15

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2011)

Ûõþ ü±Ëï Õ±Ëõþß¿é ü÷üɱ æ¿hÂËûþ Õ±Ëå¼ Îûüõ ¦§±îÂß õ± ¦§±îÂËß±Mõþ ¿ä¿ßÂÈüß Âó±ú ßÂËõþ ÎõËõþ±ËBå î±ËðõþÛß¿é õËh± ÕÑú ¿õËðú û±S± ßÂËõþ¼ ý×ÑùɱË`Âõþ Î÷±é ¿ä¿ßÂÈüËßÂõþ 10.9% ö±õþîÂÏûþ, Õ±Ë÷¿õþß±ûþ 4.9%, ß±ò±ë±ûþ2.1%, Õ˦†˜¿ùûþ±ûþ 4.0%¼ Ûß¿é ü÷ϕ±ûþ æ±ò± ¿áËûþËå, 1989 ÎïËß 2000-Ûõþ ÷ËñÉ ö±õþËîÂõþ Ûß¿é Û¶ï÷ü±¿õþõþÎ÷¿ëÂßÂɱù ßÂËùæ ÎïËß Âó±ú ßÂõþ± ¦§±îÂßÂËðõþ 54% Õ±Ë÷¿õþß± Âó±¿h ¿ðËûþËå¼ ý×ÑùɱË` Îõþ¿æ¦†˜±ëÇ ö±õþîÂÏûþ ò±ËüÇõþüÑàɱ 1998-Û ¿åËù± 30, 2005-Û 3551¼ Lancet Âó¿Sß± ÷™LÃõÉ ßÂõþËå - Health-worker migration,especially for those whose training is funded by the public, is a substantial loss of scarce publicresources. •ÂóÓËõDZM•— ÛõþßÂ÷ Ûß ÎÛ¶•Â±ÂóËé ձËõþßÂõ±õþ ¿õò±ûþß ÎüËòõþ ÷Ëî± ¿ä¿ßÂÈüß ûÒ±õþ± Õ±Ëåò îÒ±Ëðõþ ßÂï±ö±õ± ÎûËî Âó±Ëõþ¼ Û¶ßÔÂîÂÂóË•Â, æò¦¤±Ë¦šÉõþ ñ±õþí± Ûß¿é ðúÇòáî Õõ¦š±ò¼ ÎßÂõù÷±S Û¶¿ú¿•Âî ¿ä¿ßÂÈüß ýÝûþ±ý×Ûà±Ëò ûË渚 òûþ, ü±÷±¿æß ðúÇËòõþ Û¶•Ÿ Ûà±Ëò Ûß±™Là 敿õþ¼

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17

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The world cannot remain half healthy and half sick and still maintain its economic, moraland spiritual equilibrium. (World Health Assembly President, T. Scheel, 1951).

Executive summary

This essay contends that central to the question of affordable and sustainable health systemsis having a viable health care financing system.

This having been said, several words of caution are expressed right upfront to avoid over-simplifying the issues.

To put African health systems in the context of other such systems in the world, a quickdiagnosis is made. This is followed by an analysis of the very prevalent fee for service systemwith its inconsistencies, inequity, room for abuse and ultimately unsustainability. The role ofmedicines in the overall picture of funancing health care is then put into perspective.

Several potential solutions for Africa are then explained including, but not limited to, taxfinancing, social insurance schemes and combinations thereof; systems of cross-subsidizationare explored, as are the unfair geopraphic (provincial) budgetary allocations of the healthbudgets in the continent and ways to remedy the same. The essay closes with a more in depthanalysis if community-based health insurance schemes, looking at their attributes, how to getthem started, and finally warns of their caveats.

1. General remarks

1.1 I think the crux in the question of affordability and sustainability here are viable healthcare financing systems; all the rest may be important, but is more ‘icing on the cake’.

1.2 Nevertheless, to stave off unrealistic technocratic solutions as a dream, several words ofcaution are called for upfront:

i) Ultimately, the name of the game is NOT to become efficient at giving health careto the poor, BUT rather to reduce poverty!... and NOT much is happening in this front. Wehave declared a worldwide war against poverty and poverty has won! [Centainly, if poverty wasan infectious disease, the rich would do much more to eradicate it..]

ii) In health care financing (HCF), the task is NOT about adapting services to poverty;that would be merely coping– not resolving Africa’s problems. Moreover, just increasing thehealth care delivery systems’ efficiency will not lead to increased accesss as much as very rapid

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OPTIONAL HEALTH CARE FINANCINGMECHANISMS FOR AFRICAN

COUNTRIES : WHAT IS VIABLE ?

Õ±™LÃæDZ¿îÂß –

Claudio SchuftanMD, Ho Chi Minh City

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economic growth will NOT automatically result in improved health! Decreasing the level ofcare to make it cheaper is NOT an option either.

iii) For the years to come, local resources in rural areas of Africa can and will NEVERfinance 100% of the needed health care.

iv) Cost-effectiveness analyses do NOT have an equity dimension and, therefore, mustbe used with conscious restraint if they are to be useful at all for achieving equity-orientedhealth targets.

v) The key issues to center a discussion on HCF are:- How to finance the health care system;- How to best allocate available resources; and, most importantly,- How to increase the efficiency AND equity effect of allocative actions taken.

vi) Finally, if we are to succed, sentences starting with “The Government should” areout! Stop complaning, stop promising: DO! [That is why I start this essay with what does anaffordable and sustainable system look like?,... and not ‘should look like’...]

2. A sorry diagnosis?

A quick look at the African countries shows that still today income maldistribution is verymuch with us.

The numbers show that rich countries use around 7% of their income on health yet poorcountries are using around 10-11% (around 25% of the income in the poorest families). In 2003,the average spending on health care in all developing countries worldwide was US$ 11/capita.(It is deemed this amount must be increased to $60).

Households are the main source financing health care services altogether (close to 80% inmany countris) and, through open hidden fees, also finance up to 60% of the public sectoralready.

Government allocations to the health sector have been declining in real per capita terms inmost Sub-saharan African countries. Increasing government financing for health has historicallyofter been below population growth and inflation rates. It has been easy for the central govern-ment to set targets and then ... not to pay.

Against this background, the disease burden of the poorest quintile is roughly threefold thatof the richest, their expectancy is more than 10 years shorter, and their infant mortality rate ismore than twice as high.

Close to one third of the patients who need hospitalization fail be be hospitalized : around80% due to financial constraints. There is also evidence that poor patients abscond due to lackof money to pay hospital bills.

In many countries in the continent, unofficial payments to (mostly) doctors are estimated tobe much higher than official payments for hospital services. People wrongly think these pay-ments – formal as well as informal – are necessary for receiving proper treatment. [We needto challenge this assumption that one can only receive good care if one is able to pay for it].

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But keep in mind that health care seeking contacts with private providers are not primarilywith doctors, but overwhelmingly with drug sellers (... close to 60% of the people self-medi-cate!!)

Ergo, the poor face cost-related barriers to accessing health care. Medical expenditures arenow one of the main causes of why people become poor (the ‘medical poverty trap’).

Additionally, we have experienced a breakdown of the district-level (or equivalent) healthcare system, the village health workers network, and traditional medicine has also decreasedsignificantly in many countries in Africa.

Some countries have national compulsory health insurance – which only covers the moreaffluent quintiles.

It is not exaggerated to estimate that a good 80% of private practitioners are primarilyemployed in the public health care sector. But they are not making a decent living, so, now, evena big part of their salaries has to be generated locally. The problem is sometimes so acute thateven traditinally preventive health care facilities have had to start providing curative servicesto make money.

Furthermore, hospitals all over have started to operate private wards. Most have ended upbeing subsidized by funds from regular hospital operations – rather than the other way around– primarily because a) the more affluent users using these wards are charged below full cost,and b) VIPs do not pay when hospitalized there.

3. Fee for service-financed health care

The charging of (explicit and implicit) fees in public health facilities is Inconsistent withequity objectives; revenues from it only cover about 10% of all health expenditures (althoughup to 50% of hospital expenditures). These fees thus only marginally contribute in terms ofoverall HCF and they grossly increase inequity.

In the user system (a regressive tax), the sick pay more; the poor pay more; children andthe elderly pay more.

The fee for service system increases the burden on the sick, especially the rural. It hasweakened the structure of preventive care, because it has decreased funding for it causing a lossof preventive care staff with the ones left having poor skills.

If and when fees have been raises, they have NOT cross-subsidized the poor, i.e. the real-location of funds user fees to the poor has, so far, been rather limited or non-existent. In alltruth, user fees can hardly be used for subsidizing the care of the poor.

User fees are increasingly replacing government recurrent expenditures in health, includingsalaries; user fees are now the main source of income for many health workers. We are thuswitnessing an “under-the-table” commercialization of public health services.

On the other hand, there is NO positive relationship between high user charges and goodquality of care – for either the rich or the poor. And, if the fee for service system does not havea financial ceiling, i.e. a budget, it becomes very difficult to control total costs.

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Under the fee for service regime, providers tend to over-provide costly services (e.g. extradiagnostic tests and costly treatments) neglecting the needs for regular services of the rest ofthe population. This clearly gives priority to the more profitable segment of the health caremarket.

With facilities competing for fees, the referral system has also been weakened; there hasbeen a veritable change from cooperation to competition between providers.

User fees are unlikely to improve the current situation.

It is thus obvious that market-oriented strategies for HCF with high user fees have generatedmore negative than positive effects on equitable access.

4. Medicines : How much of a culprit ?

Drugs account for up to 70% of overall health expenditures. They, therefore, ARE of keyimportance to HCF.

Drug vendors in the private sector are the relief providers of choice and they are NOT healthprovidrs (nor, as a fait accompli, do we give them any minimum training!). Why do peoplechoose them? Because of the limited (mostly economic) access they have to professional healthcare services: the poor often have no choice; self-medication is thus a major item of householdexpenditure.

Otherwise, private health care providers earn a large share of their income selling drugs intheir private offices. This is as unethical as it is dangerous, causing losses to society that endup wasting money on unnecessary, useless or dangerous drugs, (Note that expensive drugscontribute more to the income of the provider selling the drugs...and these are the medicinespushed by the veritable enemies of poor people’s health – the pharmaceutical houses represen-tatives).

The regulation of the commercial drug market thus is of critical importance. But the controlof the cost of drugs is difficult. The government simply has to develop (and/or expand) itscapacity to monitor and control this market – at the same time strengthening the overall drugmanagement system.

National Essential Drug Programs (EDPs) are in desperate need of enforcement (with thesedrugs only having low mark-ups).

Moreover, prescription audits are needed (using carbon copy pads that include the diagnosisand drugs precribed). The focus is to be on decreasing the use of antibiotics, injections, steroidsand vitamins, i.e. controlling the irrational use of drugs.

An option to also consider is the replacement of the mark-up-per-drug system by a fixedcharge per prescription.

5. A basket of potential solutions ?

I see some general ‘golden rules’ that I think do apply to HCF almost everywhere in Africa.Among them are the following:

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i. In HCF, one has to measure any planned intervention against the cost of resulting ill-healthif nothing is done. The horizon should be to progressively plan to increase access to healthservices by the poor over a 3-5 years period.

ii. A larger population of users allows for economies of scale. Ideally, in that population, thehealthy should subsidize the sick, the rich should subsidize the poor*, the working shouldsubsidize the dependent (mostly children and the elderly).

(*. i.e. a progressive taxation with higher rates of taxation of the higher income groups.)

iii. Also, a greater cross-subsidization across income groups is needed. (One option to keepin mind is for private for profit hospitals to be taxed at levels that will secure cross-subsidiza-tion to public hospitals).

iv. Any future HCF scheme will continue to have to primarily draw from traditional thirdparty payers. i.e., the government (national and local), different insurance schemes, the patientsthemselves, donors and community health care funds.

v. To universalize access to health services, one needs to subsidize the poor using both localand outside funds coming both from inside and outside the health sector.

vi. Insurance schemes cannot replace a national publicly financed health care system; theycan only contribute to it. Subsides will thus be required even for well-designed and efficientlyrun public insurance schemes.

vii. In general, our choices in HCF will drive health sector either towards:- a market-oriented privatized system;- a hybrid system where the government and the private sector play equal roles;- a fully tax subsidized system as in the (far) part; or

- a direction in which the government takes the key role and the private sector isconsidered a complementary component, but shares the same responsibilities and tasks(including preventive care).

viii. There is no escape : In one way or another, African governments have to increase theirhealth spending. But they have to gear it to pro-poor interventions, e.g. preventive services andservices directed at the disease of poverty; it is these that have to be fully financed.

ix. Making resources available is not enough; they can be mis-used, under-utilized andwasted in many different ways. As part of any HCF strategy, measures have to be taken to haveall health resources used efficiently.

x. Also assessing medical technologies in use or proposed for use is of critical importancefrom the HCF point of view as this makes it possible to reduce or rule out costly treatmentswithout proven benefits.

xi. User fee exemption schemes are infinitely more difficult to implement than havingacross-the-board low or no user fees for the more vuinerable populations. Alternatively, thegovernment can grant tax exemptions to poor districts.

xii. Exemptions are nevertheless needed for all cases of public health importance such asTB, STDs, HIV/AIDS (!)

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xiii. Even if painful, another avenue that needs to be pursued is adjusting personnel deploy-ment to current levels of services provided. Mobilizing the under-utilized manpower is thus alsoa must; facilities are not infrequently overstaffed relative to patient load; much time is wastedwaiting for patients.

xiv. Furthermore, patients tend to seek care at too high levels of the health system (hospitalsover health centers and dispensaries) and this is very costly. Efforts are needed to ensure moreappropriate entry levels of consultation. Consequently, patients have to be seen first at dispen-sary level (or equivalent) where it is definitively cheaper. Incentives will have to gear consul-tations to this entry point. In practical terms, this means having to strengthen these facilities andthe referral system!... and that is easier said than done.

xv. For any HCF scheme to succeed, there also is a need for management training.

6. ‘Righting the wrong’ in the obsolete geographic allocation of funding for health.

Financial resources for health should be driven according to need (with resources going toclearly identified priority areas), and not be based on a per-capita basis (where paying does nottake into account the more vulnerable populations and those with lower ability to pay).

The HCF Africa will advocate-for calls for a needs-based health care planning, and thismeans reallocating tax revenues from better off to poor regions. Why?, because only tax fundsare amenable to be reallocated from rich to poor regions.

Currently, tax funds (the funding for health included) often favor better-off provinces orstates, for instance, allocating funds according to the hospital beds: this simply reinforcesexisting differences!

Allocation according to need considers size of the population, disease burden of differentgroups and their ability to pay.

To accomplish this, needs-based resource allocation, indexes do exist already. There is aneed to further devolop and adopt country-specific needs-based indexes though, for resourcesto be more equitably allocated between regions, taking into full account total resources avail-ability and deciding “how to cut the cake”. [Note that a special index for allocating funds forpreventive services according to need is also needed].

For all the above reasons, other than tax financing health costs, by far the more appropriatechoice for HCF in Afica is to focus on possibilities of risk pooling and pre-payment, ensuringthat both healthy and sick people coutribute via taxes and social health insurance.

7. And the winner is ...

In the hierarchy of cost-effective ways of providing health care, surely a national, tax-financed health system has shown to be the most equitable. When we talk about government,responsibility, like in the Alma Ata Declaration, this is what was meant.The right to health isactually grounded on the latter.

But there are difficulties; the public budget for health is often in the vicinity of 1% of GNP;without sufficient funds, how can Health For All be achieved? A political compromise is needed

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(but is not forthcoming) to increase public health expenditures to something between 2 and 3%of GNP and to ensure the new funds are used efficiently and in relation to right to healthpriorities.

African governments are left with the task of making the above happen. For that, civilsociety needs to organize much more to aggressively demand these changes.

Many, nevertheless, think that starting community-based health insurance (CBHI) process isa step in the right direction since it helps getting beneficiaries involved in decision-making inhealth and can empower them to become active in the larger struggle for a tax-financed uni-versal health coverage. Here is how it is perceived it w/should work.

7.1. CBHI : Some general attributes and preconditions :

i. Social insurance – in this case CBHI – is a household responsibility system; it is meantfor people in the informal sector, mostly the rural and urban poor; as any insurance, it is basedon risk sharing and resources pooling; it is more viable where the community is alreadyorganized for other purposes, but the point is made that CBHI certainly does not solve theproblems of communities or groups that are just too poor.

ii. A CBHI system assures a more equitable coverage, a potentially more equitable geo-graphical access, a greater equity in the financing of its operations, a potential for health carecost controls and an increased efficiency in the use of resources, as well as good financialsustainability and a chance for improved quality of care. It provides a greater latitude comparedwith pure tax financing of health care (and for sure compared with the user fee system).

[The alternative of going back to full direct tax financing of health services would requireconsiderable budgetary reallocations that are not as politically viable now as implementing asound CBHI].

iii. Implementing a CBHI scheme needs a clear goverment policy and legal framework. Tobegin with, three major policy changes are deemed necessary.

– legislation for a community tax of 1.5-2% of income.– an additional central government tax support of 0.2-0.5 of GDP; and– changes in the personnel compensation system allowing for bonus payments.

iv. The option here proposed is to gradually develop a subsidized community-based healthinsurance system that covers an increasing proportion of the curative care needs of the ruralpopulation and is jointly financed by community contributions, pulic funds and, initially, alsoforeign aid, i.e., community contributions are matched by public funds. (The public sectorcontinues to pay for traditional preventive services as before).

v. A fully voluntary CBHI system will inevitably lead to an adverse selection problem (withmostly the sicker and the elderly wanted to join). A compulsory system will also not work.People at the community/village level will have to make a local voluntary-but-collective deci-sion to join the scheme. Piloting is recommended.

vi. Note that a subsidized rural health insurance system also helps the allocation of resourcesto different provinces according to need. A special fund to support less developed areas (remote,minorities) will have to be created as needed.

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vii. The main challenge will ultimately be to convince people that what is proposed is forthem to reduce their ‘under-the-table payments’, and, instead, start paying a clearly identifiedlocal health tax.

7.2. Getting started (a non-exhaustive listing) :

i. A village can only join the CBHI scheme once 60% of its members have agreed tosubscribe; membership can be individual or household-based. (Note that, to keep premia low,members can choose to adopt a user co-payment of 10-20%).

ii. Once the community accepts to join, people get together and make a pre-payment (aninvestment, really, since they will not have a financial burden at the time of illness). At thistime, communities can also determin0e exemption mechanisms to be applied.

iii. Getting the CBHI started will require social mobilization to make people understand itslong-term benefits. For instance, the membership will be educated on the philosophy andmechanics of the new health care financing scheme and on how the service delivery system willwork from now on. They will also be trained in cost-saving measures in the provision of healthcare services. Members will further need education on insurance principles and the principlesof democratic supervision.

iv. Some ‘benefits’ from ambulatory services (in part a moderate mark-up on drugs?) can berealized to help pay for needed in-patient care and for accidents.

v. Increasing members’ awareness of personal and community health issues is very impor-tant as well in an effort to reduce morbidity and ensuing consultations. In a related matter, anadditional important benefit to be discussed with members is that, if the quality of healthservices is below standard and causes health problems – such as EPI-related infections stillbeing prevalent-beneficiaries will be able to claim compensation.

vi. For those who will need subsidies, sequentially, communities will need to identify poorhouseholds; define the support they need where this support is to come from; this means that,as part of the scheme, a community health care fund has to be established for the indigent.

vii. Once a CBHI is in place, it is foreseen that a large share of resources now going to theprivate providers would return to the public providers.

7.3. Caveats to keep in mind when setting up a CBHI scheme :

i. Most importantly, the government has to enjoy sufficient popular credibility upfront forthe successful organization and management of a nationwide CBHI system.

ii. No less important is our understanding that, unlesss quality health care is guaranteed,there will be few takers. In general CBHI must offer benefits such that the common person willwant to bocome part of it. i.e., the challenge is to ‘create-a-demand’, especially in rural areas.

iii. As regards the payment of this insurance premia, a process of consultation has to precedethe drawing up of policy plans for any future CBHI. Premia are best set with the communityaccording to their objectively assessed purchasing power, in this same manner, premia are tobe (re) set annually.

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iv. At the end, premia should be attractive as relates to the coverage offered to members, aswell as competitive and fair in the reimbursements paid to affiliated provider institutions.

v. Premia are paid annually in cash or in kind using a sliding scale (or percentage ofincome). The challenge is for payments to be made on time – and to be 100% accunted for.One has to be flexible and tailor premia collection dates to the periods when the communityhas the means to pay (e.g., after the harvest). They can be collected either as deductible or asa door-to-door contribution.

vi. Irregular accounting or embezzlement in any CBHI scheme will make matters worse.

vii. As regards participation in CBHI, the local community has to set up a committee tooversee the whose pre-payment system. This participation is particularly important in themanagement of the finances of the dispensary of health center to provide members entry andreferral services; it represents a real (and indispensable) shift-in-the-balance-of-influence infavor of the users of services.

viii. In a CBHI scheme, users are thus empowered to audit accounts and to oversee the useof funds, as well as to monitor health workers, i.e., one should look at CBHI as an instrumentof community empowerment where members who join really have a voice, if for no otherreason than because they are directly contributing to shoulder the costs. [Note that CBHI alsopromotes gender equality and ensures women have direct and easy access to health centers].

ix. Finally, the complexity of organizing these schemes is not to be understimated; it limitsour ability to scale them up rapidly.

Acknowledgements. Many concepts mostly taken from Goran Dahigren’s and David Dunlop’swrittings on the topic.

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2¼ ü÷ϕ±¿é ßÂËõþËå Îõ±¥¤±ý×-Ûõþ ‘ô±ëÂ×Ë`Âúò ôÂõþ ¿õþü±äÇ ý×ò ß¿÷ëÂ׿ò¿é Îýùï’ üѦš±¼3¼ ÕòÅüg±ò ßÂËõþËå Âó¿}Â÷õË/õþ üõþß±¿õþ ë±M•±õþËðõþ üÑáêÂò ‘Îýùï ü±¿öÇÂËüü ÕɱËü±¿üËûþúò, ÝÎûþ©† Îõ/ù’,

ëÂ×Ë{¡à ßÂõþ± ýËûþËå üõþß±¿õþ Û¶ú±ü¿òß üѦ¨±õþ ß¿÷¿éÂ-õþ ß±Ëå ÎÂóú ßÂõþ± ¦œ±õþß¿ù¿ÂóËî¼4¼ Ûý× ¿õø¸Ëûþ ÕüÑàÉ õý×ÂóS Õ±Ëå¼ Õ±Ë÷¿õþß±ûþ ‘Î÷¿ëÂËßÂûþ±õþ’ Û¶ßÂËŠ ¿úqËðõþ ¿ä¿ßÂÈü± ÛõÑ ‘Î÷¿ëÂËßÂëÂ’ Û¶ßÂËŠ

õÔXÂËðõþ ¿ä¿ßÂÈü± ÎðÝûþ± ýûþ¼ õ±¿ßÂËðõþ æòÉ ÕËòËßÂõþ õÏ÷±Ã›¶ï±õþ õÉõ¦š± Õ±Ëå¼ ñòÏ Îðú&¿ùËî տñß±Ñúò±á¿õþßÂý× õÏ÷±Ã›¶ï±õþ Õ™LÃöÇÅÂM•¼

5¼ J. E. Rohde : Health for All in China, in Practising Health for All, Ed. D. Morley, J. Rohde

& G. Williams, OWP, 1983.

6¼ Õ±òjõ±æ±õþ Âó¿Sß± 21 ¿ëÂËü¥¤õþ, 1991¼7¼ Âó¿}Â÷õË/õþ ‘E±á ÕɱßÂúò Îô±õþ±÷’ ۶߱¿úî ÂóÅ¿™¦¸ß±&¿ùËî ÝøÅ̧ñ æáËîÂõþ ò±õþßÂÏûþ ¿äÂS ëÂ×ðⱿéÂî ýËûþËå¼8¼ WHO & UNICEF : Report of the International Conference on Primary Health Care Alma-

Ata USSR, 1978.

9¼ National Health Policy : Government of India, Ministry of Health & F.W. 1982.

[ ÂóÅò ۶߱¿úî ]

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I am greatly honored to be chosen as the 2011 recipient of the prestigious Gwangju Prizefor Human Rights. It is indeed an honour not just for me but also the countless other humanrights workers struggling to establish justice, peace ad equity all over India, including Chhattisgarhwhere I live and work. Let me begin by thanking all those who have taken the time to advocateabout me and on behalf of me, and then take this opportunity to speak for myself and in myown words.

I would like to thank the people of South Korea and in particular the citizens of Gwangjuwhose historic struggles have freedom, democracy and justice core values of their society. Themartyrs of Gwangju will remain an inspiration to people all over Asia as we struggle to makethe world a better place.

First, I shall try to briefly clear up some possible misconceptions about myself. I did notviolate any laws and never was disloyal to the people of my country. I condemn, unequivocally,all violence by any all individuals and agencies. I believe that violence is an invalid and unsus-tainable approach to achieving goals, whether these are the goals of the state or the goals ofindividuals operating outside the law. Because the state is sworn to uphold the Constitution, Ibelieve we are entitled to hold agents of the state to a higher standard than we hold outlaws.As members and office-bearers of the People’s Union for Civil Liberties, it is the responsibilityof my colleagues and myself to help hold the state accountable to the promises of the IndianConstitution.

But the state does only consist of the government or its agencies. As a society, we are allpart of the state, and there would be no state without us. We often tend to think of violenceonly in terms of the use of weapons and explosives against others. However, there is anotherform of violence in society, which is structural in nature, which I believe is even more pervasiveand pernicious than guns and bombs because it is all around us and we have stopped noticingit. It is this other form of violence that concerns me as paediatrician and public health physician.

I would like to begin my speech here today by first telling you very briefly about myself andmy work but follow this with my perspectives on what is happening in my home country India,which is home to over one-sixth of all humanity on this planet. I will also try to deal with theglobal context which is affecting the health and human rights situation in India.

It was nearly four decades ago that I, as a pediatrician trained at the Christan MedicalCollege. Vellore in southern India after a brief stint at the Jawaharlal Nehru University in NewDelhi decided to go and work in Chhattisgar. My graduate thesis at CMC had focussed onsevere malnutrition in children and the theme of nutrition and its interface with health and wellbeing has been a life-long area of concern for me.

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Gwangju Prize : Acceptance speech ofDr Binayak Sen

ü÷ü±÷¿ûþßÂÏ –

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Chhattisgarh, a province in Central India that till ten years ago usedto be part of the larger province of Madhya Pradesh, was created in 2000as a separate state ostensibly to benefit the large population of indig-enous people or ‘adivasis’ there.

However, Chhattisgarh is also the most mineral rich state in the country and iron-ore,limestone, dolomite, coal, bauxite are found in abundance. The province also produces 20% ofthe India’s steel and cement and is also a major centre of thermal power production. Much ofthe mineral resource lies below adivasi lands. Yet throughout India as well as in Chhattisgarh,the adivasis are a much-neglected group, long deprived of such basics as nutritional security,health care and education, who are now also suffering displacement from their natural habitatand their traditional livelihood resources as politically favoured commercial interests seek toexploit the state’s vast mineral wealth in their lands.

When we first arrived here my wife Dr. llina Sen (who is sociologist with a special interestin gender studies) and I, decided to work with the Chhattisgarh Mines Shramik Sangh (CMSS)which was a unique trade union movement among mining and steel plant workers led by thelegendary Shankar Guha Niyogi. Under Niyogi’s leadership the mine workers’ organization leda militant struggle for the rights of indigenous, contractual mine workers, and combined thiswith a strong commitment to social initiatives that were anchored in the strength of the people.The idea of basing health outreach programmes on the strength of community based healthworkers was born here. In the mid-eighties we moved to the capital city of Raipur and foundedRupantar, a community-based non-government organization (NGO) that aimed at an integratedapproach to health care and human rights, including women’s rights and food security. Usingthis platform we contributed to the mainstreaming of health worker based community healthprogrammes that has now been adopted nationally in India. However, my health work inChhattisgarh for the last 30 years has demonstrated to me again and again that there is a clearrelationship to peoples’ nutrition social, economic and political well being and the state of theirhealth. Health can never exist in isolation and without a broader concept of entitlements.

My participation in human rights work started with my joining the People’s Union for CivilLiberties (PUCL), a long-established and respected Indian human rights organization estab-lished by the late Jai Prakash Narayan during the dark days of the Emergency when the libertyof speech and expression of ordinary citizens stood suspended. When the new state of Chhattisgarhwas formed. I became the secretary of the PUCL in Chhattisgarh and in the course of time, itsNational Vice-President. A lot of my human rights work consisted of highlighting the depriva-tions of the tribal communities and exposing instances of state insensitivity as well as policeatrocities against them.

This was a period when the government of Chhattisgarh was engaged in a major project ofland acquisition and mega development that deprived the adivasis of their access to commonproperty resources in land, water and forest, as well as existing livelihood option. State actionin the forested parts of the province, ostensibly against the Maoists, severely compromisednormal life, with repressive laws, police brutality, and the sponsorship of a vicious civilianmilitia or vigilante group called the Salwa Judum. On behalf of the PUCL, my colleagues and

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I organised objective enquires into the atrocities of this militia. We also led enquiries into socalled “encounter killings”, by which security agencies sometimes secretly liquidate suspectedmilitants. One such enquiry ultimately led to registration of criminal cases and issuing of arrestwarrants against eight erring police officers, much to the discomfort of the state police.

The PUCL has also strongly criticized over the years the forced displacement of the adivasiswithout proper rehabilitation and without sharing with them the fruits of economic devolopmentwhich is mainly based on exploitation of mineral wealth located in their natural habitat.

Almost certainly because of my growing involvement in human rights work and exposureof state atrocities on indigenous populations on 14 May 2007, I was detained for allegedlysupporting the outlawed Maoists, thereby violating the provisions of the Chhattisgarh SpecialPublic Security Act 2005 (CSPSA) and the Activities (Prevention) Act 1967, and for indulgencein seditious activity.

On 24 December 2010 a lower court in Raipur sentenced me along with two others torigorous life impresonment for ‘sedition’, under an outdated colonial-era law that was formu-lated by our imperial masters in the nineteenth century, and used for long against fighters forIndia’s freedom from British rule.

Today, as I stand before you here in Gwangju I have been freed on bail by the SupremeCourt of India which in a hearing on 15 April has said clearly that the laws on sedition has beenwrongly applied in my case and there is no evidence at all for such a charge. My appeal tooverturn the conviction and sentence of the imprisonment continues at the Chhattisgarh HighCourt and I am determined to fight the case till it is finally established that my actions werealways in the interst of justice with equity, and were never seditious in nature.

What I have said so far about Chhattisgarh, applies today to all of India. India the countryI belong to, is an ancient and great nation. It is a land of stupendous deversity of people,cultures, languages and ethnicities. It is a land that gave rise to at least four major religions ofthe world Hinduism. Buddhism, Jainism and Sikhism and to numerous great philosophers,mathematicians, physicians and social revolutionaries.

Today, India is considered around the world as a rapidly developing country posting eco-nomic growth rates of around 8-9 percent consistently over the last several years. Along withChina, which is much further ahead, India is seen as a powerhouse of the global economy inthe decades to come and already it is home to a very large number of doller billionaires, perhapsthe largest such number in Asia.

In our own times as we look around this vast and populated country though the picture thatone sees is not as rosy as it is made out to be. India is also home to the world’s largest numberof people living in absolute poverty. In 2007 a study on the unorganized sector in India, basedon government data for the period between 1993-94 and 2004-05, found that an overwhelming836 million people in India live on a per capita consumption of less than Rs 20 or 0.50 US centsa day. (1)

In 2010 a UNDP / Oxford University study, using a new Multi-dimensional Poverty Index(MPI), said that eight Indian provinces alone have more poor than 26 African nations put

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together. The report said that acute poverty prevails in Bihar, Chhattisgarh, Jharkhand, MadhyaPredesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal which together account for 421million people, 11 million more “MPI poor” than in the 26 poorest African countries.

As a physician and a pediatrician in particular what concerns me is that such absolutepoverty among such large numbers of people really translates into a major health disaster theproportions of which can only be called genocidal. I have a specific technical reason for usingthe word genocide and do not wield it in a rhetorical manner.

The Indian National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of theadult population of India has a Body Index of less than 18.5 and can be considered as sufferingfrom chronic under nutrition. If we disaggregate the data. we find that over 50% of the sched-uled tribes (Adivasis), and 60% of the scheduled castes (dalits) have a BMI below 18.5.

The WHO says that any community with more than 40% of its members with a BMI below18.5 may be regarded as being in a state of famine. By this criterion there are various subsetsof the population of India-the scheduled tribes, scheduled castes, – which may be regarded asbeing permanently in a state of famine.

So it is not any general population that is suffering the consequences of poverty-inducedmalnutrition but specific ethnic groups and hence my use of the term ‘genocide’ as per theUnited Nations definition. All this is, of course, in addition to the mundane reality, to whichwe have become inured, of 43% of children under 5 in India being malnourished by weight forage criteria has the world’s largest number of malnourished children and according to theUNICEF over 2 million Indian children die every year due to malnutrition related diseases.

I want to bring to your and indeed the attention of the world that it is precisely this sectionof the population, that is stricken by famine, that is today the principal target of a widespreadpolicy of expropriation of natural and common property resources, in a concerted and oftenmilitarized programme run by the Indian state.

For a long time, despite their cash poverty, the Adivasis of central India, living in extremepoverty, nevertheless survived through their access to common property resources- the forest,the rivers, and land- all of which are now under a renewed threat of sequestration and privatizationas global finance capital embarks on its latest phase of expansion. The doctrine of eminentdomain vests ultimate ownership of all land and natural resources in the state. Under cover ofeminent domain, vast tracts of land, forest and water reserves are being handed over to theIndian affiliates of international finance capital.

Land acquired from ordinary people in Chhattisgarh, as also in other parts of India, has beenhanded over to the industrial houses for the purpose of mining or building large steel and powerplants. With a few honourable exceptions, the personnel articulation the agency of state powerhave almost uniformly possessed a colonial mindset. It is not as if the people have not resisted.The forced takeover of indigenous land is being met with resistance that is multi hued, yet thestate has chosen to brand it under the single category of Maoist, and has met it with brutalityand human rights violations. The social fabric in many of these regions is today polarized

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beyond immediate rectification, and the deep fissures in our society willtake time to heat.

Ladies and Gentlemen, on this solemn occasion, I would like to make an appeal to all ofyou. In the times we live while oppression is most actualy mainfested in remote and local placeslike Baster district of Chhattisgarh the truth is that the forces behind such oppression are oftenglobal in nature. It is well recognized now that the tsunami-like flow of capital around the worldis a source of tremendous tragedy for many communities around the world which do not fit intothe idelogically straitjacketed confines of the ‘market economy’.

Countries like South Korea that have suffered the ravages of colonialism in the past and risenfrom the ashes of the Second World War to become industrially and econimically leadingnations of the world have a special responsibility today. It is the responsibility of ensuring thatthey do not do the kind of violence and exploitation to the people of the Third World what theythemselves were subjected to in the past by others.

I want to bring up the specific case of the South Korean steel giant POSCO which hasembarked on a USD 12 billion dollar project in the Indian state of Orissa, which at USD 12billion to mine iron ore, build a port and a mega-steel plant.

Indian activists have pointed out repeatedly that from a national point of view the MoUsigned by the Orissa government with POSCO to give it the rights to mine over 600 milliontonnes of high grade iron ore is a scam of immense proportions. According to the original MoU,the royalty that POSCO will pay for the iron ore is around Rs. 24 per tonne whereas the sellingprice in the international market is around Rs. 5000 today. Besides all this POSCO and itsinvestors from around the world are to be illegally given nearly 5000 acres of land that wasoriginally forest land and connot be used for any other purpose under Indian law without theconsent of forest dwelling people.

For more than five years now the POSCO Pratirodh Sangram Samity (PPSS), a local people’smovement in Jagatsingpur district, has been bravely resisting the POSCO Project which theatensthe livelihood of thousands of agriculturists, workers and small businesses in the area besidesdevastating the local enviornment and ecology. Over 30,000 people, mostly farmers and fisherfolkare expected to the displaced.

Even as we speak here today large contingents of the Orissa police are moving into thevillages settled on the targeted land for the POSCO project to uproot local communities usingbrute force. I would like to appeal to the South Korean people and the people of Gwangju inparticular to strongly oppose the POSCO project in solidarity with the brave farmers andfishermen of Jagatsingpur. POSCO should withdraw its investment in this project immediatelyand an inquiry launched in both South Korea and India into the circumstances under which sucha project was considered and cleared.

The spirit of the Gwangju Prize for Human Rights calls upon all of us to continue to opposeviolations of human rights in every form, wherever it occurs and whatsoever the costs of suchopposition. We remain committed to Peace, but realize that there cannot be any peace without

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equity and social justice. I am confident that my appeal to you will beheard and responded to and the solidarity of the South Korean people willforever remain with the oppressed people of India and other parts of Asiaand the world. Thank you.

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Õɱ¥¤ÅËùk ä±ùßÂõþ± üõþß±Ëõþõþ ÎïËß ÕïÇ üÑáèý ßÂõþËõ¼ Ûý× Ã›¶ßÂËŠõþ ò±÷ ÎðÝûþ± ýù ‘¿ò}Âûþ û±ò’ ۶ߊ¼ ëÂ×Âóõþ ÎïËßÂÎäÂò± æ±ò± ßÂòü±ùËéÂKé ¿òËûþ±á ßÂõþ± ýù¼ îÂï±ß¿ïî Public Private Mix (PPM) ÷ËëÂËù Û¶¿î õvËß ÛßÂõ± Ûß±¿ñß Õɱ¥¤ÅËùk ÎßÂò±õþ •Âóh ³Âò ÎäÂò± Îù±ßÂËß õ± ÕËïÇõþ ¿õ¿ò÷Ëûþ Âó±ý×Ëûþ ÎðÝûþ±õþ— ñÓ÷ ÂóËh Îáù¼ ÕËòßÂé±ßÂËûþß õåõþ Õ±Ëáõþ âéÂò±õþ ÷î¼ ûàò ¿ü/ÅËõþ é±é±Ëðõþ æòÉ üõþß±Ëõþõþ Îæ±õþ ßÂËõþ æ¿÷ Õ¿ñáèýËíõþ ¿õ•ËX ßÔÂø¸ßÂÛ¶¿îÂËõþ±ñ q• ýËûþËå¼ Îüý× ü÷Ëûþ ¦¤±¦šÉ ðlËõþõþ Õ±Ëõþß ëÂ×Èü±ýÏ Õ±÷ù± NRHM-õþ ÕËïÇ ÎëÂËß ÎëÂËß Û¶¿î¿é õvËßÂßv±õ Ý NGO Îðõþ é±é± Îß±¥ó±òÏõþ Õɱ¥¤ÅËùk ¿õîÂõþí ßÂËõþ •Îû Âó¿õþËø¸õ± Õ¿äÂËõþý× ÷Åï ïÅõËh ÂóËh— ðÅ-îÂõþôÂÎïËßÂý× ö±ù Õ±÷ð±òÏ ßÂËõþò¼

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õþ ò±Ë÷ Âó¿}Â÷õË/ ¿õ•« õɱ˂Âõþ ßÂËûþßÂ’ú Îß±¿é é±ß± ¦¤±¦šÉ à±Ëî ¿õ¿òËûþ±á ýûþ¼ ûËïBå ¿õËðú-w÷í-ôÓ¿îÇÂ-ô±ëÂ×ö©†±õþà±ò±¿Âóò±, Îðð±õþ ÕÛ¶Ëûþ±æòÏûþ ¿ò¥§÷±Ëòõþ ûòS ÎßÂò±, é±ß± ¿òËûþ Û¶äÅÂõþ ¿òËûþ±á •î±Ëðõþ ÷±ý×Ëò— Ûý× üõ ßÂËõþý×é±ß±&¿ù îÂåòå ßÂËõþ ÎðÝûþ± ýûþ¼ ý±üÂó±î±ù õ± ¦¤±¦šÉ õÉõ¦š±õþ Îß±ò ëÂ×i§¿î ßÂõþ± ýûþ ò±¼ Ûõ±õþ Îû¿é ßÂõþ± ýù î±ձõþÝ ÷±õþ±Rß¼ NRHM Ý RCH ۶ߊ ÛõÑ ÎßÂfÏûþ Ý õþ±æÉ ¦¤±¦šÉ ðlËõþõþ Âó¿õþߊò± ÕòÅû±ûþÏ Ã›¶¿î ÂóÒ±ä ý±æ±õþæòüÑàɱûþ •Õ±¿ðõ±üÏ ÕñÅÉ¿ø¸îÂ Ý Âó±ý±¿h Ûù±ß±ûþ ¿îÂò ý±æ±õþ æòüÑàɱûþ— Õõ¿¦šî ëÂ×Â󦤱¦šÉ ÎßÂf •Sub Centre—&¿ùËß IFID, NRHM-õþ é±ß±ûþ ÎìÂËù ü±æ±Ëò±õþ ß±æ ßÂõþ± ýù, ANM ¿òËûþ±á ýù û±õþ± Îüý× áè±Ë÷õþ ¦š±ûþÏ õ±¿üj±ýËõò Ý ëÂ×Â󦤱¦šÉ ÎßÂËfõþ Îð±îÂù±ûþ Õ±õ±üËò ï±ßÂËõò ÛõÑ Ã›¶¿î ý±æ±õþ æòüÑàɱûþ ASHA Îðõþ IMNCI Û¶öÔ¿îÂÕ±ñÅ¿òß Û¶¿ú•Âí ÎðÝûþ± ýù¼ Ûüõ ßÂõþ± ýù ëÂ×Â󦤱¦šÉ ÎßÂËf ¿òõþ±Âóð Û¶üËõõþ •Safe Delivery— æòɼ áɱõþ±æÝ Õɱ¥¤ÅËùËkõþ üѦš±ò ßÂõþ± ý¿Båù Û¶Ëûþ±æòÏûþ Îõþô±ËõþËùõþ æòɼ ÎßÂò± ýù Û¶äÅÂõþ ûLaÂó±¿î - üõþ?±÷¼

áè±Ë÷õþ áõþÏõ Û¶üÅ¿îÂËðõþ ¿òõþ±Âóð Û¶üõ Ý Âó¿õþËø¸õ± ÎðÝûþ± ÛËðõþ Õ±üËù ëÂ×ËVúÉ òûþ, ÛËðõþ Õ±üù ëÂ×ËVúÉ¿ò÷DZí, ¿òËûþ±á, ÎßÂò±ß±é±õþ ÷±ñÉË÷ ÕËìÂù ÕïÇ ëÂ×Âó±æÇò¼ Îüé±ý× ýù¼ Ûý× õɱÂóß ձRü±ËîÂõþ Âóõþ ÎßÂÌúËù, Õ¿ù¿àî¿òËVÇú Ý ¿ù¿àî ձËðúõËù õù± ýù Îû î±õþ± ‘Îõ±¿ñüMW’ ù±ö ßÂËõþËåò Ûý× :±ò ÕæÇËò Îû ëÂ×Â󦤱¦šÉ ÎßÂf ßÂËõþ

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Îß±ûþ±¿ù¿é Îë¿ùö±¿õþ üyÂõ òûþ¼ î±ý× ëÂ×Â󦤱¦šÉ ÎßÂËf Îë¿ùö±¿õþ ßÂõþ±õþ ðõþß±õþ Îòý×, 2nd ANM Îðõþ Õ±õ±üËò-Ý üõü÷Ëûþ ï±ß±õþ Û¶Ëûþ±æò Îòý×, 2nd ANM Îðõþ Õ±õ±üòËß ÎöÂË/ üö±¦šù •Meeting Hall— ßÂõþ± Îý±ßÂý×îÂɱ¿ð¼ Institutional Delivery Îî ëÂ×Èü±ý ¿ðËî Û¶¿ú•Âí Û¶±l ð±ý×õþ± institution Û ÎßÂü Õ±òËù Îû ü±÷±òÉü±¥œ±¿òß ÎÂóî õg ßÂËõþ ÎðÝûþ± ýù¼ Õɱ¥¤ÅËùk Âó¿õþËø¸õ± õg ßÂËõþ PPP Model ‘¿ò}Âûþ û±ò’ ۶ߊ q• ßÂõþ±ýù¼

Õ±õþÝ ÛßÂñ±Âó Û¿áËûþ î±õþ± Îâ±ø¸í± ßÂõþËùò Îû Û¶¿î ¿Sú ý±æ±õþ æòüÑàɱûþ •Õ±¿ðõ±üÏ ÕñÅÉ¿ø¸îÂ Ý Âó±ý±¿hÂÛù±ß±ûþ Û¶¿î ßÅ¿h ý±æ±õþ æòüÑàɱûþ— Îû Primary Health Centre (PHC) Õ±Ëå Îüà±ËòÝ Normal

Delivery ýËõ ò±¼ ÎßÂõù÷±S BPHC / RH ÛõÑ î±Ëðõþ Õ™LÃáÇî Ûß¿é PHC Îß ¿ä¿ý•î ßÂËõþ òîÅÂòö±ËõÂóÅò¿òÇ÷±í Ý Õ±õ±üò ÆîÂõþÏ ßÂËõþ •Õ±Ëõþ± é±ß± Õ±üËõ— Îüà±Ëò Û¶üËõõþ õÉõ¦š± ßÂõþ± ýËõ¼ Ûý×üõ Û¶ßÂËŠõþ ÕËòßÂÎÂó±ú±ßÂÏ ò±÷ ÎðÝûþ± ýù¼ Îß±ï±Ý SNSU, Îß±ï±Ý SNCU ý×îÂɱ¿ð ßÂõþ± ýËõ õËù ÕËòß é±ß±õþ ۶ߊ ôÒ±ð± ýù¼Õ±õþÝ é±ß±, Õ±õþÝ ÷Åò±ô± ä±ý×¼ Î÷±V± ßÂï± ýù Ûî õåËõþõþ ü±îÂ-ß±`Â-õþ±÷±ûþí Âóh±Ëò±õþ Âóõþ Îß±¿é Îß±¿é é±ß±¿õ¿òËûþ±Ëáõþ Âóõþ áè±Ë÷õþ ü±ñ±õþí ÷±òÅø¸ ¿ß ÎÂóËùò – ëÂ×Â󦤱¦šÉ ÎßÂËfõþ ¿ð¿ð÷¿íõþ± ¿ßÂåÅ ü÷Ëûþõþ æòÉ éÂÏËß ÎðËõò,Û¶±ï¿÷ß ¦¤±¦šÉ ÎßÂËf Õ±ñ± ë±M•±õþõ±õÅ õ± ¦¤±¦šÉßÂ÷ÇÏõþ± ¿ßÂåÅ ü÷Ëûþõþ æòÉ Îõþ±áÏ ÎðàËõò Ý ¿ßÂåÅ õ¿h ÎðËõò¼ ü±ñ±õþíÛ¶üËõõþ æòÉ î±Ëðõþ õþ±î¿õËõþî ðÅ™¦¸õþ à±ò±àj òðÏò±ù± ÎÂó¿hÂËûþ åÅéÂËî ýËõ õvß Û¶±ï¿÷ß ¦¤±¦šÉ ÎßÂËf õ± áè±÷Ïíý±üÂó±î±Ëù¼ Õ±õ±õþ ü±÷±òÉ æ¿éÂùî± Îðà± ¿ðËù â¿éÂõ±¿é ÎõËä Îüà±ò ÎïËß åÅéÂËî ýËõ ÷ýßÓÂ÷± ý±üÂó±î±ù“Îæù±ý±üÂó±î±ù“Î÷¿ëÂËßÂù ßÂËùËæ¼

Õ±Ëáý× õËù¿å Ûý× üõ Îòî± - Õ±÷ù±õþ± :±òÏ&íÏ ÷±òÅø¸¼ î±õþ± ÕËòß õåõþ õþ±æòÏ¿î ßÂËõþ •Â÷î±üÏò ýËûþËåò,ÎßÂëÂ×õ± ëÂ×Bä ¿ú•Â±õþ Âóõþ Õ±ý×. Û. Ûü. ýËûþËåò, ÎßÂëÂ×õ± ¿ä¿ßÂÈü±ú±Ë¦a ¦§±îÂß ýËûþ ÕËòß¿ðò Û¶ú±üò â±éÂËåò¼ ÛËðõþ÷¿™¦¸©¨ üõ ü÷Ëûþ üäÂù¼ Ûõþ± Ûõ±õþ ¿üX±™Là ¿òËùò ‘¿ò}Âûþ û±Ëò’ ýËBå ò±¼ Û¶üÅ¿îÂËðõþ æòÉ ‘÷±îÔÂû±ò ۶ߊ’Û¶Ëûþ±æò¼ ü±¥x¿îÂß ÎßÂfÏûþ üõþß±õþ ÎⱿø¸î ‘æòòÏ Ý ¿úq üÅõþ•Â± ß±ûÇS•÷ •JSSK—’, û± Ûî¿ðò ‘æòòÏ üÅõþ•Â±Îû±æò± •JSY—’ ò±Ë÷ Âó¿õþ¿äÂî ¿åù, -õþ ü±Ëï ûÅM• ßÂËõþ ‘÷±îÔÂû±ò’ Âó¿õþËø¸õ±õþ ÷ËñÉ æiœ±Ëò±õþ Âóõþ Õ±ê±ú ¿ðò Õõ¿ñòõæ±îÂËßÂõþ •Neonates— Âó¿õþËø¸õ± õþ±àËùò¼ Õ±üù Îàù±¿é ÎàùËùò ÕòÉ û±ûþá±ûþ¼ Ûî ¿ðò ‘¿ò}Âûþ û±ò’ PPP

Model Û ¿åù, Ûõ±õþ ‘÷±îÔÂû±ò’ ÂóÅËõþ±é±ý× Private ýËûþ Îáù¼ ÷Åò±ô± Ý òîÅÂò ß±÷±ý×Ëûþõþ æòÉ òîÅÂò ÷Ôáûþ±Ë•ÂSÛ¶Ëûþ±æò¼ Ûõ±õþ Û¶üÅ¿îÂ Ý òõæ±îÂËßÂõþ Âó¿õþËø¸õ± õÉ¿îÂËõþËß ü±¿õÇß 敿õþ ¦¤±¦šÉ Âó¿õþËø¸õ±õþ Õ™LÃáÇî Îõþô±ËõþËùõþ æòÉÛ¶õîÇÂò ßÂõþËùò 24 âKé±õþ ‘¿ò}Âûþ û±ò ۶ߊ’¼ Ûõþ Âó¿õþ¿ñ Ý ¿õ¿òËûþ±á ¦¤±ö±¿õß ö±Ëõý× ÕËòß õhÂ Ý ÎõúϼձÂó±îÂî ÛËß õvß ™¦¸Ëõþ PPP ÷ËëÂËù õþ±à± ýù¼ ¦¤±ñÏòî±õþ Âóõþ ÎïËß ßÂËûþß ý±æ±õþ Îß±¿é é±ß± õÉûþ ßÂËõþ, û±õþÕËòßÂé±ý× ¿õËðúÏ Ùí Õïõ± ëÂ×ËVúÉ Ã›¶Ëí±¿ðî ¿õËðúÏ ü±ý±ûÉ, Û¶±ûþ Û¶¿î¿é Âó¿õþߊò±, ß±ûÇS•÷ Ý Ã›¶ßŠ õÉïÇî±õþÂóõþ Ûý× ‘÷±îÔÂû±ò’ Ý ‘¿ò}Âûþ û±ò’ Û¶ßÂËŠõþ Âó¿õþí¿î ¿ß ýËõ î± ö¿õø¸Éî õùËõ¼ Õ±Âó±îÂî ¿õ¿òËûþ±á, ¿ò÷DZí, ¿òËûþ±áÝ ÎßÂò±ß±é±õþ õÉûþõUù ÂóõÇ äÂùËå¼ Ã›¶±ï¿÷ßÂö±Ëõ ÛéÅÂßÅÂý× ôÂù ýù Îû ÕîÂÏËî Âó¿}Â÷õË/õþ BPHC &¿ùËî •ÎßÂfÏûþ÷±Ëò CHC õ± FRU— Îõþ±áÏ Îõþô±Ëõþõþ æòÉ Ûß¿é ßÂËõþ üõþß±õþÏ Õɱ¥¤ÅËùk î±õþ ä±ùßÂ Ý ßvÂÏò±õþ üý ¿åù¼ Ûàòî±õþ± ï±ßÂËå ò±¼ Îõþô±ËõþËùõþ æòÉ ü¥óÓíÇö±Ëõ PPM ò±Ë÷ Õïõ± üõþ±ü¿õþ Û¶±ý×ËöÂé üѦš±&¿ùõþ ëÂ×Âóõþ ý±üÂó±î±ùßÂîÇÔÂÂó•Â Ý Îõþ±áÏõþ õ±¿hÂõþ Îù±ßÂËß ¿òöÇÂõþ ßÂõþËî ýËõ¼ Û¶±ï¿÷ßÂö±Ëõ ßÂùß±î± Ý Îæù± úýõþ&¿ùõþ Õ±úÂó±ËúõþõvËßÂõþ •Âóh ³Âò ù±öÂæòß— æòÉ Âó¿õþõýò õÉõü±ûþÏõþ± ÎéÂG±Ëõþ ÕÑú ¿òËBåò, ðÓõþõîÇÂÏ Ý ðÅáÇ÷ Õ=Áù&¿ùËî•Âóh ³ò Õù±öÂæòß— î±õþ± ÛËßÂõ±Ëõþý× Õ¿òBåÅß¼ ÕïÇ±È Ã›¶ßÂËŠõþ ÎõËò¿ô¿üûþ±¿õþËðõþ ëÂ×Âóõþ ÕËòß é±ß± àõþä ßÂËõþÝ

44

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¦¤±¦šÉ ßÂ÷ÇÏ, õÅ¿XÂæÏõÏ, ÎÂóú±æÏõÏ üË÷î ü÷™¦¸ ò±á¿õþßÂËß Ûý× ü÷™¦¸ æò¿õËõþ±ñÏ òÏ¿îÂõþ ¿õ•ËX üõþõ ýËûþ

45

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Alberto Granado, who accompanied Ernesto ‘Che’ Guevara on a 1952transcontinental journey of discovery across Latin America that wasimmortalized in Guevara’s memoir and on-screen in “The Motor CycleDiaries”, died in Cuba on 5.03.’ 11.

Granado and Guevaras’ road trip, begun on a broken down motor cyclethey dubbed La Poderosa (The Powerful) awoke in Guevara a socialconsciousness and political convictions that would help turn him intoone of the most iconic revolutionary of the 20th century.

In our school days when we read ‘Che Guevara’s Diary’, translated by‘Padatik’ poet Suvash Mukhopadhaya, our hairs became straight. Laterwe read different books on Che as well as his writings. Here we mustmention one excellent translation of Che’s memoir with photos, ‘CholteChe,’ published by Riti Prakashani. We became spelbound finding thehigh level of thinking, quest and convictions at their early medicoslives and their planning and organization of such a brave, difficult,long, adventurous and romantic voyage.

Also another great film on their journey is “The motor Cycle Diaries”produced byRobert Redford and directed by Walter Sallas of Chile.The film is not only an authenticated documentation of the famousjourney but it also vividly depicts the mental transformation ofChe and Granado toward underprivileged. Witnessing deep povertyand oppression across the continent– Chile to Colombia, particularlythe mine workers and leper patients of Peru they changed their futureaims of lives. Cinematographically the film is also superb and bringsus to the wonderful nature and beautiful lives of Latin America,The La Plata, The Pampas, The Patagonia, The Pacific Coast,The Andes, The forests of upper stream Amazon etc.

After the journey Granado stayed at a leper clinic in Venezuela and

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Obituary 1

Dr. Granado passes away

– Comp : Arani Sen

46

Che went up to Miami, US, returned to Buenos Aires to finish hismedical course and then dedicated himself for revolutions in LatinAmerica and Africa. After Cuban revolution at Che’s invitation Granedovisited Cuba and spent a low profile life there teaching Bio Chemistryin Havana University.

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ë± ð±õþß±ò±ï Îß±é¿òü– ðÏÂó±?ò õþ±ûþ

¦œõþ¿íß± 2 –

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ÎõúÏ ñÓ÷Âó±ò, ä±, ß¿ôÂÂ, ÕɱùËß±ýù Îä±Ëàõþ æËùõþ ™¦¸Ëõþõþ ¦š±¿ûþQ ßÂ÷±ûþ¼Ûõþ ÂóËõþõþ öÓ¿÷ß± ä•Å ¿ä¿ßÂÈüËßÂõþ¼ ¿î¿ò Îõþ±áÏõþ ü÷üɱ Ý î±õþ ëÂ×ÈÂó¿Mõþ ß±õþËíõþ ü±Ëï ü±÷?üÉ ÎõþËà ¿ßÂåÅ

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India is badly affected by ragging, a form of abuse on newcomers toeducational institutions (commonly called hazing in the United States). Theincreasing privatisation of higher education has led the academic insti-tutions in India to experience an increasing number of ragging-relatedincidents.

Present State

A report from 2007 highlights 42 instances of physical injury, and reports on ten deathspurportedly the result of ragging. Ragging has reportedly causes at least 30-31 deaths in the last7 years. In the 2007 session, approximately 7 ragging deaths have been reported. In addition,a number of freshmen were severely traumatized to the extent that they were admitted to mentalinstitutions. Ragging in India commonly involves serious abuses and clear violations of humanrights. Ofter media reports and others unearth that it goes on, in many institutions, in theinfamous Abu Ghraib style; and on innocent victims.

In many colleges, like IIT Bombay and IIT Hyderabad, ragging has been strictly banned.However, this ban has not been very effective, as seen by the number of ragging of cases stillreported by the media. Ragging involves gross violations of basic human rights. The seniors areknown to torture juniors and by this those seniors get some kind of sadistic pleasures.

Though ragging has ruined the lives of many, resistance against it has grown up onlyrecently. Several Indian states have made legislatures banning ragging, and the Supreme Courtof India has taken a strong stand to curb ragging. Ragging has been declared a criminal offence.

The Indian civil society has also started to mount resistance, only recently.

But in India, ragging is more infamous for its ubiquitous presence in the educational insti-tutions. According to the observations by the Dr. Raghavan Committee, which has been con-structed by the Union Human Resource Devolopment ministry on the orders of the SupremeCourt of India, the medical colleges are the worst affected in India.

However, India’s first and only registered Anti Ragging NGO, Society Against Violence inEducation (SAVE) has suppored that ragging is also widely and dangerously prevalent inEngineering and other institutions, mainly in the hostels.

Legislation

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Ragging in India– Editorial Board

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In 1997, the state of Tamil Nadu first passed laws related to raggingSubsequently, a major boost to anti-ragging efforts was given by a landmarkjudgement of the Suppreme Court of India in May 2001, in response to a PublicInterest Litigation filed by the Vishwa Jagriti Mission.

The Ministry of Human Resources Development (MHRD), following a directive by theSupreme court, appointed a seven member panel headed by ex-CBI director Dr. R. K. Raghavanto recommend anti-ragging measures. The Raghavan Committee report, submit-ted to the court in May 2007, includes a proposal to include ragging as aspecial section under the India Penal Code. The Supreme Court of Indiainterim order (based on the recommendations) dated May 16, 2007 makes itobligatory for academic institutions to file official First InformationReports with the police in any instance of a complaint of ragging. Thiswould ensure that all cases would be formally investigated under criminaljustice system, and not by the academic institutions own ad-hoc bodies.

The Indian Supreme Court has taken a strong stand to prevent ragging. In 2006, the courtdirected the H.R.D. Ministry of the Govt. of India to form a panel which will suggest guidelinesto control ragging.

The panel, headed by the former director of C.B.I. Dr. R.K. Raghavan, met victims, guard-ians and others across the country. The Raghavan committee has placed its recommendation tothe Honbl. Supreme Court, which has given its order on the issue.

Welcoming the Supreme Court’s recent judgmet on ragging Dr. Raghavan, the former CBIdirector, who is the chairman, Monitoring Committee for the Prevention of Ragging, said,“there are finally signs that the recommendations to prevent ragging in colleges will be takenseriously.”

Supreme Court in 2007 directed that all the higher educational institutions should includeinformation about all the ragging incidents in their brochures/prospectus of admission.

UGC Regulation On Curbing The Menace Of Ragging In Higher Education Institutions,2009

In 2009, in the wake of Aman Kachroo’s death, University Grants Commission (UGC)passed UGC REGULATION ON CURBING THE MENACE OF RAGGING IN HIGHEREDUCATIONAL INSTITUTIONS, 2009 These regulation mandate every college responsibili-ties to curb the meance of ragging, including strict pre-emptive measures, like lodging freshersin a separate hostel, surprise raids especially at nights by the anti-ragging squad and submissionof affidavits by all senior students and their parents taking oath not to indulge in ragging. Themain features of the regulations are :

Responsibilities of Educational Institutions

1. Applicable to ALL higher educational institutions, imparting education beyond 12 yearsof schooling.

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BEFORE AND DURING ADMISSION AND REGISTRATION :

2. Every public declaration, brochure of admission/instruction booklet or the prospectusto print these regulations in full.

3. Telephone numbers of the Anti-Ragging Helpline and all the important functionaries inthe institution, members of the Anti-Ragging Committees and Anti-Ragging Squads etc. to bepublished in brochure of admission / instruction booklet or the prospectus.

4. Every student and his/her parents to file an affidavit avowing not to indulge in ragging.

5. The institution to prominently display posters detailing laws andpunishment against ragging.

6. Anti-ragging squad to ensure vigil at odd hours during first fewmonths at hostels, inside institution premises as well as privately com-mercially managed hostels.

AFTER ADMISSION

7. Printed leaflet to be given to every fresher detailing addresses and telephone numbers ofthe Anti-Ragging Helpline, Wardens, Head of the institution, all members of the anti-raggingsquads and committees, and relevant district and police authorities.

8. Identity of informants of ragging incidents to be fully protected.

9. Faculty members assigned to students to make surprise visits and to maintain a diary ofhis/her interaction with the freshers.

10. Freshers to be lodged, as far as may be, in a separate hostel block.

11. Head of the institution, at the end of each academic year, to send a letter to the parents/guardians of the students who are completing their first year in the institution informing themabout these Regulations.

ANTI-RAGGING COMMITTEE and ANTI-RAGGING SQUAD

12. Anti-Ragging Committee to be nominated and headed by the Head of the institution, andconsisting of representatives of civil and police administration, local media, Non GovernmentOrganizations involved in youth activities, representatives of faculty members, representativesof parents, representatives of students belonging to the freshers’ category etc.

13. Duty of the Anti-Ragging Committee to ensure compliance with the provisions of theseRegulations.

14. Anti-Ragging Squad to be nominated by the Head of the Institution for maintaining vigil,oversight and patrolling functions and shall remain mobile, alert and active at all times.

15. Anti-Ragging Squad to make surprise raids on hostels.

16. Discreet random surveys to be conducted amongst the freshers every fortnight during thefirst three months.

17. The Heads of institutions affiliated to a University or a constituent of the University tosubmit a weekly report on the status of compliance with Anti-Ragging measures and a monthlyreport on such status thereafter, to the Vice-Chancellor of the University.

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18. The Vice Chancellor of each University to submit fortnightly re-ports, including those of the monitoring Cell of Ragging in case of anaffiliating university, to the State Level Monitoring Cell.

COMPLAINT OF RAGGING

19. First Information Report (FIR) to be filed within twenty four hours of receipt of suchinformation or complaint of ragging, with the police and local authorities.

20. Head of the institution to forthwith report the incident of ragging to the District LevelAnti-Ragging Committee and the Nodal officer.

21. Institution shall also continue with its own enquiry and remedialaction to be completed with-in seven days.

Responsibilities of University Grants Commission (UGC)

1) The Commission to verify that the institutions strictly complywith the requirement of getting the affidavits from the students and theirparents/guardians as envisaged under these Regulations.

2) The Commission to make it mandatory for the institutions to incorpo-rate in their prospectus, the anti-ragging directions of the CentralGovernment or the State Level Monitoring Committee.

3) The Commission to maintain an appropriate data base to becreated out of affidavits, and such database to also function as a recordof ragging complaints received, and the status of the action taken thereon.

4) The Commission shall make available the database to a non-governmen-tal agency.

5) The Commission to include a specific condition in the UtilizationCertificate, in respect of any financial assistance or grants-in-aid toany institution, that the institution has complied with the anti-raggingmeasures.

6) The Commission to constitute an Inter-Council Committee tocoordinate and monitor the anti-ragging measures in institutions acrossthe country.

7) The Commission to institute an Anti-Ragging Cell within the Commis-sion to provide secretarial support for collection of information andmonitoring, and to coordinate with the State Level Monitoring Cell andUniversity Level Committees for effective implementation of anti-raggingmeasures.

Use of Right To Information

Despite all these legislations, the implementation has been slow on thepart of the educatinal institutions. Many anti-ragging activists haveadvocated use of right to information (RTI) by the freshers / victims toensure that the institutions follow the rules to curb ragging strictly. For

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example, one of the strongest reasons for ragging to happen is that theraggers are dead sure that parents would never ever get to know theirheinous acts. The affidavit filed by parents to the institution has thename, address and telephone numbers of the parents of the senior students.A fresher can file RTI applications, even without disclosing identity byusing a friend’s help and name, to get a copy of this affidavit, and thencall/write himself or make his parents talk to ragger’s parents to rein inhim. Also, the college and the UGC can be made to follow the anti-raggingmeasures strictly by the use of RTI. Once freshers take courage and startdoing that, it is a general feeling that ragging may drastically reduce inIndia, as every student will become a soldier in the fight againt ragging.

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‘The National Food Security Actmust include strong safeguards’

Sample RTI applications have also been posted by some of the anti-raggingwebsites to help students in that.

Anti-ragging movement

With the situation of ragging worsening yearly, there is emerging aspontaneous anti-ragging movement in India. Several voluntary organiza-tions have emerged, who conduct drives for public awareness and arrange forsupport to victims.

Online groups like Coalition to Uproot Ragging from India (CURE),Stopragging, No Ragging Foundation became the major Anti-Ragging groups onthe Internet. Among them, the No Ragging Foundation has transformed into acomplete NGO and got registered as Society Against Violence in Education(SAVE) which is India’s first registered Anti-Ragging non profit organiza-tion (NGO). These groups are working on issues related to ragging. Each ofthem is running anti ragging websites and online groups.

The Indian media has been playing a crucial role by exposing ragging incidents and theindifference of many concerned institutions towards curbing the act. The Supreme Court ofIndia has directed, in its interim judgement, that action may be taken even against negligentinstitutions. ANTI-RAGGING HELP LINE : 1800 - 180 - 5522 or 155222.

[Compiled from internet – Editorial Board]

A letter to the Prime Minister on the importance of a ‘near-universalPDS.’

July 21, 2011

Dr. Manmohan Singh

Prime Minister of India

Respected Prime Minister, We are a group of research scholars and student volunteers whohave just spent three weeks surveying the Public Distribution System (PDS) around the country.We are writing to share a few thoughts on the National Food Security Act in the light of thisexperience.

Our survey covered more than100 randomly-selected villages spread over nine States (Andhra

¿ä¿êÂÂóS –

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Pradesh, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Orissaa, Rajasthan,Tamil Nadu, and Uttar Pradesh). We inspected the local Fair Price Shops andinterviewed more than a thousand “BPL” households. Oblivious of the heator rain, we reached the country’s remotest nooks and corners and spared noeffort to understand people’s situations and views.

This survey points to an impressive revival of the PDS across thecountry. In all the sample States, with the notable exception of Bihar, therehave been major initiatives in the recent past to improve the PDS and theseefforts are showing results. Most of the sample households were getting thebulk if not the whole of their foodgrain entitlements under the PDS (up to35 kg per month, at a nominal price). The days when up to half of the PDS grainwas “diverted” to the open market are gone.

PDS Survey 2011 : selected findingsA detailed survey of the public distribution System was conducted in nine States in May-June2011 by student volunteers.Two inportant findings :1. Evidence of a major revival of the PDS across the country (even in States like Orissa andUttar Pradesh). Main exception : Bihar.2. Where PDS works, people much prefer food to cash transfers

Average monthly Average purchase Proportion (percentage) ofpurchase of as proportion of respondents who :

PDS grain (kg/ full quota* Prefer food Prefer cashhousehold (per cent) to cash to food

Andhra Pradesh 14.9 99 91 6Orissa 29.2 97 88 6Chhattisgarh 33.2 95 90 2Himachal Pradesh 37.1 93 81 9Tamil Nadu 17.9 92 71 11Rajasthan 26.0 87 60 15Uttar Pradesh 30.7 77 42 34Jharkhand 24.9 71 66 22Bihar 11.2 45 21 54All States 24.0 84 67 18

* “Full quota” refers to PDS grain entitlements of sample households. based on official norms. Additional grain quotassupplied in response to recent Supreme Court orders have been accounted for in Himachal Pradesh, Orissa, Rajasthanand Uttar Pradesh; other States did not lift this additional quota. For Orissa, figures pertain to rice only (Wheat entitle-ments are not clear).

Note : The survey was conducted in 106 random-selected villages, spread over two districts in each sample State. Itcovered 1,227 BPL households (including “Antyodaya” households and related categories). The figure are provisional andsubject to minor revisions.

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We also found that the PDS had become a lifeline for millions of ruralhouseholds. A well-functioning PDS virtually guarantees that there isalways food in the house. This is an enormous relief for people who liveon the margin of subsistence, and a welcome support for everyone. It is abig step towards the end of hunger, which has blighted this country forc e n t u r i e s .

The bad news is that the BPL list is very defective. In many States, entirecommunities have been left out, and almost everywhere, there are enormousexclusion errors. This has severely reduced the effectiveness of the PDSas a tool of food security. Therefore, we support the case made recently bya group of a academic economists for a “near-universal PDS,” whereby allhouseholds are entiled to food subsidies unless they meet well definedexclusion criteria.

The said economists also believe that there is a strong (though unspeci-fied) “theoretical case” for cash transfers as an alterative to the PDS. Wediscussed this proposal with the respondents, and found that a majorityopposed it. The reluctance was particularly strong in areas with a well-functioning PDS, and among poorer households. Further, we felt that thereasons they gave for opposing cash transfers were generally quite thoughtful and convincing.

In most cases, the reasons pertained in one way or another to food security – an overwhelm-ing concern for poor households. For instance, many respondents were worried that moneymight be misused or frittered away. Where markets are distant, they wondered where theywould buy grain, and how they would cope if there is a sudden increase in local food prices.Even where markets are accessible, there were apprehensions, such as a fear that traders mightraise prices if the PDS is closed. Similarly, the local bank was often said to be too far,overcrowded, or difficult to handle. Many respondents had a bitter experience of the bankingsystem in the context of Mahatma Gandhi National Rural Employment Guarantee Act (NREGA)wage payments. In contrast, the familiarity and convenience of the localFair Price Shop were widely valued. It is only in areas where the PDS wasnot working, notably Bihar and parts of Uttar Pradesh, that we foundsubstantial interest in cash transfers as a possible alternative.

Accordingly, we urge you to ensure that the National Food Security Act includes the stron-gest possible safeguards against a hasty transtion from food entitlements to cach transfers.

We do recognise, of course, that there in enormous scope – and urgent need – for furtherimprovements in the PDS. We have some suggestions on this too, and would be glad to discussthem with you at your convenience.

Signatories : Anindita Adhikari (independent researcher, Patna); Ankita Agarwal (indepen-dent researcher, Delhi); Megha Bahi (Delhi School of Economics, Delhi); Pooja Balasubramanian(St. Xavier’s College, Mumbai); Balu (Jawharlal Nehru University, Delhi); B, Lakshmi (KiroriMal College, Delhi); Manish Choudhury (Hindu College, Delhi); Sakina Dhorajiwala (Jai HindCollege, Mumbai); Jean Dreze (Universisy of Allahabad); Anchal Dutt (Law College, DelhiUniversity); Ashish Gupta (University of Allahabad); Aparna John (independent researcher,Delhi); Purava Joshi (St. Xavier’s College, Mumbai); Samyktha Kanan (IIT, Madras); ReetikaKhera (IIT, Delhi); Sirus Joseph Liberio (University of Mumbai); Radhika Lokur (St. Xavier’sCollege, Mumbai); Aleesha Mary Joseph (St. Stephen’s College, Delhi); Swathi Meenakshi(Anna University, Chennai); Karuna Muthiah (independent researcher, Dindigul); BijayaniMohanty (independent reseacher, Bhubaneshwar); Rajkishore Mishra (independent rearcher,Bhubaneshwar); Kuber Nag (IIT, Madras); Sudha Narayanan (Cornell University); Soheb Niazi(Jawaharlal Nehru University, Delhi); Gaurav Poddar (St. Stephen’s College, Delhi); RaghavPuri (Lee Kuan Yew School of Public Policy, Singapore); Aakriti Rai (St. Xavier’s College,

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