India – Put Gram Sabhas in charge of all social sector schemes


NAGAPATTINAM, May 22, 2013

P. V. Srividya

Mani Shankar Aiyar in conversation with The Hindu in Mayiladuthurai, Tamil Nadu. Photo: B. Velankanni Raj
Mani Shankar Aiyar in conversation with The Hindu in Mayiladuthurai, Tamil Nadu. Photo: B. Velankanni Raj
TOPICS

Mani Shankar Aiyar-led committee prescribes a mechanism for panchayat control

How relevant is panchayat raj in the everyday lives of the people? What is the role of panchayat raj institutions (PRIs) in poverty alleviation and human development? Is poverty alleviation possible through a peripheral role for panchayats as conceived in various Central sector schemes?

Taking up these questions, the Mani Shankar Aiyar-led Expert Committee on “Leveraging Panchayat Raj Institutions for effective delivery of public goods and services,” which submitted its report to the government recently, has suggested that the Gram Sabha should be empowered to monitor and make decisions on all the social sector schemes — Central and State. Citing MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act) scheme as the model for other schemes, Mr. Aiyar told The Hindu in Mayiladuturai that this move will remove the lacunae in the ‘last mile delivery’ of the schemes.

A panchayat-driven social sector expenditure model empowers the community with a sense of ownership as against the bureaucracy-driven, top-down model currently inbuilt in the Central sector schemes. It calls for a rethink on the way central sector schemes (CSS) on poverty alleviation are designed and the need to retrieve PRIs from the fringes to their rightful place as drivers of rural welfare.

Outcomes are not in sync with the outlays, says the report. The multifold increase in social sector expenditure has barely translated into positive outcomes. There was no tangible rise in the Human Development Indices, despite the exponential increase in social sector expenditure.

The Committee — drawing its template from the Prime Minister’s address to the Conference of Chief Ministers in 2004 that calls for a rethink on the top-down design of programmes — prescribes Activity Mapping for each CSS. Activity Mapping envisions clear delineation of “functions, finances and functionaries,’ shifting the ownership of Schemes from the line departments to elected Panchayats. The report illustrates model Activity Mapping for eight CSS to lead the way.

Grassroots devolution

When the Panchayat Raj experiment was started two decades ago, there was a certain degree of naïveté in believing that effective devolution would just happen, Mr. Aiyar recalls. “Unlike the West, with its local government experience in parishes and counties, here local government was imposed from above. We had to devolve, while the West evolved from local governments.” But, ours was the first such experiment at grassroots devolution leading to tangible social engineering, says Mr. Aiyar.

The Committee’s recommendations include a Centre-drafted model Gram Sabha law to motivate State legislation; freezing of rotation of reserved seats to two or three terms to incentivise good work and facilitate capacity building of panchayat leadership; incentivise PRIs for transparency and accountability and the States to devolve; reorient the outlook of lower bureaucracy to panchayats. The report also prescribes collateral and institutional measures such electronic tagging of funds, setting up of a National Commission for Panchayat Raj, and strengthening Gram Sabhas in PESA areas (tribal areas to which the Panchayat system has been extended by law).

The report recommends the MGNREGA scheme and BRGF (Backward Regions Grant Fund) model that locate PRIs as central to implementation. “We have wonderful examples in MGNREGA and BRGF. MGNREGA was initially worked out without a role for Panchayats. On my personal intervention and literally in a midnight, government’s amendment to the Bill, (and) a strong role for Panchayats came by. Today, it is a highly functional scheme,” says Mr. Aiyar.

While the Committee advocates strong Gram Sabhas that the panchayats are accountable to, the Bill on Land Acquisition lends only consultative powers to the Gram Sabhas.

Even as Mr. Aiyar sees no inherent conflict between intent and action, he does believe there are vested interests. ‘The Sub Committee under me strongly recommended consent by Gram Sabhas. But, there are always vested interests.” Also, most States have not legislated on powers for the Gram Sabhas.

According to the report, effective devolution leads to better outcomes, which in turn engenders political will. It was lack of bureaucratic will and not political will that has stalled effective devolution, says Mr. Aiyar. “My recommendations as chairperson of the Empowered Sub Committee of the NDC (National Development Council) were not acted upon by the Planning Commission. The Deputy Chairperson of the Planning Commission and the Cabinet Secretary are not elected and their inability to enforce their own circulars reflects lack of bureaucratic will.” The political class did not bear down on the bureaucracy like it did with MGNREGA.

“It is bureaucracy that will have to produce the methodology of devolution. But they did not. Now our report illustrates how to do it through Activity Mapping. They just have to implement it.” Recounting a personal conversation with Rajiv Gandhi in 1989, Mr. Aiyar says the former Prime Minister envisioned a generation’s time for effective devolution. “It is only 20 years now; we have five more years to realise that dream, if our recommendations are implemented.”

 

#India -Pharma firms ply doctors with gifts #medicalethics


Published: Thursday, Dec 27, 2012, 5:30 IST
By Sandeep Pai | Place: Mumbai | Agency: DNA

Even as the prime minister Manmohan Singh-led National Development Council meets on Thursday to discuss a law to curb unethical practices adopted by pharmaceutical companies to persuade doctors to promote their products, a four-month investigation by DNA has shown that the ‘pay-for-prescription’ practice flourishes.

While doctors admit that there is a grave danger of drugs being overused when pharmaceutical companies woo doctors and stockists with various sops for promoting their drugs, even the parliamentary standing committee on health and family welfare in a report dated May 8, 2012 says there is no let-up in this “evil practice”. It says, “… pharma companies continue to sponsor foreign trips of many doctors and shower them with high value gifts like air conditioners, cars, music systems, gold chains etc… to obliging prescribers who then prescribe costlier drugs as quid pro quo. Ultimately all these expenses get added up to the cost of drugs.” What’s more, the pharma firm-doctor nexus is not limited to innocuous over-the-counter drugs, a DNA investigation has found.

Take the example of US Vitamin (USV) Ltd, a major player in the oral antibiotics market. In August 2011, its product manager wrote to company representatives appreciating their efforts in making its product, Drego-D, the Number 1 prescribed brand in the preceding two months. The letter went on to say they should also push another drug, Drego, similarly, given the huge opportunity it presents. All doctors except paediatricians have the potential to prescribe Drego, the letter urged. Drego and Drego-D are both Schedule H drugs, to be sold only on the prescription of a registered medical practitioner.

The letter goes on to detail the promotional activities for the Drego group of drugs, including “on demand campaign” every month specifically for general practitioners, ENT specialists, orthopaedics, gynaecologists and more. l Turn to p9

The “engagement” and “development activity” for these doctors included investment of Rs65,000/ year or Rs80,000 per year on one or two selected doctors for a single drug, the letter revealed.

“…with such a line of promotion we are sure that you all will very easily achieve a minimum per member per month (PMPM) of 250 strips of Drego & 350 strips of Drego-D,” the letter said, going on to insist that representatives should, during their field work, ensure that doctors give Drego prescriptions “on priority”. The letter posted a target a business worth Rs14 crore for a single drug in a single year.

The company’s brochure also says doctors stood to win a smartphone or LCD television once they enter the “MPower Club” for a certain number of prescriptions of Zylera, a drug for nasal problems or asthma-like symptoms, also a Schedule H drug.
Franco India, expected to have a turnover of Rs2.1 billion this year, offers a variety of gifts to doctors, including a hamper of basmati rice, handmade orange soap, an all-in-one mobile phone charger and other stationery items.

Svizera Healthcare, a division of Maneesh Pharmaceuticals Limited, issued a brochure called Club Inspira 2010-2011, which invites doctors to become members by prescribing products worth Rs50,000 between May and August 2010. The prescriptions would have to be for Si-Fixim, Si-Fixim XL, Si-Fixim CV, FlanZen, FlanZen D/DP and others.

These are all highly sensitive drugs. Si-Fixim is generally used for the treatment of infections caused by susceptible bacteria. Doctors prescribe the medicine to patients suffering from upper respiratory tract infections, such as pharyngitis, sinusitis, tonsillitis and lower respiratory tract infections like acute bronchitis and acute exacerbation of chronic bronchitis etc. FlanZen is prescribed for reducing inflammation and edema occurring due to rheumatic disorders, surgeries, breast engorgements, pregnancy-related thrombophlebitis as well as fibrocystic breast diseases. It causes hypersensitivity reactions including rashes, abdominal discomfort and nausea if not taken properly.
Those entering the ‘club’ would be eligible for a gift, with their options ranging from a microwave oven, digital camera, a gold coin, etc.

While doctors get incentives for prescriptive drugs, incentives are offered to stockists for non-prescriptive drugs too. Though some may debate that there is nothing wrong in offering incentives to the stockists, but others believe it does make the stockist unethically push for product in order to win the gifts. While doctors get incentives for prescriptive drugs, incentives are offered to stockists for non-prescriptive drugs too.

A Gelusil festival extravaganza was announced by Pfizer to strengthen the product’s position as the Number 1 antacid in its category. Distributors were offered slab-wise gifts for achieving targets and also a chance to participate in a lucky draw. A similar offer had been launched last year for Becosules, the vitamin supplement. On offer was a chance to win diamond pendants, gold chains, travel bags, LCD televisions, home theatres, and wrist-watches.

While most pharma companies DNA approached refused to respond to queries on ethical practices while promoting drugs, Pfizer spokesperson Shyam Kumar said the company takes compliance with norms very seriously. “In fact, over the past several years, Pfizer has taken very significant steps to strengthen our internal controls and pioneer new procedures in the area of compliance. Corporate integrity is an absolute priority for Pfizer, and we will continue to take appropriate actions to strengthen public trust in our company.”

Dr Kailash Sharma, member, board of governors, Medical Council of India, and director, academics, Tata Memorial hospital, said, \”MCI has already given strict guidelines but the practice of accepting gifts is so prevalent, it becomes difficult to monitor. Doctors must restrain themselves from accepting gifts or foreign trips from pharma companies. There is a need to bring in penal provisions for pharma companies, which offer gifts to doctors. There is also a need to audit the accounts of pharma companies to know how much they are spending on publicity.”

 

Draft Twelfth Five Year Plan 2012-17 Planning Commission GOI, can be downloaded


DRAFT  Twelfth Five Year Plan 2012-17 Planning Commission  Government of India, you can download now
http://planningcommission.gov.in/plans/planrel/12thplan/welcome.html

NDC meeting on 12th plan on 27 Dec

Plan document says the govt’s cash transfer programme will be a major step towards improving efficiency
Kirthi Rao , livemint.com
First Published: Wed, Dec 05 2012. 

The government envisages ‘adoption of a target to move major subsidies and major beneficiary payments to a cash basis linked to Aadhar by the end of the 12th Plan period. Photo: Priyanka Parashar/Mint
The government envisages ‘adoption of a target to move major subsidies and major beneficiary payments to a cash basis linked to Aadhar by the end of the 12th Plan period. Photo: Priyanka Parashar/Mint

New Delhi: The 12th Plan document moved a step closer to approval by the apex decision-making authority of the country, the National Development Council (NDC), with the draft being posted on the plan panel’s website for discussion.
The NDC meeting is to be held on 27 December, the link on the plan panel website said. Media reports had earlier said the document would be discussed on 29 December.
The document targets 8.2% growth in the five years from 2012 to 2017 based on the direct cash transfer programme that the government espouses that “adoption of a target to move major subsidies and major beneficiary payments to a cash basis linked to Aadhar by the end of the 12th Plan period would be a major step towards improving efficiency.”
With the draft 12th plan document titled Faster, Inclusive and More Sustainable Growth put up for discussion on the plan panel’s website, it has moved a step closer to approval by the apex decision-making authority of the country, the National Development Council.
The NDC meeting is to be held on 27 December, the link on the plan panel website said. Media reports had earlier said the document, which targets 8.2% growth in the five years from 2012 to 2017, would be discussed on 29 December.
Total resources for the central plan are estimated to be Rs.43.33 trillion, down from the Rs.47.69 trillion estimated at the time of the Full Planning Commission meeting in September as the resources of Public Sector Enterprises turned out to beRs.4.3 trillion lower than estimated then.
The share of rural development and panchayati raj sectors in the centre’s gross budgetary support has been lowered from the 25.01% realised in the 11th Plan to a projected 18.86%. Projected share of health and child development sector, however, has been raised from the 7.09% realised in the 11th Plan to 11.45%.
On direct cash transfers for subsidies, the draft document suggests setting 2017 as a target for implementation all over the country.
“Adoption of a target to move major subsidies and major beneficiary payments to a cash basis linked to Aadhar by the end of the 12th Plan Period would be a major step towards improving efficiency,’ the document said.

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