How Austerity Kills the Public Health System


By DAVID STUCKLER and SANJAY BASU, NYT

EARLY last month, a triple suicide was reported in the seaside town of Civitanova Marche, Italy. A married couple, Anna Maria Sopranzi, 68, and Romeo Dionisi, 62, had been struggling to live on her monthly pension of around 500 euros (about $650), and had fallen behind on rent.

Angus Greig

Because the Italian government’s austerity budget had raised the retirement age, Mr. Dionisi, a former construction worker, became one of Italy’s esodati (exiled ones) — older workers plunged into poverty without a safety net. On April 5, he and his wife left a note on a neighbor’s car asking for forgiveness, then hanged themselves in a storage closet at home. When Ms. Sopranzi’s brother, Giuseppe Sopranzi, 73, heard the news, he drowned himself in the Adriatic.

The correlation between unemployment and suicide has been observed since the 19th century. People looking for work are about twice as likely to end their lives as those who have jobs.

In the United States, the suicide rate, which had slowly risen since 2000, jumped during and after the 2007-9 recession. In a new book, we estimate that 4,750 “excess” suicides — that is, deaths above what pre-existing trends would predict — occurred from 2007 to 2010. Rates of such suicides were significantly greater in the states that experienced the greatest job losses. Deaths from suicide overtook deaths from car crashes in 2009.

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

At one extreme is Greece, which is in the middle of a public health disaster. The national health budget has been cut by 40 percent since 2008, partly to meet deficit-reduction targets set by the so-called troika —  the International Monetary Fund, the European Commission and the European Central Bank — as part of a 2010 austerity package. Some 35,000 doctors, nurses and other health workers have lost their jobs. Hospital admissions have soared after Greeks avoided getting routine and preventive treatment because of long wait times and rising drug costs. Infant mortality rose by 40 percent. New H.I.V. infections more than doubled, a result of rising intravenous drug use — as the budget for needle-exchange programs was cut. After mosquito-spraying programs were slashed in southern Greece, malaria cases were reported in significant numbers for the first time since the early 1970s.

In contrast, Iceland avoided a public health disaster even though it experienced, in 2008, the largest banking crisis in history, relative to the size of its economy. After three main commercial banks failed, total debt soared, unemployment increased ninefold, and the value of its currency, the krona, collapsed. Iceland became the first European country to seek an I.M.F. bailout since 1976. But instead of bailing out the banks and slashing budgets, as the I.M.F. demanded, Iceland’s politicians took a radical step: they put austerity to a vote. In two referendums, in 2010 and 2011, Icelanders voted overwhelmingly to pay off foreign creditors gradually, rather than all at once through austerity. Iceland’s economy has largely recovered, while Greece’s teeters on collapse. No one lost health care coverage or access to medication, even as the price of imported drugs rose. There was no significant increase in suicide. Last year, the first U.N. World Happiness Report ranked Iceland as one of the world’s happiest nations.

Skeptics will point to structural differences between Greece and Iceland. Greece’s membership in the euro zone made currency devaluation impossible, and it had less political room to reject I.M.F. calls for austerity. But the contrast supports our thesis that an economic crisis does not necessarily have to involve a public health crisis.

Somewhere between these extremes is the United States. Initially, the 2009 stimulus package shored up the safety net. But there are warning signs — beyond the higher suicide rate — that health trends are worsening. Prescriptions for antidepressants have soared. Three-quarters of a million people (particularly out-of-work young men) have turned to binge drinking. Over five million Americans lost access to health care in the recession because they lost their jobs (and either could not afford to extend their insurance under the Cobra law or exhausted their eligibility). Preventive medical visits dropped as people delayed medical care and ended up in emergency rooms. (President Obama’s health care law expands coverage, but only gradually.)

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The $85 billion “sequester” that began on March 1 will cut nutrition subsidies for approximately 600,000 pregnant women, newborns and infants by year’s end. Public housing budgets will be cut by nearly $2 billion this year, even while 1.4 million homes are in foreclosure. Even the budget of the Centers for Disease Control and Prevention, the nation’s main defense against epidemics like last year’s fungal meningitis outbreak, is being cut, by at least $18 million.

To test our hypothesis that austerity is deadly, we’ve analyzed data from other regions and eras. After the Soviet Union dissolved, in 1991, Russia’s economy collapsed. Poverty soared and life expectancy dropped, particularly among young, working-age men. But this did not occur everywhere in the former Soviet sphere. Russia, Kazakhstan and the Baltic States (Estonia, Latvia and Lithuania) — which adopted economic “shock therapy” programs advocated by economists like Jeffrey D. Sachs and Lawrence H. Summers — experienced the worst rises in suicides, heart attacks and alcohol-related deaths.

Countries like Belarus, Poland and Slovenia took a different, gradualist approach, advocated by economists like Joseph E. Stiglitz and the former Soviet leader Mikhail S. Gorbachev. These countries privatized their state-controlled economies in stages and saw much better health outcomes than nearby countries that opted for mass privatizations and layoffs, which caused severe economic and social disruptions.

Like the fall of the Soviet Union, the 1997 Asian financial crisis offers case studies — in effect, a natural experiment — worth examining. Thailand and Indonesia, which submitted to harsh austerity plans imposed by the I.M.F., experienced mass hunger and sharp increases in deaths from infectious disease, while Malaysia, which resisted the I.M.F.’s advice, maintained the health of its citizens. In 2012, the I.M.F. formally apologized for its handling of the crisis, estimating that the damage from its recommendations may have been three times greater than previously assumed.

America’s experience of the Depression is also instructive. During the Depression, mortality rates in the United States fell by about 10 percent. The suicide rate actually soared between 1929, when the stock market crashed, and 1932, when Franklin D. Roosevelt was elected president. But the increase in suicides was more than offset by the “epidemiological transition” — improvements in hygiene that reduced deaths from infectious diseases like tuberculosis, pneumonia and influenza — and by a sharp drop in fatal traffic accidents, as Americans could not afford to drive. Comparing historical data across states, we estimate that every $100 in New Deal spending per capita was associated with a decline in pneumonia deaths of 18 per 100,000 people; a reduction in infant deaths of 18 per 1,000 live births; and a drop in suicides of 4 per 100,000 people.

OUR research suggests that investing $1 in public health programs can yield as much as $3 in economic growth. Public health investment not only saves lives in a recession, but can help spur economic recovery. These findings suggest that three principles should guide responses to economic crises.

First, do no harm: if austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects. Each nation should establish a nonpartisan, independent Office of Health Responsibility, staffed by epidemiologists and economists, to evaluate the health effects of fiscal and monetary policies.

Second, treat joblessness like the pandemic it is. Unemployment is a leading cause of depression, anxiety, alcoholism and suicidal thinking. Politicians in Finland and Sweden helped prevent depression and suicides during recessions by investing in “active labor-market programs” that targeted the newly unemployed and helped them find jobs quickly, with net economic benefits.

Finally, expand investments in public health when times are bad. The cliché that an ounce of prevention is worth a pound of cure happens to be true. It is far more expensive to control an epidemic than to prevent one. New York City spent $1 billion in the mid-1990s to control an outbreak of drug-resistant tuberculosis. The drug-resistant strain resulted from the city’s failure to ensure that low-income tuberculosis patients completed their regimen of inexpensive generic medications.

One need not be an economic ideologue — we certainly aren’t — to recognize that the price of austerity can be calculated in human lives. We are not exonerating poor policy decisions of the past or calling for universal debt forgiveness. It’s up to policy makers in America and Europe to figure out the right mix of fiscal and monetary policy. What we have found is that austerity — severe, immediate, indiscriminate cuts to social and health spending — is not only self-defeating, but fatal.

Odisha to seek six more weeks to conduct Niyamgiri Gram Sabhas


BS Reporter  |  Bhubaneswar  May 17, 2013

In its April 18 order, SC had directed the Odisha govt to conduct Gram Sabhas at Niyamgiri within three months to seek the mandate of the locals

 
 
 
 
 
 

The Odisha government today said it would seek six more weeks from the Supreme Court (SC) to conduct Gram Sabhas to decide the fate of bauxite mining at the ecologically sensitive Niyamgiri hills.

“We are going to request the apex court to grant us six more weeks for the conduct of gram sabhas, as it is not feasible to conduct these within the SC-stipulated timeline. The Sabhas will be held in 12 villages on the Niyamgiri hills,” said state law minister Maheshwar Mohanty.

In its April 18 order, SC had directed the Odisha government to conduct gram sabhas at Niyamgiri within three months to seek the mandate of the locals on the proposed bauxite mining project of Odisha Mining Corporation (OMC) and Vedanta Aluminium (VAL), and also decide on fresh claims, if any, regarding community, individual, cultural and religious rights of the Dongria Kondh tribe residing these hills. The court had said the claims for these, to be taken up by gram sabhas, should be filed in six weeks.

According to the apex court order, the Gram Sabha decisions were to be communicated by the state government to the Union Ministry of Environment & Forests, which would decide on allowing mining at Niyamgiri within two months of securing the report.

In a letter dated May 2, the Ministry of Tribal Affairs had asked the state Scheduled Caste and Scheduled Tribe development department to issue advertis\ements in local newspapers, informing tribals and forest dwellers in Kalahandi and Rayagada districts to file claims of religious and cultural rights, along with the individual and community rights, under the Forest Rights Act. It had urged the state government to display the notification related to holding gram sabhas, along with the details of the Supreme Court order, in all villages in the two districts, irrespective of their proximity from the mining site.

To ensure transparency was maintained in the identification of claims, copies of these notification should be sent to all civil society groups and non-governmental organisations active in these districts, it had said.

However, as it was unable to find clarity on the conduct of gram sabha proceedings in the Supreme Court order, the state Scheduled Caste and Scheduled Tribe department had consulted the law department.

Opening the Niyamgiri bauxite mines, spread over Kalahandi and Rayagada districts, is crucial for the functioning of Vedanta Aluminium’s one-million-tonne alumina refinery at Lanjigarh. The refinery, which depends entirely on bauxite sourced from outside, has been shut since December 5, 2012, due to unavailability of the commodity.

 

#India – Chaos in the iron age #mustshare


Author(s):
M Suchitra
Sugandh Juneja
Issue Date:
2013-5-31

miningPhotos: M Suchitra

Bellary district of Karnataka and Goa portray India’s very own gold rush. Today, they are the bywords for rampant violation of mining and environmental laws, unscientific depletion of resources and concentration of mining profits in the hands of a few. The plunder has also spread to other iron ore-rich states of the country.

It all started around 2003-04 with China going on a construction spree in the run up to the 2008 Olympics.

China is the principal importer of Indian iron ore and procures 91 per cent of what India exports, according to the Indian Bureau of Mines(Interactive graphic: India’s iron ore exports to various countries over the years) [1]

Before 2003, it used to buy only high-grade iron ore, with at least 58 per cent iron content. But with the Olympics approaching, it started procuring even fines (ore in powder form) and ores with as low as 45 per cent of iron content. The Chinese developed technology that enabled them to mix this low-grade ore with very high-grade ore imported from Brazil and Australia. The Chinese demand also pushed up the international prices of iron ore.

This paved the way for chaos and scams that India’s iron ore-rich states witness today. Everyone hoped for a windfall from the sudden demand. Those who owned mines and those who did not mined without clearances, encroached upon forest and other’s lease areas; and excavated, transported and exported more than permitted. No one stuck to the approved mining plan. They even extracted minerals from waste dumps. It was a colossal plunder in connivance with the state governments, Union Ministry of Environment and Forests and IBM. The states lost revenue and the nation its rich resources. In the process of reckless mining, forests were cleared, hills were ravaged, farmlands were destroyed, streams and rivers were polluted, groundwater got contaminated, and the health of people and livestock was compromised.

Government-appointed committees entered the scene and unearthed shocking stories of illegalities and loot of iron ore. They also brought to the fore the intertwined interests of politicians and industry and the failure of the authorities to regulate mining.

Karnataka and Goa were the first ones to come under scanner. In Karnataka, the Lokayukta, the state’s ombudsman, estimated in its July 2011 report the total loss to the state exchequer at Rs 16,085 crore. The Supreme Court-appointed Central Empowered Committee’s (CEC) interim report on Bellary in April 2011 estimated that between 2003 and 2010, Rs 15,245 crore worth of iron ore was illegally exported from the region. It recommended a ban on mining in the region.

Percentage of India’s total iron ore production from different states (darker shade indicates higher production)
Take mouse over states for statistics

 

But in its February 2012 report, CEC backtracked and recommended resuming iron ore mining in Bellary and two other districts subject to conditions. It prescribed a model on the basis of which legality of mines can be categorised and they can be allowed to operate. It also suggested ways to restore the devastated ecology of the region (see ‘Bellary to bleed again’ [2]).

Mining companies in Goa are now going through the tests that Bellary was put through in the last two years. Surveys are under way, data is being compiled, accounts are being audited. Justice M B Shah Commission, constituted by the Centre in 2010 to probe illegal mining of iron and manganese ore in the country, has submitted its report, following which the Goan government has imposed a ban on mining of iron ore in the state. One of the key findings of the Shah Commission is that the state is incurring losses to the tune of Rs 35,000 crore due to illegal iron ore mining. The Supreme Court is also hearing the matter. As CEC is estimating losses from illegal mining in Goa, the mining industry in the state is under constant fear that CEC might recommend the Bellary model for Goa’s mines (see ‘Goa next’ [3]).

The next in line is Odisha. The 2010-11 report of IBM shows Odisha produces the maximum 37 per cent of iron ore in the country, followed by Karnataka and Goa (see graph). The Shah Commission has already heard mining companies and is preparing its report on the extent of illegalities in the state.

The Supreme Court’s Bellary judgement is the first of its kind in a mining case involving illegalities, irregularities, criminalities and corruption of unbelievable magnitude, and sets a precedent for all cases related to illegal mining, be it in Goa, Odisha, Chhattisgarh or Jharkhand.

M Suchitra from Bellary and Sugandh Juneja from Goa analyse whether it is possible to safeguard the environment while keeping the industry happy and if the Supreme Court order for Karnataka can be a one-size-fits-all policy.

Bellary to bleed again

Supreme court eases ban on mining in Bellary. it is doubtful if its ravaged environment can be healed

At least eight companies have resumed mining in BellaryAt least eight companies have resumed mining in Bellary

 

 

It’s sleepless nights again for the residents of Kamtur village. Located on the fringes of the Kumaraswamy forest range, one of the six iron ore-bearing mountaintops in Karnataka’s Bellary district, Kamtur is surrounded by seven mines. On April 18, the Supreme Court eased ban on mining in Bellary, which used to be the nerve-centre of India’s illegal iron ore mining till two years ago.

Kamtur residents say they have lost almost everything to the frenzied mining—their fields, crops, grazing land, streams and even a large portion of their common burial ground. “Mines were encroaching upon us from all sides,” says N H Malleswaram, a member of the gram sabha. Most people sold their land to mine owners under threat. Those who managed to retain their land could not grow anything as piles of red iron dust rendered their fields barren. “We want to live without iron dust in our lungs,” says 70-year-old Thimmappa. Like many others in the village, he also suffers from breathing difficulty. The primary health centre in the village is a small, unfinished building where cattle take refuge from searing heat.

The Supreme Court ban in July 2011 had offered them some relief. During the ban, only the National Mineral Development Corporation (NMDC), India’s largest public sector mining company, was operating in their neighbourhood.

ballery

On April 18, the court lifted the ban on 90 iron mines with certain conditions. With this, 108 of the 166 mines in Bellary, Chitradurga and Tumkur may soon be back in business. Eight of the 18 mines that received the court’s approval in September last year, are operating.

The court’s judgement is based on the recommendation of its forest advisory wing, the Central Empowered Committee (CEC), which probed illegal mining in Bellary and the two other districts. The court had ordered the investigation after Samaj Parivartana Samudaya (SPS), a non-profit in Dharwad, filed a public interest petition in 2009 against the state government for not curbing illegal mining in the region.

While Kamtur and several other villages in the hinterlands of the three iron ore mining districts are worried, mine owners and ore-starved steel industries rejoice over the judgement.

“Since the ban we have been operating at 60-70 per cent capacity due to ore crunch,” says P K Murugan, vice-president of JSW Steel. JSW, one of the largest integrated steel companies in India, requires 60,000 tonnes a day for its plant at Toranagallu in the heart of high-grade iron ore belt of Bellary-Hospet. “We want mining to come back in full swing,” hesays. Srinivasa Rao of Karnataka Sponge Iron Manufacturers Association, says the ban has rendered half of the 70 sponge iron plants sick.

Byword for plunder

What attracts these mining and steel companies to Bellary is its rich deposit of reddish-brown haematite iron ore, a high-quality ore with iron content up to 65 per cent. A 2005 estimate by the Indian Bureau of Mines (IBM) puts the reserves in Bellary at 1,148 million tonnes. Before the ban, Karnataka produced about 40 million tonnes per annum (MTPA), one-fifth of the country’s annual iron ore production. Eighty per cent of this came from Bellary.

But this was just the official figure. The actual production of iron ore through illegal mining was much more and so was illegal export (see ‘Illegal export…’). The sudden spurt in iron ore and steel prices in the international market following China’s demand was showing its impact. Bellary had become the byword for plunder.

imageFigures in million tonnes Sources: Central Empowered Committee report, Indian Council for Forestry Research and Education report

“The government took no corrective measures even after the Lokayukta, the state’s Ombudsman, filed a detailed report in 2008 on illegal mining,” says S R Hiremath, president of SPS.

The report brought to light chilling stories of illegalities, irregularities and crimes by the mining mafia in connivance with politicians and bureaucrats. Bellary was transformed into a republic of lawlessness by mining baron Gali Janardhan Reddy, his brothers Karunakara Reddy, Somasekhara Reddy, and their close associate B Sriramulu. In 2008, they became part of the BJP-led state government. Janardhan Reddy became tourism minister and miniter in-charge of Bellary, Karunakara Reddy the revenue minister, B Sriramulu the health minister and Somasekhara Reddy headed the state milk development corporation.

Timeline

2003 China boom begins

2003 Karnataka de-reserves 1,162,000 ha for private mining

2004 Report of the National Environmental Engineering Research Institute (NEERI) on planning and management of scientific mining in Karnataka. Report gathers dust

2005-10 Demand peaks. Reckless mining and export begins. Loss to state: Rs 16,085 crore

2006 State government appointed Justice U L Bhatt Commission to probe illegal mining. No significant result

2007 Investigation goes to the Lokayukta

2008 Lokayukta Justice Santosh Hegde submits first report on mining irregularities. Indicts B S Yeddyurappa and many senior officials and companies. Government ignores the report

2009 Non-profit Samaj Parivartana Samudaya files petition in Supreme Court

2010 Supreme Court asks CEC to investigate. Karnataka bans export of iron ore

2011 CEC submits interim report. Lokayukta submits its second report. Then chief minister Yeddyurappa quits. Supreme Court imposes ban on mining, first in Bellary, then extends it to Chitradurga and Tumkur. NMDC exempted. CBI arrests Gali Janardhan Reddy for illegal mining

2012 Supreme Court allows 18 mines to resume operation

April 18, 2013 Allows 90 mines to operate. Cancels 51 leases. Suspends 7. Caps production at 30 million tonnes per annum

There was tremendous political pressure on the mines department to issue new leases. Even when the state’s requirement was 20-25 MTPA, IBM gave permission for 82 MTPA of iron ore. The Union Ministry of Environment and Forests (MoEF) sanctioned clearances. According to a statement by former chief minister B S Yeddyurappa in the Assembly in 2010, between 2003-2010, 30.5 million tonnes of iron ore worth Rs 15,245 crore was plundered from Bellary. The Lokayukta’s final report in July 2011 estimated the state’s loss due to illegal mining was more than Rs 16,000 crore. Yeddyurappa had to step down from the chief minister’s post since he was also indicted in the report. Janardhan Reddy has been behind the bars since September 2011.

Large-scale mining in Bellary led to severe damage to its environment, reveals an environmental impact assessment by the Indian Council for Forestry Research and Education (ICFRE), Dehradun. ICFRE did the study in 2011 on behalf of the state government as directed by the Supreme Court. It found 9,500 ha of forests have been cleared for mining in Bellary alone. Air has been severely polluted and groundwater contaminated with iron, manganese and fluorides. A Comptroller and Auditor General (CAG) report released last year reveals increased incidence of tuberculosis, respiratory disorders and decreased livestock population in the region.

In the interim report submitted in April 2011, CEC had expressed shock and concern over the magnitude of legal violations. All mining scams in the country become insignificant in front of Bellary, it observed. In its final reports, CEC changed stance and suggested the court should allow mining.

“CEC seems to be acting as an engine for resuming mining rather than protecting the forest and the environment,” alleges Hiremath.

Conditions apply

For restarting mining, CEC classified mines into A, B and C categories, taking encroachment as the criterion for determining whether their operations were legal or illegal. Forty-five mines which did not encroach or encroached in small ways outside their sanctioned area come under category A. Category B mine are those which encroached an area up to 10 per cent of the lease area through mining pits and up to 15 per cent by way of waste dumping. This category includes seven mines along the inter-state boundary destroyed by Gali’s mines in Andhra Pradesh. The court has allowed all category A and 63 out of 72 category B mines to resume operations. It has suspended the seven leases till the boundary is fixed by the Surveyor General of India. Category C mines are those where the leaseholder has encroached on more than 10 per cent of the lease area through mining pits and over 15 per cent by dumping waste. The court ordered cancelling 51 leases, including all 49 category C leases.

“The category C leases are cancelled because they were involved in flagrant violation of the Forest Conservation Act or mining in others’ lease areas,” the court observed in the judgement. The cancelled leases will be auctioned through international tenders.

“This categorisation is faulty,” says Hiremath. It takes encroachment as the only criterion for determining whether operations were legal or illegal. It is arbitrary to measure the extent of encroachment as percentage of the sanctioned lease area, instead of the actual encroached area, points out P Vishnu Kamath, co-petitioner in the case. Kamath says there should be only legal and illegal categories, decided on the basis of encroachment, the quantity of ore extracted by leaseholders and other illegalities like mining without clearances, evading royalty and subletting leases.

In fact, the Supreme Court in its order of September 28, 2012 had asked CEC to constitute a committee and assess within three months the actual quantity of ore illegally extracted by each leaseholder. “CEC has not constituted the committee so far,” says Hiremath.

Moreover, category A leaseholders are not holy cows, Kamath says. Many of them have leases in other two categories. Minerals Enterprises Ltd, the first company that resumed operation after the ban, has two leases in category B. State-owned Mysore Minerals Ltd, which has been named in Lokayukta reports, has one mine in category A, but two in category B and one in category C. “This is as if you murder somebody in Andhra Pradesh and claim to be innocent in Karnataka,” says Kamath.

Quite naturally, category A leaseholders are happy. Category B leaseholders heave a sigh of relief and prefer not to comment on categorisation. Those who come under category C are crestfallen. They argue that the Mines and Minerals (Development and Regulation) Act has not fixed any percentage for assessing encroachment, and hence such categorisation violates the Act. Anil Lad, owner of VSL Mining Company and the newly elected MLA from Bellary, says he will file a review petition against putting his mine in category C. Tapal Ganesh, a small-time mine owner, the only one who resisted Gali’s diktats, sounds depressed. His mine falls among the seven suspended by the court. “I do not think I will be able to start my family business in near future,” says he. He was physically attacked by Gali’s goons when in 2010 he tried to give statements to CEC.

Industry needs protected

To meet the state’s requirement, the court has capped the amount that can be extracted from the region—25 MTPA from Bellary and 5 MTPA from Chitradurga and Tukmur. It says the ore produced should be used only by the steel and other industries in Karnataka and neighbouring areas. The judgement does not ban export, but says only those ore rejected by the domestic industries can be exported. It has also lifted the embargo on issuing new mining leases.

To avoid illegalities, the court has asked the leaseholders who have been allowed to operate to get all clearances afresh. Besides, they will have to implement reclamation and rehabilitation (R&R) plan in a time-bound manner. The main thrust of R&R plan is afforestation, developing safety zone, green belt, soil conservation through controlling surface runoff by building retaining walls, check dams, rock-fill dams and stabilisation of accumulated waste dumps. ICFRE is preparing R&R plan for each mine and has done it for 70 leases.

Category A mines can start mining after initiating R&R plan and after the monitoring committee, set up by the Supreme Court in 2011 to carry out e-auction of the ore, certifies its progress. Category B mines will have to complete R&R plan before resuming work. Though leases of category C mines have been cancelled, they will also have to implement R&R plan. “Nobody can escape from implementing R&R,” says Dipak Sarmah, additional principal chief conservator of forests and chairperson of the monitoring committee.

image

  • Net Present Value (NPV) Rs 8-10 lakh/ha of forest land diverted for non-forest purpose. This is a one-time payment
  • Afforestation cost: Rs 1.25 lakh/ha. For this mine owner identifies revenue land equal to lease area. The forest department does afforestation
  • Safety zone: Rs 1.25 lakh/ha. Miners have to develop a 7.5-metre green belt along the boundary of the lease inside the lease area
  • Royalty: 10 per cent of the net sales value. This was abysmally small till 2008 at Rs 19 per tonne of fines and Rs 27 per tonne of lumps
  • Forest Development Tax (FDT): 12 per cent of net sales value. The tax was introduced in 2008. Mining companies moved the high court, which ordered to pay 6 per cent tax till the case is finalised. Case pending.
  • Value added tax (VAT): 2 per cent of net sales value
  • Production cost/tonne: Rs 300
  • Average price of iron ore/tonne: Rs 2,500
  • Profit calculated: 500-600%
  • After starting e-auction in 2011, royalty, FDT and VAT have been transferred to buyers

Expenses of implementing R&R will vary from plan to plan and will be between Rs 5 crore and Rs 20 crore. Besides implementing R&R plan, the court asked category B and C leaseholders to pay penalties: Rs 5 crore for each ha encroached by way of mine pits and Rs 1 crore for each ha encroached for dumping overburden initially. Kamath says it is paltry compared to the 500-600 per cent profit margin in the business (see ‘Economy of mining…’).

The court has asked the monitoring committee to retain 10 per cent of the sales proceeds of old stock of A and B leaseholders and the entire sales proceeds of the old stock of C leaseholders. The sales proceeds, together with the penalties and the amount received through auctioning category C mines, will go to a special purpose vehicle (SPV), called Karnataka Mineral Rich Region Development Corporation (KMRDC). It will implement an environment management plan of Rs 30,000 crore for 30 years for mining-affected zones. The projects include health, education, water supply, employment and biodiversity conservation “for ensuring inclusive growth of the area surrounding the mining leases”. Ironically, the fund will also be spent on setting up facilities like conveyor belts, railway sidings and widening of roads, which can be used for transporting iron ore.

“We have apprehensions about SPV,” says Hiremath. “It seems its special purpose is to take mining forward rather than compensating for the environmental devastation.”

Besides, at a production rate of 25 MTPA, the iron ore deposits of Bellary will be exhausted within 40 to 50 years. The nation will not be able to pass on its rich resources to the next generation. “This is against the principle of intergenerational equity,” says Hiremath. In fact, In 2010, while illegal mining was at its peak, the state government was signing MoUs with steel companies, including Tata Metaliks, Arcelor Mittal India, JSW Steel, Posco India. The industries have promised to invest Rs 1.2 lakh crore.

Sagar Dhara, director of Hyderabad non-profit Cerena Foundation, says ICFRE and CEC should have quantified the environmental damage in monetary terms before recommending resumption of mining. Cerena Foundation did a study in Sandur taluk of Bellary on behalf of the petitioners and estimated a loss of Rs 200 crore a year in agriculture alone. A moratorium on mining should have been declared for a few years till the physical and biological reclamation got completed, he says.

A Bellary without mining

Amlan Aditya Biswas, deputy commissioner of Bellary, says the ban did not affect the district’s economy much. Bellary has been an agrarian economy. At the time of the ban, some 10,300 people were employed in 70 active mines in the district. After companies retrenched workers, local residents who had joined the mining force returned to their traditional livelihoods (see ‘Onion v ore’).

Onion v ore

In Bhujanganagar village in Sandur valley, farmer Bharmappa got a bumper harvest of onion despite this year’s severe drought. “I harvested 44 tonnes of onion from one hectare,” he says, standing tall amid his farm hands.

“When mining was in full swing, yield had gone down to 24 tonnes,” says he. Besides, it was difficult to get farm hands then. The fertile valley is known for its vegetables and onions. But following the mining boom many had leased out their farms for stocking iron ore and for mining.

For the rest, it was difficult to grow crops due to iron dust. Since the ban, residents have returned to growing onions, maize and millets.

The state also did not incur any revenue loss during the ban. “Instead, revenue increased even when production came down,” says H R Srinivas, director of the states mines department in Bengaluru. Before the ban, IBM decided the price of iron ore and it used be around Rs 1,300 a tonne, he says. Since the ban, sale is done through e-auction by the monitoring committee and the rate was fixed by NMDC. “Average price rose to Rs 2,500 a tonne,” explains Srinivasa, who is also the convener of the committee. Transport was the sector severely hit by the ban. Many had bought tipper trucks on credit during the boom to transport ore to ports in other states. “Every tipper truck employed at least three people,” says B Badewali, president of Hospet Truckers Association. With the ban about 3,000 tipper trucks are now lying idle. Repaying has become difficult the owners and banks have started loan recovery procedures.

In the last 20 months, in the absence of reckless mining, forests and streams have started showing healthy signs. “We have spotted a few sloth bears and a rare species of snake that was seen in India only once before,” says S Manikandan, deputy conservator of forests.

Despite the court’s approval, it will not be easy for many companies to resume mining since they are fighting criminal cases in lower courts among themselves. The CBI is also investigating a few cases related to illegal mining. The court has clearly said its judgement will not affect the ongoing investigations. The petitioners also plan to approach the court again to review the judgement. They had asked for legal actions against all those involved in illegal mining, including those named in Laokayukta’s reports, and had prayed for two independent committees, one with powers to prosecute and the other with expertise to monitor R&R plan and SPV. “The judgment has not addressed many of our concerns,” says Kamath.

Goa next

Will the Bellary prescription work for Goa?

Sesa  
Goa’s Bicholim mineSesa Goa’s Bicholim mine (Photo: Sugandh Juneja)

The Codli mines in South Goa resemble large amphitheatres flanked by flights of steps. Till a few months ago, excavators and earthmovers could be seen here tearing into the crust to scoop out red earth that contained high concentrations of iron ore. Tipper trucks would then transport it to Murmugao and Panaji ports from where ships ferried the ore to destinations like China. Today the whir of turning wheels is missing in Codli. The mines, owned by one of the country’s biggest mining firms Sesa Goa, are waiting like 138 others for the Supreme Court order to resume mining.

The ban is not only on mining. Companies cannot even sell their iron ore stocks. “We have three million tonnes of iron ore lying but cannot sell it until the court allows,” says Joseph Coelho, manager of the Codli mines.

goa [4]

Mining activities had come to a halt in Goa much before the Supreme Court ban. The state government dealt the first blow. In September 2012, days after a commission headed by Justice M B Shah submitted its report to Parliament citing illegalities in all mines in Goa, the government temporarily suspended mining activities in the state. That month, the Union Ministry of Environment and Forests (MoEF) issued a direction under Section 5 of the Environment Protection Act, 1986, to suspend environmental clearances of all 139 mines in Goa.

The Supreme Court order came in October 2012, following a petition by Goa Foundation, a non-profit working on ecological issues. It ordered that the mine leases, found violating the norms by the Shah Commission, should be suspended and asked its Central Empowered Committee (CEC) to investigate the illegalities.

Timeline

October 6, 2011
Goa’s Public Accounts Committee says almost half of active mines in the state are illegal. Two-thirds of the mines in forest areas do not have clearances and have felled 140,000 trees

August 24, 2012
Indian Bureau of Mines (IBM) writes letter to Goa government, saying overburden dump within lease area should be regulated in terms of approved mining plan; those outside need approval from mines ministry or a Central authority

August 31, 2012
Goa government writes letter to IBM, saying removal of ore from overburden dump has been stopped since September 2011

September 7, 2012
M B Shah Commission report, citing illegalities in all mines in Goa, tabled in Parliament. Union mines ministry writes to Goa government, asking it to immediately restrict removal of overburden dumps outside lease area till appropriate mechanism is evolved

September 10, 2012
Goa suspends mining operations in all mine leases

September 14, 2012
Union environment ministry issues notice to cancel environmental clearance of all 139 mine leases in Goa

October 3, 2012
Goa government sets up R M S Khandeparkar Committee to investigate Shah Commission report

October 5, 2012
Supreme Court accepts petition by non-profit Goa Foundation and directs its Central Empowered Committee to look into mining illegalities in Goa

December 7, 2012
Central Empowered Committee submits its interim report

March 11, 2013
Directorate of Mines and Geology and the state government launch a scheme, Mining affected/impacted relief scheme, 2013, to provide financial assistance to people who have been affected by ban

Goa has also set up its own inquiry committee under retired judge R M S Khandeparkar to investigate the Shah Commission report.

Justifying the new committee, Goa’s deputy chief minister Francis Dsouza says, “The question is whether the apex court should have stopped all the mines. Legal mines should not have been shut as the livelihood of a large number of people is at stake.” Goa today finds itself caught between livelihood concerns and sustainable use of resources. With no solution in sight, the state could be handed down a model recently introduced 400 kilometres away in Karnataka.

There is a constant fear that the model pronounced in the Supreme Court judgement for reopening mines in Bellary could be used in Goa.

R K Verma, principal secretary of Goa’s mines department, says Bellary lost two years trying to take a decision on ways to resume mining. A similar term could be disastrous for Goa. Verma offers an alternative way: “We will book all illegal people, but legal operations should be allowed to resume as soon as possible.”

Atul Jhadav, president of Goa Barge Owners’ Association, explains: If the Bellary model is applied to Goa, most mines would fall in category C. The Supreme Court has cancelled leases of category C mines in Bellary because of highest number of illegalities, including dumping of overburden (soil removed to extract the minerals) outside the mine lease areas. Most mines in Goa dump their overburden outside the lease area, Jhadav says.

Besides, mining is the backbone of Goan economy, says Nilesh Cabral, MLA from Curchorem in South Goa.

Dharamaduda village is a few kilometres from Codli mines. About 80 per cent of the 12,000-odd population in this village earned their livelihood from these mines. Apart from direct employment, several residents in Dharamaduda own tipper trucks that ferried iron ore from the mines. Some worked as drivers and helpers in the trucks, while the others opened shops and eateries around the mines. Guru B Gaonkar, sarpanch of Dharamdauda, says a petrol pump set up in the village to fuel trucks used to pay tax to the village panchayat, depending on its business. It hardly contributes now. “We understand that mining creates pollution and traffic problems, but it is a trade off we are ready to accept,” says Gaonkar. He wants mines to be reopened as people from his village are migrating to distant places in search of work.

State government figures show in 2009-10, revenue from mining contributed 13.5 per cent to the state’s GDP. This is on a par with the hotel and the tourism industry. This apart, the industry claims that mining provides direct and indirect employment to nearly 300,000 people, or half of the state’s workforce.

Those who have lost their livelihoods now question why they are being punished when the fault lies elsewhere. “We were never involved in any illegal activity,” says William D’costa of Barge Owners’ Association. Most barges have loans of Rs 5 crore to Rs 6 crore attached to them. “Without mining we are unable to pay installments to the banks that are now sending us notices,” he adds. The association has written to the Reserve Bank of India and the state government to grant relief in loan repayment.

 

The ban has impacted almost every household in Goa because the breadwinners are associated either with mining or the Murmugao Port Trust, says P M Pandiyan, chairperson of the trust. Since iron ore exports comprised 80 per cent of the port’s operation, commercial activity has come to a standstill. Last year, this profit-making venture accrued a loss of Rs 108 crore. It was its first loss in history. The trust has asked the state to step in, Pandiyan informs.

The stakeholders of Goa’s iron ore mining sector do not want to give up easily. They have united to form the Goa Mining People’s Front (GMPF).

Christopher Fonseca of GMPF says 30 per cent of the state’s population has been jobless for eight months. “Environment is important but the government should think about our livelihoods too.” The state government has offered a year-long monetary compensation scheme for those who lost their livelihood because of the ban (see ‘Cushion for ban’).

The river linking schemes

In March, Goa’s chief minister announced a year-long relief scheme by passing a notification. Targeted only at a few taluks affected due to ban on mining, the scheme recognises that the ban has resulted in an “economic crisis” for those employed directly. It estimates that 25,000 families have been rendered jobless. Under the scheme, family of a tipper truck owner, engaged in mining, will receive Rs 8,000 per month. For a second truck, the family gets Rs 4,000 per month. The money will be released retrospectively from October 2012, when the ban was imposed, till September 2013. People who have lost mining jobs will be paid Rs 3,000 to Rs 12,000 a month based on their salary slab. People employed in mining-related activities will receive between Rs 3,000 and Rs 6,000 a month. They will have to establish that they were engaged in such activities for at least three years as of September 2012. The money will be released retrospectively from January till December 2013. So far, the state government has received 5,000 applications

Subhash Phaldesai, MLA from mining belt of Sanguem, says this is not enough. Claude Alvares, executive director of Goa Foundation, says the government should instead compensate those who have been displaced after their farmlands have been destroyed by pollution from mining. “The mineral does not belong to the government. It belongs to the people of Goa. But our assets are being destroyed, while a handful make merry,” he adds.

Plunder, then ponder

The reason for Alvares’ resentment can be found in the Shah Commission’s report. It points to a number of illegalities, including mining without licence, mining outside lease area, production of ore beyond permitted capacity, and illegal transportation. CEC’s interim report submitted in December 2012 reiterates most of these findings but presses for a detailed survey.

One of the most serious concerns recorded by both the Shah Commission and CEC is a mismatch between production and export figures of iron ore from Goa. Data submitted to CEC by the Indian Bureau of Mines (IBM) and exporter’s association shows about 40 million tonnes of iron ore was exported illegally over a five-year period (see ‘Illegality in excess’ on p35). Mining companies say the additional exported ore came from overburden dumps.

Earlier, IBM classified ore with less than 55 per cent iron content as overburden, which does not have much market demand. In 2009, it lowered the threshold value to 45 per cent. Overburden does not meet IBM threshold but it may still contain a significant amount of iron. Royalty need not be paid for overburden if it is not sold, says Mineral Concession Rules of 1960. But if it is sold or exported then a tax has to be paid to the state. A senior official of IBM says before selling this overburden, the state should be informed, which should ideally verify the quality and quantity of iron content and ascertain the royalty to be paid.

Industry insiders say the state mines department usually does not inspect what the industry sells from the overburden. This gives the industry the leeway to export good quality iron ore as overburden and evade royalty. Mining companies in Goa used this leeway to benefit from the soaring demand in the international market that peaked in run up to the Beijing Olympics and continued even after the Games.

A check on illegal shipping of minerals came only in 2010, after the state government made it mandatory for the companies to get a no-objection certificate from the mines department to export iron ore after paying royalty.

Overburden of controversies

Such illegality is at the helm of a recent spat between the state and the Centre over the authority to give permission for export of overburden.

MoEF and the Union Ministry of Mines (MoM) claim it is the Centre’s prerogative to give permission for export of overburden. Responding to one such claim in March 2011, Goa opined that environmental clearance is not required to remove minerals from overburden dumps. But in October 2011, MoM wrote back asking for necessary measures to prevent passing off of illegally extracted ore as overburden.

In July 2012, MoM again wrote to the state government that overburden handling, or removal of ore from overburden, for exports has an environmental impact and hence requires environmental clearance. The Goa government replied that overburden handling was stopped in September 2011.

On the very day Shah Commission’s report was tabled in Parliament, MoM asked the state to ban removal of ore from overburden lying outside the lease area till an appropriate mechanism is evolved. This points to the fact that the authorities, both at the Centre and the state, were aware of these illegalities.

S Sridhar, executive director of Goa Mineral Ore Exporters Association, has another concern. IBM does not allow mine lease holders to store overburden in mineralisation zone (areas that contain minerals). Given that mine leases in Goa are right next to each other, the only option is to keep them outside the lease area, he adds.

Most mine owners in Goa started operating during the Portuguese period. Under the Portuguese Colonial Mining law the maximum size of a Goa mine is 100 ha and the mines are contiguous.

IBM officials explain that they discourage dumping on mineralisation zone as it leads to locking up of minerals for future. Verma says dumping outside the lease area requires permission from the revenue department because of changes in land use. “In some cases this permission was obtained, but most ignored this requirement.”

There is no way out for the mine owners in Goa. Ambar Timblo, managing director of Fomento Resources, says the authorities were aware of the problem all along. “We always show our overburden dumps whether inside or outside the mine correctly to MoEF, IBM and the state pollution control board.”

Down To Earth analysed a few environmental clearances granted by MoEF. None of the clearances mentioned whether the overburden should be stored within the mine lease area. All it says is “overburden shall be stacked at earmarked dump site(s) only and shall not be kept active for long periods”.

Whose buffer is it anyway?

The Wildlife Conservation Strategy of January 2002 states that area within 10 km of the boundary of a national park or a sanctuary should be notified as eco-fragile zone. The Union Ministry of Environment and Forests (MoEF) asked states to submit their proposals notifying these areas. But in 2005, the National Board of Wildlife (NBWL) decided that the eco-sensitive zone should be site-specific, following which MoEF again informed states about the change. In 2006 the Supreme Court ordered that all projects within 10 km of national parks and sanctuaries should go to NBWL for clearance, until the eco-sensitive zones were notified. Supreme Court’s advisory body, Central Empowered Committee, stepped in and classified the national parks and wildlife sanctuaries in the country into six categories based on their area (see table). MoEF disagrees with this classification and has stuck to its original 10 km definition. R K Verma, principal secretary of Goa’s mines department, says, “The buffer zone should be site-specific and wherever possible, should be confined to natural barriers like rivers.”

Even if one goes by Verma’s definition, there is ambiguity over who is the competent authority to approve projects in buffer zones. MoEF in May 2011, wrote to Goa’s Chief Wildlife Warden (CWW), clarifying that NBWL is the only authority to approve mining in the buffer zone. Approvals for mining within buffer without placing them before NBWL also violate the 2006 Supreme Court order. But more than 100 iron ore mining leases, including Sesa Goa’s Codli mines, have clearance only from CWW, though they fall in the buffer zone. “Our interpretation of the order in terms of competent authority was CWW. So we approached it for approval. Now with MoEF saying 10 km, this is clearly a grey area. This needs to be resolved urgently so that we know where we stand,” says Ambar Timblo of Fomento Resources.

image

Now the state mining department has asked all mining companies to declare dumps with location, quantity and quality of the stock. “We estimate that there is 700 million tonnes of overburden. The department will now scrutinise these in detail,” says Verma. The Goa government now plans to auctions this overburden. From ecological point of view, overburden dump handling is important in Goa as its mining belt is close to major wildlife areas.

Eco-sensitive enough?

The iron ore-rich eastern Goa is also home to six wildlife sanctuaries and a national park. The CEC report says MoEF has cleared 20 mining leases within the sanctuaries. This contravenes the February 2000 order of the Supreme Court, which prohibits mining leases within national parks and sanctuaries, and applies retrospectively. Violating the December 2006 order of the apex court, MoEF has approved another 23 mines within one kilometre of the sanctuaries. CEC, in its interim report, has recommended quashing all the 43 permissions, identifying those responsible for the approvals and initiating action against them.

imageAll figures are in Million Tonnes (Source: CEC (Interim) Report)It is not just MoEF, the state is also to be blamed for such illegalities. Of the 120 mining leases cleared by MoEF, 112 are located within 10 km of protected wildlife habitats. Many of them have approvals only from Goa’s Chief Wildlife Warden. This is when the apex court in its 2006 order had observed that the standing committee of the National Board of Wildlife (NBWL) of MoEF had to peruse and approve all environmental clearances for projects located within 10 km of protected wildlife habitats. There is confusion over the competent authority to clear activities in this zone (see ‘Whose buffer is it anyway?’).

CEC’s interim report states “MoEF by its various actions and inactions de facto ensured mining operations in a large number of leases continue to take place in violation of directions of this Hon’ble Court.” CEC thus recommends that all environmental clearances granted to mines within the 10 km buffer be suspended and scrutinised by NBWL. The court can then decide their fate based on NBWL’s recommendation.

The way ahead

What does Goa have to look forward to given that illegal mining has taken its toll not only on its ecology but also on economy?

Mining in Goa may not start for the next five years, say Alvares. “We have foolishly stuck to our heritage of mining.” He says if Goa ends up like Karnataka, mining should be capped at 10 MTPA. Timblo says it is unlikely that production will start soon and the cap on production will be the new model of mining in Goa. Managing director of Sesa Goa, P K Mukherjee, refuses to comment on this subjudice case but says his only concern is about his employees. Verma hopes that conditions are not too stringent, like in Bellary.

CEC has recommended a model similar to that of Bellary, where an environment impact assessment and reclamation and rehabilitation plan need to be prepared by Indian Council for Forest Research and Education. It has also suggested a block-wise cap for mining.

But is the Bellary formula the right template for the rest of the country? Can it bring order to the iron ore mining industry?

With inputs from Srestha Banerjee

Bellary case file

Will it help sound mining or mining companies?

imageIllustration: Anirban Bora

The Bellary case—and perhaps now the Goa case—is setting a precedent for mining regulations in the country. It will define how the offenders are judged, how serious is their crime and how they should be penalised. In other words, it is developing the mining penal code for the country. It is setting the framework for future environmental management, including the limits on how much mineral extraction is “sustainable”. In addition, the judgements set the framework for how local people will “benefit” from mining. Therefore, in many ways these decisions are overarching and are definitely needed as the current regulatory system has been decimated. The question that needs to be discussed is whether the judgements go far enough in deciding the sustainable framework for mining in the country. Or, indeed, if these are in the right direction.

Mining Penal Code

The Central Empowered Committee (CEC) of the Supreme Court has classified mining into three categories—A, B and C—taking encroachment as the basis of the nature of offence committed. To judge the quantum of offence, CEC has taken the ratio of the lease area of each mine to respective encroachment.

Category A: No major encroachment outside the lease area. This does not mean this category is “clean” on other accounts. The mine operations are allowed after the reclamation and rehabilitation (R&R) plan is started.

Category B: Encroachment up to 10 per cent of the mine lease area for mining pit and dumping of waste in area up to 15 per cent of the lease area. They have to complete R&R and pay some fines before resuming operations.

Category C: Encroachment more than 10 per cent of the lease area and dumping of waste in area, which is more than 15 per cent of the lease area. Their lease will be cancelled and then auctioned for captive use.

The bottom line, after all the rigmarole and more than two years of judicial scrutiny, is that all mines, big and small, big offenders or small offenders, will continue in some form or another. The problem with this manner of categorising penalties is threefold. One, that CEC has defined the “nature” of offence in a very limited manner, which does not take into account the environmental fallout or the cumulative impact of the mines in the region. In this way, when mining reopens—first A, then B and then C—it could well be business as usual. The best that is being offered is that there will be an R&R plan, which will take into account “afforestation, check dams, stablisation of waste dumps, soil conservation, rainwater harvesting and use of modern mining technologies”. There is nothing to suggest that these methods will add up to sustainable mining, even if a cap is put on the total mining that will be allowed.

Two, this rulebook could well end up incentivising large mines to commit large offence. The simple fact is that the Bellary formula will work against small mines, as it is based on quantifying the extent of violation as a percentage of the mine lease area. This will end up “legalising” non-compliance of large mines. Mines with large lease areas, for instance of 1,000 hectares, could have encroached 100 ha and still be in legal B category.

Three, the issue of illegal iron ore extraction and sales has been ignored by CEC in defining illegality. In 2012, the Supreme Court directed CEC to assess within three months the actual quantity of illegal iron ore that was sold, so that companies could be fined. But this has not happened. So mines have opened and many more will open soon, and all the talk of recovering ill-gotten funds may well be brushed under the carpet. Small wonder the mining barons are once again in power in Bellary.

C for captive

Allowing C category mines in the future once they are auctioned for captive use presumes illegal mining will thus remain in check. But the fact is captive mines discount natural resource, allow transfer pricing and promote poor mining practices, as is evident from cases across the country. Worse, it will distort the market by creating certain companies who will have access to cheap iron ore through captive mines, while others will have to buy ore from the market at higher costs. It is also clear that companies with cheap raw material are not driven to innovate or to be frugal and efficient in their use.

For instance, the recent rating of Indian steel companies done by Delhi non-profit Centre for Science and Environment found that the three top-rated companies did not have captive mines for iron ore—their cost of raw material was high and they invested in efficiency, which in turn brought down emissions. Companies with captive mines—Tata Steel, Jamshedpur; Jindal Steel and Power Limited, Raigarh; and SAIL, Rourkela—were rated low in environmental performance.

Unscientific cap

The Dehradun-based Indian Council of Forestry Research and Education (ICFRE) has recommended in its environmental impact assessment (EIA) done at the behest of the Supreme Court that there should be a “cap” on the quantum of iron ore mined in the Bellary region. The Supreme Court has endorsed the recommended “cap” of 30 million tonnes per annum (MTPA)—25 MTPA in Bellary and 5 MTPA in neighbouring Chitradurga and Tumkur districts. The “cap” is not based on environmental or socio-economic factors. Instead, the ICFRE report mentions that it is suggesting this limit “since the annual iron ore requirement of Karnataka is around 30 MTPA and majority of its demand is met from Bellary”.

This sets a bad precedence for environmental governance and has huge implications for inter-state matters. The limit is unscientific and is not based on cumulative impact assessment, taking into account the carrying capacity of this eco-sensitive forested region. It would also signal that states should “mine” for their own captive consumption—mine and only mine.

SPV for community

The Supreme Court has directed that a special purpose vehicle (SPV)—the Karnataka Mineral Rich Region Development Corporation—be set up under the chairmanship of the state chief secretary. The SPV will collect the fines, penalties, money raised from the auction of C category mines and 10 per cent of the sale price of all iron ore sold from Bellary, and will implement projects for socio-economic development and mining infrastructure. In other words, a parallel government is being proposed to the district administration. It is not clear how this recommendation is in consonance with what is being discussed currently in Parliament. The Mines and Minerals (Development and Regulation) Bill, 2011, presently with Parliament, includes provisions for benefit sharing and local area development. Will the SPV model be in contravention of the Bill or will it set a precedent?

No accountability

There are four key departments that can be held most accountable for the extent of illegal mining in Bellary (and Goa). One, the forest department as it turned a blind eye to the takeover of its land. Two, the state mining department, which gave leases and clearances with total indifference. Three, Nagpur-based Indian Bureau of Mines, which gave permissions to increase mining from 20 MTPA to 80 MTPA without any care or scrutiny for impacts. And four, the Ministry of Environment and Forests (MoEF), which gave environmental and forest clearances to anyone and everyone without any assessment.

The fact is government officers who “connived”, “consented” or simply did nothing to stop the rot have not been held accountable. The worst part is that today these departments—represented in the Supreme Court monitoring committee—have become all-powerful and are back in the business to decide the fate of Bellary without any institutional reform.

The Bellary model does not provide the design of an effective institutional framework for environmentally sound and regulated mining in the country. The model, instead, once again depends on committees of the court to oversee management, which is at best a short-term solution. In this way, the Bellary case does not mean the end of illegal mining or a new dawn for sustainable mining in the country.


Source URL: http://www.downtoearth.org.in/content/chaos-iron-age

 

World Health Statistics 2013 show narrowing healthgap


 


World Health Organization – May 2013

Available online at: http://bit.ly/12uJNUs

“….15 May 2013 – The world has made dramatic progress in improving health in the poorest countries and narrowing the gaps between countries with the best and worst health status in the past two decades, according to the World Health Statistics 2013. “Intensive efforts to achieve the Millennium Development Goals have clearly improved health for people all over the world,” says Dr Margaret Chan, Director-General of WHO.


World Health Statistics 2013 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

This year, it also includes highlight summaries on current trends in official development assistance (ODA) for health.

Progress on the health – Available in 3 languages English French Spanish

DOWNLOAD THE REPORT IN ENGLISH, BY SECTION

 

Table of contents and introduction

Part I. Health-related Millennium Development Goals

Part II. Highlighted topics

Part III. Global health indicators

Annex 1: Regional and income groupings


THE INDICATOR COMPENDIUM

World Health Statistics 2013 – Indicator compendium

 

 

Controversy looming large over Chutka nuclear project


Shashikant Trivedi  |  Bhopal  May 15, 2013 Last Updated at 09:23 IST

Upcoming project in MP to displace local tribal population; proposed site in highly seismic zone near Kanha National Par

Locals of Mandla district will once again raise their voices against 1400 MW NPCIL (Nuclear Power Corporation India Limited) Chutka project which is coming up in highly seismic zone, near Kanha national park and adjacent  to one of the least polluted river Narmada. State government officials have already issued land acquisition notices to local people, almost all of them are tribal, and have slapped a NEERI (National Environmental Engineering Research Institute) report which is Greek to them.

The district administration has called a public hearing on 24th of this month to invite claims, objections and suggestions suggestion on the project that pose risk to rich diversity and more importantly pre-historic evidences of human civilization in the area. Members of Chutka Parmanu Sangharsh Samiti, have demanded immediate cancellation of the meeting and threatened to stage dharna from 20th of this month if their demand is not met.

NEERI has readied environment impact assessment report on the project.  On the other hand district collector told BS that all formalities and documentation procedures have been completed and there are people who want this project to come up.

Interestingly, when world is debating safety of nuclear power project after 2011 Fukushima disaster in Japan, Jabalpur-Mandla belt also experienced an earthquake on 22 May 1997 of 7 magnitude on Richter. The epicenter of this earthquake was at Kosamghat –hardly 20 kilometers away from the proposed site.

According to Navratan Dubey, secretary of Chutkha Parmanu Sangharsh Samiti, the district collector handed over the NEERI report on 21 April 2013 to them and gave one month period to study it. “Entire report is in English and is in scientific terms, how can villagers study it and come up with even suggestions? He asks, “The NEERI took two years to prepare it and they want us to analyse it in one month. We have demanded the district collector to give a Hindi version of the report and a time of two months so that villagers can understand it. It would be impossible for them even if they are in favour of the project,” Dubey said, “We will launch our protest from 20 of this month if they do not listen to us. We want the public hearing to be cancelled.”

Villagers of Chutka, Tatighat, Kunda, Bhaliwara and Patha are in the core area of the project. Villagers are more enraged as they have already been displaced due to Bargi dam on Narmada River. The project site also falls under the scheduled area.

The district collector Lokendra Singh Jatav told BS telephonically from Mandla, “We have given them enough copies of the NEERI report in Hindi and enough time. There are people who want development and they are in favour of the project, we will go ahead as per schedule. We have already issued land acquisition notifications and few with vested interest are opposing it.”

Though the project is yet to come out of the drawing board, the district administration has issued notices under the 1994 land acquisition Act. Members of Chutka Parmanu Sangharsh Samiti also allege that district administration officials are forcefully moving ahead without taking them into confident. “They have not taken permission from gram sabhas and ignored decisions and resolutions of villagers in contrast to the fact that Panchayats (Extension to the Scheduled Areas) Act, 1996, has vested all rights on deciding developmental activities to the gram sabhas,” said Rajkumar Sinha, who is fighting for rights of oustees of Bargi dam. He is advising villagers on Chutka Parmanu Sangharsh Samiti on environment and other issues.

The samiti members said they were already displaced when the Bargi dam on Narmada River was conceived. “We are strictly against the project as we do not want to move for another project,” Dubey added. The district collector was not available for comment. However the district collector clarified that all legal and documentary procedures have been completed.

 

Making Choices: The Rhetoric and The Reality #Gender #Vaw


By Sanjana Gaind, ultraviolet.in

 This is the third of a series of posts written from the experiences at CREA of implementing a program called “Count Me IN! It’s My Body: Advancing Sexual and Reproductive Health and Rights of Young Girls through Sports”. The first and second posts are here. CREA is a feminist human rights organization based in Delhi (www.creaworld.org).

Sanjay: Yeh aapka kaaryakram theek nahin hai. (This programme of yours is not right.)

Me: kyun? (Why?)

Sanjay: Ladkiyon ke sanskaar bigaad raha hai.  (It is corrupting the values of girls.)

Me: Kaisey? (What do you mean?)

Sanjay: Bahar maidan mein khel rahi hai, football ke liye ladai kar rahi aur humarein muhn lag rahi hai. (They are playing outside in the field, fighting for the football with us, and talking back to us.)

Me: In teeno mein se, aapko dikkat kis baat se hai? (Out of these three things, what bothers you the most? 

Sanjay: Sabhi se hai. Humko teeno ki hi aadat nahi hai na. (All three of them. We are not used to such behaviour of girls.)[1]

On any given day, I would argue with him incessantly, making it very clear that the problem is not with the girls but with him. But, that day, I let him have the last word. Not because I had nothing to say to him, but because I felt a great sense of achievement and pride on behalf of the girls who had upset him and had challenged the patriarchal order and structure which is his comfort zone. He is visibly upset with the young girls in his village who have begun to question his authority. There are many other such men and boys in other villages as well, where the girls have begun to occupy and reclaim spaces like public grounds, which have traditionally been seen to be “male-only” spaces. They are angry, upset, and disturbed by this sudden demand for space by the girls.

The increasing number of female bodies in a playground, running, playing, jumping, laughing, and fighting is upsetting norms, challenging controls, and transforming spaces. These are bodies that are meant to be invisible inside and not visible outside in public spaces. These are bodies that are meant to be monitored and controlled inside homes, those four-walled bastions of patriarchy. In this established order, how they choose to dress, choose to roam, choose to express, and choose to interact with others is not their decision. However, now in small and not-so-small ways, these structures of power, of domination and silencing are being challenged. While some men and boys are not very happy with this overt display of female bodies in the field, there are others who are being supportive and encouraging of this trend. Some react angrily, some positively, and some violently.

It is not just the men and boys who are curious about what is happening. When sessions on topics like bodily changes, menstruation, sex, pregnancy, choice, consent, pleasure, rights, and autonomy are held as part of the It’s My Body programme, many mothers accompany their daughters to these meetings to check what is being ‘taught’. The local health workers are keen to participate in sessions on health, hygiene, nutrition, and menstruation. Sessions on sex, sexuality, choice, consent, and pleasure make them uncomfortable. The discomfort is not just at their end.

We also share this anxiety in talking about these issues freely and openly. The fear of backlash and antagonism makes us choose our strategies, messages, mediums and language strategically and carefully. The title of the programme, ‘It’s My Body’, when translated into Hindi— Mera Sharir, Mera Adhikaar, comes across as ‘bold’ or ‘radical’ and there is some hesitation in using it, both on our part as well as that of organisations co-implementing this programme with CREA[2]. The programme is very often projected as a programme on Reproductive Health, and the ‘S’ and ‘R’ in Sexual and Reproductive Health and Rights are used cautiously. Words like ‘hak’ , ‘adhikaar’, ‘pasand’, ‘anand’ ,’yaunikta’ (right, preference, pleasure, and sexuality) are used selectively and only in certain ‘safe’ settings and spaces. But, what happens, when these conversations are translated into actions outside these constructed ‘safe’ spaces?

When Rashmi (name changed), from Jharkhand, insisted on wearing jeans in the village, her mother pulled her out of the programme. Neha (name changed) has refused to marry the boy her parents chose for her because she doesn’t like the way he looks. Her parents are shocked and unhappy with this new assertion of her right to say ‘NO’. Kavita(name changed ) slapped the boy who grabbed her hand at the tea shop. The first thing that she had to explain to her parents, family, and others was – why was she roaming outside the house in the evening? Sunita, Mamta, and Jyoti (names changed ) come to attend these meetings on their bicycles. Some boys hide behind the trees place thorn traps on the way to puncture their bicycles, so that they can trouble and tease them. As a result, the girls have stopped staying back for volleyball practices in the evening and head home before it gets dark.

There are several question marks and circumscriptions outside of these ‘safe’ settings, where girls feel ‘empowered’, informed, and confident. All our conversations and discussions in these spaces and the choices girls make often have repercussions. What is the kind of resistance they face outside these safe spaces? How do they negotiate with those who are not part of this ‘safe’ space? How do they retain this confidence when they are outside this setting? What are the struggles they face to be a part of this group? Why is it that if something goes wrong, it is the girls who have to back down? Why does the fear of harassment, abuse, and violence hold them back from participating in these collectives?

The fear of the consequences for some of these young girls, who are questioning, challenging, and transforming the established social order, is ever-present. This compels us to reflect on our own strategies. We often ask ourselves whether we should tone down the rhetoric? Or should we let this fight run its own course? How do we make our processes of change more inclusive to include others who serve either as gatekeepers or as allies in this process? Creating exclusive, rights affirming and safe spaces for women and girls is necessary. But is that enough when the application of these rights is in the “real world”?

Sanjana Gaind works at CREA as Program Coordinator – Young Women’s Feminist Leadership. Sanjana is interested in the application of artistic and creative methodologies in activism and development. She has used mediums like theatre, music, art and sports in her work with young girls and women on issues of gender, sexuality and rights.

Big Thank You to Meenu, Shalini, Pooja and Rupsa for the ideas and feedback they shared.


[1] This conversation took place with a 26- year-old man in Jharkhand on 11 March 2013, at an International Women’s Day event that was organised by CREA and Mahila Mandal, as part of CREA’s ‘It’s My Body’ programme. Sanjay [(name changed]) is the captain of the village football team.

[2] It’s My Body- Advancing Sexual and Reproductive Health and Rights of Adolescent Girls through Sports, is a programme led by CREA and co-implemented with ten women-led, community-based organisations in rural and urban areas of Bihar, Jharkhand and Uttar Pradesh. 

 

#India – Clinical drug trials in Rajasthan claim 95 lives


STAFF REPORTER, tHE hINDU

291 cases of serious adverse events reported

Drug trials on humans in Rajasthan over the last eight years have claimed 95 lives, while 291 persons experienced serious adverse events, according to the State government’s latest deposition before the Supreme Court in an ongoing public interest litigation.

While informing the apex court of the figures, the Rajasthan government has sought to be made part of the overall monitoring and regulatory framework regarding clinical trials in order to protect the health of its citizens, deal with rogue trials and expedite the compensation process.

The 95 deaths include those caused due to the trials, besides deaths due to the natural history of the disease and other unrelated health events.

Four cases of death were deemed fit for compensation by sponsor companies out of which two had been compensated, while the process of compensating the other two was on.

This information was revealed in an affidavit submitted earlier this year by Rajasthan Chief Secretary C.K.Matthew to the Supreme Court, hearing a public interest litigation petition. A committee appointed by the state government came up with these figures after collecting data from 60 principal investigators regarding 213 clinical trials, conducted between 2005-2012.

However, the total number of deaths could be much higher as a total of 326 trials were conducted in Rajasthan during this period.

Some of the drugs for which trials were conducted include Talactoferril, Kremezin, Aliskirel, SU011248 (code name), Prasugrel and Clopidogrel.

In line with responses from other State governments in the case, the Rajasthan government too, has argued for higher powers to the States in the overall monitoring and regulatory framework regarding clinical trials.

“Certainly, the State government needs to be part of the whole process or else how are we to know what steps are to be taken [to deal with rogue trials],” Mr. Matthew told The Hindu .

In its deposition, a copy of which is with The Hindu , the Rajasthan government argued that while the Drugs and Cosmetic Act 1945 was a Central legislation, the State government was primarily responsible for the health of its citizens.

“The data would clearly reveal that sometimes clinical trials have significant adverse impact on the health of patients…existing rules need to be amended accordingly, especially with regard to immediate care for persons suffering SAEs and…with respect to compensation [in case of mortality],” the State government has argued.

It has also called for the strengthening of the existing framework “with sufficient safeguards…with penalties as well as adequate compensation”.

The government argued in favour of an online monitoring system for persons undergoing trials and a proper accreditation system for the selection of principal investigators in which the State government should have a role to play.

Since almost all Ethics Committees overseeing the propriety of the trial process are in-house bodies of sponsor hospitals of which Principal Investigators are also members, the government has called for Ethics Committees to be detached from trial sponsoring sites/institutes.

According to information submitted to the court by the Union Health Secretary in the case, a total of 2,644 deaths and 11,972 SAEs were reported during clinical trials in India between January 2005 and June 2012.

 


  • State government seeks higher powers in overall monitoring, regulatory framework
  • Government argues in favour of online monitoring system

 

Recent Supreme Court order in Vedanta case holds hope for tribal community life


 

Published on Down To Earth (http://www.downtoearth.org.in)

 


My god v your resource

Blog Intro:

Recent Supreme Court order in Vedanta case holds hope for tribal community life

Author(s):
Richard Mahapatra

 

imagePhoto: Digpatra

Is a village council qualified to deal with religious beliefs? The answer lies in a recent order by the Supreme Court in the Vedanta case. Gram sabhas (village councils consisting of all voters in a village) in Odisha’s Rayagada and Kalahandi districts will decide whether the industrial activities of Vedanta violate the constitutional right of tribal communities to worship. Translated into practice, the order means voters in a few villages will decide the fate of the multi-billion- rupee project based on their religious beliefs. Though parroted often that religious belief is a private concern, the apex court’s order is exceptional in making religious decision a community one. Those who understand tribal ways of life will vote for this order.

In the past, many orders of the apex court—several of them highly controversial and a few where the court had to issue clarifications—dealt with religion-related issues, including defining Hinduism. In many cases related to religion the judiciary has been cautious and has limited verdicts to ensure the constitutional rights to practice any religion. Going by senior advocates and judicial experts, the Constitution gives more importance to public purpose than to general religious rights. That is why most often the apex court gets to decide on contests between the two.

Though the Vedanta order cannot be clubbed with such cases in a clinical fashion, it is definitely a case related to religion and associated beliefs. There are a few reasons that make this case interesting.

First, it is a perfect case where the government’s power to acquire land for public purpose and having right over minerals are in direct conflict with religious rights of local communities. Secondly, the religious belief in question is that of tribal communities. Unlike many religions, tribal religious beliefs are manifested in tangible living forms like forest, land and water. In this case, the direct conflict between religious belief and public purpose becomes intense as the public purpose acquisitions are the gods and goddesses of the tribals. For the Dongria Kondhs in Odisha, the Niyamgiri hill is the Niyam Raja or god. Thirdly, tribals do not have any supreme religious head or bodies to protect and interpret beliefs. Tribal beliefs are pure functional codes for maintaining the fragile ecology-economy equation that sustains them. This is where the court’s order to assign the village council, that enjoys constitutional powers, to take a call on the religious rights comes as an acknowledgement of the fact that the standard law and religion approach to tribal areas will not work.

Village councils are the new institutions that governments are targeting for effective service delivery. They are fast emerging as tools to turn representative local governments into participatory ones. Whether to identify a beneficiary for a programme or to prepare a village water security plan, at least technically, people have direct say over local development decisions. There are many ways to interpret a court order, but the current order has immense ramification for this institution; it may open up a new front for direct intervention by voters in contentious issues. Never ever have voters been mandated to mediate in such a case. In tribal areas, it is a judicial order to get back to their age-old participatory and commune system of governance.

But here comes the challenge: will the government accept the apex court order in the right spirit?

There is no dearth of cases where village council meetings are engineered to get favourable decisions. Applying all possible tricks, projects that have adverse local impacts, including the case of Vedanta, have handed over dubious consents. Studies carried out across the country show that people hardly attend village council meetings because they never work out in their interests. The court’s interpretation of tribal right to worship and the right to decide on it in general village meeting applies equally to all tribal areas, the hotspots of industrial and mineral development. Though the court upheld the government’s right over the country’s 85 billion tonnes of mineral resources, it also upheld the right of tribal communities over gods and goddesses residing over the resources.

In the next one fortnight, the tribal communities of the two districts will vote not just on their right but also on a mini but crucial plebiscite on the government’s will to implement the court order. Closely, and with vested interests, India’s tribal population will be watching.


Source URL: http://www.downtoearth.org.in/content/my-god-v-your-resource

 

Maternal Health Activist Madhuri of JADS arrested #Vaw #Tribalrights


 

English: National Rural Health Mission of India

English: National Rural Health Mission of India (Photo credit: Wikipedia)

 

Five Years of NRHM-JSY and more than a decade of RCH: continuing maternal deaths in Barwani and MP
Background
Janani Suraksha Yojana (JSY) was launched under the National Rural Health Mission (NRHM) in
April 2005 as a safe motherhood intervention, with the specific objective of reducing maternal and
neo-natal mortality by relying on institutional delivery as the primary strategy for making available
medical care during pregnancy, delivery and post delivery period, and thus promoting safe
motherhood. All women are encouraged to avail institutional care during pregnancy and delivery,
and through ASHAs recruited specifically for this purpose institutional delivery is being promoted
among poor pregnant women. JSY is a 100 % centrally sponsored scheme, and it links cash
incentives to pregnant women with hospital delivery and post-delivery care. Reproductive and
Child Health (RCH-I) has been operational since 1997 as a project to provide a variety of
reproductive and child health services in rural areas to bring down maternal and infant mortality, in
order to reduce fertility rates and achieve population control. The second phase of the program
(RCH-II) also commenced in 2005. NRHM itself was launched with the promise to improve
availability and accessibility to health care services to the rural population, especially the
disadvantaged groups including women and children, by strengthening public health systems for
efficient service delivery, improving access, enabling community ownership and demand for
services, enhancing accountability and promoting decentralization.
It is against this context of programmes and interventions and associated fund flows from
the central government and several international agencies that one needs to view the status of
public health services, of maternal and child health in the country in general and specifically in the
high-focus states like MP, and the developments in Badwani that is the focus of this report.
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly
adivasi district in south-western MP. Nearly a thousand people gathered under the banner of
Jagrit Adivasi Dalit Sangathan (JADS), a mass organisation, to protest against extremely
negligent treatment of women in pregnancy and labour, particularly the death on 29th November
2010 of Vypari bai, an 8-months’ pregnant woman admitted in the District Hospital.
The people had come for this rally
from far-flung adivasi villages of the
district, and sought to draw attention to and
to protest against extreme callousness and
ill-treatment regularly meted out to women
in pregnancy and labour by the public
health system, particularly the District
Hospital (DH). A quick perusal of the DH
records indicated that between April-
November 2010 there had been 25 maternal
deaths, and 9 maternal deaths had been
recorded in this hospital in the month of
November 2010 alone. In addition, deaths
of 21 neonates (within 24 hours of birth) had been recorded, related to 511 deliveries conducted
in the hospital during November 2010. People complained that women with problems during
pregnancy and labour were frequently referred to Indore Medical College Hospital, located 150
kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death’ instead of ‘institutional delivery’
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the
morning of 27th November 2010 to reach the District Hospital, having been referred from the
PHC at Bokrata, and then from the CHC at Pati. She had been carried in a `jhuli’ (cloth sling)
over the first 10 kms from her village to Bokrata, from where the family managed to get the
Janani Express ambulance. She had experienced a convulsion that morning, and had high blood
pressure (BP) and eclampsia at the time of admission in the DH around 1.30 pm on 27th
November.
Following her examination by a gynaecologist at the time of admission in the DH on 27th
Nov., she was visited only once by another doctor during the entire day on 28th Nov. She had been
prescribed medicines after admission to control her BP, but her treatment sheets show only two
measurements of BP during the entire stay from 27th to 29th Nov. No attempt seems to have been
made to deliver the baby, by either induction or cesarean, as is the standard procedure in such
cases. An ultrasound scan on 28th November (for which the woman was taken by auto-rickshaw to
a private centre even though the hospital has this facility) showed the presence of live foetus.
Both the mother and mother-in-law of Vyparibai are trained health workers, presently
working as ASHAs in the NRHM. The mother-in-law Dunabai in desperation attempted to contact
the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the
patient’s family. Moreover the doctor on duty, after checking the patient only once on 28th, was
also absent from the hospital premises. After repeated efforts to contact her, at late night at around
11 pm on 28th November, she instructed the nurse on duty that the relatives could take the patient to
Indore, but did not bother to examine the patient or modify the treatment. When the family went to
the doctor’s residence (which is within the hospital premise at a stone’s throw from the ward) on
28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go,
saying she would phone the instructions to the nurse. The young woman finally breathed her last at
5 am on 29th November 2010, without medical attention despite being admitted in the District
Hospital.
Both the block CHC and Barwani DH are CEMONC (Comprehensive Emergency Obstetric
Neonatal Care) centres, and the DH is equipped with a Blood Bank. Such centres are supposed
to provide emergency services related to pregnancy/ delivery round the clock and 365 days a year.
In any case, a hospital at the level of district hospital is supposed to provide emergency services at
all times, whether or not it is a CEMONC. Further, there is provision that in case of complications,
CEMONC centers can contract-in services of private medical practitioners. So she could have been
referred under the ‘Janani Sahayogi Yojana’ to one of the two local private hospitals. The DH has
four gynaecologists and two anaesthetists, who could have ensured Vypari bai’s delivery. However,
the case paper shows that nearly 35 hours after admission, the patient had been referred to the
medical college hospital in Indore at around 11 PM on 28th. Further, the family was asked to sign
an undertaking, stating that they were refusing to take her to Indore and they took responsibility for
the consequences. It has been repeatedly experienced that, rather than using the institutional
provisions, patients are generally referred to Indore. And are also made to sign such undertakings.
Several other cases of denial of services leading to complications and ill-treatment at all
levels of health services have been documented by JADS. Few illustrative ones are described
below.
District Hospital, Barwani – Baltabai, 20 years, Village- Ubadagad, Pati Block,
On 6th June 2010, 9-months’ pregnant Baltabai was taken to Pati CHC with labour pains, by bus at around 12
o’clock in the afternoon. There was no doctor in the CHC. When the family contacted the BMO and
requested him to see Baltabai, the BMO did not do so, but simply arranged for the Janani Express
Ambulance and referred the patient to the District Hospital. Around 3 PM Baltabai was admitted in the
female ward of the DH. Not a single doctor was present in the female ward, ostensibly because `it was
Sunday’. The nurse on duty informed the doctor who was supposed to be on duty, but was not physically
present in the hospital premises, about the serious condition of Baltabai. She was advised some blood test,
and after the blood report was available, referred by the doctor to M.Y. Hospital, Indore. During this period
the relatives were not adequately informed about the condition of the patient and need for referral. What is
more serious is that the family was not informed about intrauterine foetal death. Following the nurse’s
advice to go to the local hospital instead of Indore, the family took Baltabai to the private trust hospital in
the Barwani town, where the doctor examined Baltabai and informed them that the foetus was dead. She
recommended an emergency operation to remove the dead foetus and save the mother. The family had no
option but to go ahead with this surgery. They incurred a cost of around Rs 10,000/- and an additional Rs.
7000/- were spent on medicine. The family, dependent on daily-wages, had to borrow money from local
money lenders at very high interest rate.
On 14th June Baltabai was discharged from the trust hospital. However, her agony was not
over yet. On reaching home that evening she complained of abdominal distension and pain. On 15th
June, at 4 am she was taken to a private practitioner, where she was cathetarised, and again referred
to the DH, where she was treated till 21st June. On 21st June Baltabai was referred to M. Y. Hospital
Indore for treatment of paraplegia. What exactly happened to Baltabai from15th – 21st June is not
very clear, largely because there are no trustworthy clinical records. Why and how Baltabai
developed paraplegia was never explained to the family members and other concerned people.
Fortunately Baltabai’s condition improved in the M.Y. Hospital and she was subsequently
discharged on 1st July. The ordeal of Baltabai lasted for 24 days (6th June to 30th June), and has left
the family severely indebted.
In September 2008 a woman in labour at the District Hospital was referred by the attending
doctor to Indore as a case of obstructed labour. The family took her to the local Trust hospital,
where a caesarean operation was performed and the child delivered safely. However, due to the
delay the child developed complications and had to be admitted in the neo-natal intensive care unit
(NICU) in the DH.
CHC-Pati block – Meera, Patel phaliya , Pati
Meera had symptoms of threatened abortion since the second month of pregnancy; and was treated
at CHC, Pati. However, the doctor advised her that she should not rely on the medicines available
in the hospital, and made the family purchase injections and medicines from outside the hospital,
worth about Rs 1000-1200. Meera followed all the instructions given by the doctor, as she was told
that she would have a difficult labour. Despite this treatment Meera had intrauterine bleeding one
morning. When she called up the CHC for the Janani Express ambulance she was told that since
she was from Pati itself, she should go to the hospital by herself, and would not be provided the
ambulance. The lady walked over 5-8 km, for almost 2 hours, bleeding and in terrible pain, to reach
the CHC. At the CHC, she was informed that the baby had died in the womb. The family was
forced to purchase few special medicines from outside for the operation to remove the dead foetus.
PHC Menimata – Baniya Bai
On the night of 11th November 2008 Baniya bai went to the PHC Menimata for delivery. The
compounder and nurse asked her family for Rs 100, which the family did not give. The next
morning she was forced to leave the hospital on grounds of being anaemic. Baniya Bai, in
labour pain, managed to crawl out to the road outside the PHC, where she delivered with the help
on the local dai. She was then sent by members of JADS to CHC Silawad by the Janani
ambulance.
These are not isolated cases; there are reports of similar incidents of maternal deaths and
denial of treatment at the health centres, including the DH in Barwani.
Demanding Accountability for Negligence
We were visiting Barwani to get a firsthand
account of the situation there
concerning health services, particularly
in the District hospital. On the morning
of 28th December when we tried to meet
the CMHO and the concerned lady duty
doctor (who happens to be the CMHO’s
daughter) we were told that they were
out of town. The gynaecologist who had
admitted Vypari bai on 27th November
said she had anemia and eclampsia and
was not in a condition to be operated
upon; and that they did not have a
ventilator in the hospital. This
gynaecologist was not around the day
after admission (28th November) to monitor the progress; she is usually out of the hospital four
days of the week performing sterilization operations in family planning camps.
We observed the rally taking place outside the DH on 28th December. About 500 people
(nearly half of them women) had gathered at the entrance of the DH at around 12 noon, by which
time the OPD was almost over. The 2-3 doctors present there left when they heard the rally
approaching. The police tried to snatch away from the rallyists their microphone and the cart on
which it was placed; however the rallyists managed to convince them that they would leave very
soon. About fifteen minutes later the people moved away from the hospital premises and
continued their dharna on the road in front of the Collectorate office, well away from the DH.
Several activists and ordinary village women, including the mother-in-law of the deceased
Vyaparibai spoke of their travails at the DH. A set of 22 issues concerning the District hospital,
which were mentioned in the memorandum of demands, were read out to the assembled people.
The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the
ADM came and just gave a brief assurance that the issues would be responded to in writing in 15
days time. By around 4 PM the rally had dispersed.
Response by the administration – ‘the message is secondary, crack down on the messenger’
We met the Collector on 28th December evening after the rally and apprised him of the state of
affairs in the DH. It emerged that the process of carrying out maternal death reviews had not
been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector,
the CMHO and CS came when they were summoned. According to the CMHO such maternal
deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring
them down to zero’. When pointed out that the DH was a CEMONC centre, that there were 4
serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths
were still taking place, there was no satisfactory response. The Collector appreciated our
bringing things to his notice, and said he would initiate
the task of Maternal Death Reviews. At the same time,
he also hinted at linkages of the mass organisation with
‘Bastar’ and ‘Andhra Pradesh’, thereby seeking to
discredit the people’s organisation as being associated
with the ‘Naxalites’, who have been outlawed by the
central government.
We are now extremely shocked and dismayed
that two days after this rally (on 30th Dec.) as per local
press reports, the police has foisted several charges on
the leaders of JADS and 200 people who participated
in the protest. They have been charged with Sec 146 of
IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause
death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3)
of MP Kolahal Rules. On 31st December one of the activists of the organisation, Bachhiya bhai,
was arrested and sent to jail on charges that were slapped on him and others in 2008, when they
had protested against the denial of services in PHC Menimata (described above).
It needs to be mentioned that the pilot phase of community-based monitoring of rural
health services in MP under NRHM had been implemented in Barwani during 2007-08. Even
prior to this the mass organisation JADS had been actively addressing the health problems in the
area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC
Pati and dialogue with health officials (with the intention to improve them), was followed up
with a rally at Barwani town on the dismal state of health services in the DH. So the area has a
history of peaceful rallying for improvement of rural health services. However, there seems to
have been hardly any concerted response from the administration to address the genuine
problems faced by and raised by the people.
Is the situation restricted to Badwani?
The situation regarding maternal deaths seems to be similar in many other districts of MP. The
audit report of NRHM in MP by the CAG gives an idea of the serious situation in the state.
According to the CAG audit report for the period 2005-06 to 2008-09 incidences of maternal and
infant deaths in MP remained high. In the 12 districts surveyed for the audit there had been 1377
maternal deaths in all in the four-year period – Betul recorded 152, Bhopal 269, Indore 162,
Shahdol recorded 393, Dhar recorded 125, Ujjain 124, and so on. Shahdol district reported 55
maternal deaths in 2008-09. The audit report also points out that despite increase in number of
institutional deliveries, post-delivery mortality remained alarmingly high. The Maternal Mortality
Rate remained high at 379 per lakh live births. Interestingly, the state government has fixed a
lower target than that of the central government for reduction of MMR and IMR. While NRHM
envisages MMR of less than 100 per lakh live births and IMR of 30 per 1000 live births by 2012,
the MP government has set these at less than 220 and 60 respectively. It has said that due to
shortage of manpower it was not possible to achieve the NRHM targets! The audit also found that
Maternal Death Review Committees were to be constituted at each district, but had not been done.
A large number of neo-natal deaths also seem to be occuring: according to figures (collected by
RCH – NRHM for monitoring and evaluation) between April-November 2010, there were 154 neonatal
deaths in the entire district of Badwani, of which 133 have been recorded at the District
Hospital (3879 deliveries recorded at the DH in the same period).
Some other findings of the CAG audit indicate that even after four years of NRHM the
state government was not taking adequate measures to address the long-standing problems of
lack of basic medical facilities, lack of physical infrastructure, and of doctors and other staff.
For instance: the number of health centres fell short of the prescribed norms; several centres,
particularly sub-centres were functioning without buildings; none of the institutions had been
upgraded to Indian Public Health Standards (IPHS); of the 82 CHCs designated as first referral
units (FRUs) 80 percent were non-functional and the rest were only partially functional. The
state government itself acknowledged that the health centres are non-functional due to shortage
of man-power. 101 out of 297 PHCs in the 12 districts studied were running without doctors,
despite the provision for hiring contractual staff under NRHM. Monitoring Committees too at
state and at lower levels to review the activities under NRHM had not been formed till 2009.
One also finds that several hundreds of crores of rupees have been spent over the past few
years under RCH-JSY. Government reports show that the allocations for RCH-JSY had increased
since 2005, and expenditure too had increased from Rs 26.29 crores in 2005-06 to Rs 344.87
crores in 2008-09. By 2009-10 Rs 797.65 crores from NRHM funds had been spent on activities
to improve maternal and child health.
Issues and Concerns
We wish to draw attention to the grave situation that seems to be building up in places like
Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc,
were launched as flagship programmes. On one hand, the government is spending several
hundreds of crores of rupees annually, is vigorously promoting institutional deliveries as a
panacea for high maternal and infant mortality, and talks of safe and guaranteed health services;
through processes such as community monitoring it is promoting the idea of demanding
accountability from the public health machinery. On the other hand, the ground reality in places
like Barwani shows little change. And when people get organized to demand accountability
through peaceful actions, attempts are made to discredit and ‘brand’ their leaders, to intimidate
and repress them, and to shield the responsible officials who seem to be to completely indifferent
to the plight of the patients.
One finds that in spite of several interventions and expenses of crores of rupees, women
continue to die in large numbers. Majority of these deaths are avoidable and completely
unacceptable. It is precisely these preventable deaths that JSY claims to address, right from
ante-natal care (ANC) to post-delivery care of mother and new-born, by getting the pregnant
women to register soon after pregnancy and `motivating’ them to go to a hospital for delivery.
However, the ground reality indicates that the government is not improving the `health’ of the
health facilities in order that they treat satisfactorily women in labour, especially those with
complications. This is corroborated by the findings of the audit of the performance of NRHM in
MP. The experiences of ill-treatment narrated by the rural women also point to the apathy of the
doctors and the poor quality of care they receive when they come in pain and suffering.
How many more such `institutional deaths’, complications and denial of services, are to
occur before the hospital doctors become responsible and accountable; before the state health
department, the health ministry, the rogi kalyan samitis, the district health societies, the
numerous managers, planners, consultants, and international agencies look beyond their
ritualistic exercises of working on technical assistance, planning, evaluating, re-evaluating, replanning,
merely recording numbers of pregnant women registered, of institutional deliveries and
of beneficiaries etc., in the name of safe motherhood and child health, and seriously take note of
the reality of the deaths of women and infants?
Dr Abhay Shukla – National Joint Convenor, Jan Swasthya Abhiyan
Dr Indira Chakravarthi – Public Health Researcher, Delhi
Rinchin – Bhopal
8.1.2011

 

 

Madhuri of JADS has been arrested for fighting against contnuing Maternal Deaths In Barwani #Vaw #Tribalrights


 

 

English: National Rural Health Mission of India

 

Five Years of NRHM-JSY and more than a decade of RCH: continuing maternal deaths in Barwani and MP

 
Background
Janani Suraksha Yojana (JSY) was launched under the National Rural Health Mission (NRHM) in
April 2005 as a safe motherhood intervention, with the specific objective of reducing maternal and
neo-natal mortality by relying on institutional delivery as the primary strategy for making available
medical care during pregnancy, delivery and post delivery period, and thus promoting safe
motherhood. All women are encouraged to avail institutional care during pregnancy and delivery,
and through ASHAs recruited specifically for this purpose institutional delivery is being promoted
among poor pregnant women. JSY is a 100 % centrally sponsored scheme, and it links cash
incentives to pregnant women with hospital delivery and post-delivery care. Reproductive and
Child Health (RCH-I) has been operational since 1997 as a project to provide a variety of
reproductive and child health services in rural areas to bring down maternal and infant mortality, in
order to reduce fertility rates and achieve population control. The second phase of the program
(RCH-II) also commenced in 2005. NRHM itself was launched with the promise to improve
availability and accessibility to health care services to the rural population, especially the
disadvantaged groups including women and children, by strengthening public health systems for
efficient service delivery, improving access, enabling community ownership and demand for
services, enhancing accountability and promoting decentralization.
It is against this context of programmes and interventions and associated fund flows from
the central government and several international agencies that one needs to view the status of
public health services, of maternal and child health in the country in general and specifically in the
high-focus states like MP, and the developments in Badwani that is the focus of this report.
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly
adivasi district in south-western MP. Nearly a thousand people gathered under the banner of
Jagrit Adivasi Dalit Sangathan (JADS), a mass organisation, to protest against extremely
negligent treatment of women in pregnancy and labour, particularly the death on 29th November
2010 of Vypari bai, an 8-months’ pregnant woman admitted in the District Hospital.
The people had come for this rally
from far-flung adivasi villages of the
district, and sought to draw attention to and
to protest against extreme callousness and
ill-treatment regularly meted out to women
in pregnancy and labour by the public
health system, particularly the District
Hospital (DH). A quick perusal of the DH
records indicated that between April-
November 2010 there had been 25 maternal
deaths, and 9 maternal deaths had been
recorded in this hospital in the month of
November 2010 alone. In addition, deaths
of 21 neonates (within 24 hours of birth) had been recorded, related to 511 deliveries conducted
in the hospital during November 2010. People complained that women with problems during
pregnancy and labour were frequently referred to Indore Medical College Hospital, located 150
kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death’ instead of ‘institutional delivery’
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the
morning of 27th November 2010 to reach the District Hospital, having been referred from the
PHC at Bokrata, and then from the CHC at Pati. She had been carried in a `jhuli’ (cloth sling)
over the first 10 kms from her village to Bokrata, from where the family managed to get the
Janani Express ambulance. She had experienced a convulsion that morning, and had high blood
pressure (BP) and eclampsia at the time of admission in the DH around 1.30 pm on 27th
November.
Following her examination by a gynaecologist at the time of admission in the DH on 27th
Nov., she was visited only once by another doctor during the entire day on 28th Nov. She had been
prescribed medicines after admission to control her BP, but her treatment sheets show only two
measurements of BP during the entire stay from 27th to 29th Nov. No attempt seems to have been
made to deliver the baby, by either induction or cesarean, as is the standard procedure in such
cases. An ultrasound scan on 28th November (for which the woman was taken by auto-rickshaw to
a private centre even though the hospital has this facility) showed the presence of live foetus.
Both the mother and mother-in-law of Vyparibai are trained health workers, presently
working as ASHAs in the NRHM. The mother-in-law Dunabai in desperation attempted to contact
the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the
patient’s family. Moreover the doctor on duty, after checking the patient only once on 28th, was
also absent from the hospital premises. After repeated efforts to contact her, at late night at around
11 pm on 28th November, she instructed the nurse on duty that the relatives could take the patient to
Indore, but did not bother to examine the patient or modify the treatment. When the family went to
the doctor’s residence (which is within the hospital premise at a stone’s throw from the ward) on
28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go,
saying she would phone the instructions to the nurse. The young woman finally breathed her last at
5 am on 29th November 2010, without medical attention despite being admitted in the District
Hospital.
Both the block CHC and Barwani DH are CEMONC (Comprehensive Emergency Obstetric
& Neonatal Care) centres, and the DH is equipped with a Blood Bank. Such centres are supposed
to provide emergency services related to pregnancy/ delivery round the clock and 365 days a year.
In any case, a hospital at the level of district hospital is supposed to provide emergency services at
all times, whether or not it is a CEMONC. Further, there is provision that in case of complications,
CEMONC centers can contract-in services of private medical practitioners. So she could have been
referred under the ‘Janani Sahayogi Yojana’ to one of the two local private hospitals. The DH has
four gynaecologists and two anaesthetists, who could have ensured Vypari bai’s delivery. However,
the case paper shows that nearly 35 hours after admission, the patient had been referred to the
medical college hospital in Indore at around 11 PM on 28th. Further, the family was asked to sign
an undertaking, stating that they were refusing to take her to Indore and they took responsibility for
the consequences. It has been repeatedly experienced that, rather than using the institutional
provisions, patients are generally referred to Indore. And are also made to sign such undertakings.
Several other cases of denial of services leading to complications and ill-treatment at all
levels of health services have been documented by JADS. Few illustrative ones are described
below.
District Hospital, Barwani – Baltabai, 20 years, Village- Ubadagad, Pati Block,
On 6th June 2010, 9-months’ pregnant Baltabai was taken to Pati CHC with labour pains, by bus at around 12
o’clock in the afternoon. There was no doctor in the CHC. When the family contacted the BMO and
requested him to see Baltabai, the BMO did not do so, but simply arranged for the Janani Express
Ambulance and referred the patient to the District Hospital. Around 3 PM Baltabai was admitted in the
female ward of the DH. Not a single doctor was present in the female ward, ostensibly because `it was
Sunday’. The nurse on duty informed the doctor who was supposed to be on duty, but was not physically
present in the hospital premises, about the serious condition of Baltabai. She was advised some blood test,
and after the blood report was available, referred by the doctor to M.Y. Hospital, Indore. During this period
the relatives were not adequately informed about the condition of the patient and need for referral. What is
more serious is that the family was not informed about intrauterine foetal death. Following the nurse’s
advice to go to the local hospital instead of Indore, the family took Baltabai to the private trust hospital in
the Barwani town, where the doctor examined Baltabai and informed them that the foetus was dead. She
recommended an emergency operation to remove the dead foetus and save the mother. The family had no
option but to go ahead with this surgery. They incurred a cost of around Rs 10,000/- and an additional Rs.
7000/- were spent on medicine. The family, dependent on daily-wages, had to borrow money from local
money lenders at very high interest rate.
On 14th June Baltabai was discharged from the trust hospital. However, her agony was not
over yet. On reaching home that evening she complained of abdominal distension and pain. On 15th
June, at 4 am she was taken to a private practitioner, where she was cathetarised, and again referred
to the DH, where she was treated till 21st June. On 21st June Baltabai was referred to M. Y. Hospital
Indore for treatment of paraplegia. What exactly happened to Baltabai from15th – 21st June is not
very clear, largely because there are no trustworthy clinical records. Why and how Baltabai
developed paraplegia was never explained to the family members and other concerned people.
Fortunately Baltabai’s condition improved in the M.Y. Hospital and she was subsequently
discharged on 1st July. The ordeal of Baltabai lasted for 24 days (6th June to 30th June), and has left
the family severely indebted.
In September 2008 a woman in labour at the District Hospital was referred by the attending
doctor to Indore as a case of obstructed labour. The family took her to the local Trust hospital,
where a caesarean operation was performed and the child delivered safely. However, due to the
delay the child developed complications and had to be admitted in the neo-natal intensive care unit
(NICU) in the DH.
CHC-Pati block – Meera, Patel phaliya , Pati
Meera had symptoms of threatened abortion since the second month of pregnancy; and was treated
at CHC, Pati. However, the doctor advised her that she should not rely on the medicines available
in the hospital, and made the family purchase injections and medicines from outside the hospital,
worth about Rs 1000-1200. Meera followed all the instructions given by the doctor, as she was told
that she would have a difficult labour. Despite this treatment Meera had intrauterine bleeding one
morning. When she called up the CHC for the Janani Express ambulance she was told that since
she was from Pati itself, she should go to the hospital by herself, and would not be provided the
ambulance. The lady walked over 5-8 km, for almost 2 hours, bleeding and in terrible pain, to reach
the CHC. At the CHC, she was informed that the baby had died in the womb. The family was
forced to purchase few special medicines from outside for the operation to remove the dead foetus.
PHC Menimata – Baniya Bai
On the night of 11th November 2008 Baniya bai went to the PHC Menimata for delivery. The
compounder and nurse asked her family for Rs 100, which the family did not give. The next
morning she was forced to leave the hospital on grounds of being anaemic. Baniya Bai, in
labour pain, managed to crawl out to the road outside the PHC, where she delivered with the help
on the local dai. She was then sent by members of JADS to CHC Silawad by the Janani
ambulance.
These are not isolated cases; there are reports of similar incidents of maternal deaths and
denial of treatment at the health centres, including the DH in Barwani.

 
Demanding Accountability for Negligence
We were visiting Barwani to get a firsthand
account of the situation there
concerning health services, particularly
in the District hospital. On the morning
of 28th December when we tried to meet
the CMHO and the concerned lady duty
doctor (who happens to be the CMHO’s
daughter) we were told that they were
out of town. The gynaecologist who had
admitted Vypari bai on 27th November
said she had anemia and eclampsia and
was not in a condition to be operated
upon; and that they did not have a
ventilator in the hospital. This
gynaecologist was not around the day
after admission (28th November) to monitor the progress; she is usually out of the hospital four
days of the week performing sterilization operations in family planning camps.
We observed the rally taking place outside the DH on 28th December. About 500 people
(nearly half of them women) had gathered at the entrance of the DH at around 12 noon, by which
time the OPD was almost over. The 2-3 doctors present there left when they heard the rally
approaching. The police tried to snatch away from the rallyists their microphone and the cart on
which it was placed; however the rallyists managed to convince them that they would leave very
soon. About fifteen minutes later the people moved away from the hospital premises and
continued their dharna on the road in front of the Collectorate office, well away from the DH.
Several activists and ordinary village women, including the mother-in-law of the deceased
Vyaparibai spoke of their travails at the DH. A set of 22 issues concerning the District hospital,
which were mentioned in the memorandum of demands, were read out to the assembled people.
The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the
ADM came and just gave a brief assurance that the issues would be responded to in writing in 15
days time. By around 4 PM the rally had dispersed.
Response by the administration – ‘the message is secondary, crack down on the messenger’
We met the Collector on 28th December evening after the rally and apprised him of the state of
affairs in the DH. It emerged that the process of carrying out maternal death reviews had not
been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector,
the CMHO and CS came when they were summoned. According to the CMHO such maternal
deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring
them down to zero’. When pointed out that the DH was a CEMONC centre, that there were 4
serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths
were still taking place, there was no satisfactory response. The Collector appreciated our
bringing things to his notice, and said he would initiate
the task of Maternal Death Reviews. At the same time,
he also hinted at linkages of the mass organisation with
‘Bastar’ and ‘Andhra Pradesh’, thereby seeking to
discredit the people’s organisation as being associated
with the ‘Naxalites’, who have been outlawed by the
central government.

 
We are now extremely shocked and dismayed
that two days after this rally (on 30th Dec.) as per local
press reports, the police has foisted several charges on
the leaders of JADS and 200 people who participated
in the protest. They have been charged with Sec 146 of
IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause
death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3)
of MP Kolahal Rules. On 31st December one of the activists of the organisation, Bachhiya bhai,
was arrested and sent to jail on charges that were slapped on him and others in 2008, when they
had protested against the denial of services in PHC Menimata (described above).
It needs to be mentioned that the pilot phase of community-based monitoring of rural
health services in MP under NRHM had been implemented in Barwani during 2007-08. Even
prior to this the mass organisation JADS had been actively addressing the health problems in the
area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC
Pati and dialogue with health officials (with the intention to improve them), was followed up
with a rally at Barwani town on the dismal state of health services in the DH. So the area has a
history of peaceful rallying for improvement of rural health services. However, there seems to
have been hardly any concerted response from the administration to address the genuine
problems faced by and raised by the people.
Is the situation restricted to Badwani?
The situation regarding maternal deaths seems to be similar in many other districts of MP. The
audit report of NRHM in MP by the CAG gives an idea of the serious situation in the state.
According to the CAG audit report for the period 2005-06 to 2008-09 incidences of maternal and
infant deaths in MP remained high. In the 12 districts surveyed for the audit there had been 1377
maternal deaths in all in the four-year period – Betul recorded 152, Bhopal 269, Indore 162,
Shahdol recorded 393, Dhar recorded 125, Ujjain 124, and so on. Shahdol district reported 55
maternal deaths in 2008-09. The audit report also points out that despite increase in number of
institutional deliveries, post-delivery mortality remained alarmingly high. The Maternal Mortality
Rate remained high at 379 per lakh live births. Interestingly, the state government has fixed a
lower target than that of the central government for reduction of MMR and IMR. While NRHM
envisages MMR of less than 100 per lakh live births and IMR of 30 per 1000 live births by 2012,
the MP government has set these at less than 220 and 60 respectively. It has said that due to
shortage of manpower it was not possible to achieve the NRHM targets! The audit also found that
Maternal Death Review Committees were to be constituted at each district, but had not been done.
A large number of neo-natal deaths also seem to be occuring: according to figures (collected by
RCH – NRHM for monitoring and evaluation) between April-November 2010, there were 154 neonatal
deaths in the entire district of Badwani, of which 133 have been recorded at the District
Hospital (3879 deliveries recorded at the DH in the same period).
Some other findings of the CAG audit indicate that even after four years of NRHM the
state government was not taking adequate measures to address the long-standing problems of
lack of basic medical facilities, lack of physical infrastructure, and of doctors and other staff.
For instance: the number of health centres fell short of the prescribed norms; several centres,
particularly sub-centres were functioning without buildings; none of the institutions had been
upgraded to Indian Public Health Standards (IPHS); of the 82 CHCs designated as first referral
units (FRUs) 80 percent were non-functional and the rest were only partially functional. The
state government itself acknowledged that the health centres are non-functional due to shortage
of man-power. 101 out of 297 PHCs in the 12 districts studied were running without doctors,
despite the provision for hiring contractual staff under NRHM. Monitoring Committees too at
state and at lower levels to review the activities under NRHM had not been formed till 2009.
One also finds that several hundreds of crores of rupees have been spent over the past few
years under RCH-JSY. Government reports show that the allocations for RCH-JSY had increased
since 2005, and expenditure too had increased from Rs 26.29 crores in 2005-06 to Rs 344.87
crores in 2008-09. By 2009-10 Rs 797.65 crores from NRHM funds had been spent on activities
to improve maternal and child health.
Issues and Concerns
We wish to draw attention to the grave situation that seems to be building up in places like
Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc,
were launched as flagship programmes. On one hand, the government is spending several
hundreds of crores of rupees annually, is vigorously promoting institutional deliveries as a
panacea for high maternal and infant mortality, and talks of safe and guaranteed health services;
through processes such as community monitoring it is promoting the idea of demanding
accountability from the public health machinery. On the other hand, the ground reality in places
like Barwani shows little change. And when people get organized to demand accountability
through peaceful actions, attempts are made to discredit and ‘brand’ their leaders, to intimidate
and repress them, and to shield the responsible officials who seem to be to completely indifferent
to the plight of the patients.
One finds that in spite of several interventions and expenses of crores of rupees, women
continue to die in large numbers. Majority of these deaths are avoidable and completely
unacceptable. It is precisely these preventable deaths that JSY claims to address, right from
ante-natal care (ANC) to post-delivery care of mother and new-born, by getting the pregnant
women to register soon after pregnancy and `motivating’ them to go to a hospital for delivery.
However, the ground reality indicates that the government is not improving the `health’ of the
health facilities in order that they treat satisfactorily women in labour, especially those with
complications. This is corroborated by the findings of the audit of the performance of NRHM in
MP. The experiences of ill-treatment narrated by the rural women also point to the apathy of the
doctors and the poor quality of care they receive when they come in pain and suffering.
How many more such `institutional deaths’, complications and denial of services, are to
occur before the hospital doctors become responsible and accountable; before the state health
department, the health ministry, the rogi kalyan samitis, the district health societies, the
numerous managers, planners, consultants, and international agencies look beyond their
ritualistic exercises of working on technical assistance, planning, evaluating, re-evaluating, replanning,
merely recording numbers of pregnant women registered, of institutional deliveries and
of beneficiaries etc., in the name of safe motherhood and child health, and seriously take note of
the reality of the deaths of women and infants?
Dr Abhay Shukla – National Joint Convenor, Jan Swasthya Abhiyan
Dr Indira Chakravarthi – Public Health Researcher, Delhi
Rinchin – Bhopal
8.1.2011

 

 

 

 

 

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