Ritu Priya

Polio Eradication Initiative in India: Deconstructing the GPEI

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spearheading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of “near success” by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.

Critical perspectives on the NIMH initiative “Grand Challenges to Global Mental Health”.

Fleischhacker WW; and the EUFEST Study Group. Sexual dysfunction in first-episode schizophrenia patients: results from European First Episode Schizophrenia Trial. J Clin Psychopharmacol 2011 Jun;31(3):274-80. 4. Juruena MR, de Sena EP, de Oliveira IR. Safety and tolerability of antipsychotics: focus on amisulpride. Drug Healthc Patient Saf 2010;2:20511. 5. Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry 2006 Sep;163(9):1504-9. 6. Stahl SM. Essential psychopharmacology. The prescriber’s guide. 1 South Asian Edition. New Delhi: Cambridge University Press; 2007. 7. American Psychological Association. Answers to your questions: For a better understanding of sexual orientation and homosexuality [Internet]. Available from http://www.apa.org/helpcenter/sexual-orientation.aspx [cited 2012 Mar 21]. 8. Kalra G. A psychiatrist’s role in “coming out” process: Context and controversies post-377. Indian J Psychiatry 2012 Jan-Mar;54; 54(1):6972.

“Antivaccine Lobby” replies to the BMJ

We are a group of paediatricians, healthcare activists, teachers in public health, and bureaucrats who have championed universal immunisation in India throughout our working lives, so we were taken aback at being called an “antivaccine lobby” in the BMJ .1 Studies funded by the World Health Organization show that the incidence of Haemophilus influenzae type b (Hib) in India is lower than projected.2 Furthermore, probe studies from Asia show that Hib vaccine does not significantly reduce the burden of disease compared with placebo.3 We discuss the anecdotal evidence and the farcical equity argument used to recommend the pentavalent vaccine (diphtheria, pertussis, tetanus, Hib, hepatitis B) in India4 in our rapid response,5 and concentrate here on the safety issue. Meta-analysis shows that the combined vaccine is not as effective as single vaccines administered separately6; therefore it is not used widely in the West, where reporting of adverse events is reliable. Pentavalent vaccine was withdrawn in Sri …

Developing a public health cadre in 21 st century India: Addressing gaps in technical, administrative and social dimensions of public health services

This paper presents a possible framework for designing a public health cadre in the present context, with lessons from health services development of the last six decades. Three major gaps that the public health cadre is meant to bridge have been identified. These are capacities within the system to address the technical requirements (epidemiological and health systems analysis); administrative/managerial dimensions; and the social determinants of health. Therefore, it argues that the cadre must not only have a techno-managerial structure, but also create a specific sub-cadre for the social determinants of health.

Peri-Urbanism in Globalizing India: A Study of Pollution, Health and Community Awareness

This paper examines the intersection between environmental pollution and people’s acknowledgements of, and responses to, health issues in Karhera, a former agricultural village situated between the rapidly expanding cities of New Delhi (India’s capital) and Ghaziabad (an industrial district in Uttar Pradesh). A relational place-based view is integrated with an interpretive approach, highlighting the significance of place, people’s emic experiences, and the creation of meaning through social interactions. Research included surveying 1788 households, in-depth interviews, participatory mapping exercises, and a review of media articles on environment, pollution, and health. Karhera experiences both domestic pollution, through the use of domestic waste water, or gandapani, for vegetable irrigation, and industrial pollution through factories’ emissions into both the air and water. The paper shows that there is no uniform articulation of any environment/health threats associated with gandapani. Some people take preventative actions to avoid exposure while others do not acknowledge health implications. By contrast, industrial pollution is widely noted and frequently commented upon, but little collective action addresses this. The paper explores how the characteristics of Karhera, its heterogeneous population, diverse forms of environmental pollution, and broader governance processes, limit the potential for citizen action against pollution.

Aren't technological choices central to designing health systems?

This paper argues that delivery of technology-based preventive, promotive and curative care is one of the central tasks of any health-care system and therefore it forms one of the central pivots for rational structuring/re-structuring of a health-care system. The development of our public health system has, historically, adopted health technologies (HT) uncritically and thereby not explicitly developed institutional mechanisms to assess them for rational choice. Determinants of HT policy choices and structuring of a service delivery system based on that are discussed with examples of modern low cost HT, technologies of codified health knowledge systems other than the modern and local health traditions. Various forms of institutional structures for HT assessment and R and D using a comprehensive primary health-care approach are suggested.

Learning to live with AIDS

New approaches may be needed if AIDS is to be controlled.

Regulating the Medical Profession: Challenges and Possibilities of the National Medical Commission Bill, 2017

The National Medical Council Bill, 2017, was tabled in Parliament on 29 December 2017 with the proposal to replace the Medical Council of India (MCI) as the regulatory body for medical education and practice in the country. This was the response of the PMO-NITI Aayog Committee, which was formed after the Parliamentary Standing Committee for Health and Family Welfare in its 92nd report strongly indicted the functioning of the MCI and recommended a complete restructuring. The Bill sets out various proposals with the aim to regulate the quality of doctors produced as well as the ethics of their practice. Its content has raised much contestation from the medical fraternity. A host of issues have emerged, such as, what professionalism should mean and what forms of regulation should be put in place, and what mechanisms have to be considered in order to balance the interests of the public and the medical fraternity so that the restructuring that is sorely required can go through.

Planning process under the National Rural Health Mission: achievements and challenges for better implementation

The National Rural Health Mission (NRHM) framework for implementation envisaged that District Health Action Plans would be the central hub for decentralised planning, inter-sectoral convergence, implementation and monitoring. These would feed into the annual State Programme Implementation Plans (PIP). Communitisation, including village planning, and locally suited innovations were to be encouraged. District Planning did not however emerge as a creative tool in the eleventh plan period of the Government of India. This paper attempts to document the processes of planning under the NRHM at state, district and village levels. It also dwells on probable reasons for failure of use of the plans for resource allocation and implementation of the component strategies and activities in the plans.