Attn Delhi – JOIN the GLOBAL DAY of ACTION on McDONALD’S @6june


JOIN the GLOBAL DAY of ACTION on McDONALD’S

on 6th June, 2013 at 6PM

at McDonald’s in the C.P. (B-24, Inner Circle, Opposite gate No. 2 of Rajiv Chowk Metro Station)

Dear friends,

As many as 47 unions, labor federations, youth, and human rights organization from over 30 countries are observing Global Day of Action on McDonald’s on 6th June, 2013.  McDonald’s agents recruit low-wage temporary workers from developing countries to come to work in McDonald’s franchises in the United States. These international subcontracted workers from Asia and Latina America reported that they paid $3,000 to $4,000 apiece to participate in the U.S. State Department’s J-1 student guestworker program, expecting decent work and a cultural exchange. Instead, McDonald’s used them as a sub-minimum wage captive workforce. Workers faced:

  • Threats of deportation by McDonald’s franchise management
  • As few as four hours of work a week at $7.25 an hour, with exorbitant housing deductions that brought their net pay far below minimum wage
  • Shifts as long as 25 hours with no overtime pay
  • Being packed into employer-owned basement housing, up to eight students to a room, for $300 each per month
  • Retaliation by the McDonald’s franchisee and labor supplier Geovisions, including surprise home visits and cuts to work hours

Despite threats of deportation by the franchise management, these young workers bravely joined the National Guestworker Alliance (NGA), went on strike and launched a campaign to demand dignity and the freedom to organize for themselves, and for all McDonald’s workers. On March 6, temporary international workers on J-1 visas from around the world went on strike to expose severe exploitation and retaliation at McDonald’s restaurants in the United States. They joined U.S. workers and union leaders in demanding that the fast food giant take responsibility for labor abuse at its restaurants—and their fight reached the pages of Wall Street JournalThe Nation, and NBC News.

As workers, trade unions, students, fathers, mothers, human rights organizations and community members from countries around the world where McDonald’s agents recruit international labor we are demanding an end to the abuse.

We demand that McDonald’s:

 

1.      Agree to end exploitation and retaliation of the international guestworkers recruited to work in all U.S. stores; and

 

2.      Guarantee freedom of association and the right to organize without retaliation for all of McDonald’s workers worldwide.

The AFL-CIO, the IUF and the ITUC is supporting the Global Day of Action against exploitation and retaliation at McDonald’s, coordinated by the National Guestworker Alliance (NGA) on June 6, 2013. We request you to join the protest in New Delhi in front of the McDonald’s in the C.P. (Opposite Gate No. 2 of Rajiv Chowk Metro Station) and join hands with following organizations protesting world-wide 

1.      ·American Federation of Labor and Congress of Industrial Organizations (AFL–CIO)  – United States

2.      ·Alliance of Progressive Labor (APL) – Philippines

3.      ·Centro de Documentación en Derechos Humanos “Segundo Montes Mozo S.J.” (CSMM)

4.      ·Confédération Chrétienne des Syndicats Malgaches (SEKRIMA) – Madagascar

5.      ·Confédération Française des Travailleurs Chrétiens  (French Democratic Confederation of Labor) (CFDT) – Gilles Desbordes – France

6.      ·CNS “Cartel ALFA” – Romania

7.      ·Egyptian Federation of Independent Trade Unions (EFIT) – Bassem Halaka – Egypt

8.      ·Health Services Workers Union of Ghana (HSWU) of TUC – Franklin Ansah – Ghana

9.      ·Independent Trade union of Miners of Ukraine – Deputy Head Anatolyi Akimochkin – Ukraine

10.  ·International Trade Union Confederation (ITUC) – Jeroen Beirnaert – Brazil

11.  ·International Union of Food workers (IUF) – General Secretary Ron Oswald – Switzerland

12.  ·International Union of Food workers (IUF) – Vijay Hiremath – India

13.  ·International Union of Food workers – 식품 농업 호텔 요식 캐터링서비스 관광 연초 및 유사산업 국제노동조합연 (Hotel Food and Agriculture Hospitality and Catering services) (IUF Korea) – South Korea

14.  ·IUF Thailand: Cuisine and Service Workers Union and the Cook and Servers Workers Union of Thailand – Thailand

15.  ·IUF Poultry Workers’ Rights Network – Thailand

16.  ·Federation of Hotel, Restaurant, Plaza, Apartment, Catering and Tourism Workers’ Free Union (FSPM)/IUF – Indonesia

17.  ·Federación Nacional de Trabajadores en Industrias de la Alimentación, Hoteles, Bebidas, Tabaco y Afines (FENTIAHBETA) – Dominican Republic

18.  ·Pakistan Hotel, Restaurant, Clubs, Tourism, Catering and Allied Workers (PHRCTCAWF)/IUF – Pakistan

19.  ·International Union of Food workers Hong Kong Catering & Hotels Industries Employees General Union (CHIEGU)/IUF

20.  ·Justicia for Migrant Workers (J4MW) – Canada

21.  ·Jobs with Justice/American Rights at Work (United States)

22.  ·Kommunistinen Nuorisoliitto KomNL (The Finnish Communist Youth Alliance) – Simo Suominen – Finland

23.  ·La Confédération générale des travailleurs de Mauritanie (CGTM) General Confederation of Mauritanian Workers – Mauritania

24.  ·La Confederación Paraguaya de Trabajadores C.P.T – Presidente FRANCISCO BRITEZ RUIZ – Paraguay

25.  ·La Fédération Générale du Travail de Belgique (FGTB HORVAL) (General Federation of Labor) – Yves Demeuse       – Belgium

26.  ·La Plataforma Interamericana de Derechos Humanos, Democracia y Desarrollo (PIDHDD) – Ecuador

27.  ·Le Bureau National de l’Association Malienne des Expulsés ( AME) – President Ousmane Diarra – Mali

28.  ·Migrant Rights Centre Ireland (MRCI)  – Ireland

29.  ·New Trade Union Initiative  (NTUI) – General Secretary Ashim Roy – India

30.  ·National Union of Workers in Hotel, Restaurant and Allied Industries (NUWHRAIN) – Philippines

31.  ·National Day Labor Organizing Network (NDLON) – United States

32.  ·National Guestworker Alliance – Argentina – Malaysia – Mongolia – Romania – Poland – Turkey

33.  ·Proyetco de Derechos Economicos Sociales y Culturales (Project for Economic Social and Cultural Rights) (ProDESC) – Alejandra Ancheita – Mexico

34.  ·Restaurant Opportunities Center – United States

35.  ·Services Industrial Professional and Technical Union – Ireland

36.  ·SEEB – SP – Central Única dos Trabalhadores (CUT) (Unified Workers’ Central) -Rita Berlofa – Brazil

37.  ·Sindicato dos Trabalhadores em Gastronomia e Hospedagem de São Paulo e Região (SINTHORESP) (Trade Union of Workers in Lodging and Dining in Presidente Prudente and Region) – Brazil

38.  ·Socialist union of Youth / SZM Slovakia – Chairman Miroslav Pomajdík – Slovakia

39.  ·Society for Labor and Development (SLD) – India

40.  ·UITA (SIREL), Uruguay (International Union of Food workers) – Patricia Iglesias Aguirre – Uruguay

41.  ·Unite the Union – Jennie Formby – Great Britain

42.  ·Unite Union – Mike Treen – New Zealand

43.  ·United Worker Congress – United States

44.  ·Vereinte Dienstleistungsgewerkschaft (Ver.di) (United Services Union) – Jeffrey Raffo – Germany

45.  ·Workers Organizing Committee of Chicago – United States

46.  ·Zimbabwe Congress of Trade Unions (ZCTU) – Zimbabwe

47.  ·Zimbabwe Chamber of Informal Economy Associations (ZCIEA) – Zimbabwe

We hope you can add your country and organisation to this list or join the already planned action.

Thank you!  

In solidarity,

Parimal Maya Sudhakar

+91-8800241099

Project Coordinator – Migration

Society for Labour and Development

New delhi

 

World Bank President Jim Kim calls user fees ‘unjust and unnecessary’ #healthcare


World Bank President Jim Kim today at World Health Assembly called these fees ‘unjust and unnecessary’
 
‘The issue of point-of-service fees is critical.  Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.  This is both unjust and unnecessary.  Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind.  Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.’

World Bank Group President Jim Yong Kim’s Speech at World Health Assembly: Poverty, Health and the Human Future

World Bank Group President Jim Yong Kim

World Health Assembly

Geneva, Switzerland

May 21, 2013

As Prepared for Delivery

Poverty, Health and the Human Future

Mr. President, Director-General Dr. Margaret Chan, Excellencies, colleagues and friends:

We stand at a moment of exceptional possibility.  A moment when global health and development goals that long seemed unattainable have moved within our reach.  A moment, also, when dangers of unprecedented magnitude threaten the future of humankind.  A moment that calls us to shed resignation and routine, to rekindle the ambition that has marked the defining chapters of global public health.

A generation must rise that will drive poverty from the earth.  We can be that generation.

A generation must rise that will end the scourge of inequality that divides and destabilizes societies.  We can be that generation.

A generation must rise that will bring effective health services to every person in every community in every country in the world.  We will be that generation, and you—members of this Assembly—will lead the way.

Yes, I’m optimistic.  I’m optimistic because I know what global health has already achieved—what you have achieved.

In 2011, global average life expectancy reached 70 years, a gain of six years since 1990.  The global child mortality rate has fallen 40 percent in the same period.  In the ten years since Dr. LEE Jong-wook announced WHO’s commitment to support countries in scaling up antiretroviral treatment for AIDS, 9 million people in developing nations have gained access to this life-saving therapy.  These are just a few of the milestones of recent progress.

I have another reason to be optimistic.  I know global health is guided by the right values.

Thirty-five years ago, the Alma-Ata Conference on Primary Health Care set powerful moral and philosophical foundations for our work.  The Declaration of Alma-Ata confirmed the inseparable connection between health and the effort to build prosperity with equity, what the Declaration’s authors called “development in the spirit of social justice.”

Alma-Ata showed the importance of primary health care as a model of health action rooted in the community; responsive to the community’s needs; and attuned to its economic, social and cultural aspirations.  Alma-Ata set the bar high.  But we continue to struggle to provide effective, high-value primary health care to all our citizens.  Unfortunately, none of WHO’s 194 Member States has yet built the perfect health care system.  We can all get better and we know it.

But in the grand spirit of Alma-Ata, we must focus again on the link between health and shared prosperity.  And, this time, we must turn our loftiest aspirations into systems that build healthier, more productive, more equitable societies.

For what Alma-Ata did not do was provide concrete plans or effective metrics for delivering on its admirable goals.  In many cases, frontline efforts inspired by Alma-Ata lacked strategy; evidence-based delivery; and adequate data collection.  This shouldn’t have been surprising, and I’m certainly not criticizing global health leaders of that time.  Indeed, many of the architects of Health For All are my heroes to this day.

Today, we have resources, tools and data that our predecessors could only dream of.  This heightens our responsibility and strips us of excuses.  Today we can and must connect the values expressed at Alma-Ata to strategy and systems analysis; to what I have been calling a “science of delivery”; and to rigorous measurement.  And we must actually build healthier societies.

The setting for this work is the growing movement for Universal Health Coverage.

The aims of universal coverage are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness: whether from out-of-pocket payments for health care or loss of income when a household member falls sick.

Every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality, and affordability.  Priorities, strategies and implementation plans will differ greatly from one country to another.  In all cases, countries need to tie their plans to tough, relevant metrics.  And international partners must be ready to support you.  All of us together must prevent ‘universal coverage’ from ending up as a toothless slogan that doesn’t challenge us, force us to change, force us to get better every day.

The good news is that many countries are challenging themselves, measuring outcomes and achieving remarkable progress.  Turkey launched its “Health Transformation Program” in 2003 to provide access to affordable, quality health services for all.  Formal health insurance now covers more than 95 percent of the population.  The health reform is one of a bundle of factors that have contributed to Turkey’s health gains.  Between 2003 and 2010, Turkey cut its infant mortality rate by more than 40 percent.

Thailand’s universal coverage reform dates from 2001.  The program has substantially increased health care utilization, especially among the previously uninsured.  And, as of 2009, the program had already reduced by more than 300,000 the number of Thai people suffering catastrophic health care costs.

And let me acknowledge that Thailand launched its universal coverage program against concerns over fiscal sustainability initially raised by my own institution, the World Bank Group.  Thailand’s health leaders were determined to act boldly to provide access for their whole population.  Today the world learns from Thailand’s example.

Many other countries are also advancing.  And the growing momentum for universal health coverage coincides with a new chapter in the global fight against poverty.

Last month, the organization I lead, the World Bank Group, committed to work with countries to end absolute poverty worldwide by 2030.  For the first time, we’ve set an expiration date for extreme poverty.

And we know that fighting absolute poverty alone is not enough.  That’s why we’ve set a second goal.  We’ll work with countries to build prosperity that is equitably shared, by nurturing economic growth that favors the relatively disadvantaged in every society.  We’ll track income growth among the poorest 40 percent of the population in every country and work with country leaders to continuously improve policy and delivery, so countries can achieve economic progress that is both inclusive and sustainable – socially, fiscally, and environmentally.

To end poverty and boost shared prosperity, countries need robust, inclusive economic growth.  And to drive growth, they need to build human capital through investments in health, education and social protection for all their citizens.

To free the world from absolute poverty by 2030, countries must ensure that all of their citizens have access to quality, affordable health services.

This means that, today as never before, we have the opportunity to unite global health and the fight against poverty through action that is focused on clear goals.

Countries will take different paths towards universal health coverage.  There is no single formula.  However, today, an emerging field of global health delivery science is generating evidence and tools that offer promising options for countries.

Let me give just one example.  For decades, energy has been spent in disputes opposing disease-specific “vertical” service delivery models to integrated “horizontal” models.  Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a “diagonal” approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system.  We’ve seen diagonal models succeed in countries as different as Mexico and Rwanda.

Whether a country’s immediate priority is diabetes; malaria control; maternal health and child survival; or driving the “endgame” on HIV/AIDS, a universal coverage framework can harness disease-specific programs diagonally to strengthen the system.

As countries advance towards universal health coverage, there are two challenges we at the World Bank Group especially want to tackle with you.  These two areas are deeply connected to the goals on poverty and shared prosperity I described a moment ago.

First, let’s make sure that no family, anywhere in the world, is forced into poverty because of health care expenses.  By current best estimates, worldwide, out-of-pocket health spending forces 100 million people into extreme poverty every year, and inflicts severe financial hardship on another 150 million.  This is an overwhelming form of affliction for people, as the anguish of impoverishment compounds the suffering of illness.  Countries can end this injustice by introducing equitable models of health financing along with social protection measures such as cash transfers for vulnerable households.

Second, let’s close the gap in access to health services and public health protection for the poorest 40 percent of the population in every country.  Improving health coverage and outcomes among the poorer people of any country is critical to building their capabilities and enabling them to compete for the good jobs that will change their lives.  We have to close health gaps, if we’re serious about reducing economic inequality, energizing countries’ economies and building societies in which everyone has a fair chance.

The issue of point-of-service fees is critical.  Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.  This is both unjust and unnecessary.  Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind.  Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.

Now let me tell you five specific ways the World Bank Group will support countries in their drive towards universal health coverage.

First, we’ll continue to ramp up our analytic work and support for health systems.  Universal coverage is a systems challenge, and support for systems is where the World Bank Group can do the most to help countries improve the health of your people.

I was recently in Afghanistan, where the Bank Group has been working with the government and other partners to rebuild the country’s health system.  In Afghanistan, this abstract term ‘health system’ quickly becomes personal.  Let me tell one story. Several years ago, Shakeba, a young woman from Parwan province, gave birth at home, because there was no health center she could go to.  She developed complications and lost her baby.  Earlier this year, Shakeba gave birth to another child—in the delivery room of a recently-opened health center, with modern equipment and skilled personnel.  Shakeba and her new baby are thriving.  Improving health systems literally means life or death for many mothers and children.

The number of functioning health facilities in Afghanistan grew more than four-fold from 2002 to 2011.  During this time, the country reduced under-five mortality by more than 60 percent.

Middle-income countries may face very different challenges.  Many middle-income countries I visit are suffering from an epidemic of hospital-building.  In some countries, I’ve seen brand-new, ultra-sophisticated emergency facilities where specialists are preparing to treat, for example, complicated emergencies like diabetic ketoacidosis.  But when patients are released from these facilities, they can’t get adequate support in the routine, daily management of illnesses like diabetes, because the primary care system has been starved of financing.  It makes no sense to pour resources into responding to downstream complications, without investing in upstream prevention and disease management that could often keep those complications from happening in the first place.

When countries anchor their health systems in robust primary care and public health protection, health care costs can be controlled.  We will work with all countries to do just that.

Our second commitment is that we will support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality.

Reaching these two MDGs is a critical test of our commitment to health equity.

We must continue to focus on the MDGs, even as we prepare for the post-2015 development agenda.  The MDGs have given energy and focus to everyone in the global development community. We have not finished the job.  Now is the time to do it.

Last September at the United Nations General Assembly, I announced that the World Bank Group would work with donors to create a funding mechanism to scale up support for MDGs 4 and 5.  Since then, we have been expanding our results-based financing for health, focusing on the maternal and child health goals.  Our results-based financing fund has leveraged substantial additional resources from the International Development Association, IDA, the World Bank Group’s fund for the poorest countries.  This has been an unquestioned success: the trust fund has multiplied resources for maternal and child health.  Over the past five years, we have leveraged $1.2 billion of IDA in 28 countries, including $558 million for 17 countries since last September alone.  Now we are working with Norway, the United Kingdom and other partners to expand this effort.

Results-based financing is a smart way to do business.  It involves an up-front agreement between funders and service-providers about the expected health results.  Payment depends on the delivery of outcomes, with independent verification.  Results-based financing also allows citizens to hold providers accountable.  It puts knowledge and power in ordinary people’s hands.

These programs all have rigorous impact evaluations. In Rwanda, the impact evaluation showed officials that performance incentives not only increased the coverage and quality of services, but also improved health outcomes.  The study found that babies were putting on more weight, and that children were growing faster.

Our third commitment is that with WHO and other partners, the World Bank Group will strengthen our measurement work in areas relevant to universal health coverage.  In February, the Bank and WHO agreed to collaborate on a monitoring framework for universal coverage.  We’ll deliver that framework for consultation with countries by the time of the United Nations General Assembly in September.

We don’t have enough data.  For example, we don’t yet measure the number of people forced into poverty by health expenditures in every country each year.  We will work with countries and partners to make sure we get better data so countries can achieve better outcomes.

Fourth, we will deepen our work on what we call the science of delivery. This is a new field that the World Bank Group is helping to shape, in response to country demand.  It builds on our decades of experience working with countries to improve services for poor people.  As this field matures, it will mean that your frontline workers – the doctors and nurses, the managers and technicians – will have better tools and faster access to knowledge to provide better care for people.

Distinguished ministers, as you move towards universal coverage, tell us where you’re hitting barriers in delivery.  We’ll connect you and your teams to global networks of policymakers and implementers who have faced similar problems.  We’ll mobilize experienced experts from inside and outside the World Bank Group, including from the private sector, where much of the best delivery work happens.

Fifth and finally, the World Bank Group will continue to step up our work on improving health through action in other sectors, because we know that policies in areas such as agriculture, clean energy, education, sanitation, and women’s empowerment all greatly affect whether people lead healthy lives.

Mexico has done an impressive job in this respect.  Mexico’s Seguro Popular, for instance, works in concert with the Oportunidades cash transfer program.  Oportunidades has increased poor people’s spending capacity and reduced the depth of poverty.  It has also raised school enrollment and access to health services among the poor.  Meanwhile, Seguro Popular has reduced out-of-pocket health care payments and catastrophic health expenditures, especially for the poorest groups.  All countries can’t match Mexico’s resources.  But promising options for similar types of action exist for all countries.

When ministers of health seek to integrate expanded health coverage with efforts to reduce poverty, the World Bank Group’s policy advice, knowledge resources and convening power are at your disposal.  For instance, we can help facilitate discussions with ministries of finance.  We saw promising steps in this direction at the meeting of African health and finance ministers in Washington last month.

But specific actions from the World Bank Group must be part of a wider change in how we work together as a global health community.

The fragmentation of global health action has led to inefficiencies that many ministers here know all too well: parallel delivery structures; multiplication of monitoring systems and reporting demands; ministry officials who spend a quarter of their time managing requests from a parade of well-meaning international partners.

This fragmentation is literally killing people.  Together we must take action to fix it, now.

Aligning for better results is the approach of the International Health Partnership, or IHP+.  And it’s gaining momentum.  Earlier today, Director-General Margaret Chan and I took part in an IHP+ meeting.  It’s inspiring to see more and more countries taking charge, setting the agenda based on strong national plans, and making development partners follow the lead of governments.

We are reconfirming our shared commitment to IHP+ as the best vehicle to implement development effectiveness principles and support countries driving for results.   But, honorable ministers, we must hold each other accountable.  We all have to be ready to pound the table and demand that we stop the deadly fragmentation that has hindered the development of your health systems for far too long.  The stakes are high and the path will be difficult, but I know we can do it.

My friends,

Together, we face a moment of decision. The question is not whether the coming decades will bring sweeping change in global health, development and the fundamental conditions of our life on this planet. The only question is what direction that change will take:

Toward climate disaster or environmental sanity;

Toward economic polarization or shared prosperity;

Toward fatal exclusion or health equity.

Change will come—it’s happening now. The issue is whether we will take charge of change: become its architects, rather than its victims. The gravest danger is that we might make decisions by default, through inaction. Instead, we must make bold commitments.

Since the turn of the millennium, we have experienced a golden age in global health, shaped by the achievements of the leaders in this hall. But will history write that the golden age expired with its hopes unfulfilled, its greatest work barely begun? That it sank under the weight of economic uncertainty and leaders’ inability to change, to push ourselves beyond our old limits?

We know what the answer must be. The answer that the peoples of all our nations are waiting for—those living today and those yet to be born.

We can do so much more. We can bend the arc of history to ensure that everyone in the world has access to affordable, quality health services in a generation.

Together, let’s build health equity and economic transformation as one single structure, a citadel to shelter the human future.

Now is the time to act.

WE MUST BE the generation that delivers universal health coverage.

WE MUST BE the generation that achieves development in the spirit of social and environmental justice.

WE MUST BE the generation that breaks down the walls of poverty’s prison, and in their place builds health, dignity and prosperity for all people.

Thank you.

Cultures cause violence against women not the length of skirts #Vaw #Womenrights #moralpolicing


Banamallika Choudhury

‘We have low crime statistics here’ our instructor at Chulalongkorn University told us during the orientation of new students in Bangkok. “Most common thing that can happen to you is someone snatching your bag away or cheating you off your money. And we do not have crime against women,” she said. At that point I wondered if she really meant it or if it was her English. For how can there be no crime against women in a city as big and bad as Bangkok? 3 months of living there later, it turned out that indeed it is a city very safe for women.

A lifetime’s experience of growing up in India and the rising incidents of violence against women makes me think – why is it that just across a few hundred km, there are places, people, countries where it is absolutely safe for me to be a tourist, wear the shortest of shorts and walk back drunk from a night club alone at 2 O’clock in the night. And how is it that my own society, where I am born and where I have grown up and where I continue to live makes me feel unsafe taking a city bus during the day to work?

Of the recent Delhi gang-rape case, the anger that young people demonstrated on the streets of Delhi and the solidarity shown from other parts of the country is inspiring. However, some of the opinions that floated on my facebook page were disturbing. It looked to me like most people thought stricter law and punishment would end violence against women. Not really, I say. For we already have many laws and punishment in place but this has been no deterrent to patriarchal mindsets that perpetrate women’s subordination. Yes, the question is about subordination and discrimination. Not how brutal or how ghastly the crime is. And here lies the answer of culture.

Only a change in cultural practices and attitudes towards women will change the societies which right now are terribly tilted to one side. How women are treated in a society is not only reflected by how terribly they are raped but also how women are restricted in their daily lives. The fact that inherently most people feel women are weak, less informed, needing protection at the best and loose, immoral and should be controlled at the worst show that women are generally considered unequal in our societies and mind. But these ideas about women are not the same in all societies. These considerations about women change from Delhi to Lhasa, from Guwahati to Shillong, from Dimapur to Imphal and from Agartala to Aizawl. This shows it is all in the mind and all in the culture.

The good thing is cultures can be changed. In Thailand’s history of women, it is said in their societies too women occupied a lesser position, were expected to be caring, docile and looking after their husband, children and family. Their popular King Rama IV, who tried to modernize the country somewhere in the middle 1800s, was sure that women’s status in their society needs to change for them to become a modern nation. He took women out of the homes into the economic productivity zones and insisted they lower the length of their traditional skirt. Not that short skirts are a sure sign of modernization but his logic behind this was damn cool. He said that those long skirts limited women’s movement and if they had to go out and participate in the world equally with men, they better be able to move. That I call logic. Thailand’s endeavour for the equality of women continued beyond Rama IV. In 1932 Thailand was one of the first Asian countries to give voting power to women. Today, the Thai women make up for 47% of the workforce including businesses making them the highest percentage of women in the Asia-Pacific. Not that everything is perfect in Thailand, but it is also considered one of the safest countries in the world for women both domestic and tourists.

Therefore by taking measures, personal and official, we too can change things. For this a whole lot of self-questioning is prerequisite. Let us see what frivolous-yet-having-impact kind of myths are there about women in our society. Are women bad in maths and science? Can girls rapture their hymen by riding bicycles and climbing trees? Are they physically incapable of carrying heavy load or doing jobs that require physical strength? Are women cantankerous or nagging by nature? Do women listen to music? Are women mostly emotional that rational? Can women make sensible decisions about money, investment, buying of big things like cars, house, TV? Do they know what latest gadget has entered the market? Are single women cranky? Do all women have the desire to become a mother? Do women have less capacity to drink then men? Is menstruation a dirty thing? Are pregnant women something special? Have you ever told a boy he is acting like a girl if he is whining or crying? Do you find effeminate men funny or repulsive? Do you think you have a say in who your sister is hanging out, seeing, going around with? Do you have a say in what your girlfriend wears? Do you think women are goddesses or exotic creatures? Have you ever wondered what women were doing while history happened? Do you feel uncomfortable when someone says I am a feminist?

An honest answer to these questions will reveal how patriarchy plays out in the minutest of our daily events, thoughts, conversations. Most of the time, we let these things pass our lives without even registering the perpetration of patriarchy and violence against women they cause. Yes, rape is not the only violence against women. Patriarchal thoughts and practices are.

At times I despair thinking it has taken Thailand 200 years to reach where they are now (Thailand is just an example and not even a perfect one). But I am hopeful in knowing that it can be changed. Our commitment and will to change things have to start at the personal and reach out to the political level. The recent report of Justice Verma Committee

(http://www.thehindu.com/multimedia/archive/01340/Justice_Verma_Comm_1340438a.pdf) is a step towards this positive direction. In Arvind Narayan of Alternative Law Forum, Bangalore’s word “What is particularly moving and inspiring about the Report is that it does so by placing the autonomy and indeed the sexual autonomy of women at the very centre of its discourse.” (http://kafila.org/2013/01/25/the-verma-committee-alchemizing-anger-to-hope-arvind-narrain/). And this is precisely what we all need to do.

Put women in the centre. Recognise that every woman is an individual and has her opinion, feelings, circumstances and experiences, physicality, sexuality, aptitude, angels and demons. Let her decide what she wants. By assuming you can decide for your daughter, sister, friend, wife, neighbor and the girl on the street you are automatically putting her in an automatically subordinate position. And in an unequal world, there is bound to be violence.

Although I have found many similarities between South East Asia and North-East India, I feel sad to say that this is one of the aspects where the dissimilarity is stark. The societies of North-East which were supposed to be more equal for women are changing fast to compete with the most gender violent places. Walking about in Guwahati, the similarity is more with Delhi than with Hanoi although our physical distance is the opposite. And only by accepting this and not harping on the myth that North-East is safe for women, can we begin changing. If we have to emulate and adopt other cultures, let us chose the ones that are more respectful to its members. Let us chose the ones that ensure safety for all. Let us resist the ones that drag us down to a violent future. Let this be our neo-colonial resistance.

Banamallika Choudhury loves to travel and talk. Her mainstay passion is the North-East of India and the post-sub-neo discourses. Luckily her job with ActionAid India provides opportunities to practice all of these daily.

 original article -http://www.thethumbprintmag.com

 

Fake Drug Plague or Pharmaceutical Industry Attack on Generics?


by Pratap ChatterjeeCorpWatch Blog
June 13th, 2012

Are Africa and South East Asia just suffering from a deluge of fake medicines that is causing disease resistance to rise? Or are they also suffering from a deluge of poorly informed media articles, encouraged by the pharmaceutical industry that wants to make war on generic drugs?

A recent article published in the latest issue of the Lancet Infectious Diseases magazine examines a new study by the U.S. National Institutes of Health noting that a third of malaria drug samples examined from the two regions were found to be fake or substandard.

The magazine says that it is “simplified and neutral” to “use falsified as a synonym for counterfeit, devoid of considerations of intellectual property” and urges the use of tough measures to combat these fake drugs.

Similar articles on “fake” drugs appear regularly in the medical publications like the British Medical Journal as well as major business publications like the Financial Times, which suggest that the black market for fake drugs generated $75 billion in revenues in 2010.

Pfizer, a New York company, is particularly active in the campaign against “fake drugs.” There is good reason for Pfizer to be concerned: Viagra, Pfizer’s brand of sildenafil citrate, is one of the most popularly faked drugs. James Love, the executive director of Knowledge Ecology International, a Washington NGO, notes that “It is quite clear that theoverwhelming majority of counterfeit busts involve Viagra and other erectile dysfunction drugs.”

The data on drug busts is not that surprising given the fact Viagra is an expensive drug in high demand from people who are willing to buy it under the counter or online.

However, such “lifestyle” drugs – as they are often called – are quite different from cancer drugs which are not faked quite as often. Indeed the problem is far more complex: there is a wide range of so-called “fake” drugs such as spurious drugs, counterfeit drugs, falsely labeled drugs (wrong dates, missing ingredients etc.) and poor quality drugs which the Lancet proposes to lump together.

And by introducing the term “devoid of considerations of intellectual property” the Lancet is also including the trade in generic drugs.

It is these generic drugs that pharmaceutical industry lobbyists like the Pharmaceutical Research and Manufacturers of America (PhRMA) and the U.S. Chamber of Commerce, both major lobbyists in the U.S., want the media to attack, says Love.

Here’s where the problem arises: “For political reasons, PhRMA and the Chamber plays up the counterfeit angle quite a bit, to justify a very broad intellectual property right enforcement agenda, by mixing together the counterfeit, falsified, substandard or fake drug categories,” he writes.

Love says that the Lancet suggestion to use “simplified and neutral” language could well lead to problems for buyers in poor countries. He notes that “corporate intellectual property right holders … are lobbying governments for stronger IPR enforcement measures. These lobby groups present dangerous drugs as the core motivating factor for legislation that has little to do with solving the bulk of the substandard and dangerous drug problem, and they also seek to introduce measures the undermine the trade in high quality legitimate generic products.

“One risk is that the various anti-counterfeit drug initiatives will be used to further undermine legal parallel trade in branded drugs. Another is that surveillance of trade in unpatented and unbranded chemicals will be used to further expand monopoly power,” Love adds.

Let’s unpack that a bit. What’s the legal parallel trade in branded drugs? Well, drug manufacturers themselves often sell their drugs cheaper in countries with big public health systems or just because the population is too poor to pay for Western prices. These drugs are sometimes sold back legally to buyers in other countries. Technically this trade could be shut down. (See “Murky Medicines” for an interesting article on how the U.K. buys medicines abroad legally at cheaper prices)

What about unpatented and unbranded chemicals? Are they a good idea? Well, it turns out that even the major drug makers use unpatented and unbranded chemicals all the time. Drugs typically contain one or more active pharmaceutical ingredients (APIs). If these APIs are patented, the patent holder can make a lot of money. But a lot of drugs are made from cheap (and perfectly good) unpatented APIs that even the big companies buy to make their branded drugs.

When countries like Thailand or India allow generic manufacturers to make drugs (either because the license has expired or to deal with an urgent healthcare crisis), these manufacturers turn to the very same API producers. Where it gets complicated is that the API producers are in a tough spot because if they supply the generic manufacturers, the big boys have been known to cut them off. (Bristol-Myers Squibb used this strategy in Thailand to cut off production of the AIDS drug ddI)

Basically what Love is saying is that if we use a hammer to address the issue of drugs, all the problems of generic, spurious, counterfeit, falsified and poor quality drugs look like different kinds of nails, when in fact some of them may not even be nails at all. “If authors systematically see the problem in ways consistent with drug company lobbyists, they are not seeing the whole picture,” he concludes.

Stamp out spurious drugs by all means, check to make sure that expired drugs are not re-labeled, and test batches to make sure that low quality drugs are not slipped into the market, but be careful of stopping the sale of perfectly good generic drugs that can save lives at a dramatically cheaper price by making them illegal.

Women ‘Invisible’ in Myanmar


Aung San Suu Kyi visits polling-stations in AprilAung San Suu Kyi visits polling-stations in April

Source: IPS: Roberto Tofani

While Aung San Suu Kyi enjoys iconic status in Myanmar (also known as Burma), women remain invisible in this country steeped in Buddhist tradition and emerging from decades of military rule.

“Her (Suu Kyi’s) image suggests that there is space for women,” Ma Thida, a surgeon who is also a director of the ‘Myanmar Independent’ weekly newspaper published from Yangon (also Rangoon), tells IPS. “She is a great example for all Burmese women.”

Ma Thida was sentenced to 20 years’ imprisonment in 1993 on charges of “endangering public peace, having contact with illegal organisations and distributing unlawful literature.” She was released after five years in the notorious Insein prison.

“Today, the overall situation seems better compared to two or three years ago, but it’s far from ideal,” says Ma Thida, one of thousands of women who have contributed to bringing about changes towards democracy in Burma.

According to the Assistance Association of Political Prisoners, an independent non-profit founded by former political prisoners living in exile and based out of the border town of Mae Sot in Thailand, there are 18 females among the 473 political prisoners in Myanmar.

On paper, women suffer no discrimination with restrictions on civil liberties applying equally to all, regardless of gender.

Myanmar has ratified the international convention on elimination of all forms of discrimination against women (CEDAW), but the 2008 constitution does not quite conform to it.

For example, in appointing or assigning duties to civil services personnel the constitution prescribes that there be no discrimination “based on race, birth, religion, and sex”, but it also says that “nothing shall prevent appointment of men to the positions that are suitable for men only.”

Burmese activists shout anti-China slogans during a protest against the Myitsone dam in 2011. Photo: Ahmad Yusni/EPABurmese activists shout anti-China slogans during a protest against the Myitsone dam in 2011. Photo: Ahmad Yusni/EPA”At the moment we cannot still talk or discuss freely about gender discrimination or gender equality,” says a female rights activist who prefers not to be named because of her involvement in the campaign against the construction of the Myitsone dam on the Irrawaddy River.

The controversial hydroelectric project, developed jointly by Myanmar’s power ministry, the privately-owned Asia World Company of Burma and China Power Investment Corporation, was suspended by Myanmar authorities last year, following protests.

“That controversial decision to suspend construction, which was welcomed by environment groups, was the result of protests held mostly by women,” the activist said.

“When Burmese official media reported the decision to suspend construction the women seemed to have disappeared because they were asked to sit on the ground while the cameras focused on government officials,” she said. “The presence of women in our society is extensive but we are still invisible.”

The same paradox extends through Myanmar’s political life in which women have been struggling behind the lines for years and are happy to take a back seat when it comes to leadership roles.

“Sometimes it’s not so easy to raise these kinds of issues even within women’s groups as the majority of women think that their role is within the family and that their role in society cannot change,” says Mon Mon Myat, a writer and women’s rights activist.

“In a male-dominated, Theravada Buddhist society there are many cultural barriers that limit women’s behaviour and functioning,” Mon Mon Myat told IPS.

“Female journalists, for example, cannot take pictures or videos of the audience, because they are not allowed to go up to vantage positions because as women they cannot stay above men or Buddhist monks,” explained Mon Mon Myat.

That cultural barrier contrasts sharply with the images of Suu Kyi waving or talking to people from a balcony at her house or at a party office.

An exception

Suu Kyi, according to Mon Mon Myat, is an exception because she is the daughter of Gen. Aung San, a venerated national hero closely associated with Myanmar’s independence movement.

In fact, Suu Kyi takes care to prefix her father’s name to hers, although the custom in Myanmar is for women to use their own given names through life without taking on the name of father or husband.

“Though she is a woman, Suu Kyi is a symbol of peace and democracy in our country. That is why, we can see big crowds of monks and men strongly showing their support for her,” Mon Mon Myat said.

“The outlook of the country has to change if this country is going to be democratic, but for that there has to be more freedom in the media first,” says ‘Vic’, a 24-year-old writer who goes by that pen name.

Women activists and journalists who dared oppose the junta paid a heavy price with many of them systematically tortured, raped or killed by troops fighting a long war against ethnic militias in the Shan, Kachin and Karen states,

In 2002, the Shan Women’s Action Network denounced the systematic use of rape by the Burmese military in a report where some found the courage to speak out about their own experiences.

“It is still not possible to talk freely about rape cases committed by Burmese soldiers on ethnic women in remote areas,” said Mon Mon Myat.

In many cases, she said, women do not think of rape as gender discrimination but as a problem “of fate in a society that frowns on the weaker sex wearing inappropriate dress or going to inappropriate places.”

“In Myanmar, families may prefer to be silent about a rape, making it difficult for the victim to seek justice in the courts,” said Mon Mon Myat.

Women, inside and outside Myanmar, have been able to network through the Women’s League of Burma, an organisation of women drawn from 13 different ethnic groups that is “working for the advancement of the status of women towards a peaceful and just society.”

“Changing mindsets, especially among mid-level administrators and ordinary people is essential,” says Grace Swe Zin Htaik, a former actress who devotes herself to campaigning for health and gender issues. “It will take a long time before we achieve gender equality in Burma,” she told IPS.

Though poorly represented in legislative bodies and government positions, women like Mon Mon Myat draw hope for the future from the fact that females slightly outnumber males in Myanmar’s population, presently estimated at 55 million.

There is also the memory of better times before British colonial rule (1824–1948) when Myanmar followed a matriarchal system and women held rights to own property and hold high office.

Kashmir girl bags Silver Medal in Thailand, despite fighting all odds


 

ABID KHAN, in Greater Kashmir

Srinagar, Mar 30: Fighting all odds, a Valley based martial art player has shined in the World Muaythai championship by bagging silver medal in Bangkok Thailand. The 9th WMF World Muaythai championship was held at Nibbhati Indoor Stadium Bangkok from March 14 to 23 in which Uroosa Gazi daughter of Ghulam Mohi-ud-din was lone player from JK representing India.

Before leaving for the championship Uroosa fought all odds in her home State due to the lack of sponsors for her Bangkok trip. It was only after her father was able to get instant loan from JK Bank that she was able to achieve her dream and go for the participation.
The Indian contingent comprised of 14 players and before leaving for the event all the players went through three day coaching camp at Bangalore.
In the world event Uroosa participated in under-17 category in which there were six competitors from different countries. In her semi-final match she was against Thailand player whom she defeated easily while in final her opposite number from Australia proved too strong for her. She had to settle for the silver medal.
“It was unbelievable to see myself participating at such a grand stage. In my first match I was nervous but in second I was able to cope up with that. I should have won gold but the final opponent proved too quick for me” said Uroosa who has won numerous medals in different martial events till date.
“I am concentrating now on the future events and hope to get many more opportunities in future,” Uroosa told Greater Kashmir.
She was selected for the championship on the basis of her performance in National Muaythai championship held in Hyderabad. In the event young Uroosa bagged gold medal and was adjudged as best girl fighter.
After her brilliant performance in the world event and becoming first girl from JK to win national at such grand stage Uroosa’s mother hopes that people concerning the sport will help her daughter in the future events.
 “By winning medal at world stage my daughter proved how such talent she has. I have no grudge against anyone for not helping her. I am hopeful that her performance will speak itself and people concerned with the sports will help her in future events,” said Uroosa’s mother Tahira Tabassum.

Read original article here

What Twitter’s New Censorship Policy Means for Human Rights


Image representing Twitter as depicted in Crun...

Twitter dropped quite the shocker last week when it declared its new policy to remove tweets in certain countries to abide by specific national laws. While a tweet will remain visible to the rest of the world, specific messages will disappear in the target country (e.g., following requests by governments).

The ensuing backlash saw a lot of people screaming “censorship” (ironically, on Twitter). While the first wave of criticism has quickly calmed down, for a human rights watchdog, the announcement is quite alarming:

As we continue to grow internationally, we will enter countries that have different ideas about the contours of freedom of expression… Until now, the only way we could take account of those countries’ limits was to remove content globally. Starting today, we give ourselves the ability to reactively withhold content from users in a specific country — while keeping it available in the rest of the world.

A new policy for old-school repression

Twitter claims that this isn’t a dramatic shift in policy, but rather clarification of existing policy, with a “fix.” Previous removals of content were global, for example, when they removed a tweet, no one could see it anywhere. Now, country-by-country, Twitter can block content specially tailored to that country. In a bizarre logic, the increase in control of information in response to government demands means, according to Twitter — less ‘censorship.’

One may incredulously respond that country-specific removal would further disadvantage people who saw Twitter as a means of circumventing illegal restrictions on their speech and expression. Further disadvantaging people who’ve turned to the service as a means of empowering themselves through voice, assembly, and access to information.

Though there has been an outpouring of anger in response, some are quite pleased. Today, Thailand became the first government to publicly endorse Twitter’s decision. China and Iran haven’t made any statements (China’s state-run newspaper did praise the move), but I suspect they’re pleased, as are several other governments that have sought to shut down Twitter at the first sign of dissent.

As an aside I should note that — as with any attempt to control information (see my post on SOPA/PIPA — there are already easy ways — five at last count — to bypass Twitter’s blocks.

Outrage and tough choices

I’ve appreciated the outrage, given the importance (not to be confused with value) of Twitter. I have no doubt that information posted on Twitter — and any other large public networking platform — has resulted in all manner of things, from the terrible, to the great.

We know that information spread via Twitter has saved countless lives, from natural disasters such as in Japan or in humanitarian crises, such as in Cote d’Ivoire. Twitter has contributed to regime change in repressive places. It has even helped free a prisoner in Kashmir and has become a valuable network for citizen journalists and concerned citizens, such as in Mexico. It is a medium by which human rights advocates carry forward their work, such as our Eyes on Syria project (look for #EyesonSyria — but maybe not if you are in Syria), or Amnesty’s own Twitter account.

But for all of these goods, information on Twitter has surely created harm. In crisis, it can become a dangerous medium for rumors or misinformation (or “terrorism” charges). Al-Shabab‘s recent banning of the International Red Cross (a violation of international law of the highest order) was communicated via Twitter. Indeed, Kenya‘s military has been fighting Al-Shabab on the ground, as well as in the twitterverse.

Importantly, information has no inherent value… it is the effect of the content that lends moral weight.

Twitter has never had to make difficult decisions about that content, however. Twitter has never had to be responsible for controlling content in the manner its new policy will require of it. And Twitter will be called on by governments around the world to censor. The cat is out of the bag, and the decisions that will need to be made by Twitter lawyers and staff should give them sleepless nights. At some point — somewhere — harm will be done by those choices. Voices will be silenced. Lives will be lost. Twitter will inevitably make mistakes, and the world will be different as a result. It is a power it would have been wise to deny having.

The stark fact is that — like traditional media, housing, agriculture, or any of the other sectors upon which humanity’s ability to fully enjoy their human rights is dependent — profit motivates great innovations in the digital world. Profit also motivates consolidation and control.

The source of the immense outrage over the policy says more about our collective confusion over digital networking tools than Twitter’s policy. Twitter is seen as a public good. But it is not. Twitter is a (private) company, one that probably made over $100m in profit in 2011 — though its profit potential may be an order of magnitude higher. It is a company like any other, with motives. As with other companies, we — as consumers — have leverage.

But far from suggesting a boycott, let’s start with the basics.

#International Law

I appreciate Twitter’s appeal to the rule of law. Let me make my own.

We have an international body of law that protects the rights of people, and sets forth the obligations of governments, businesses, and the everyday person. Amnesty International and other human rights organizations spend an exceptional proportion of their resources monitoring compliance with the law, and calling out those who violate human rights law. Not just governments, but businesses as well, from Shell and Dow Chemical, to cell phone manufacturers, mortgage banks, and private security firms.

Allow me to offer a word of advice to Twitter: Laws often clash. In the U.S., there were laws on the books in the southern states that were ruled unconstitutional long before they were finally scrapped. And there are surely domestic laws in countries that will be cited by governments or security elements as a basis for denying speech via Twitter that will clash with international human rights law. They will be illegal domestic ‘laws’ in contravention of established international human rights laws. They will be unjust laws.

What will Twitter do?

At some point, Twitter will be pressured by governments to change its terms of service so the work around for access to blocked tweets becomes a use violation…Twitter does in fact know where you are tweeting from, and can deny your ability to change your location to circumvent information blackouts.

At some point, user information and location will be demanded by a repressive regime with a cheap, and by international standards, meaningless veneer of a court order. They will demand it, and will appeal to domestic ‘law’.

What is abundantly clear is that human rights monitors and advocates — for the immense power Twitter and other digital networking tools have given them — have an entirely new domain to monitor. As with other sectors, business decisions in the digital world have human rights implications. For the immense value of Twitter, the policy announcement only brings into focus what we’ve known for some time — human rights monitors and advocates have a lot more work to do since the digital revolution. Our collective vigilance is needed more than ever, however we chose to communicate.

We will be watching you, Twitter. Take it as a measure of your importance.

Scott Edwards is Director of International Advocacy for Africa and Director of the Science for Human Rights program at Amnesty International USA.

Thai universal healthcare scheme saves 80,000 families from bankruptcy


The Bangkok Post:

Launched in 2001, the UCS covered the remaining 47 million people, mainly those who were not enrolled in two other health schemes – the civil service medical benefits for government officials and family members, and the social security scheme for employees in private sector.

An assessment by a group of independent health system researchers and economists from international organisations including the World Health Organisation, found that this universal health coverage has prevented over 80,000 families from bankruptcy due to timely health treatment during its 10 years of implementation.

Conducted in 2011, the assessment showed that catastrophic health expenditure dropped from 6.8% in 1996 to 2.8% in 2008.

Impoverishment as measured by an additional number of non-poor households falling below the national poverty line due to medical treatment costs, was reduced significantly from 2.71% in 2000 prior to the UCS, to 0.49% in 2009.

Progress in the universal health scheme was also indicated by increasing outpatient visits per member per year from 2.41 in 2003 to 3.64 in 2011.

The number of hospital admissions almost doubled between 2003 and 2011. Data from 2010 showed a very low prevalence of unmet needs for health services in Thailand.

The report suggested that considering the positive results, the scheme should be maintained, even extended to minimise out-of-pocket payment and prevent impoverishment caused by healthcare expenditure among a majority of the population.

According to the book Good Health at Low Cost 25 Years On, launched during the week-long Prince Mahidol Awards Conference, Thailand outperformed many other countries in improving health outcomes at a low health funding per capita of 2,755 baht.

Read more here

As Children Starve, Indian Hospital Inc. Gears Up to Serve The World


 

By Peter Pallot

Ties between Britain and India remain something of a wonder. While relations with some of Britain’s former colonies have grown weak, or disintegrated, the bond with the world’s biggest democracy flourishes. Perhaps it’s the cricket. Perhaps it’s the large Indian population in Britain, many of whom – doctors, nurses and others – keep the NHS afloat.

But how is health provision in the subcontinent?
“Mixed” is the kindest answer. For while India has skilfully promoted itself as a medical tourism centre, attracting patients from the Middle East, Africa and Europe, services for the majority of the billion-plus population are poor. The smart private hospitals are out of reach.
Only a quarter of the population can afford Western medicine, with the rest relying on traditional remedies or alternative treatments, such as acupuncture and Ayurvedic medicine (which can at least boast fewer adverse reactions).
Eighty-one per cent of health care across India is paid from private funds, mainly individual pockets. To compound the problem, the booming economy has attracted millions into the cities and away from the country’s rural network of hospitals.
According to the Organisation for Economic Co-operation and Development, in 2009 lower-income groups in India had less access to health care than 15 Asian countries surveyed, where, on average, only 55 per cent of health care is paid from private funds.

Infants at risk
India has come under criticism for not doing more to tackle the problem of infant deaths, the chief marker of the efficacy of a country’s health care system.
Unicef, the children’s charity, pointed out that of all deaths of children aged under one across the globe in 2008, a quarter occurred in India.
At 47 deaths per 1,000 live births, on the latest figures, infant mortality is 10 times that in the UK. However, only three years ago, the toll was 57 deaths per 1,000 live births. So progress is being made. It’s not as if funds are tight. According to PricewaterhouseCoopers, Indian health care has grown recently at a compound annual rate of 16 per cent. The accountants put the total value of the sector in 2009 at $34 billion. This translates as $34 per head, or roughly 6 per cent of GDP. The estimate for the current value of India’s health care sector is thought to be $40 billion.
For comparison, the annual budget enjoyed by the NHS is £110 billion (taking some 9 per cent of GDP) and serving a very small population relative to India.
Outstripping China
There is no questioning the need for a hugely expanded health care sector. By 2050, India’s population is projected to hit 1.6 billion, overtaking China as the world’s most populous nation.
The growth projection is not just based on fertility in India’s population. Life expectancy is fast moving to Western levels. Government drives against hepatitis and polio in the young will give another twist to the population spiral.
The number of inhabitants aged 60-plus is estimated to reach 189 million by 2025 – three times the 2004 total.
Alongside the population spurt, India’s economy can be expected to grow by at least 5 per cent a year for the next 40 years, according toGoldman Sachs, the bank.
Factors behind the forecast include urbanisation, an expanding middle class, and a rapid increase in the number of well-educated women entering the labour market.
But India has much to do. A quarter of the population is below the national poverty line. Some 300 million live on less than $1 a day.
What’s the government doing?
A drive to increase rural health care provision began in 2005. The rural health mission is aimed at improving primary care in the countryside so that fewer patients overwhelm specialist services in the cities. To that end, general practitioners have been trained in basic surgery.
Another Indian initiative is the government-run health insurance plan. The Government Insurance Company has the greatest slice of a market that in total attracts only some 11 per cent of the population. Premiums exceed $120 a year. Policyholders do not benefit from direct settlement, as in many Western schemes. Instead, customers pay from their pocket and apply for reimbursement. That can take months.

Health tourism
If the medical tourist wants to go “cheap”, few countries beat India. Reports from various sources point to huge price differences:
Heart surgery is typically priced at $50,000 in America, $14,200 in Thailand and $4,000 in India.
For liver transplants, it’s $500,00 (America), $75,000 (Thailand) and $45,000 in India.
For bone marrow transplants, prices are closer – $62,500 in both America and Thailand. In India, the bill is roughly halved.
Clearly, with some of the treatment costs a fraction of the American rates, flights and a week or two staying in a top hotel are minor factors.
India has quickly developed a lively trade, despite the known hazards of medical tourism – variable infectious-disease rates, different medical-accreditation standards for staff, and exposure to organisms against which the patient has no built-in resistance.
This last point is a particular hazard for people in fragile health. Dysentery and mosquito-borne diseases such as malaria, dengue and chikungunya fever are widespread and could derail recovery. Long flights in cramped airliners are a known risk for circulatory problems.
Most of the possible risks do not apply to established expats, who have a range of Western-level hospitals to pick from. Staff speak English, have the most modern equipment and direct links with Western hospital chains.
One such, Wockhardt Hospitals Group, is partnered by Harvard Medical International. Hospitals in this group, based in Mumbai and Bangalore, are among the best. The 400-bed Bangalore unit specialises in cardiology, orthopaedics, neurosciences and women/child care.
Wockhardt Mumbai claims very high diagnostic facilities among the usual range of services, including orthopaedics. It advertises total hip replacement at $6,500 (compared with about £12,000 in a private hospital in UK). A total knee replacement also costs $6,500.
Dr Sneh Khemka, medical director of Bupa International, knows the country well. “There are medical centres in the cities that really are truly excellent, especially Mumbai, Chennai and New Delhi.” Other cities with top-class hospitals include Hyderabad and Bangalore. But there are not enough new facilities outside the urban centres.
One exception is the Rajiv Gandhi Super Specialty Hospital, a public-private partnership, opened in 2000. It involved the Apollo Hospitals Group and the government of Karnataka, with support from the Opec fund for international development.
Dr Khemka said: “The tier-one cities are world class, with international patient clientele, and the tier-two – the Hyderabads and so on – are certainly able to cope with their metropolitan communities. But clinics and hospitals are still underinvested by government and are a massive problem.
“Sometimes the uninformed perception is that India is a dirty place and there is a higher rate of infection. But if you look at outcome data – and we’ve done quite a few inspections of hospitals in India – you’ll see they have much better outcome records than many places in Western Europe. They have meticulous attention on quality and safety.”
Bupa International has close ties with the Max hospital chain in India. Newly qualified consultant surgeons in such hospitals were about a third more experienced than their European counterparts because they were not hampered by the EU’s working time directive, Dr Khemka said. And “hotel” services in leading hospitals were outstanding.

Medical insurance
The Foreign & Commonwealth Office urges Britons going to India to buy holiday or international medical cover. It states: “You should take out comprehensive travel and medical insurance before travelling. Check exclusions, and that your policy covers you for all the activities.”
The FCO adds: “Local medical facilities are not comparable to those in the UK, especially in more remote areas. In major cities private medical care is available, but expensive. For psychiatric illness, specialised treatment may not be available outside major cities. ”

International premiums
The insurer Aviva comes out well in a list of insurers recommended by brokers Medical Insurance Services of Brighton. Aviva International Solutions, a comprehensive plan but with reduced outpatient cover, costs £715 a year for a 25 year-old in India (£643 budget).
AxaPPP comprehensive with a £100 excess costs £866 for the same person (£670 budget), while Medicare International is £1,203 (£912 budget).
For a couple (aged 34 and 31), the Aviva scheme is again cheapest at £1,615 (£1,450 budget). Again, outpatient caps apply – but no two schemes are fully comparable, as with all medical insurance plans.

Hazards
Usual hygiene advice applies strongly. The FCO says: “Take care with your water and food hygiene. Drink or use only boiled or bottled water and avoid ice in drinks. If you suffer from diarrhoea seek immediate medical attention.”
Bird flu outbreaks have occurred most recently in the north-eastern states of West Bengal and Assam. “As a precaution avoid visiting live animal markets, poultry farms and other places where you may come into close contact with domestic, caged or wild birds,” says the FCO. “Ensure poultry and egg dishes are thoroughly cooked.”
Prevalence of HIV/Aids is greater in India than in the UK: 0.3 per cent of the adult population as opposed to 0.2 per cent in Britain.

Patchwork
Europeans in rural India are unlikely to find health care to Western standards. But Indian cities are very different. As Bupa’s medical director puts it: “If you are going for elective or emergency treatment, it is absolutely fine to go to the centres in the big cities.”
This article was originally published in The Telegraph Weekly World Edition

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