Revision as of 10:17, 16 December 2020

This is a collection of articles archived for the excellence of their content.

1 Antibiotics
- 1.1 ‘64% of antibiotics sold are unapproved’
- 1.2 Use of antibiotics, India/ the world: 2000-2015
2 Breastfeeding
3 Caesarean-/ C- sections
- 3.1 HC: ‘Unwarranted C-sections violate rights’
- 3.2 2018/ Incidence is higher in private hospitals
- 3.3 2018: the extent of the practice
  - 3.3.1 2019-20
- 3.4 2019/ maternal deaths from C-sections high in developing countries: Lancet
4 Cardiovascular diseases
- 4.1 2012-14: Risk of cardiovascular diseases, state-wise
5 Cath-labs, coronary interventions
- 5.1 2010-15: sharp increase
6 Charity hospitals
- 6.1 Many misuse tax breaks: CAG
7 Charter of Patients’ Rights
- 7.1 Draft charter, 2018
8 Cost of hospitalisation
- 8.1 2016-17
- 8.2 Out-of-pocket expenses exceed 10%/ 25% of income/ consumption
9 Death, the main causes of
- 9.1 2018
- 9.2 Air pollution
  - 9.2.1 2019
10 Delivery (of babies)
- 10.1 Cost of delivery at govt hospitals
11 Drug- resistant superbugs
- 11.1 2019/ Methicillin Resistant Staphylococcus aureus in Gujarat
12 Encephalitis
- 12.1 2010, 2017
13 Government funding
- 13.1 2015-20
- 13.2 2014-18
14 Government expenditure on health
- 14.1 2012
- 14.2 2014-15
  - 14.2.1 2014-15, government expenditure on health
15 Hospitals, private
- 15.1 If built on government land: SC verdict
- 15.2 If built on subsidised land: SC verdict
16 Infrastructure
- 16.1 Ambulances (government)
17 IVF clinics
- 17.1 Less than 20% are registered
18 Medical devices
- 18.1 Import of devices, 2014-16
19 Medical negligence cases
- 19.1 2017: Cases on the rise
20 Medical, surgical advances
- 20.1 Uterus/ womb transplant/ 2017
21 Pre-natal tests
- 21.1 PG in imaging tech essential: SC
22 Private expenditure
- 22.1 2015-16: Private expenditure outstrips government
23 Shortcomings
- 23.1 Government facilities inadequate; private expensive
- 23.2 Availability of doctors
- 23.3 A shortage of hospitals
- 23.4 Inadequate Government funds
- 23.5 Better healthcare still out of bounds
- 23.6 Shortfalls in Primary Health Centres
24 Surgeries
- 24.1 Not allowed if there is no ICU
25 Techniques used
- 25.1 Digital interaction
- 25.2 Use of allopathy, on a rise
- 25.3 Stenting
26 Trends, region-wise
- 26.1 2012-16: Delhi
- 26.2 Rural-urban
- 26.3 2015: EAG states improve
- 26.4 2014: Delhi healthiest
27 All India Medical Service cadre
- 27.1 Brief history
28 See also

Antibiotics

‘64% of antibiotics sold are unapproved’

Naomi Canton, UK study: 64% of antibiotics sold in India unapproved, February 5, 2018: The Times of India

Multinational companies continue to produce and sell unregulated antibiotics in India, worsening the problem of antimicrobial resistance in the country and impeding efforts to fight drug resistance globally, a UK study said.

The report, to be made public on Monday by researchers at Queen Mary University of London and Newcastle University, said millions of antibiotic pills in the Indian market have not been regulated in India, the UK or US.

The research was published in the British Journal of Clinical Pharmacology. It found that of 118 different formulations of fixed dose combination (FDC) antibiotics being sold in India between 2007 and 2012, 64% were not approved by the Central Drugs Standard Control Organisation (CDSCO), even though sale or supply of unapproved new medicines in India is illegal.

Only 4% of the FDCs (formulations composed of two or more drugs in a single pill) were approved in the US or UK. India already has one of the highest rates globally of antibiotic consumption and antimicrobial resistance. Many of the unapproved FDCs combined poorly chosen antimicrobials likely to exacerbate resistance problems. The FDC antibiotics were sold under more than 3,300 brand names made by almost 500 pharmaceutical manufacturers, of which 12 were multinationals.

The report stated that Abbott, Astra Zeneca, Baxter, Bayer, Eli Lilly, GlaxoSmith-Kline, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, and Wyeth, manufactured 45% (53) of the 188 FDCs under 148 brand names.

Use of antibiotics, India/ the world: 2000-2015

The consumption of antibiotics in India, Pakistan, China and the world, and the rise of drug resistant microbes
From: April 2, 2018: The Times of India

See graphic:

The consumption of antibiotics in India, Pakistan, China and the world, and the rise of drug resistant microbes

Breastfeeding

See Breastfeeding: India

Caesarean-/ C- sections

HC: ‘Unwarranted C-sections violate rights’

February 14, 2018: The Times of India

Observing that “unwarranted” caesarean sections were harmful to the mother and the baby, and a violation of their fundamental rights, Delhi High Court on Tuesday asked AAP government about the steps it has taken to curb this practice by certain hospitals.

A bench of Acting Chief Justice Gita Mittal and Justice C Hari Shankar asked Delhi government’s Directorate General of Health Services (DGHS) to place on record the outcome of deliberations of a panel it had set up to examine and curb the practice of unnecessary caesarean sections (C-sections).

“The DGHS to place on record the outcome of the deliberations and steps taken, if any, on the issue,” it said and listed the matter for further hearing on July 9. The bench also asked the Medical Council of India to examine the issue and place a report before the court before the next date of hearing.

The central government took the stand that health was the responsibility of the state government, which has to formulate the regulations.

The court was hearing a PIL by an NGO which has claimed that lack of regulations was leading to increasing number of C-section births taking place in private hospitals. It has alleged that unnecessary C-sections occur as mothers are not given adequate information to make an informed decision about child birth.

2018/ Incidence is higher in private hospitals

DurgeshNandan Jha, More C-secs in pvt hosps, finds study, December 8, 2018: The Times of India

Large Numbers Done Without Medical Need

The rate of caesarean deliveries is higher in private hospitals compared to the public hospitals. Why? A first-of-its-kind survey conducted among over a dozen obstetricians and other health staff involved in child delivery at private facilities in Delhi-NCR reveals what has been an unofficial knowledge for long: commercial interests indirectly contribute to high caesarean delivery rates.

The survey results published in the journal BMC Pregnancy and Childbirth, however, states that most respondents conceded that caesarean section rates in the private maternity homes they visited were unjustifiably high, and that a substantial proportion of procedures were performed without clear medical need.

When asked about the reasons, they said providers’ convenience, in terms of time spent and timing of deliveries was the most important consideration for doctors. “Vaginal delivery could involve more than 12 hours of labour and occur at inconvenient times, particularly during the night. Caesareans allowed doctors to exercise control over the duration and timing of delivery,” the respondents said.

The obstetricians also held cited work pressure, concerns about decision making and fear of legal action as reasons behind higher caesarean delivery rate. “Decision making is very tough, how long you have to wait for a normal delivery is very difficult to assess,” said a private sector obstetrician.

According to the survey report, which was conducted by researchers from London School of Hygiene and Tropical Medicine and Sitaram Bhartia Institute of Science and Research, some respondents suggested that the use of technologies such as ‘cardiotocography’ machines for continuous foetal heart rate monitoring could also be increasing the frequency of decisions for caesarean deliveries. “They described doctors panicking or becoming ‘hyper’ when they saw decelerations in foetal heart rate, leading them to perform a caesarean section even though the labour may have progressed normally,” the report said.

On commercial interests being a reason for caesarean delivery, many respondents interviewed referred to hospitals, rather than individual doctors, being financially motivated. “Hospitals earn about 30% to 50% more revenue as the result of a caesarean delivery...,” a hospital executive told the researchers. But other interviewees insisted commercial incentives played no part in doctors’ decision, the BMC report said, adding that many emphasised that obstetricians ‘don’t do it for money but to save time’.

Lack of training of nurses in midwifery and patient demand were other factors for higher caesarean delivery in private sector, according to BMC report. “Respondents perceived that women viewed caesarean as an ‘easy way out’ of the pain of labour, and spoke about women hearing accounts of traumatic experiences, through their word of mouth or the media, which led them to request caesarean deliveries,” the researchers have stated. Other patient-related factors included the convenience of a ‘short cut’ delivery and desire to schedule deliveries on auspicious dates, the report said.

2018: the extent of the practice

Rema Nagarajan, Excessive C-secs cost families ₹5,000cr/yr, July 31, 2020: The Times of India

Excessive caesarean deliveries in private hospitals could be costing Indian families over Rs 5,000 crore extra every year. This sobering conclusion emerges from an analysis of data compiled from three official reports released recently by the Sample Registration System, the Civil Registration System and the National Statistical Office (NSO).

An analysis of the data reveals that 28.5 lakh more caesarean sections were done in private hospitals across the country in 2018 than the acceptable international ratio of normal to caesarean births. The average extra cost of each such procedure comes to about Rs 18,000. This means that the 28.5 lakh extra caesarean deliveries cost a total of Rs 5,130 crore.

An estimated 26 million babies were born in India in 2018, as per the civil registration system (CRS) report. According to the Sample Registration System report of 2018, India’s rural birth rate is 21.6 while the urban rate is 16.7.

Pvt hosps report 55% C-secs, govt ones 17%

About 66% of the estimated mid-year population of 1.3 billion, or 860 million, was in rural areas and 443 million (34%) in urban areas. Applying the birth rates to these figures gives us 18.6 million babies born in rural India and 7.4 million in urban areas in 2018. The NSO report on health expenditure shows that 21.3% of deliveries in rural India and 47.8% of those in urban areas happened in private hospitals. Thus, the number of babies born in private facilities would have been 39.6 lakh in rural India and 35.4 lakh in cities and towns. That’s a total of 75 lakh childbirths in private hospitals. The C-section rate in private facilities was 55%, 38 percentage points more than just 17% in government facilities. If we treat the 17% figure as a yardstick, there were 28.5 lakh more caesarean sections done in the private health sector than the acceptable rate.

The NSO report also gives the average expenditure on normal and caesarean deliveries in both rural and urban areas. Comparing these shows that a caesarean delivery cost on average Rs 16,475 more in villages and Rs 19,548 more in towns and cities. Taking the overall average for the extra cost at about Rs 18,000, and multiplying this by the 28.5 lakh extra caesarean deliveries in the private sector gives us a figure of Rs 5,130 crore.

But is 17% a reasonable yardstick? In Nordic countries, known to have the best healthcare, caesarean sections constitute about 17% of all deliveries. The international healthcare community has considered the ideal rate for caesarean section to be between 10-15% since 1985, said a WHO statement.

India’s own c-section rates have been steadily rising from 9% in 2005-06 to 18% in 2015 and 28% in the latest NSO report. “It is shocking and alarming that the proportion of csections has jumped from just 17% in the National Family Health Survey of 2015-16 to 28%. It goes to show that we need to intervene immediatel...,” said Dr Rinku Sengupta of Sitaram Bhartia Hospital, one of the few private hospitals to make its caesarean rates public.

2019-20

Rema Nagarajan, December 15, 2020: The Times of India

% share of C-section childbirth in India, 2019-20
From: Rema Nagarajan, December 15, 2020: The Times of India

The normal delivery is no longer normal in private hospitals. In 10 of the 18 states (including the UT of J&K) for which the National Family Health Survey 2019-20 data has been released, C-sections accounted for a majority of deliveries in private facilities, and in three of them, for over 80%. The data shows that the trend has only worsened in almost every state in the four years between the earlier survey and this one.

Despite West Bengal and J&K having the highest C-section rates in the private sector, 83% and 82% respectively, the overall share of C-sections in the two states was 32.6% and 41.7% as most deliveries happened in public facilities where the rates were much lower.

The overall C-section rate in Telangana was over 60%, making C-section the new normal for deliveries in the state. Almost half of all institutional births in Telangana happened in the private sector, where the C-section rate was 81.5%. The state also had the highest C-section rate (45%) for public facilities.

Barring a few states, the proportion of C-sections went up sharply in both private and public facilities since the last survey in 2015-16. The highest jump was in private facilities in Assam, where C-sections went from 53% to 71%.

Gujarat has lowest caesarean rate of 31% in private hospitals

However, in both Assam and West Bengal, private facilities accounted for only about a quarter of all births. Gujarat had the lowest caesarean rate of 31% in the private sector. Public facilities invariably have lower caesarean section rates than private facilities, but the rates have gone up even in the public sector across all states, except in Nagaland, Mizoram and Meghalaya.

C-section rates below 10% are considered to show underuse. By that yardstick, the very low C-section rates in the public sector in Bihar, just 3.6%, a marginal improvement over 2.6% in 2015-16, ought to be a cause for worry. In the three north eastern sates too the C-section rate in public facilities is below 10%.

The international healthcare community has considered the ideal caesarean rate to be 10-15% since 1985, said a World Health Organisation (WHO) statement.

In Nordic countries, known to have the best healthcare, caesarean sections constitute about 17% of all deliveries. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate, the statement said, adding that C-sections should ideally only be undertaken when medically necessary.

Several studies have shown that C-sections can increase the chance of death and complications. The WHO observed in a 2015 statement that the lack of a reliable and internationally accepted classification system to produce standardised data to enable comparison has made it challenging to define an optimal caesarean section.

2019/ maternal deaths from C-sections high in developing countries: Lancet

Bindu Shajan Perappadan, Maternal deaths following C-sections in low and middle-income countries 100 times those in high-income countries: Lancet, April 5, 2019: The Hindu

Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries.

Maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, with up to a third of all babies dying, according to data compiled from over 12 million pregnancies. This is according to a new review published in The Lancet, which has considered 196 studies from 67 low and middle-income countries.

Information released by the World Health Organization under its sexual and reproductive health section further adds from the study that data from 1990 to 2017 show that a quarter of all women who died while giving birth in low and middle-income countries had undergone caesarean section.

“The outcomes for women in low and middle-income countries are far worse than we expected,” said first author, Dr. Soha Sobhy of Queen Mary University of London.

Dr. Ana Pilar Betrán, medical officer, WHO, added that the overuse versus underuse of caesarean section is a current global concern and the focus of debates and research.

“In many low and middle-income countries, overuse and underuse coexist, making it particularly difficult to increase the provision of caesarean section to those women in need without aggravating the overuse which, in turn, places women at higher risk of complications,” she said.

Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries. Timely access to caesarean section when needed is required for safe childbirth, but ‘too little, too late,’ or ‘too many, too soon’ are part of a problem, and not a solution notes the study.

A third of all deaths following caesarean section were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia, 22% to sepsis, and 14% to anesthesia related causes.

The study further says that while many women in need of caesarean sections still do not have access to it, particularly in low-resource settings, many others undergo the procedure unnecessarily, for reasons which are not medically justified.

Lead author Professor Shakila Thangaratinam, Queen Mary University of London, added: “Caesarean sections are the most commonly performed operation worldwide. They are meant to be life saving for both mother and baby. Now that we know the risk factors and countries associated with poor outcomes, we can make a more targeted effort so that timely and safe caesarean sections can be done wherever they are needed.”

The authors also highlighted that training is needed in decision making to reduce unnecessary caesarean sections, and in appropriate intrapartum care including instrumental deliveries to reduce caesarean sections performed in the second stage of labour, which carry greater risk.

Cardiovascular diseases

2012-14: Risk of cardiovascular diseases, state-wise

R. Prasad, Kerala most at risk of cardiovascular disease, finds national survey, June 19, 2018: The Hindu

The risk of cardiovascular disease, state-wise- rural and urban areas
From: R. Prasad, Kerala most at risk of cardiovascular disease, finds national survey, June 19, 2018: The Hindu

Adults in urban areas and those with a higher household wealth, are more at risk

Two recent national surveys of nearly 8,00,000 adults between 34 and 70 years, has found that people of Kerala — across sexes — were most at risk of cardiovascular diseases while those in Jharkhand were least likely to have the condition. A gender break down, however, puts the women of Goa at highest mean cardiovascular risk at 16.73% while men in Himachal Pradesh and Nagaland were most vulnerable with mean cardiovascular risk of 24.23%.

The studies carried out between 2012 and 2014, found wide variations in the average 10-year risk of a fatal or nonfatal cardiovascular disease event among States. A paper published on June 19 in PLOS Medicine found the risk ranging from a low of 13.2% for both sexes in Jharkhand to 19.5% in Kerala.

Urban tendency

The study, led by researchers at Public Health Foundation of India and Harvard T.H. Chan School of Public Health, found that adults in urban areas, as well as those with a higher household wealth, tended to have a greater cardiovascular risk.

With 19.90%, adults living in urban areas in Kerala had the highest mean risk, followed by West Bengal (19.12%) and Himachal Pradesh (18.97%). In contrast, those living in urban areas of Daman and Diu had the lowest mean risk (12.60%), followed by Bihar (13.63%) and Arunachal Pradesh (14.71%).

In general, the cardiovascular risk is lower in rural areas compared with urban areas. But Goa has bucked this trend with the rural areas showing a higher mean value (18.92%) than the urban areas (18.79%).

In the case of Kerala, the difference between highest mean risk in rural (19.23%) and urban areas (19.90%) is meagre.

The study used the data from the District Level Household Survey-4 (DLHS-4) and the second update of the Annual Health Survey (AHS). The surveys covered 27 of the 29 States and five of the seven Union Territories.

The same questionnaire and methodology was used throughout to collect clinical, anthropometric, and biomarker measurements.

While smoking (a risk factor for CVD) was more prevalent in poorer households and rural areas, wealthy households and urban locations faced risks from high body mass index, high blood glucose and high systolic blood pressure.

Cath-labs, coronary interventions

2010-15: sharp increase

Sushmi Dey, Number of cath-labs in country up 100% in 5 years, May 4, 2017: The Times of India

Cath-lab centres, coronary interventions, coronary interventions per centre, total stents and stents per procedure, 2010-15; Sushmi Dey, Number of cath-labs in country up 100% in 5 years, May 4, 2017: The Times of India

Infant mortality and the availability of doctors. See also Infant mortality: India

Shortage of skilled manpower in government hospitals as a percentage of requirement, Graphic courtesy: The Times of India

Vacant specialist seeds in various medical departments, Graphic courtesy: The Times of India

India and the world: India is the 103rd healthiest country ; Graphic courtesy: The Times of India, November 15, 2015

Coronary Interventions Rise By 51% In Just One Year: Study

Cath-labs and coronary interventions in India are increasing exponentially , adding substantially to healthcare expenses.While cath-labs have more than doubled in the last five years, from 251 in 2010 to 630 in 2015, coronary interventions rose 51% within a year, between 2014 and 2015, a new study by a thinktank shows.

Increased interventions have resulted in a higher number of stents being used in procedures. The data shows 4,75,000 stents were used in 2015 for 3,75,000 coronary interventions. The figures stand out as just 1,46,719 stents were used in 1,17,420 cardiac interventions in 2010.

A paper published by Observer Research Foundation (ORF), based on analysis of data from different sources, highlights the potential role of price control in keeping health care costs in check. Acknowledging stent price capping is a significant step by the government, it suggests India needs greater transparency in costing systems, outcomebased measurements and evidence-based policy-making.

Authored by Ramesh Bhat, former professor at IIM Ahmedabad and president of the Indian Health Economics and Policy Association, and Denny John, Evidence Synthesis Specialist at Campbell Collaboration, the study says any analysis of the implications of economic regulations, including price controls, will need a detailed appreciation of market forces.

Cardiovascular diseases are now the leading cause of mortality in India, with a quarter of all deaths in 2015 attributed to the disease. According to the Global Burden of Disease (GBD) 2015 study , death rate due to heart diseases in the country stood at 272 per 100,000 population. Even with such figures, the paper suggests, cardiovascular diseases in India remain highly under-diagnosed though the number of coronary interventions like angioplasty are growing every year.

Moreover, the findings show, the use of expensive high-end drug eluting stents (DES) has also gone up contributing to the increasing healthcare costs. According to the paper, the share of DES in the total use of stents has reported a compounded annual growth rate (CAGR) of 53.52% between 2002 to 2015, whereas total stent usage has grown by 22.86% in the same period.

It also highlighted the sources of financing of coronary procedures in India, which has a great deal of impact on household expenditures as majority of it is still borne out-of-pocket. The findings show over 43.9% of the financing of the coronary procedures in 2014 were conducted through out-ofpocket expenditure. Analysis of the NSSO 71st round done in the paper also show that one-fifth of hospitalisations due to CVD were paid for by borrowings or sale of personal assets. The same survey found that 53% of the population suffered from `catastrophic' health expenditures.

The study says severity of penalty is essential to price control and in determining compliance. Besides, the government or the regulator will also need to create an ecosystem to ensure effectiveness of such regulation.

Advocating for more effective monitoring of quality of medical products, the paper says, “Given the fact that currently the market for medical devices is poorly regulated, and there is no formal system to monitor quality of care, price control could have a negative impact in terms of entry of inferiorquality and outdated products in market“.

The paper recommends setting up of a Medical Technology Assessment Board (MTAB) to initiate evidencebased health policy process.

Charity hospitals

Many misuse tax breaks: CAG

`No clear definition of charitable', August 21, 2017: The Times of India

Income tax exemptions worth hundreds of crores have been given to hospitals claiming to be charitable institutes, but they may be doing little or no charity , according to a recent report of the Comptroller and Auditor General. CAG has asked for measurable parameters to assess the extent of charitable activities by hospital trusts availing tax exemptions as the public exchequer could be losing crores without any public benefit.

While various sections of the Income Tax (I-T) Act allow hospitals, nursing homes and medical research institutes to avail of relief and incentives, many institutions that charge patients claim and get exemption by virtue of the fact that they are registered as trusts, the report pointed out. The fact that the I-T Act has no performance-spe cific definition of what is “charitable“ is part of the is “charitable“ is part of the problem, says a CAG report .

Many charitable trusts receiving significant amounts in gross receipts were not being selected for scrutiny by the I-T department, according to CAG.The report examined cases completed from 2012-13 to 2015-16.

Even when measurable parameters exist for assessing the extent of charitable activities, the I-T department is unable to deny exemption, said the CAG report. For instance, the Bombay Public Trusts (BPT) Act, which governs charitable trusts in Maharashtra, required trusts to fulfil certain conditions -including setting aside 10% of beds for free treatment of the poor and 10% for treatment at concessional rates and putting 2% of total billing into an indigent patient fund to treat the poor. The CAG audit of 10 trust hospitals registered under this act found that a majority did not fulfil these conditions.Since the I-T Act does not identify non-compliance with the BPT Act as grounds for denying exemption and has no measurable parameters of its own, these hospitals continue to get exemption worth crores despite flouting the conditions.The audit found that these 10 hospitals alone had “availed non-justified exemption“ that amounted to Rs 77 crore.

The audit cited the example of a charitable trust in Kolkata that was “functioning as an intermediary of a corporate hospital“. In another case, a trust was collecting fees for a threeyear postgraduate course in a Mumbai hospital. The course itself had been declared illegal by the Medical Council of India. Despite these violations, the I-T department could not deny exemption “for carrying out unauthorised business in the garb of charity“.

Section 80G of the I-T Act, which provides exemption to donations that charitable trusts receive, stipulates that receipts issued to the donor should bear a reference number and date of the order. However, the audit found that section 80G certificates were available in just 10% of 87 cases in the standalone hospital category . For instance, a Pune-based trust involved in education and the medical sector received a corpus donation of Rs 19.4 crore in 2012-13, of which Rs 16 crore was shown to be received from one company that has an authorised and paidup share capital of just Rs 5 lakh. The financial statements of this donor were not available.Despite a preponderance of such violations of the conditions of section 80G, no action was found to have been taken, noted the report.

Charter of Patients’ Rights

Draft charter, 2018

Charter frees patients from grip of hospitals, September 18, 2018: The Times of India

If the draft Charter of Patients’ Rights put out by the health ministry is implemented, it would give patients the right to buy medicines from any registered phar macy and get diagnostic tests from any accredited diagnostic lab instead of being forced by a hospital to use its in-house pharmacy or lab. The charter, including this and 17 other rights, has been put up on the ministry’s website seeking comments and suggestions from the public.

The charter also includes the right to emergency care without demanding payment, right to have all originals or copies of inpatient records, investigations and case papers within 24 hours or

a maximum of 72 hours, right to all information regarding diagnosis, modality of treatment to be given and cost of treatment along with a detailed itemised bill at the end of treatment and right to second opinion from any doctor the patient chooses. If the charter were to be implemented as it stands, hospitals would also not be able to refuse to let families of dead patients take the body without paying the bill.

According to the notice on the website, the ministry plans to implement the charter through state governments. The charter was drafted by the national Human Rights Commission after the National Council of Clinical Establishments, a statutory body under the Clinical Establishments Act, recommended that it be framed. Feedback on the draft can be given till September 30.

The NHRC draft recommends mechanisms for implementing the charter.

Cost of hospitalisation

2016-17

Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: The Times of India

Average cost per case of hospitalisation, state-wise
From: Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: The Times of India

Average cost per case of hospitalisation, urban, state-wise
From: Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: The Times of India

About a quarter of all rural households and one in five urban families in India are forced into debt or sale of assets to meet hospitalisation costs. This is true across income levels, revealed the National Health Profile 2017 published recently by the Central Bureau of Health Intelligence.

In rural India, about twothirds — ranging from 65.6% in the poorest to 68% for the richest — depend on household income or savings, while 27% of the poorest households and 23% of the richest households depend on borrowings for hospitalisation costs. In urban India, 68% of the poorest and about 80% of the most well-off households depend on their own income and savings.

As they get richer, their reliance on borrowings goes down from 22% among the poorest to 14% among the richest. In rural India, about 1% of the population, whether rich or poor, meet hospitalisation costs through sale of assets. This is negligible among urban households.

Hospitalisation most expensive in rural Guj

Roughly 5% of rural and urban households are helped out by friends and relatives to meet the cost.

The data on hospitalisation was from the health expenditure survey conducted by the National Sample Survey Organisation from January 2013 to June 2014. The data also shows that getting hospitalised was most expensive in Gujarat for rural households and in Assam for those who lived in towns and cities. The average cost per hospitalisation case in rural areas was Rs 32,500 in Gujarat, over four times as expensive as in UP. Similarly, each hospitalisation in urban Assam cost on an average about Rs 52,368 nearly seven times as much as in urban Delhi.

Next to Assam, the urban areas of Goa and Himachal Pradesh were the most expensive places to get inpatient treatment, costing over Rs 37,000 and Rs 35,200 per hospitalisation case.

Interestingly, in states with very high total per capita sending on health, such as Himachal Pradesh, Uttarakhand, Kerala and J&K, the average expenditure on each hospitalisation was not among the highest. This could be due to higher spending on out-patient costs. In many of these states, the presence of a robust public hospital network could also be the reason for lower expenditure on hospitalisation as several of them also have the highest government spending per capita on health.

Out-of-pocket expenses exceed 10%/ 25% of income/ consumption

Radheshyam Jadhav, Healthcare costs land 5cr Indians in poverty, December 15, 2017: The Times of India

Coverage of essential health services in India
From: Radheshyam Jadhav, Healthcare costs land 5cr Indians in poverty, December 15, 2017: The Times of India

50% Of World Population Can’t Afford Services

At least half of the world’s population cannot obtain essential health services and each year about 100 million people, including in India, are being pushed into poverty because they have to pay for healthcare out of their own pockets.

‘Tracking Universal Health Coverage: 2017 Global Monitoring Report’, a new report by the World Bank and the World Health Organization released on Wednesday has revealed that currently 800 million people spend at least 10% of their household budgets on health expenses for themselves, a sick child or other family member. For almost 100 million, these expenses are high enough to push them into extreme poverty, forcing them to survive on $1.90 or less a day.

The report looks at “catastrophic” spending on health on the basis of out-of-pocket expenditures exceeding 10% and 25% of household total income or consumption. About one-sixth of households in India (exceeding 10% household income) and 3.9% (exceeding 25% household income) bear such spending exceeding a household’s ability to pay without reimbursement by a third party.

Among the Brics countries, South Africa, which spends 8.7% of GDP on health, and Russia, which has a predominantly state-funded healthcare system, had just 0.1% and 0.6% respectively, of households spending over 25% of their income on healthcare. This figure was 0.8% in the US. China had the highest proportion (4.8%) and in Brazil it was 3.5% of households.

According to the report, 808 million worldwide incur catastrophic health spending at the 10% level. Latin America and Asia have the highest rates of people with out-ofpocket expenditures exceeding 10% or 25% of total household consumption or income.

The report states that 4.2% and 4.6% households in India, based on two different poverty lines, are impoverished by spending on health. Given that there are about 24 crore households in India, that would mean around a crore households or a population of nearly 5crore being impoverished. In these cases, a household is forced by an adverse health event to divert spending away from things like food, shelter and clothing, to an extent that its spending on these items is reduced below the level indicated by the poverty line.

The levels of health service coverage vary widely between countries. The Universal Health Coverage (UHC) service index is highest in East Asia (77 on the index) and Northern America and Europe (also 77). Sub-Saharan Africa has the lowest index value (42), followed by Southern Asia (53). The index is correlated with under-five mortality rates, life expectancy and the Human Development Index. UHC means that all people receive the health services they need, including public health services designed to promote better health, ensuring that the use of these services does not expose the user to financial hardship.

Incidence of catastrophic payment has been increasing between 2000 and 2010.

Death, the main causes of

2018

March 17, 2020: The Times of India

The Top 10 causes of Death in India in 2019
Deaths by swine flu in India, 2015- 2020
From: March 17, 2020: The Times of India

See graphic:

The Top 10 causes of Death in India in 2019
Deaths by swine flu in India, 2015- 2020

Air pollution

2019

Vishwa Mohan, October 22, 2020: The Times of India

Deaths due to air pollution in 2019
From: Vishwa Mohan, October 22, 2020: The Times of India

Long-term exposure to air pollution contributed to around 6.7 million deaths globally from stroke, heart attack, diabetes, lung cancer, chronic lung diseases, and neonatal diseases in 2019 with China (1.8 million) and India (1.6 million) together accounting for more than half of such deaths, says the annual 'State of Global Air 2020' report.

While stating that air pollution is globally the fourth highest cause of death, the report says it is the largest risk factor for deaths for India, followed by high blood pressure. The report, however, notes the success of the ‘Pradhan Mantri Ujjwala Yojana Household LPG’ programme, saying it helped dramatically expand access to clean energy, especially for rural households and helped reduce “household air pollution exposure”. “Overall, air pollution is now the fourth highest cause of death among all health risks,”said the report. .

Air pollution kills 1.2L infants in India in 1st month of life: Study

Air pollution is now the fourth highest cause of death among all health risks, ranking just below high BP, tobacco use and poor diet,” said the report, released by the Health Effects Institute, an independent, non-profit research institute funded jointly by the US Environmental Protection Agency, industry, foundations, and development banks.

While the report identifies air pollution as the top risk factor for India, the Indian government has in the past rejected numerical estimates, saying that though studies have identified such pollution as a cause or contributory factor for ill-health, making projections or establishing direct linkages for deaths lacks sufficient evidence. The HEI, which for the first time did a comprehensive analysis of air pollution’s global impact on the newborn, found that “outdoor and household particulate matter pollution” contributed to the deaths of nearly 5,00,000 infants globally, including 1,16,000 infants in India, in their first month of life.

The report noted that nearly two-thirds of those deaths were linked to use of solid fuels like charcoal, wood and animal dung for cooking, saying the most deaths for the youngest infants were related to complications from low birth weight and pre-term birth. Though it said India’s National Clean Air Programme has spurred action on air pollution sources across India, it said the levels were still stagnant for outdoor PM 2.5. It noted that over half of these deaths in India were associated with outdoor PM2.5.

“This evidence is a reminder of continuous worsening of health risk from air pollution in India. Not only the absolute death burden from PM 2.5 is high, but it has also increased the maximum — by as much as 61% between 2010 and 2019,” said Anumita Roychowdhury, air pollution expert and executive director of the Centre for Science and Environment. “The interaction of Covid-19 with the continued global rise in chronic illness and related risk factors over the past 30 years has created a perfect storm fuelling Covid-19 deaths,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at University of Washington, Seattle, USA.

Delivery (of babies)

Cost of delivery at govt hospitals

Shivani Azad, Cost of delivery at govt hospitals highest in Manipur, Delhi: Survey, February 14, 2018: The Times of India

Top 10 states and Union Territories where cost of delivery is highest in government hospitals
From: Shivani Azad, Cost of delivery at govt hospitals highest in Manipur, Delhi: Survey, February 14, 2018: The Times of India

In 2011, the Centre had started the Janani Shishu Suraksha Karyakaram (JSSK) under which a pregnant woman was entitled to free delivery at government hospitals across India.

But a state-wise breakup of delivery costs according to the Niti Ayog’s ‘Healthy States Progressive India Report' says that delivery at government hospitals continues to cost the poor a lot of money. Manipur tops this list, with Rs 10,076 being required to deliver a child at a government hospital. This is followed by Delhi, at Rs 8719.

Dinesh Arora, director (health), Niti Aayog, said, “Our analysis of out of pocket expenditure for various states is based on the National Family Health Survey-4 data, which was released in 2015-16. We are sure that in the last two years things have improved significantly.”

In West Bengal, the cost, according to the report, is Rs 7,782; Kerala Rs 6,901, and Arunachal Pradesh Rs 6,474. In contrast, in Dadra and Nagar Haveli a family had to spend just Rs 471.

Taking note of the fact that the Centre had been spending crores on improving maternal and child care in India, authors of the report have asked the states to buck up. The report read: “Given the number of National Health Mission (NHM) interventions targeting pregnant women, such as Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakaram (JSSK), and Referral Transport to ensure free delivery at public health facilities, the states should aim to reduce the OOP expenditure.”

Though the reason behind higher cost of delivery at government facilities in the north-east has largely been attributed to geographically challenging terrain and unavailability of trained staff, Delhi, Mahasthra and Karnataka’s charges have left many wondering.

Sharing the reasons behind increased delivery costs in “richer” states, Uttarakhand family and health welfare society director general Dr Archana Srivastava said, “Round-the-clock availability of drugs, diagnostics and transport facilities play a major role in determining OOP expenditure.”

Drug- resistant superbugs

2019/ Methicillin Resistant Staphylococcus aureus in Gujarat

Paul John, Drug-resistant superbug is invading Gujarat!, February 3, 2019: The Times of India

Gujarat has been a sitting duck to the emerging threat of deadly superbugs. Now one such bacteria, the drug resistant Methicillin Resistant Staphylococcus aureus (MRSA), a ‘hospital superbug’, is spreading fast and turning up even in poultry, milk and fish products in Gujarat. It is one of those rogue bacteria that can thwart curing properties of most known antibiotics and prove life-threatening.

MRSA is being reported by government veterinary and agriculture institutes, fisheries and even by a study of a poultry product. MRSA infects skin and soft tissue, the bloodstream, and may cause pneumonia in humans.

The story of MRSA (or ‘Mersa’ as its pronounced) in Gujarat goes back to 2008, when the Gujarat Cancer Research Institute (GCRI) began disease surveillance as part of the Indian Network for Surveillance of Antimicrobial Resistance (INSAR). GCRI approached OPD patients and collected 722 Staphylococcus aureus samples from skin and soft tissue infections, blood stream infections and respiratory infections. Of these samples, 57% turned out to contain MRSA.

As recently as in February 2018, at SSG Hospital, of 40 low birth-weight newborns with sepsis — a potentially life-threatening condition caused by the body’s response to an infection — nearly 17 showed presence of MRSA.

Since the drivers of antimicrobial resistance include antimicrobial use and abuse in human, animal, and environmental sectors, researchers have now demanded a ‘One Health’ approach — which envisions a collaborative effort of multiple health science professions for people, domestic animals, wildlife, plants, and our environment.

Ahmedabad’s NHL Medical College’s department of microbiology studied 1,002 bacterial isolates from wounds and pus samples of various patients in April 2018 and 96 samples were found to have MRSA. In Bhuj, from a total of 186 children reporting urinary tract infections (UTIs) between December 2016 and June 2017, 10% of urine cultures were found to contain MRSA.

"In nature, about 10% of bacteria are gram positive, and MRSA is one such bacteria," says disease expert Dr Bhavini Shah. She adds that the bigger challenge is the growing antibiotic resistance in the 90% gram negative bacteria, as most people get infected by them in India.

"To fight antibiotic resistance, we need coordinated action in society," says Shah. She adds, "In MRSA cases, we have strict treatment policies. Patients with previous history of MRSA and those who have freshly contracted it are given the antibiotic Vancomycin, an uncommon antibiotic," Shah said.

Today, almost a decade after it was first noticed in Gujarat, studies suggest that MRSA was found in poultry meat in Anand district when tests were conducted by the Anand Agriculture University in February 2018.

From salt-treated ribbonfish in Veraval, the Regional Centre of ICAR-Central Institute of Fisheries Technology isolated a gene that causes resistance in MRSA. From 55 milk samples taken from animals having Staphylococcus aureus-caused bovine mastitis — persistent inflammation of the udder tissue — by the Department of Veterinary Microbiology of Dantiwada Agricultural University, 11 were found to have MRSA.

WHAT IS MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of staphylococcus resistant to many antibiotics. Normally, the bacteria lives in the nose and on the skin and generally doesn’t cause any harm. However, when they go resistant like MRSA and multiply uncontrollably, it could be dangerous.

In MILK: Nov 2017

Agency: Department of Veterinary Microbiology, Sardarkrushinagar Dantiwada Agricultural University,

Staphylococcus aureus (S.aureus) causes bovine mastitis. The study investigated the incidence of MRSA in milk samples collected from animals having bovine mastitis. Of 11 milk samples, 4 tested positive for MRSA, which also showed presence of mecA gene that showed maximum identity with the Human MRSA isolates which indicated that cross species spilling of MRSA had rendered it as one of the important zoonotic bacteria

In FISH: Aug 2017

Agency: The Regional Centre of ICAR-Central Institute of Fisheries Technology, Veraval,

A draft genome sequence of a methicillin-resistant Staphylococcus aureus (MRSA) was isolated from salted dried ribbonfish from Veraval in Gujarat. Scientists at the CIFT institute isolated methicillin resistant mecA and femA genes from the fish samples

In POULTRY: Feb 2018

Agency: Department of Veterinary Public Health and Epidemiology, Anand Agricultural University

The study investigated occurrence of MRSA in raw poultry meat. A total of 23 Staphylococcus aureus isolates were obtained. Among the 23 isolates, 4 (1.6%) tested positive for MRSA and the mecA gene — found in bacterial cells, which allows bacteria to resist antibiotics such as methicillin, penicillin and similar drugs.

Symptoms: Most often, the staph bacteria causes mild infections on the skin, like sores or boils, but once they turn resistant they can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract. MRSA is very contagious and can spread through direct contact.

IN HOSPITALS

SURENDRANAGAR: November 2017

Agency: Microbiology Dept, GMERS Medical College, Junagadh

In a study at the government tertiary hospital in Surendranagar, 194 Staphylococcus aureus bacterial samples from patients were isolated. Of these, 69 were positive for MRSA. Overall prevalence of MRSA was 35.56%. The greatest occurrence of MRSA was in the medicine ward (45.31%), followed by the surgery ward (21.87%) and the orthopedic ward (15.62%). MRSA occurred most often in pus samples (43.75%) followed by urine (26.56%), wound swabs (12.5%), sputum (10.93%), blood (3.12%) and body fluids (1.56%).

AHMEDABAD:

March-April 2018

Agency: Department of Microbiology, NHL Medical College

In a study of 1,002 bacterial isolates from pus and wounds of patients, 261 samples were found to contain Staphylococcus aureus and of these, 96 had MRSA. These were 100% sensitive to antibiotics such as linezolid and vancomycin, 65% sensitive to gentamicin and 74.6% sensitive to doxycycline.

VADODARA: February 2018

Agency: Department

of Pediatrics, SSG Hospital, Vadodara

Almost 40 newborn babies with suspected sepsis were tested. The most common bacteria for early onset of sepsis were Klebsiella, Pseudomonas and MRSA, contributing 17% each to the bacteriological profile.

RAJKOT: November 2018

Agency: Department of Microbiology, PDU Medical College

Some 300 samples taken from various sites in the hospital were found to have Staphylococcus aureus. Of the 300 samples, 76 (25%) were found to have MRSA. Hospital-acquired MRSA was more common than community-acquired MRSA. All the clinical samples were resistant to penicillin, 48.68% to ciprofloxacin and levofloxacin, 23% to cotrimoxazole, 9.21% to tetracycline, 6.57% to gentamycin, 3.94% to chloramphenicol. All the samples were sensitive to linezolid, vancomycin and rifampicin. 　

Encephalitis

2010, 2017

Encephalitis killed over 500 across country in 2017, The Times of India, Aug 16 2017

Disease Wreaks Havoc In UP And Assam

The deaths of scores of children in a Gorakhpur hospital have put the focus on Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) but these deadly diseases have been creating havoc in UP and other states for years.

As per the data on the website of the Directorate of National Vector-Borne Disease Control Programme (NVBDCP), since January 1 to August 13 this year, 1208 cases of AES have been reported in UP , and of these 152 resulted in the death of the patient. In the same period 112 cases of JE were reported in which three lives were lost, the data says.

According to the data, another state which has been badly affected is Assam where 1534 cases of AES were reported, and 128 patients lost their lives. The state reported 482 cases of JE of which 67 resulted in death, as per the data.

Overall, 5,926 cases of AES have been reported in the country till August 13 this year, of which 406 deaths have been reported. The country also witnessed 93 JE deaths this year, out of 903 cases reported in the same period.

According to additional director, health, Dr Pushkar Anand, 139 deaths of patients, mostly children have been reported from the paediatric ward of state-run Baba Raghav Das Medical College, this year in UP . Six cases of deaths were reported from August 12 to August 14, he added. In UP , the most severely affected dis tricts are Gorakhpur, Maharajganj, Kushinagar, Basti, Siddharthanagar, Sant Kabir Nagar, Deoria and Mau.

NVBDCP data reveals that in 2010, UP reported 3540 cases of AES, which claimed 494 lives.In 2015, as many as 479 lives were lost due to AES of which 2894 cases were reported. JE claimed 42 lives from the 351 reported cases, according to the official data. In 2016, 3919 cases of AES were reported in which 621 lives were lost.The death toll due to JE stood at an all time high of 73 out of 410 cases reported. Apart from UP , this year, AES and JE deaths were reported from Assam, Bihar, Manipur, Odisha and West Bengal.

Government funding

2015-20

Government expenditure on healthcare, as a percentage of the GDP and in per capita terms, 2015-20
From: April 16, 2020: The Times of India

See graphic:

Government expenditure on healthcare, as a percentage of the GDP and in per capita terms, 2015-20

2014-18

The availability of hospitals, medical colleges, doctors and other medical professionals in India: 2014-18
From: February 1, 2020: The Times of India

See graphic:

The availability of hospitals, medical colleges, doctors and other medical professionals in India: 2014-18

Government expenditure on health

2012

The Times of India

Government’s expenditure on health, India and the world: 2012; Graphic courtesy: The Times of India, May 25 2015

When it comes to government expenditure on health, India's is among the lowest in the world. In 2012, at 60 PPP* dollars per capita, it was barely 1.4% of the US government's per capita health $ expenditure of 4,153 PPP dollars.Despite having such a high per capita public expenditure on health, the extremely high cost healthcare system in the US means the government covers only 47% of total healthcare costs. In the UK and Japan, more than 80% of the cost is covered by government. In India, government expenditure is only 30.5% of total expenditure on health *purchasing power parity Source: WHO; Research: Atul Thakur; Graphic: Sunil Singh

2014-15

Rema Nagarajan, Health: Govts spending less force people to fork out more, November 30, 2017: The Times of India

The per capita expenditure of Indian states on health, 2014-15
From: Rema Nagarajan, Health: Govts spending less force people to fork out more, November 30, 2017: The Times of India

Per Capita Healthcare Spend In HP 6 Times As Much As In Bihar

The government spent more than Rs 2,000 per person per year on health in Himachal Pradesh while in Bihar per capita government spending was just Rs 338, about one-sixth as much. This wide disparity in government spending between states also results in a corresponding variation in how much people are forced to spend from their own pockets.

Government spending includes what’s spent by all levels of government, but about two-thirds of the total nationally is by the states. These facts emerge from the National Health Accounts 2014-15 just uploaded on the union health ministry’s website.

In Himachal, people had to pay only about half the total health expenditure from out of their own pockets, while in Bihar their share was 82%. The national average for households’ share of the total spending was less than two-thirds.

The pattern of low government spending leading to a very high share of the burden of health expenditure being borne by the people is clear in the case of states where government share of spending was the smallest. As a share of the total health spend, Andhra Pradesh had the lowest, 15.4%, leaving people to shoulder 78%. In Bihar, the government’s share was just 16.5%. Shockingly, in Punjab, considered one of the most prosperous states, government spending was just 17% of the total health expenditure, while people spent 79.3% from their own pockets.

The two figures do not add up to 100% because total health expenditure also includes private or government-funded health insurance, spending by NGOs and by external donors. Thus, in some states, despite a low share of government in total health spend, the share of households is not too high. For instance, while in Maharashtra the government spends only 17% of the total, the households’ share is only about 60%, the remaining 27% being accounted for largely by insurance.

So where is all this money going? According to the NHA, private hospitals (26%) and private clinics (5%) accounted for almost a third of the total health spending, while pharmacies raked in another 29%. The share of government hospitals and clinics was just over 20%. Diagnostic labs and patient transport accounted for about 5% each. Inpatient care was 35% and outpatient care about 16% of the total health expenditure, while medicines and medical products accounted for almost 30%.

Another revealing statistic that emerges from the NHA is that a mere 5.3% of the total was spent on preventive healthcare.

2014-15, government expenditure on health

Rema Nagarajan, Govt’s aam aadmi health spend: ₹1,100/yr, December 3, 2017: The Times of India

If what the central government spends on providing healthcare for its own employees is a measure of what decent healthcare costs, what governments (central and states put together) spend for the ordinary citizen is a paltry sixth of that amount. The recently released National Health Accounts (NHA) 2014-15 shows that the average government spend per citizen per year was just Rs 1,108, against almost Rs 6,300 per central government employee.

Even the most generous government spending among states, Himachal Pradesh at just over Rs 2,000 per capita, doesn’t come close to matching this. According to the NHA, India’s health expenditure in 2014-15 worked out to Rs 3,826 per person. Of this, what people had to spend from their own pockets was Rs 2,394 (63%). The government’s expenditure on Central Government Health Services for serving and retired babus, current and ex-MPs, the judiciary and so on was Rs 2,300 crore.

Health minister J P Nadda informed Parliament on February 27, 2015 that CGHS had 36.7 lakh beneficiaries. That makes it about Rs 6,300 per CGHS beneficiary.

Per capita spend on ESIS was ₹379 in 2014

This is close to the figure of Rs 6,376 per beneficiary given by Nadda while replying to a Parliament question in December 2015. “This expenditure, however, does not include expenditure for hospitalisation in respect of serving government employees, which is borne by the departments/ministries,”

stated Nadda. Thus, the actual per capita spending on CGHS could be much higher.

In 2014-15, the Union government’s expenditure on the National Health Mission meant to boost the public healthcare system was Rs 20,199 crore. Spread it over a population of roughly 1.25 billion and you get a paltry Rs 162 per head.

If NHM had spent the same amount per capita on citizens as the Centre spent on its own employees, it would have needed a budget almost 40 times bigger, or about Rs 8 lakh crore, or almost half of the entire government budget for that year.

A 2011Planning Commission report on health insurance models had noted that CGHS spending was mostly driven by high-end tertiary care provided by big corporate hospitals. It noted that the average hospitalisation expenditure per beneficiary was the highest under CGHS. Though CGHS and the Employee State Insurance Scheme (ESIS) are the only insurance schemes providing comprehensive healthcare coverage, including outpatient care, preventive/wellness care and hospitalisation, the per capita spending on ESIS was just Rs 379 in 2014. ESIS covered 5.6 crore people at the time, including workers and their families. If the National Health Mission aspired to provide ESIS kind of coverage, it would only have to increase its budget about two and a half times.

The Planning Commission report stated that ESIS was probably managing to keep costs down because it relied heavily on its own facilities, unlike CGHS, which has increasingly become dominated by private providers. This appears to have reduced whatever little incentive legislators, bureaucrats and judges might have had in ensuring a wellrunning public health system. CGHS is primarily funded by taxpayers. Contributions from employees form a small fraction of what is actually spent.

For the common man, healthcare spending has become the second most common reason for indebtedness and impoverishment.

Hospitals, private

If built on government land: SC verdict

The Times of India, Sep 2, 2011

Treat poor for free: SC to pvt hospitals

New Delhi: Poor patients will get free treatment in 40 private, state-of-the-art multispecialty hospitals in Delhi without exception and for any disease or ailment, Supreme Court said.

A bench of Justices R V Raveendran and A K Patnaik asked these private hospitals, which had got land at concessional rates from the government, to reserve 10% of their inpatient department (IPD) capacity and 25% of OPD for free treatment of poor patients.

Though 27 private hospitals had fallen in line, 10 hospitals had challenged a Delhi HC order asking them to provide free treatment to poor. The court dismissed all the petitions.

Good work by small hospitals swung case

Many private hospitals in the city argued against free treatment to the poor in court. But appearing for Delhi government's Directorate of Health Services, Dr R N Das turned the tables on the reluctant hospitals by presenting before the court bills of poor patients running to over Rs 1 lakh being borne by small super-specialty hospitals like National Heart Institute.

However, it accepted senior advocate Rajeev Dhavan’s suggestion and said, “Our order will not come in the way of hospitals making arrangements on their own by way of sponsorships or endowments, the bottom line being the patients should not be charged with the burden of treatment.”

With Fortis Escort Heart Institute, two Max Super Specialty Hospitals and Bhagwati Hospital falling in line, the court had on August 25 asked the seven hospitals which were reluctant to provide free treatment to poor patients to submit a fresh proposal and asked the government to hold discussions. These hospitals had challenged the HC's March 2007 order passed on a PIL by an NGO through advocate Ashok Aggarwal.

The government said the HC order had directed these hospitals to provide 10% of IPD and 25% OPD free of cost to all eligible poor patients in all respects including all diagnostic, imaging and laboratory investigation facilities available in the private hospitals. These tests include X-ray, ultrasound, CT scan, MRI, among others. Sir Ganga Ram Hospital, National Heart Institute and Batra Hospital were spending over Rs 50,000 on each poor patient, the government said annexing copies of bills.

The 27 hospitals had provided free treatment to 29.26 lakh poor patients in OPD, 99,681 of them in IPD, the government informed the court in its latest affidavit

If built on subsidised land: SC verdict

AmitAnand Choudhary, SC: Pvt hospitals on subsidised land have to treat poor for free, July 10, 2018: The Times of India

In a big relief to poor patients who cannot afford costly treatment in private hospitals, the Supreme Court on Monday held that all hospitals which were provided land at subsidised rates by government authorities would have to provide free treatment to the economically weaker sections with 25% of OPD and 10% of IPD (in-patient department) reserved for poor patients.

The apex court passed the verdict on a batch of petition filed by private hospitals of Delhi, but the order would have implications in other states where hospitals and nursing homes were given land at concessional rates by the government. Some of the aggrieved hospitals had approached SC challenging the Delhi HC order which had directed them to provide free treatment to poor patients.

There are over 50 hospitals in Delhi which were given land at concessional rates by DDA after the management of the hospitals promised to provide free treatment to poor patients. But as they didn’t honour the commitment, Delhi-based NGO ‘Social Jurist’ filed a PIL in the Delhi High Court for implementation of the agreement.

Delhi HC, in a series of orders since 2002, had held that the hospitals were obliged to reserve 25% of OPD and 10% of IPD for poor patients and provide free treatment including free admission, bed, medication, treatment, surgery and nursing facilities, consumables and non-consumables. The court, however, exempted some hospitals in 2014 whose agreement with the government authorities did not have the provision to provide free treatment. The Centre, thereafter, approached SC against the 2014 order.

Senior advocate Ajit Sinha, appearing for the Centre, contended that the hospitals were given land at “throwaway” prices to ensure that poor patients would be treated free-of-cost and the hospitals would reserve beds for the poor even if the agreement did not mention the provision for free treatment.

After hearing the contention of hospitals and the Centre, a bench headed by Justice Arun Mishra held that all hospitals, built on land given at subsidised rates would have to provide free treatment to poor.SC said lease of the hospitals would be cancelled if they failed to comply with the order.

The bench even decided to monitor the functioning of the hospitals and directed Delhi government to report periodically on compliance of its order. It said the hospitals which failed to comply with its order would face contempt proceedings.

Infrastructure

The Times of India, Dec 13 2016

Ventilator, some information about the types of ventilators; Graphic courtesy: The Times of India, Dec 13 2016

`Drop the archaic, invest in new tech'

DurgeshNandan Jha

In a big and heavily populated country like India, it's very difficult to narrow the gap between demand and supply . It always strains the infrastructure. Healthcare is one area where the available infrastructure isn't enough to meet the ever-rising demand. But doctors at AIIMS Trauma Center say investing in newer technologies could at least prevent a crisis-like situation.

Ambu-bags are archaic.“We don't use ambu-bags at all.We have purchased disposable ventilators for emergencies, which cost Rs 5,000 (approx), and which run on their own,“ said Dr Deepak Agrawal, senior neurosurgeon, AIIMS.

Apart from providing life support during transportation (within or outside the hospital), the disposable ventilators also help wean off patients from regular ventilator support, Agrawal added.

Mohammad Javed is a case in point. The 15-year-old boy from Hazaribagh in Jharkhand has been on ventilator support since 2013, when he suffered a spinal injury . “He doesn't require full life support. So, we put him on a disposable ventilator so that he could go out of the hospital,“ Dr Agrawal said.

Adult respiration is about 12 times per minute, while children breathe faster. Venti lators do that for patients who can't respire on their own.

Dr U K Valecha, director, department of anaesthesia at BLK Super Specialty Hospital said ambu-bags are primitive and mustn't be used at all. “At our hospitals, we have ICU ventilators that are interactive. The key parameters like oxygen saturation and respiratory rate are adjusted in these machines automatically as per the patient's requirements,“ he said.

While ICU ventilators are ideal, their cost is exorbitantly high and trained personnel are required to monitor them 24x7.Private hospitals charge a lot for these services. Many ICU experts say basic ventilators with controls to monitor parameters could be used in less critical patients. “No developed country or even the developing nations use manual, hand-held devices as a replacement for mechanical ventilators,“ Dr Valecha added.

In his address at the 56th International Respiratory Congress of the American Association of Respiratory Care, Robert M Kacmarek, an expert in respiratory care, said the current generation of ICU ventilators are the most complex and versatile of any mechanical ventilator ever manufactured. “The ICU ventilators of the future will be able to integrate electronically with other bedside technology; they will be able to effectively ventilate all patients in all settings, invasively and non-invasively; alarm systems will be smart and decision support will be available,“ he added.

Ambulances (government)

See graphic: Total ambulance services under National Health Mission and number of people per ambulance, state-wise

Total ambulance services under National Health Mission and number of people per ambulance, state-wise; The Times of India, Dec 12, 2016

IVF clinics

Less than 20% are registered

Sushmi Dey, Only 20% IVF clinics, 2% ART units registered with ICMR, Aug 21 2017: The Times of India

Centre Plans To Regulate Such Centres

Less than 20% IVF clinics and a miniscule 2% ART centres operating in India are registered with the Indian Council of Medical Research, prompting the government to consider making enrolment of such facilities with the council mandatory.

In a move to regulate mushrooming infertility clinics and make them more accountable for services and costs, the government is planning to issue a notification.Though the provision is part of the pending Assistant Reproductive Technology Bill, the health ministry is looking at a separate notification to roll out the regulation. While there are over 20,000 ART clinics across the country providing IVF (In Vitro Fertilisation) and IUI (intrauterine insemination ) services, merely 1,500 clinics have applied for registration with ICMR so far. “A comprehensive ART registry will be the first step to transparency in costs and quality ,“ R S Sharma, senior deputy director general, division of reproductive biology maternal health and child Health told TOI.

Of this number, only around 390 have actually completed the enrolment process, ac cording to the ART registry set up by ICMR in 2013. A single IVF cycle can cost anywhere between Rs 1.5 to Rs 2.5 lakh.

The demand for IVF and ART services is rising and could be linked to emerging demographics. There is a rise in the proportion of women in reproductive age of 20-44 years (a 14% increase estimated between 2010 to 2020). The rise is skewed towards women in the age bracket of 30-44 years (20% estimated increase in same period). The latter display lower fertility rates.

Enrolment means compliance with ICMR guidelines like submitting documents related to infrastructure, trained manpower and procedures as per a prescribed format.“ART registry is the first step to ensuring quality treatment. We identify ART clinics ourselves too and ask them for documents but they are not meeting requirements. It is a major challenge in bringing in any kind of transparency ,“ R S Sharma, said.

The large numbers of clinics and their misuse for sex determination is a major concern for the government. In the absence of a detailed regulation, a “grey market“ of unprofessional ART clinics are operating taking advantage of couples looking to have children.

There is also no benchmark for pricing. Some clinics charge exorbitant fees while others indulge in unethical practices that adversely affect the recipient of the treatment, medically and socially , experts say.

According to a 2015 Ernst & Young report, an estimated 55% of treatments take place in eight metros. Most of the insurance schemes do not cover such procedures or treatments, leaving such couples with huge out of pocket expenditures. The report also concludes that the absence of a regulatory framework leads to poor treatment outcomes and patient care.

Medical devices

Import of devices, 2014-16

See graphic.

Medical devices that were imported in 2014-16 and the share on China in those imports; The Times of India, May 31, 2017

Medical negligence cases

2017: Cases on the rise

DurgeshNandan Jha, Medical negligence cases rising: Study, March 27, 2017 The Times of India

Most Plaints For Wrong Treatment, Finds AIIMS Dept

Wrong treatment is the most common reason for people to complain about medical negligence, followed by lack of care, no treatment and forced discharge, a study by AIIMS forensic department has revealed.

The study involves interviews of families of 20 patients who died due to alleged negligence. While 13 cases involved private hospitals, seven were from government ones in and around south Delhi.

Dr Abhishek Yadav, who led the study , told TOI that allegations were found to be more common in age groups of children and adolescent (50%) with a declining trend with increase in age. “The super-specialty hospitals are accused of negligence in 65% cases,“ he added.

The allegation against the hospitals, both private and government, is in the ratio of 1.8:1, Yadav said. “Wrong treatmentprocedure was the main reason (45%),“ he added.

Recently , Delhi Medical Council deregistered two orthopaedic surgeons for six months for operating the wrong leg of a 24-year-old man who was admitted at Fortis Hospital in Shalimar Bagh after fracturing his right foot.

Dr Sudhir Gupta, professor and head of forensic sciences department, AIIMS, said incidence of alleged negligence has gone up signi ficantly over the past few years. “People are more aware about their rights. Also, recent court rulings in favour of the complainants where there is proven case of negligence has encouraged others to take up their grievances,“ he said.

AIIMS has recommended that doctors working in emergency and ICUs should be trained in declaring death of the patient to the relatives or a counsellor may be appointed for it.

Doctors said lack of communication between the doctors and patient is a major cause of discontent. “Doctors should refrain from ma king vague promises of complete recovery and should always explain the complication or unforeseen danger associated with the treatment procedure,“ said a doctor at the institute.

Dr Girish Tyagi, registrar of Delhi Medical Council, said they get 20-30 complaints of negligence every month. “The number has gone up significantly in the past few years,“ he said.

As per a report published in British Medical Journal, medical error is the third leading cause of death in the US, accounting for 2.5 lakh deaths every year. But no such data is available in India. Patients often allege that doctors try to save each other even when the case is referred to medical boards for investigation.

Medical, surgical advances

Uterus/ womb transplant/ 2017

Umesh Isalkar, RAISING HOPE - Pune doctors pull off India's first womb transplant, May 19, 2017: The Times of India

A team of doctors from Pune successfully performed the country's first uterus transplant on a 21-year-old woman from Solapur on Thursday . The breakthrough surgery was also the world's first laparoscopically (keyhole and minimally invasive) assisted live uterine transplant. The previous successful transplants were done only through open surgery .

The woman, who suffers from a congenital uterus absence, was fitted with her mother's womb, which was retrieved mainly through keyhole surgery .The subsequent transplant of the uterus was done through an open surgery . The entire operation lasted nine hours.

The surgery has opened a new gateway to motherhood for women who do not have a uterus, or those who have uteruses that do not function.The only options hitherto for such women were surrogacy or adoption.

Pune's Galaxy Care Laparoscopy Institute (GCLI), where the surgery was done, was granted a licence by the state's directorate of health services to carry out the transplant. “The surgery was successful. Both the recipient and the donor are stable. However, the next 48 hours are crucial for determining the success of the surgery ,“ said oncosurgeon Shailesh Puntambekar and cardiovascular thoracic surgeon Sanjeev Jadhav who performed the surgery along with a team of 10 other doctors.

Incidentally , Jadhav, who hails from Pune, has become the first transplant surgeon in the world to have performed transplants of the heart, lung, kidney and uterus.

Pre-natal tests

PG in imaging tech essential: SC

PG in imaging tech must for conducting pre-natal tests: SC, March 15, 2018: The Times of India

The SC mandated that only a postgraduate in ultra-sonography or imaging techniques could be allowed to conduct pre-natal diagnostic tests, staying the Delhi HC’s order which had quashed the Centre’s rule prescribing qualification for conducting such tests.

The HC had ruled that Section 2(p) of the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, defining a sonologist or imaging specialist as a person possessing postgraduate qualification in ultra-sonography or imaging techniques, was bad because there was no such qualification recognised by MCI and the Act did not empower the statutory bodies to devise and coin new qualification.

A CJI-led bench said Parliament had conferred rulemaking authority upon the Centre to specify minimum qualification for persons to be employed for conducting the tests and the HC was not right in interpreting the law.

“Parliament which has the unquestioned authority and legislative competence to frame the law considered it necessary to empower the Central government to frame rules to govern the qualifications of persons employed in genetic counselling centres, laboratories and clinics. The wisdom of the legislature in adopting the policy cannot be substituted by the court in the exercise of the power of judicial review,” the bench said.

Private expenditure

2015-16: Private expenditure outstrips government

Sushmi Dey, Govt’s shrinking footprint in India’s healthcare, December 27, 2018: The Times of India

Health expenditure as % of state GDP (2015-16)
From: Sushmi Dey, Govt’s shrinking footprint in India’s healthcare, December 27, 2018: The Times of India

Across States, Out-Of-Pocket Expediture On Healthcare Outstrips Stagnant Govt Spending By A Significant Margin

The public health expenditure in India, or what the government (Centre and state combined) spends on health, has remained constant over years in most states and is even less than the national average of 1.2% of GDP, making India one of the biggest private spenders on health among the low-middle income countries, latest data from National Health Accounts (NHA) show.

India’s public expenditure on health in 2015-16 was Rs 1,40,054 crore.

In major states like Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh, the government’s share in the total health expenditure continues to hover between 1.1-1.3% of gross state domestic product (GSDP), despite a substantial increase in healthcare costs. Public health spending in Maharashtra stood at a mere 0.7% of GSDP in 2015-16, against a total health expenditure of almost Rs 57,000 crore. Consequently, increasing the out-of-pocket burden.

Even in Kerala, where the health indicators are better than other parts of the country, public health spending as share of GSDP is limited to merely 1%, whereas the total health expenditure stood at 4.5% of GSDP.

Jammu & Kashmir accounted for the largest share of public spending on health at 1.7% of GSDP in 2015-16. However, the total expenditure in the state was also high as a percentage of its GSDP at 4.2%.

In Gujarat, the home state of PM Narendra Modi, the government spent 0.8% of GSDP in 2015-16, much below the national average. However, the state also accounted for a comparative total lower health expenditure as percentage of GSDP at 2%.

The data was recently presented in Parliament by minister of state for health Anupriya Patel during the ongoing session.

Around 67.8% of total expenditure on health in India is paid out of pocket. The world average is 18.2%.

This assumes significance as the Centre has proposed to raise the public health expenditure to 2.5% of GDP by 2025.

Experts say the target is too ambitious given the current spending by states and the lack of resources for generating revenue. “There is no doubt that the government needs more investment for creation of healthcare infrastructure but looking at macroeconomic fundamentals, there is very little money whereas the liabilities are huge,” says Sujatha Rao, former health secretary.

Rao says unless the Centre is able to expand the taxpayers ratio and states are able to give around 8% of its revenue expenditure for health, compared with 3-5% currently, it would not be possible to meet the target.

The government expenditure on healthcare has increased to 1.18% of GDP in 2015-16 from 0.96% in 2005-06. In 2014-15, the total expenditure incurred on health as a percentage of GDP was 3.89%, whereas the government share stood at 1.13% of GDP.

At present, the Centre shares around 30% of the total public health expenditure, the rest is borne by states.

With India not meeting its previous public health spending goals, healthcare experts are apprehensive about the current targets. The National Health Policy, 2002, had set a target of 2% of GDP by 2010; the United Progressive Alliance government, in 2004, had set a goal to increase publichealth spending to 2-3% of GDP over a five-year period; and the Centre’s 12th five-year plan set the target at 1.87% of GDP by March 2017.

Despite these targets, India’s public-health expenditure is amongst the lowest in the world, lower than most low-income countries.

The Centre has proposed to raise the public health expenditure to 2.5% of GDP by 2025. But it would be impossible to meet the target unless states raise revenue expenditure on health to 8% from 3-5% currently.

Shortcomings

Government facilities inadequate; private expensive

Where State Drives Patients To Private Wards

Beds per 1000 people in government hospitals in major states (2013) and a comparison with some other countries; Graphic courtesy: The Times of India, September 19, 2015

Rema Nagarajan

The Times of India Sep 19 2014

Availability of doctors

`More docs, not health centres, save lives'

Central Health Service, sanctioned posts and vacancies, 2016; Graphic courtesy: The Times of India, May 28, 2016

Himanshi.Dhawan @timesgroup.com New Delhi

The Times of India Aug 19 2014

Higher No. Of Medics Help Check Crib Deaths: Study

Do hospitals translate to better healthcare? Not necessarily . States with more doctors have better healthcare indices than those with better infrastructure, data analysed by thinktank Swaniti reveals.

While better health outcomes depend on multiple reasons, it appears that doctor to population ratio had a far higher impact on infant mortality rate (IMR) or maternal mortality rate (MMR) than better infrastructure.Tamil Nadu that has fewer primary health centers (PHCs), one per lakh of population, as compared to Chhattisgarh and Odisha that have two PHCs is better placed in health outcomes.

Tamil Nadu has one doctor for 789 patients and an infant mortality rate of 21 and maternal mortality of 97.

In sharp comparison, Chhattisgarh has one doctor for 6,221 patients and witnesses 47 infant deaths for every 1,000 live births and 269 maternal deaths per 1,00,000 live births. Odisha that has one doctor for 2,500 patients, too, suffers from high infant and mother deaths. It has IMR of 53 and MMR of 258, respectively.

Interestingly , states like Andhra Pradesh, Goa, Karnataka, Kerala and Tamil Nadu alone account for 42% of all medical colleges in India thereby producing most of India's doctors. Not surprisingly , these states also have the best Doctor Population Ratio (DPR).

These states show no shortfall of doctors at PHC level and have already met the Millennium Development Goals (MDG). At least three of the five -Kerala, Goa and Tamil Nadu -have IMR below 21. Incidentally , West Bengal has one of the highest per capita coverage of primary health centres -nine per lakh population.However, it has just one doctor for 1,508 patients and IMR of 32 while its MMR is 145.

In comparison, north Indian states of Madhya Pradesh, Bihar, Uttar Pradesh, Odisha and Chhattisgarh have very few medical colleges, a fact which reflects in their DPR.

Unsurprisingly , most states with poor DPR also had a relatively high shortfall of doctors at the PHC lev el. For example a state like Bihar has one doctor for every 2,785 people. This translates to IMR of 43 and a MMR of 261.

When these numbers are viewed against the MDG target of 27 for Infant Mortality Rate in India by 2015, it becomes clear that these states need to act urgently to improve their performance in public health.

“It is important to go beyond merely having doctors and invest in improving the quality of healthcare professionals in India. National Healthcare Policy , another promise by the new government, should hopefully lead to greater public investment in healthcare, and improve the quantity and quality of healthcare in India while reducing regional disparities.

Some of the other factors are efficient utilization of funds, good quality of human resources in healthcare, and finally awareness among people. Rwitwika Bhattacharya from Swaniti said.

Shortfall of doctors: 2015

Shortfall of doctors, 2005-15: Shortfall of rural medical centres/ hospitals

The Times of India , Sep 10 2015

Subodh Varma

After 10 yrs of rural health mission, doctor shortfall up

At the country level, there is a staggering shortfall of 81% of specialist doctors, 12% of general physicians, 21% of nurses and 5% of auxiliary nurse cum midwives. Among technical support staff, shortfalls range from 29% for pharmacists to 45%for laboratory technicians and 63% for radiographers.But since a decade ago, many of these shortfalls have increased except for nurses and ANMs.

A bizarre aspect of this data put out annually by the ministry of health is that in many categories of health personnel, some states have surplus appointments while others have shortfalls. For example, at the country level, 25,308 doctors are required going by the Indian Public Health Standards (IPHS), which says that one doctor is needed for every primary health centre (PHC).But actually , there are 34,750 doctors sanctioned. 25 states have surplus doctors, the total surplus working out to 5,115.On the other hand, the remaining states have a combined shortfall of 3,002 doctors.

T Sundararaman, professor at the Tata Institute for Social Sciences and former executive director of the National Health Systems Resource Centre says, “IPHS recommended two doctors and one ayush doctor per PHC. In 2011, the doctors per PHC was revised downwards. But doctors are -unlike ANMs -paid only by the states. So many states, like Tamil Nadu, have two doctors per PHC as sanctioned. The `required' number is the statistics department's interpretation of IPHS to mean that only one doctor is required per PHC. They have no basis to do this, and one doctor per PHC is not viable. The short falls are genuine -the over appointments are not,“ he told TOI.

The surpluses in healthcare personnel arise because goal posts are shifted by lowering requirements. In reality the shortages are all round.

Doctors, in rural areas

Times of India

Funds fail to draw docs to villages

Despite 42,000cr Kept Aside For Rural Medical Care, Rs 10,000cr Lying Unspent Subodh Varma TIMES INSIGHT GROUP

As the country awaits another central government Budget, there is a growing demand for more financial muscle on several fronts. But, is throwing money at complex problems really a solution? A look at the progress of a crucial program of the government, the National Rural Health Mission (NRHM), indicates that money can’t buy everything.

One of the biggest bottlenecks facing policy-makers is that of medical personnel. Recently released data by the ministry of health and family welfare shows a shocking shortfall of doctors, nurses, health assistants, radiographers, pharmacists and other personnel in the rural health delivery structure. This is despite over 82,000 new personnel being appointed under NRHM in the past four years and many villages getting to see a doctor for the first time.

The situation is worse for qualified doctors. Just 20% of required pediatricians and only about 26% of surgeons, obstetricians and gynaecologists, and general physicians are in place. They are needed at the Community Health Centres (CHC), each serving a population of 1.2 lakh. Among technical personnel, only about 40% of the required radiographers and 47% of laboratory technicians are in place to run diagnostic labs. There is a shortfall of about 25% for pharmacists, and 16% for staff nurses.

Even at the lower rungs of the medical service hierarchy, like the health sub-centres and primary health centers, many of the key personnel are not yet appointed. Nearly a quarter of 46,000 male and female health assistants are missing, while over 60% of health workers are not yet in place. The situation is much better for the auxiliary nurse and midwife (ANM) with about 90% appointments having taken place, but that still leaves nearly 16,000 ANM posts vacant. Two ANMs are required at the primary level in order that delivery cases are handled day and night. Just about one third of the PHCs are functioning with two ANMs.

Expenditure data shows that the problem is not of resources. Out of the Rs 42,000 crores released by the central government in the past four years for NRHM, nearly Rs 10,000 crore is lying unspent with state governments. In addition, all state governments together have allocated an eyepopping Rs 1,06,388 crore for health and family welfare in their respective states.

Yet, progress under NRHM, has been uneven, and the country is still far from achieving goals set for various health indicators. “Spending money jazzing up an auto-rickshaw is not going to convert it into a car”, says public health expert Dr Amit Sengupta. A thorough revamp of the infrastructure is needed and the government needs to think afresh about it, he says.

But why are medical personnel not in place? “An indifferent political leadership and bureaucracy, deficient medical education infrastructure, especially for technical and paramedical staff, low salaries for doctors, and frustration among them in rural postings as there are no drugs, no support staff and erratic infrastructure, are some of the problems,” Sengupta said. “Sadly, doctors prefer lucrative private incomes in urban areas or foreign lands, rather than serving people in the villages,” he says.

Statewise availability of doctors

Karnataka, TN, Andhra, Maharashtra best

The Times of India, May 23 2016

Chethan Kumar India is struggling with a doctor-patient ratio of 1:1,681. This poor state of affairs is hindering healthcare services across the country. But even among the 9.5 lakh doctors, the distribution is so skewed that just four states -Maharashtra, Karnataka, Tamil Nadu and undivided Andhra Pradesh -have nearly 46% of all doctors registered in the country.

This leaves bigger states like Rajasthan, Madhya Pradesh, Uttar Pradesh and others with few doctors to share between them.

“The number of doctors in the country is just a portion of what's required to meet the minimum requirement and some states are not even in line with the national average,“ said Singhal, an associate professor (ENT) and head and neck surgeon at SMS Hospital, Jaipur.

According to the mini stry of health and family welfare, out of 9,59,198 doctors registered in the country , 4,36,910 (45.54%) are in the four aforementioned states .

Rajasthan, MP and Uttar Rajasthan, MP and Uttar Pradesh have a total of 1,31,554 doctors, making up for 13.7%, while only three of the seven northeastern states have doctors registered with them and add up to only 22,201. The rest are shared between all other states.

Experts say the situation is worse than what the ministry's statistics reveal.

“There's no doubt that there's an overall shortage and skewed distribution.The problem is that doctors register with the Indian Medical Council or in the respective states when they pass out from the courses and there's no real update.Many of these 9.5 lakh doctors may not even be in the country ,“ Dr Upendra Bhojani, assistant director, Institute of Public Health (IPH), said.

That the four states have the maximum number of doctors should come as no surprise though, as they are among the states with the highest number of medical colleges. Together, they ac count for 69% of all the colleges in the country or 290 colleges out of 422.

Karnataka, which has the highest number (50) of medical colleges in the country , has 1,01.273 doctors (third highest in the country), while Maharashtra, which has the second highest number of medical colleges (48) has the highest number of doctors at 1,53,513.

Tamil Nadu has 1,11,325 doctors and 46 medical colleges, while Andhra Pradesh has 70,799 doctors and 46 colleges. Also, as experts point out, these are also states with a considerable urban population and a good network of private hospitals.

“It's not just the private hospitals that make the difference. Many choose places considering the opportunity to run clinics which is more lucrative in urban areas. Also, they look out for other support infrastructure, like schools and so on, that is good for their families ,“ Bhojani said.

Availability of specialist doctors in CHCs

Rakesh Prakash, Only 19% specialist docs in India's health centres, Feb 5, 2017: The Times of India

India's elemental healthcare infrastructure seems to be in a `critical condition' with a meagre 19% availability of specialist doctors in the community health centres (CHCs) across the country .According to the statistics released by the Union health ministry on Friday , there is a shortfall of 17,854 medical specialists including surgeons, physicians, pediatricians, obstetricians and gynecologists.

CHCs, which are located in towns and serve as referral centres for patients coming from the primary health centres (PHCs), are vital to improving the country's healthcare landscape. The total number of specialist doctors working at CHCs across the country is 4,186 against the current requirement is of 22,040.

Among the states that face a shortfall of specialists, Uttar Pradesh (shortfall of 2,608 doctors) tops the list followed by Rajasthan (1,787), Tamil Nadu (1,464), West Bengal (1,271), Odisha (1,154), Gujarat (1,140), Madhya Pradesh (1,047) and Maharashtra (935).

The situation in Karnataka is relatively better with the availability of specialists at CHCs at 60.43% against the required strength of 824.

The only place that has reported a surplus of specialist doctors is Chandigarh (UT) with 14 doctors in the CHCs against the requirement of eight.

The shortfall of specialists in CHCs reiterates the clichéd argument that private hospitals continue to be more lucrative for doctors.

But the question is who will crack the whip? Union minister of state for health Fagan Singh Kulaste told Lok Sabha on Friday , “Health is a state subject and the primary responsibility to ensure availability of doctors and other health professionals in public health facilities lies with the respective state governments.“

But recruiting specialists is not an easy task for the state governments.Speaking on the shortage of specialist doctors recently , Karnataka's health minister K R Ramesh Kumar had said: “Though we have been offering a salary of Rs 1.25 lakh and additional incentives to specialists, not many are coming forward to serve in rural areas“

A shortage of hospitals

States, UTs with more than 1 bed in government hospitals per 1000 people; Graphic courtesy: The Times of India, August 9, 2016

Worst states in terms of availability of government hospital beds per 1000 people; Graphic courtesy: The Times of India, August 9, 2016

An expensive private sector has stepped in where govts failed -delivering health facilities that are often suspect. The trend grows while state facilities struggle to cope

Public health infrastructure is wanting by even government's own assessments. This is true of subcentres at the lowest rung to community health centres (CHCs) and district hospitals. There's a shortage of about 7,000 primary health centres (PHCs). In some states, the shortages are staggering -66% in Jharkhand, 58% in Bengal and 42% in MP . Only two-thirds of the required number of CHCs are in place.In Bihar, against a need of 774 CHCs there are just 70, a 91% shortfall. Assam has less than half of what it needs, UP 40% less.

There's an even bigger crisis of health personnel: A shortfall of 2,225 doctors in PHCs, and the gap's growing bigger. Over 36% PHCs were without a lab technician, 23% without a pharmacist. There is a 53% shortfall in radiographers. Considering just the existing infrastructure, there was a shortfall of all kinds of specialists including 72.2% of surgeons, 64.7% of obstetricians and gynaecologists, 82.1% of physicians and 73% of paediatricians. In effect, even in the existing infrastructure isn't staffed. In many states, health indicators of the urban poor are far worse than their rural counterparts, revealing how underserved the urban poor are. In the mostlyurban Delhi, there's massive shortage of subcentres, PHCs and CHCs.

The bulk of healthcare in India is provided by the private sector, that's meant escalating costs. In states like Rajasthan and Tamil Nadu, governments demonstrated how providing free drugs and diagnostics in public facilities could significantly bring down health expenditure. Yet, neither the Centre nor other states replicated these programmes. In the name of universal healthcare, government is being persuaded to become the payer for healthcare provisioned by the private health sector and administered by insurance companies. In most states, these insurance programmes have been riddled with corruption and inefficiencies such as the epidemic of hysterectomies done on hundreds of women by hospitals in Andhra to collect government money for the procedure. There's concern among health activists that state funds that could be used to strengthen public health infrastructure are getting diverted to the private sector.

Inadequate Government funds

In absolute terms, the money allocated for health by government has gone up more than 13 times from Rs 2,000 crore in 2000-01 to Rs 27,500 crore-plus in 2013-14. Yet, health expenditure is short of 1.5% of GDP though successive governments have promised that spending would touch 3%. If the promised 3% had been allotted, perhaps the public health sector could have been revolutionized to deliver quality service.

Better healthcare still out of bounds

Times of India

Types of ambulance services under National Health Mission; Graphic courtesy: The Times of India, December 12, 2016

New Delhi: India may be among the fastest growing economies in the world, but the UNDP’s Human Development Report 2006 shows that this growth hasn’t translated into better public healthcare for the citizen, at least not as yet. For instance, there are only seven countries — of the 177 that the HDR looks at — with a lower share of public expenditure in total health expenditure. These seven — Guinea, Congo, Myanmar, Cambodia, Armenia, Tazikistan and Burundi — are not exactly those with whom India would like to be compared, but they are the only ones in which the government accounts for less than a quarter of total health expenditure. For India, the share of public expenditure in the total is exactly one-fourth or 25%.

The low share of public health expenditure is not surprising, given the fact that only 13 countries spend a smaller proportion of the gross domestic product (GDP) on the health sector than India’s level of 1.2%. Apart from six of the seven mentioned above, these include Pakistan and Bangladesh in our neighbourhood as well as Azerbaijan, Georgia, Ivory Coast, Equatorial Guinea and Indonesia. One result of this low level of government spending on healthcare is that people have to spend more from their pockets to keep themselves in good health. Thus, India’s private spending on healthcare at 3.6% of GDP is higher than most. In fact, only 33 of the remaining 176 countries has a higher level on this count.

However, the high private expenditures are clearly unable to bridge the gap when it comes to things like immunisation, which are typically public programmes in most parts of the globe. Not surprisingly, India’s immunisation rate for those who are one-year old against measles is worst in the world, with just 13 countries doing worse. A similar picture emerges if we look at the numbers for full immunisation of one-year olds against tuberculosis. Again, there are a mere 20 of the 176 others who have a lower rate.

What highlights all of this as a glaring failure of our governments is the fact that India’s pool of roughly 6.5 lakh physicians is the third biggest in the world after China, which has about twice as many, and the US, which has only a few tens of thousands of doctors more than India, although for a population that’s only about onethirds the size of India’s.

Shortfalls in Primary Health Centres

Amitabh Srivastava , Licence to murder “India Today” 1/6/2016

States and UTs with the biggest percentage shortfalls in Primary Health Centres

Surgeries

Not allowed if there is no ICU

Dhananjay Mahapatra, SC: No ops in nursing homes without ICU, September 8, 2017: The Times of India

The Supreme Court has said nursing homes without an intensive care unit facility cannot carry out surgeries because ab sence of an ICU poses danger to the patient's life.

A bench of Justices Adarsh Kumar Goel and U U Lalit gave the ruling on a petition filed by Bijoy Kumar Sinha, who lost his wife due to the alleged medical negli gence of Dr Biswanath Das who conducted a hysterectomy surgery at Ashutosh Nursing Home in Kolkata.The nursing home did not have an ICU facility. The Supreme Court's ruling in a case, based on a plea filed by a man who lost his wife due to alleged medical negligence of a doctor who had conducted a surgery on her at a Kolkata nursing home which didn't have an ICU, has implications for beleaguered homebuyers of Jaypee Infratech projects.

The petitioner, Bijoy Kumar Sinha, died while fighting a lengthy 23-year-long litigation over his wife's death, in consumer forums before his son Soumik pursued the case to get justice for his mother in the Supreme Court.

The SC said that the Consumer Protection Act was an additional remedy , thereby indicating that proceedings against a realtor under the Insolvency and Bankruptcy Code 2016 wouldn't bar recourse to parallel action in consumer forums. This will boost hopes of all homebuyers facing harassment at the hands of truant realtors.

A bench of Justices Adarsh Kumar Goel and U U Lalit said, “Provisions of the Consumer Protection Act, 1986, are in addition to and not in derogation of any other law. Thus, the Act provides for additional remedies. The authorities under the Act exercise quasi-judicial powers.The award of damages (in the case filed by Sinha) is aimed at bringing about qualitative change in the attitude of service providers.“

While absolving Dr Biswanath Das of medical negligence for deciding to perform surgery on Sinha's wife, the court awarded a compensation of Rs 5 lakh to Soumik.

This ruling means that even if a realtor has been proceeded against under the Insolvency and Bankruptcy Code, people won't be barred from taking recourse to consumer forums to claim relief for deficient services.

The apex court said though an alternative dispute redressal mechanism for settlement of disputes outside courts was applicable only to civil cases, “there is no reason to exclude its applicability to consumer fora“.

“It will be open to the national commission and the state commissions to coordinate with the national legal services authority and state legal services authorities for settlement of disputes by resorting to alternative dispute redressal mechanism,“ the Supreme Court said.

Techniques used

Digital interaction

The Times of India, Jan 30 2016

Modes of doctors’ digital interaction in India, 2015; Graphic courtesy: The Times of India, Jan 30 2016

`Most doctors now prefer digital interaction'

Rupali Mukherjee

Over 60% of doctors in the country now prefer, one out of three times, digital interaction with their patients as against the traditional face-to-face interaction, indicating a trend where WhatsApp, text messages and emails are increasingly being used for consultations.This is slightly lower, but in keeping with the trend in the US, Japan and China, where a greater number of healthcare professionals (HCPs) -in certain markets, over 90% -have switched to the digital medium, using WeChat, blogs, email and text messaging to engage with patients for follow-up consults. Also, a majority of doctors -globally 60% -de mand drug companies combine the use of digital tablets and iPads along with direct interaction when medical representatives (MRs) are detailing the portfolio of medicines. These findings are part of the Digital Savvy HCP (Healthcare Practitioner) 2015, an annual global survey on the digital habits of doctors across the US, Japan, China and India, by healthcare so utions firm Indegene, sha red exclusively with TOI.

The survey involved more than 1,600 healthcare profes than 1,600 healthcare professionals across the globe, with 67% speciality doctors, and the remaining 33% general practitioners. In India, over 300 doctors were part of the survey with more than 10 years of experience, practising in tier 1 and tier 2 places across the country .

The survey found that 76% doctors in the US prefer personal interaction (of field force) along with detailing with the tablet, while the corresponding figure in India is 90%. “Doctors in the US have a higher digital adoption rate, and are more comfortable with remote detailing channels (through Skype, etc).This also works well with pharmaceutical companies in terms of costs, as well as adherence to ethical marketing code,“ Gaurav Kapoor, EVP (emerging markets), Indegene, told TOI.

As against this, doctors in India prefer a face-to-face detailing with their digital tablets, wherein they meet MRs in their clinics and the latter are equipped with detailing on their tabletsiPads.

Dr Upendra Kaul, ED, academics and research (cardiology) in Delhi-based Fortis Escorts Hospital, says, “As doctors, our bandwidth is committed to treating more and more patients and improving their health outcomes.In this pursuit, technologyled information sharing on new drugs, new indications and peer information on emerging treatment protocols is of tremendous benefit to the medical fraternity . It frees up our time for patients and at the same time, keeps us updated on the latest medical information.“

Globally , drug companies are increasingly switching to digital channels like emails, websites, webinars, apps and text messages due to compliance requirements, the survey says, adding 34% of physicians globally value the smartphone as a key resource in seeking medical information. Other devices used by doctors are laptops, PCs and tablets. India sees less than half the global usage of smartphones (by doctors), while the most preferred device for doctors here is laptops (34%).

In terms of overall digital engagement across channels, globally pharma companies are far ahead, with MSD at the top, followed by GSK, AstraZeneca and Pfizer. In India, Abbott leads the pack as the top digital engager, who doctors believe is effectively leveraging technology to reach out to them for providing drug information. Abbott is followed by MSD, Pfizer, Novartis, GSK and Sanofi.

Most MNCs here use digital technology and have equipped their field staff with tablets to engage with physicians for scientific and product communication. “For instance, Abbott's `Knowledge Genie Portal' has a host of data that can be easily accessed by physicians at their convenience, across multiple therapy areas,“ Bhasker Iyer, VP, Abbott India, said.

Use of allopathy, on a rise

The Times of India, Jul 08 2015

Choice of treatment; Graphic courtesy: The Times of India, Jul 08 2015

Mahendra Singh

90% of Indians prefer allopathy over AYUSH

Alternative medicines more popular with urban men

Despite the government's attempt over the years to popularize AYUSH (ayurveda, yoga or naturopathy , unani, siddha and homoeopathy), the people at large are still inclined towards allopathy treatment both in rural and urban India. The NSSO survey has found higher inclination towards allopathy treatment-around 90%-in both rural and urban areas. Only 5 to 7% usage of `other' type of treatment including AYUSH has been reported both in rural and urban areas.

Interestingly , a higher usage (1.5 percentage point) of AYUSH treatment by urban males than their rural counterparts was noted, while less usage of the same (0.8 percentage point) by urban females as compared to rural females was observed.

The use of allopathy was also most prevalent in treating the hospitalized cases of ailments both in rural and urban settings of the country irrespective of gender. Surprisingly , use of AYUSH for hospitalized treatment in urban areas (0.8% for male and 1.2% for female) was more than rural areas (0.4% for male and 0.3% for female).

Moreover, un-treated spell was higher in rural (both for male and female) than urban.

The relationship between the percentages of untreated spells of ailments and level of living was also revealed. Untreated spell was less in those with usually higher monthly per capital expenditure for both rural and urban sector.

The survey found that private doctors were the most important single source of treatment in both rural and urban areas. More than 70% (72% in rural areas and 79% in urban areas) spells of ailment were treated in the private sector, consisting of private doctors, nursing homes, private hospitals and charitable institutions. The number of people reporting sick is more in urban India compared to rural areas, found the survey.

Stenting

Top causes of death in India: 2010-2013;Graphic courtesy: The Times of IndiaJan 11 2016

Usage and cost of stents in India, as in Jan 2017; The Times of India, January 12, 2017

Trends, region-wise

2012-16: Delhi

See graphic

Patients with mosquito-borne diseases in Noida: 2012-16; Graphic courtesy: The Times of India, September 13, 2016

Rural-urban

The Times of India, Apr 12, 2016

Mahendra K Singh

Urban India more sick than rural; pollution, bad diet blamed

The survey found that 13.5% of women, as compared to 10.1% of men, fell sick in urban areas.

Urban India is more sick than the rural hinterland despite the mushrooming of health and wellness clinics and super-specialty hospitals, besides better per capita earnings. And this could well be attributed to increasing pollution levels and unhealthy dietary habits.

A government health survey has revealed that around 11.8% of urban and 8.9% of rural population reported ailments during a 15-day reference period. Women were found to be more vulnerable to diseases in both cities and villages.

The survey found that 13.5% of women, as compared to 10.1% of men, fell sick in urban areas, while the figures were 9.9% and 8%, respectively, in rural India. What's worrisome is that a high chunk of the population (86% in rural and 82% in urban areas) remains outside any scheme of health expenditure support.

The NSSO survey released on Monday also reiterates that people rely more on private hospitals, with over 70% spells of ailment (72% in rural areas and 79% in urban areas) being treated in the private sector. Also, private institutions dominated both rural (58%) and urban areas (68%) in treating inpatients.

Allopathy remains the preferred treatment in rural as well as urban areas. The survey found that over 90% of rural and urban population relies on allopathic treatment despite the government's efforts to promote alternative medicine.

The survey found that around 97% of urban and 96% of rural population was administered some treatment, which included selfmedication, use of medicines taken on chemists' advice and AYUSH treatment. In previous surveys, 'treatment' administered on medical advice was considered as 'treatment'. It was found that financial constraints (57% in rural and 68% in urban) were the key reasons for going for treatment without any medical advice.

2015: EAG states improve

Sushmi Dey, Good news! Laggard states see huge progress in health, March 5, 2017: The Times of India

Under five mortality rate, mothers who had full prenatal care and institutional births, state-wise; Sushmi Dey, Good news! Laggard states see huge progress in health, March 5, 2017: The Times of India

Bihar's Sex Ratio Among India's Top 5

Several of India's socio-economically backward, or Empowered Action Group (EAG), states, namely Jharkhand, Rajasthan, Odisha and Chhattisgarh, have made great strides over the last decade with regard to some of the key health indicators.

For instance, all EAG states (Bihar, Jharkhand, MP, Chhattisgarh, Odisha, Rajasthan, UP and Uttarakhand), and Assam have witnessed an increase of over 40 percentage points in institutional births, according to the National Family Health Survey-4. A rise in the number of institutional deliveries is crucial as it helps reduce maternal and infant mortality , besides ensuring better health for women and children in the long run. This is also evident in the 20 percentage point drop in the infant mortality rate in Jharkhand, Rajasthan and Odisha. “As a step towards ensur ing equitable health services across regions that suffer from disparities, special efforts were made to allocate more resources in backward states and regions,“ a health ministry official said. In 2015, the health ministry had identified 184 poorly performing districts where more resources were infused and focused programmes launched to bring about sharper improvement in outcomes.

Though the survey findings, released by the health ministry earlier this week, do not contain data for pollbound UP on account of the model code of conduct, the state registered the maximum decline, 1.1 child per woman, in the total fertility rate over the last 10 years.

Among the five states with the highest infant mortality (death within one year of birth per 1,000 live births) and under-five mortality (risk of death by age five, per 1,000 live births) rates, four are EAG -Chhattisgarh, Madhya Pradesh, Bihar and Jharkhand. Though Bihar features among the top five states vis-a-vis sex ratio, it fares the worst in female literacy rate and financial inclusion of women.

2014: Delhi healthiest

The Times of India, May 20 2016

Delhiites are healthiest, says report

If the latest statistics on social consumption on health is anything to go by, people living in the capital are healthier than those residing in other parts of the country.According to the data for January-June 2014, 48 out of 1,000 people fell ill in rural areas and 50 in urban areas in Delhi. This is much lower than the national average of 89 for rural and 118 for urban areas.

Deputy CM Manish Sisodia said the comparative figure in urban areas of Punjab was 170, Haryana 75, Himachal Pradesh 51, Jammu and Kashmir 41, Rajasthan 83, Uttar Pradesh 91and Gujarat 103.

The report brought out by the directorate of economics and statistics of the Delhi government is based on the result of the National Sample Survey 71st round on health and morbidity . It said that proportion of ailing persons was highest among the 60-plus age group followed by persons falling in the 45-59 year age group.

The report said that out of total estimated births, 5.02% were reported in rural and 94.98% in urban areas. In Delhi, 62.5% of births were reported in public hospitals.

Sisodia said the old age dependency ratio in Delhi is 6.97 which indicates that every 100 people in the age group of 15 to 59 years were supporting, physically or otherwise, about seven aged persons in the year 2014.

All India Medical Service cadre

Brief history

Five decades on, govt may form medical service cadre|Jul 04 2017: The Times of India (Delhi)

Five decades on, govt may form medical service cadre

TIMES NEWS NETWORK More than five and a half decades after a central committee had recommended the setting up of an All India Medical Service cadre along the lines of the Indian Administrative Service (IAS) or the Indian Police Service (IPS), the central government has moved a proposal to create such a cadre. Health being a state subject, the union health secretary has written to the chief secretaries of all states soliciting the views of the states. “The creation of an All India Medical Service under the All India Service Act 1951, like IAS, IPS, etc. for creating a body of professional doctors across the country has been under the consideration of the government for quite some time. Considering the fact that health is a state subject and the major requirement of health professionals is at the state level, it has been decided to solicit the views of all state governments on this issue,“ stated the letter sent to the states.

The letter, dated June 9, went on to state that doctors of the Central Health Service (a Group A service under the health ministry dealing with monitoring of various health programmesschemes) have never worked in the states and hence “do not have an appropriate perspective of the problems being faced by the state governments“. Creating the All India Medical Service could help bridge this gap and “improve technical leadership and management both at the Centre and state levels,“ the letter said.

The Health Survey and Planning Committee, better known as the Mudaliar Committee, which submitted its report in 1961 had observed that three areas -provisioning of adequate medical care, both preventive and curative; training of medical and paramedical personnel; and those for dental care and for research --were interlinked and that it was only through a coordinated programme of action in which centre and states cooperated “satisfactory and speedy results“ could be achieved.Hence it had recommended the formation of a central health cadre in which senior posts in the Central and state health ministries would be included.

Such a central cadre, which existed before independence, the Indian Medical Service (IMS), was abolished in August 1947. The committee's report noted that most of the highest administrative and specialist posts in the states were manned by officers of IMS, the Women's Medical Service and the Medical Research Department, who were officers of an all-India cadre.

More recently , in 2005, the report of the National Commission on Macroeconomics and Health (NCMH) had stated that it was necessary to take a bold decision “to constitute an All India Cadre of Public Heath Services, on lines like the IASIPS“.

“It is a great move if the government can pull it off.This is much needed, as those in the existing Central Health Services have no experience in the states and are often restricted to Delhi postings or to central government institutions in the states. They have no clue about rural health or how public health is delivered through the various tiers of the government health system. They get no training or an all-India perspective like the IAS or IPS officers receive in Mussoorie followed by their postings to rural districts,“ said former health secretary Sujatha Rao, who was also a member of the NCMH.

@@ Line 1: / Line 1: @@
+{| class="wikitable"
+|-
+|colspan="0"|<div style="font-size:100%">
+This is a collection of articles archived for the excellence of their content.</div>
+|}
+[[Category:India |H]]
+[[Category:Health |H]]
+[[Category:Development |H]]
-[[File: Kangana-Ranaut7a.jpg|With the huge success of ''Queen,'' the Filmfare award formally anointed Kangana the queen of all that she surveyed |frame|500px]]
-[[File: Kangana Ranaut3.jpg|Kangana Ranaut  |frame|500px]]
+=Antibiotics =
-[[File: Kangana Ranaut4.jpg|Kangana Ranaut  |frame|500px]]
+== ‘64% of antibiotics sold are unapproved’ ==
-[[File: Kangana-Ranaut5.png|Kangana Ranaut |frame|500px]]
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F02%2F05&entity=Ar00802&sk=A07A7EE7&mode=text  Naomi Canton, UK study: 64% of antibiotics sold in India unapproved, February 5, 2018: ''The Times of India'']
-[[File: Kangana-Ranaut9.jpg| Kangana Ranaut |frame|500px]]
-[[File: Kangana-Ranaut10.jpg| Kangana Ranaut? |frame|500px]]
-[[File: Kangna Tanu 2.png| Kangana Ranaut's dual role in ''Tanu weds Manu Returns'' (2015) was, along with the script, the main contributor to the film's major success.|frame|500px]]
-[[File: Kangna Tanu 1.png| Kangana Ranaut's position in Filmistan was cemented by ''Tanu weds Manu Returns'' (2015)|frame|500px]]
-[[File: Kangna Tanu.png| Kangana Ranaut in ''Tanu weds Manu Returns'' (2015)|frame|500px]]
-[[File: Kangana Ranaut1.jpg|Kangana Ranaut  |frame|500px]]
-[[File: Kangana Ranaut2.jpg|Kangana Ranaut  |frame|500px]]
-[[File: Kangana-Ranaut11.jpg| Kangana Ranaut |frame|500px]]
-[[File: Kangana-Ranaut12.jpg| Kangana Ranaut |frame|500px]]
-[[File: Kangana-Ranaut13.jpg| Kangana Ranaut? |frame|500px]]
-[[File: Kangana-Ranaut6.png|Kangana Ranaut |frame|500px]]
-[[File: Kangana-Ranaut14.jpg| Kangana Ranaut |frame|500px]]
-[[File:Kangana-Ranaut7.png|Kangana Ranaut; the quintessential cover girl |frame|500px]]
-[[File: kangna ranaut.jpg| Kangna Ranaut |frame|500px]]
-[[File: Hrithik Kangana emails 1.jpg| The alleged Hrithik- Kangana emails 1 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-[[File: Hrithik Kangana emails 2.jpg| The alleged Hrithik- Kangana emails  2<br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-[[File: Hrithik Kangana emails 3.jpg| The alleged Hrithik- Kangana emails  3<br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
+Multinational companies continue to produce and sell unregulated antibiotics in India, worsening the problem of antimicrobial resistance in the country and impeding efforts to fight drug resistance globally, a UK study said.
-[[File: Hrithik Kangana emails 4.jpg| The alleged Hrithik- Kangana emails 4 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
+The report, to be made public on Monday by researchers at Queen Mary University of London and Newcastle University, said millions of antibiotic pills in the Indian market have not been regulated in India, the UK or US.
-[[File: Hrithik Kangana emails 5.jpg| The alleged Hrithik- Kangana emails 5 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
+The research was published in the British Journal of Clinical Pharmacology. It found that of 118 different formulations of fixed dose combination (FDC) antibiotics being sold in India between 2007 and 2012, 64% were not approved by the Central Drugs Standard Control Organisation (CDSCO), even though sale or supply of unapproved new medicines in India is illegal.
-[[File: Hrithik Kangana emails 6.jpg| The alleged Hrithik- Kangana emails 6 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
+Only 4% of the FDCs (formulations composed of two or more drugs in a single pill) were approved in the US or UK. India already has one of the highest rates globally of antibiotic consumption and antimicrobial resistance. Many of the unapproved FDCs combined poorly chosen antimicrobials likely to exacerbate resistance problems. The FDC antibiotics were sold under more than 3,300 brand names made by almost 500 pharmaceutical manufacturers, of which 12 were multinationals.
-[[File: Hrithik Kangana emails 7.jpg| The alleged Hrithik- Kangana emails 7 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
+The report stated that Abbott, Astra Zeneca, Baxter, Bayer, Eli Lilly, GlaxoSmith-Kline, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, and Wyeth, manufactured 45% (53) of the 188 FDCs under 148 brand names.
-[[File: Hrithik Kangana emails 7a.jpg| The alleged Hrithik- Kangana emails 7a <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-[[File: Hrithik Kangana emails 9.jpg| The alleged Hrithik- Kangana emails 9 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-[[File: Hrithik Kangana emails 10.jpg| The alleged Hrithik- Kangana emails  10 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-[[File: Hrithik Kangana emails 11.jpg| The alleged Hrithik- Kangana emails  11 <br/>  [http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms   Bombay Times ''The Times of India''] |frame|500px]]
-{| class="wikitable"
+==Use of antibiotics, India/ the world:  2000-2015==
-|-
+[[File: The consumption of antibiotics in India, Pakistan, China and the world, and the rise of drug resistant microbes.jpg|The consumption of antibiotics in India, Pakistan, China and the world, and the rise of drug resistant microbes <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F04%2F02&entity=Ar00203&sk=DD7F17D9&mode=text  April 2, 2018: ''The Times of India'']|frame|500px]]
-|colspan="0"|<div style="font-size:100%">
-This is a collection of articles archived for the excellence of their content.<br/>
-</div>
-|}
-[[Category:India |K ]]
+'''See graphic''':
-[[Category:Cinema-TV-Pop|K ]]
-=Sources include=
-[https://www.facebook.com/kangnaRranaut  Kangna R Ranaut]
-=Vital statistics=
-Body Measurements: 32-23-35
-Height: 5ft 8 / 173 cm
+''The consumption of antibiotics in India, Pakistan, China and the world, and the rise of drug resistant microbes''
-Weight: 53kg / 118lb
+=Breastfeeding =
+See [[Breastfeeding: India]]
-=A profile=
+=Caesarean-/ C- sections=
-[http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=THE-KANGANA-RANAUT-GUIDE-TO-MAKING-IT-IN-31052015019041 ''The Times of India''], May 31 2015
+==HC: ‘Unwarranted C-sections violate rights’==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F02%2F14&entity=Ar00605&sk=5A8C8660&mode=text  February 14, 2018: ''The Times of India'']
-Kalpana Nair
-The indicators of having arrived as a successful Bollywood heroine are as follows: the Khans should want you in their films, brands should want you in their ads, the industry should want you at their parties, and the audience should just simply want you.Basically you should be desired, respected, envied and lusted after in equal quantities. Until recently , the arduous path to capturing the imagination of a few storytellers and then the fantasies of many million Indian men had a standard trajectory which could be summarised as: Stun them with your beauty . Then lull them with your commercial viability .Finally , surprise them again with your talent. Since her debut in 2006 as the alcoholic girlfriend of a gangster in the appropriately named Gangster, Kangana Ranaut's talent has never been in question. What have been questioned are her diction, her onscreen and off-screen choices and whether she is too “edgy“.
+Observing that “unwarranted” caesarean sections were harmful to the mother and the baby, and a violation of their fundamental rights, Delhi High Court on Tuesday asked AAP government about the steps it has taken to curb this practice by certain hospitals.
-As Tanu Weds Manu Returns races to the 100-crore club and sets this year's highest opening weekend record, here are some of the unsaid yet cardinal rules for Bollywood actresses that Kangana Ranaut has now made a habit of breaking. Please note that breaking them is not in itself a prescription for success but at least there is comfort in knowing that they are not prerequisites.
+A bench of Acting Chief Justice Gita Mittal and Justice C Hari Shankar asked Delhi government’s Directorate General of Health Services (DGHS) to place on record the outcome of deliberations of a panel it had set up to examine and curb the practice of unnecessary caesarean sections (C-sections).
-I GET YOUR BREAK BY HAVING A RELATIVE I IIN BOLLYWOODBEING A SUCCESSFULI IMODEL IWINNING A BEAUTY PAGEANT
+“The DGHS to place on record the outcome of the deliberations and steps taken, if any, on the issue,” it said and listed the matter for further hearing on July 9. The bench also asked the Medical Council of India to examine the issue and place a report before the court before the next date of hearing.
-Unlike Deepika Padukone or Anushka Sharma who were successfully modelling when they got their break or Priyanka Chopra who won Miss World or Sonakshi Sinha and Alia Bhatt who are industry kids, Ranaut worked her way into Gangster without a family reservoir of connections and experience or a parallel thriving career.
+The central government took the stand that health was the responsibility of the state government, which has to formulate the regulations.
-I DO A BLOCKBUSTER WITH THE KHANS
+The court was hearing a PIL by an NGO which has claimed that lack of regulations was leading to increasing number of C-section births taking place in private hospitals. It has alleged that unnecessary C-sections occur as mothers are not given adequate information to make an informed decision about child birth.
-Ranaut has been working in Bollywood for 9 years but has never starred in a film with Aamir, Shah Rukh or Salman Khan as a leading lady. In an industry where the Khan stranglehold has now held for over two decades, that is quite a feat.
+==2018/ Incidence is higher in private hospitals==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F12%2F08&entity=Ar01212&sk=7B6B7890&mode=text   DurgeshNandan Jha, More C-secs in pvt hosps, finds study, December 8, 2018: ''The Times of India'']
-I NEVER DO A SUPPORTING ROLE
-A cameo for a friend is fine and so is an item number. But actresses look ing to hit the big league usually do not take kindly to supporting roles. Yet in films like Fashion, Life...In a Metro and Krrish 3, Ranaut has consistently done supporting roles with no compunction.
+''Large Numbers Done Without Medical Need''
-I CAREFULLY ALTERNATE A COMMERCIAL FILMI WITH AN “OFFBEAT“ OR “MULTIPLEX“ FILM
+The rate of caesarean deliveries is higher in private hospitals compared to the public hospitals. Why? A first-of-its-kind survey conducted among over a dozen obstetricians and other health staff involved in child delivery at private facilities in Delhi-NCR reveals what has been an unofficial knowledge for long: commercial interests indirectly contribute to high caesarean delivery rates.
-Nothing wrong with doing a Piku after a Happy New Year, or a Finding Fanny after Goliyon Ki Raasleela Ram Leela, or an NH10 after PK, or a Mary Kom after Gunday . It's definitely the safer and more practical way of gaining acting cred. But it takes a special kind of appetite for risk to do a supporting role in Krrish 3 and then go into a trifecta of risky films whose success hinges almost entirely on your shoulders like Rajjo, Queen and Revolver Rani. Even when it goes wrong, you have to applaud the guts.
+The survey results published in the journal BMC Pregnancy and Childbirth, however, states that most respondents conceded that caesarean section rates in the private maternity homes they visited were unjustifiably high, and that a substantial proportion of procedures were performed without clear medical need.
-I ONLY WORK OPPOSITE STARS
+When asked about the reasons, they said providers’ convenience, in terms of time spent and timing of deliveries was the most important consideration for doctors. “Vaginal delivery could involve more than 12 hours of labour and occur at inconvenient times, particularly during the night. Caesareans allowed doctors to exercise control over the duration and timing of delivery,” the respondents said.
-While tal ented, Rajkummar Rao in Queen, R. Madhavan in Tanu Weds Manu and its sequel, and Vir Das in Revolver Rani are not big draws commercially . But that doesn't seem to be a consideration for Ranaut, whose next is Katti Batti with Imran Khan who is currently battling a reputation as box office kryptonite.
+The obstetricians also held cited work pressure, concerns about decision making and fear of legal action as reasons behind higher caesarean delivery rate. “Decision making is very tough, how long you have to wait for a normal delivery is very difficult to assess,” said a private sector obstetrician.
-I NEVER EVER ADMIT TO HAVING A LESSI ITHAN IDEAL FAMILY
+According to the survey report, which was conducted by researchers from London School of Hygiene and Tropical Medicine and Sitaram Bhartia Institute of Science and Research, some respondents suggested that the use of technologies such as ‘cardiotocography’ machines for continuous foetal heart rate monitoring could also be increasing the frequency of decisions for caesarean deliveries. “They described doctors panicking or becoming ‘hyper’ when they saw decelerations in foetal heart rate, leading them to perform a caesarean section even though the labour may have progressed normally,” the report said.
-If you hear actors in Bollywood talk about their parents, it is like listening to someone read from a Mother's or Father's Day greeting card or the script of a Karan Johar film.
+On commercial interests being a reason for caesarean delivery, many respondents interviewed referred to hospitals, rather than individual doctors, being financially motivated. “Hospitals earn about 30% to 50% more revenue as the result of a caesarean delivery...,” a hospital executive told the researchers. But other interviewees insisted commercial incentives played no part in doctors’ decision, the BMC report said, adding that many emphasised that obstetricians ‘don’t do it for money but to save time’.
-It would appear that everyone who has birthed a Bol lywood star is a supportive paragon of perfection descended straight from the heavens above. No one is compelling them to reveal the private mechanics of their family life but a modicum of truth every now and then would be nice. So when a Kangana Ranaut spoke of rebelling against her father, run ning away from home and the pervasive gender bias that seeps into everyday life in a refreshing interview with Anupama Chopra, her candour was completely unprecedented.
+Lack of training of nurses in midwifery and patient demand were other factors for higher caesarean delivery in private sector, according to BMC report. “Respondents perceived that women viewed caesarean as an ‘easy way out’ of the pain of labour, and spoke about women hearing accounts of traumatic experiences, through their word of mouth or the media, which led them to request caesarean deliveries,” the researchers have stated. Other patient-related factors included the convenience of a ‘short cut’ delivery and desire to schedule deliveries on auspicious dates, the report said.
-Kangana Ranaut drops truth bombs quite casually, she doesn't bother with setting the stage or halting for a pregnant pause.
-Her ruthless honesty is finally turning the tide in her favour . She is, she says, a “product of many coincidences, incidents and excellence“. Basking in the triumph of her double role in Tanu Weds Manu Returns, she tells KALPANA NAIR that the film was a risky choice, what she has learnt by not working with the Khans and how she ranks her own performances
-''' ''Tanu Weds Manu Returns (TWMR) has grossed the highest opening weekend figure for 2015. '' '''
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-''' Was it a risky film to take on? '''
+==2018: the extent of the practice==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%252F2020%252F07%252F31&entity=Ar00112&sk=16D67F6F&mode=text  Rema Nagarajan, Excessive C-secs cost families ₹5,000cr/yr, July 31, 2020: ''The Times of India'']
-Yes, it was a big risk because it is not a gim micky film. It has a very sensitive storyline -it asks if you actually found a tame version of your spouse with all her imperfections re moved, would you go for her or the person you first fell for? If the audience thought: `This is ultimately Kangana, so what difference does it make whether he goes with Kangana 1 or Kangana 2?' then there would be no second part to the film. It was risky taking on the responsibility of ensuring that that you cre ated two very different characters for the audience.
+Excessive caesarean deliveries in private hospitals could be costing Indian families over Rs 5,000 crore extra every year. This sobering conclusion emerges from an analysis of data compiled from three official reports released recently by the Sample Registration System, the Civil Registration System and the National Statistical Office (NSO).
-''' The last time a mainstream actress in Bollywood pulled off a central double role successfully was Kajol in Dushman (1998) and Sridevi in Chaalbaaz (1989). What is the key to doing a great double role? '''
+An analysis of the data reveals that 28.5 lakh more caesarean sections were done in private hospitals across the country in 2018 than the acceptable international ratio of normal to caesarean births. The average extra cost of each such procedure comes to about Rs 18,000. This means that the 28.5 lakh extra caesarean deliveries cost a total of Rs 5,130 crore.
-If you assign two different body lan guages to both the characters, you can pull it off. But that is hard work. You re ally need go deep into the character's upbringing, experiences, future plans and ideology . Not many actors stress on the body language of their characters but it can help you create two different personalities and help the audience give into the illusion of two different people.
+An estimated 26 million babies were born in India in 2018, as per the civil registration system (CRS) report. According to the Sample Registration System report of 2018, India’s rural birth rate is 21.6 while the urban rate is 16.7.
-''' Why haven't we seen you in a film opposite the Khans or say, young stars like Ranveer Singh, Ranbir Kapoor, Arjun Kapoor or Varun Dhawan? '''
+''' Pvt hosps report 55% C-secs, govt ones 17% '''
-It's an amazing coincidence. My films may or may not work but they are mine and I have learnt to take responsibility for them. I don't just dance at parties to celebrate a film's success but say `oh, it was the hero's film' when it flops. This has made me alert. I don't go, “Oh if that hero is doing this film it must be good“ or “I trust his instincts more than mine.“ I know actresses who, if a certain hero has been signed for a film, would chase the director for a role even without reading the script. Also, I came to the industry as this person who has nothing to lose so I have been relatively fearless. I also got really excited about the process of acting, making a career out of it, buying a house with my earnings, taking care of people. These are things you appreciate when you are an independent woman.
+About 66% of the estimated mid-year population of 1.3 billion, or 860 million, was in rural areas and 443 million (34%) in urban areas. Applying the birth rates to these figures gives us 18.6 million babies born in rural India and 7.4 million in urban areas in 2018. The NSO report on health expenditure shows that 21.3% of deliveries in rural India and 47.8% of those in urban areas happened in private hospitals. Thus, the number of babies born in private facilities would have been 39.6 lakh in rural India and 35.4 lakh in cities and towns. That’s a total of 75 lakh childbirths in private hospitals.
+The C-section rate in private facilities was 55%, 38 percentage points more than just 17% in government facilities. If we treat the 17% figure as a yardstick, there were 28.5 lakh more caesarean sections done in the private health sector than the acceptable rate.
-In a recent conversation with Irrfan you told him that that your last four roles have been so challenging that they literally gave you grey hair.
+The NSO report also gives the average expenditure on normal and caesarean deliveries in both rural and urban areas. Comparing these shows that a caesarean delivery cost on average Rs 16,475 more in villages and Rs 19,548 more in towns and cities. Taking the overall average for the extra cost at about Rs 18,000, and multiplying this by the 28.5 lakh extra caesarean deliveries in the private sector gives us a figure of Rs 5,130 crore.
-''' You have also been honest about your clashes with your father and your initial days of struggle in the industry. Where does this candour come from? '''
+But is 17% a reasonable yardstick? In Nordic countries, known to have the best healthcare, caesarean sections constitute about 17% of all deliveries. The international healthcare community has considered the ideal rate for caesarean section to be between 10-15% since 1985, said a WHO statement.
-I am completely honest with myself and people love me because I think I am very pure. I have got nothing to hide. And I am so proud of my grey hair.My mother got hers in her late 40s and I got mine in my 20s.
+India’s own c-section rates have been steadily rising from 9% in 2005-06 to 18% in 2015 and 28% in the latest NSO report.
+“It is shocking and alarming that the proportion of csections has jumped from just 17% in the National Family Health Survey of 2015-16 to 28%. It goes to show that we need to intervene immediatel...,” said Dr Rinku Sengupta of Sitaram Bhartia Hospital, one of the few private hospitals to make its caesarean rates public.
-''' In an interview, you rated your performance in Gangster higher than Queen. Why? How do you judge your performances? '''
+===2019-20===
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F12%2F15&entity=Ar00304&sk=A5DF7EC3&mode=text  Rema Nagarajan, December 15, 2020: ''The Times of India'']
-Gangster's protagonist was too flawed. She had nothing going for her.If a woman betrays her lover, falls in love with another man, kills him and then commits suicide but the audience still felt for her, then it means that the actor has done a brilliant job. In TWMR, unlike Queen, I didn't have the luxury of delving deep into the psychology and mind of my characters. It is a plot-driven, commercial film and it has a particular rhythm which you can't break. I had to surpass my limits in this film. So in a way , it was a bigger victory for me (than Queen).
+[[File: % share of C-section childbirth in India, 2019-20.jpg|% share of C-section childbirth in India, 2019-20 <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F12%2F15&entity=Ar00304&sk=A5DF7EC3&mode=text  Rema Nagarajan, December 15, 2020: ''The Times of India'']|frame|500px]]
-''' With TWMR heading towards the 100-crore club, you are being talked about as the `female Khan' or even `mini Khan'. How do you react to the title? '''
+The normal delivery is no longer normal in private hospitals. In 10 of the 18 states (including the UT of J&K) for which the National Family Health Survey 2019-20 data has been released, C-sections accounted for a majority of deliveries in private facilities, and in three of them, for over 80%. The data shows that the trend has only worsened in almost every state in the four years between the earlier survey and this one.
-For the longest time I was called `Ranawat'. My father would call and nag me and I would try and correct my name in the press. Then the media started referring to me as `Raut', then my grandfather would call me and say , “You have gone there and ruined our name.“ Just when they were getting it right, it has been turned it into `Khan'. I have no intention of becoming a `mini Khan' (laughs).
+Despite West Bengal and J&K having the highest C-section rates in the private sector, 83% and 82% respectively, the overall share of C-sections in the two states was 32.6% and 41.7% as most deliveries happened in public facilities where the rates were much lower.
-=Early life=
-Kangana was born on 20 March 1987 to Asha, a school teacher and Amardeep, a businessman. She has a elder sister, Rangoli and a younger brother Akshit. She was born in a village called Bhambla in Mandi district of Himachal Pradesh.Her family was initially in Shimla and then moved to Chandigarh
-She did her schooling in Chandigarh from DAV model school Sector 15 before moving to Shimla.She completed her high schooling in Shimla.She appeared for Medical Entrance test but failed miserably and could not become a doctor.She then moved to Delhi to become a model and theatre actor. She graduated with Bachelor's degree in Science from Delhi in March 2005.
+The overall C-section rate in Telangana was over 60%, making C-section the new normal for deliveries in the state. Almost half of all institutional births in Telangana happened in the private sector, where the C-section rate was 81.5%. The state also had the highest C-section rate (45%) for public facilities.
+Barring a few states, the proportion of C-sections went up sharply in both private and public facilities since the last survey in 2015-16. The highest jump was in private facilities in Assam, where C-sections went from 53% to 71%.
-==Trading in a comfortable life==
-[http://movies.ndtv.com/bollywood/peek-into-kangna-ranauts-rich-lifestyle-617558 Mid-day] points out that, ''Kangna left behind in her village to become an actress... a luxurious life, a 25-room haveli and an influential family. ''
-Here's what Kangna left behind in her village to become an actress... a luxurious life, a 25-room haveli and an influential family
-While people assumed Kangna Ranaut to be a struggling wannabe actress from Himachal Pradesh when she entered B-Town, the truth is far different.
+''' Gujarat has lowest caesarean rate of 31% in private hospitals '''
-The actress comes from one of the richest and politically most influential families in the state. Hers is not a rags to riches story.
+However, in both Assam and West Bengal, private facilities accounted for only about a quarter of all births. Gujarat had the lowest caesarean rate of 31% in the private sector.
+Public facilities invariably have lower caesarean section rates than private facilities, but the rates have gone up even in the public sector across all states, except in Nagaland, Mizoram and Meghalaya.
-Which explains the lakhs of rupees she spends on clothes, shoes and bags every month, more than even the top actresses of B-Town and star wives.
+C-section rates below 10% are considered to show underuse. By that yardstick, the very low C-section rates in the public sector in Bihar, just 3.6%, a marginal improvement over 2.6% in 2015-16, ought to be a cause for worry. In the three north eastern sates too the C-section rate in public facilities is below 10%.
-'''Have money, won't talk'''
+The international healthcare community has considered the ideal caesarean rate to be 10-15% since 1985, said a World Health Organisation (WHO) statement.
-A source close to Kangna confirms her family affluence, "She doesn't like talking about her family wealth as she's struggled on her own to be in her position. Besides that, she believes it's in bad taste to talk about one's wealth." Her family is from the blue-blooded Rajputs from Bhambla village in Himachal Pradesh.
+In Nordic countries, known to have the best healthcare, caesarean sections constitute about 17% of all deliveries. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate, the statement said, adding that C-sections should ideally only be undertaken when medically necessary.
-'''Our village'''
+Several studies have shown that C-sections can increase the chance of death and complications. The WHO observed in a 2015 statement that the lack of a reliable and internationally accepted classification system to produce standardised data to enable comparison has made it challenging to define an optimal caesarean section.
-Kangna has a huge 25-room ancestral house or haveli in Bhambla (currently called Surajpur) belonging to her great-grandfather. "While it was originally called Bhambla, when Kangna's great-grandfather became the local MLA, the village was named Surajpur after him. " Kangna grew up in a joint family, with her brother, sister, parents, great-grandparents, grand- parents and chacha and chachi. The family owns several acres of land in Surajpur.
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
-'''Luxurious living'''
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-Adds an insider, "Kangna's father Amardeep Ranaut is in the construction business and he supplies construction material for building roads etc for the Public Works Department (PWD) in Himachal Pradesh. She has been brought up in luxury and always had five cars parked in front of her home." But things suddenly took a turn for the worse when she decided to come to Mumbai to become an actress. Her grandfather was dead against any female from his family joining films as he felt it was demeaning.
+==2019/ maternal deaths from C-sections high in developing countries: Lancet==
+[https://www.thehindu.com/sci-tech/health/maternal-deaths-following-c-sections-in-low-and-middle-income-countries-100-times-those-in-high-income-countries-lancet/article26743421.ece  Bindu Shajan Perappadan, Maternal deaths following C-sections in low and middle-income countries 100 times those in high-income countries: Lancet, April 5, 2019: ''The Hindu'']
-'''On your own, please! '''
-Kangna's father too supported his father, and when she insisted on acting, both of them stopped talking to her. Her father told her that he would give her no financial support and she would have to make it on her own.
+''Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries.''
-'''Hard times'''
+Maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, with up to a third of all babies dying, according to data compiled from over 12 million pregnancies. This is according to a new review published in The Lancet, which has considered 196 studies from 67 low and middle-income countries.
-Kangna left home at 16 and initially stayed with a friend in Delhi before coming to Mumbai in 2005. She went through a lot of hardship but never asked her family for help. She lived in Aasha Chandra's hostel and shared a room with three other girls. It was a miserable time for her as she was cut off from her family and struggling in a strange city. It was only after Life In A... Metro that her family relented and welcomed her once again into their fold.
+Information released by the World Health Organization under its sexual and reproductive health section further adds from the study that data from 1990 to 2017 show that a quarter of all women who died while giving birth in low and middle-income countries had undergone caesarean section.
-'''Preity connection'''
+“The outcomes for women in low and middle-income countries are far worse than we expected,” said first author, Dr. Soha Sobhy of Queen Mary University of London.
-There was a family reunion when her parents, sister Rangoli and brother Akshat came to Mumbai. Today, her family is very proud of her.
+Dr. Ana Pilar Betrán, medical officer, WHO, added that the overuse versus underuse of caesarean section is a current global concern and the focus of debates and research.
-Kangna's friend insists, however, that the actress is not related to Preity Zinta. "Preity's maternal aunt is a resident of Surajpur and PZ often comes to meet her. Once during a family function of Preity's in the village Kangna and her siblings met Preity. Now they keep in touch. That's all.
+“In many low and middle-income countries, overuse and underuse coexist, making it particularly difficult to increase the provision of caesarean section to those women in need without aggravating the overuse which, in turn, places women at higher risk of complications,” she said.
-'''Kang's Grandpa'''
+Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries. Timely access to caesarean section when needed is required for safe childbirth, but ‘too little, too late,’ or ‘too many, too soon’ are part of a problem, and not a solution notes the study.
-Kangna's great-grandfather (and idol) Sarju Singh Ranaut left his job as a head clerk [and not an IAS officer; there was no IAS then] for the British government to become a freedom fighter with Mahatma Gandhi.
+A third of all deaths following caesarean section were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia, 22% to sepsis, and 14% to anesthesia related causes.
-Kangs still has the letters Gandhiji wrote to her great-grandfather. He was also the only man from his village who knew English at that time and got electricity to his village.
+The study further says that while many women in need of caesarean sections still do not have access to it, particularly in low-resource settings, many others undergo the procedure unnecessarily, for reasons which are not medically justified.
-=Early career=
+Lead author Professor Shakila Thangaratinam, Queen Mary University of London, added: “Caesarean sections are the most commonly performed operation worldwide. They are meant to be life saving for both mother and baby. Now that we know the risk factors and countries associated with poor outcomes, we can make a more targeted effort so that timely and safe caesarean sections can be done wherever they are needed.”
-'''Kathak''' Kangana is a trained Kathak dancer. Kangana has been taking training at Nateshwar Nritya Kala Mandir,Khar for the last 4 years under the guidance of Rajendra Chaturvedi.
-'''Modelling''' Kangana joined Elite Modelling Agency Delhi in 2003 with prospect of becoming a model but was not successful and hence left it before becoming a model.
+The authors also highlighted that training is needed in decision making to reduce unnecessary caesarean sections, and in appropriate intrapartum care including instrumental deliveries to reduce caesarean sections performed in the second stage of labour, which carry greater risk.
-'''Theatre''' Kangana ,joined as a theatre actor for Asmita Theatre group during 2003-2005 , before relocating to Mumbai.She came to Mumbai in early 2004 and struggled initially to get in to movies but went back to Delhi to complete her education. She also joined Asha Chandra's acting school in 2004 to brush herself to face camera.
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-'''First film''' After struggling for nearly two years she met her first director Anurag Basu in September 2005 and was selected for Gangster.
+=Cardiovascular diseases=
-==The first film she signed was 'shady' (adult)==
+==2012-14: Risk of cardiovascular diseases, state-wise==
-[http://photogallery.indiatimes.com/celebs/bollywood/kangana-ranaut/kangana-almost-signed-an-adult-film/articleshow/56288921.cms    Kangana almost signed an adult film? Jan 2, 2017, BCCL]
+[https://www.thehindu.com/sci-tech/science/kerala-most-at-risk-of-cardiovascular-disease-finds-national-survey/article24203625.ece  R. Prasad, Kerala most at risk of cardiovascular disease, finds national survey, June 19, 2018: ''The Hindu'']
+[[File: The risk of cardiovascular disease, state-wise- rural and urban areas.jpg|The risk of cardiovascular disease, state-wise- rural and urban areas <br/> From: [https://www.thehindu.com/sci-tech/science/kerala-most-at-risk-of-cardiovascular-disease-finds-national-survey/article24203625.ece  R. Prasad, Kerala most at risk of cardiovascular disease, finds national survey, June 19, 2018: ''The Hindu'']|frame|500px]]
-National Award-winning actress Kangana Ranaut, who made her debut in Bollywood with 2006 romantic crime drama film 'Gangster', says if she had not got that offer, she would have started her career with a very shady film. (BCCL)
-While talking about the turning points in her career, Kangana said on TV show: "I think the first ever would be the break that I got from my film 'Gangster'... Because I remember getting a very shady offer, I think it was not a right movie. But I was like, 'Okay, fine, I'll do it'." (BCCL)
-She added, "And then I did a photo shoot and then they gave me robe and there was nothing inside the robe. And it looked like some blue film or something and I was like, 'This doesn't look right'. Because it's obviously not the right film." (AFP)
-So did she walk out or do that film? Kangana said, "No, but then I got 'Gangster' and I'm like 'I'll do that film.' And then my producer got furious and I was in trouble for some time because I abandoned that project. And I was very young, I was 17 or 18. And if I would have not gotten 'Gangster', I am sure I would have done that film. But I think the thing about me was that I always said yes to every offer!" (BCCL)
-=Relationships: An acerbic love life=
+''Adults in urban areas and those with a higher household wealth, are more at risk''
-==Dating history==
-[http://dating.famousfix.com/tpx_329047/kangana-ranaut/dating-history Famous Fix]’s ‘Historical look at Kangana Ranaut's relationships, listed in date order’ reveals the following historical epochs:
-Kangana Ranaut and Aditya Pancholi	2004 - 2008
+Two recent national surveys of nearly 8,00,000 adults between 34 and 70 years, has found that '''people of Kerala — across sexes — were most at risk of cardiovascular diseases''' while those in Jharkhand were least likely to have the condition. A gender break down, however, puts the women of Goa at highest mean cardiovascular risk at 16.73% while men in Himachal Pradesh and Nagaland were most vulnerable with mean cardiovascular risk of 24.23%.
-Adhyayan Suman and Kangana Ranaut	2008 - June 2009
+The studies carried out between 2012 and 2014, found wide variations in the average 10-year risk of a fatal or nonfatal cardiovascular disease event among States. A paper published on June 19 in PLOS Medicine found the risk ranging from a low of 13.2% for both sexes in Jharkhand to 19.5% in Kerala.
-Kangana Ranaut and Kintaro Mori	2009 - 2010
-Kangana Ranaut and Dino Morea	February 2010
+'''Urban tendency'''
-==The men==
-''' The men in Kangana Ranaut's life '''
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/Kangana-Ranauts-alleged-relationships/photostory/31899660.cms ''The Times of India'']
+The study, led by researchers at Public Health Foundation of India and Harvard T.H. Chan School of Public Health, found that adults in urban areas, as well as those with a higher household wealth, tended to have a greater cardiovascular risk.
-==Aditya Pancholi==
-According a report in dna.com, ''' Aditya Pancholi ''' is all set to release a tell-all book where he will also allegedly reveal the juicy details of his relationship with Kangana Ranaut.
-Kangana's professional life may be going great guns, especially after films like Krrish 3 and Queen, but Kangana Ranaut's personal life is far from perfect. She has made it to the headlines time and again because of her controversial link-ups. One such episode is that of her link up with Aditya Pancholi. Kangana was allegedly in a relationship with Aditya Pancholi who is elder to her by 20 years. However, this love story, that had been kept under wraps for long, might make it to a book that is being penned down by Aditya Pancholi. If sources are to believed then, Aditya in his autobiography, will highlight details about their explosive relationship.
+With 19.90%, adults living in urban areas in Kerala had the highest mean risk, followed by West Bengal (19.12%) and Himachal Pradesh (18.97%). In contrast, those living in urban areas of Daman and Diu had the lowest mean risk (12.60%), followed by Bihar (13.63%) and Arunachal Pradesh (14.71%).
-Let's take a look at tales of Aditya and Kangana's alleged romance..
+In general, the cardiovascular risk is lower in rural areas compared with urban areas. But Goa has bucked this trend with the rural areas showing a higher mean value (18.92%) than the urban areas (18.79%).
-Kangana Ranaut was a struggler when she had met actor, Aditya Pancholi. Reportedly, the two soon fell in love and were in a relationship, despite the huge age gap of 20 years between the two and the fact that Aditya was a much married man with children. However, things began to unravel when reports of physical abuse started making the rounds. Things went kaput and the two parted ways. Aditya Pancholi was rumoured to have paid a huge amount to Kangana in order for her to buy a house. He had apparently even paid for her sister's hospital bills when she became a victim of a cruel acid attack. At a press conference, when asked about her former boyfriend, the actress said that there was a time when she and Aditya Pancholi knew each other well but also admitted to not talking to him any longer.
+In the case of Kerala, the difference between highest mean risk in rural (19.23%) and urban areas (19.90%) is meagre.
-Kangana's relationship with Aditya might now become public knowledge, what with Aditya's tell-all book
+The study used the data from the District Level Household Survey-4 (DLHS-4) and the second update of the Annual Health Survey (AHS). The surveys covered 27 of the 29 States and five of the seven Union Territories.
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Aditya-Pancholi-had-warned-Adhyayan-about-Kangana/articleshow/52021470.cms ''The Times of India'']
+The same questionnaire and methodology was used throughout to collect clinical, anthropometric, and biomarker measurements.
-''' Aditya Pancholi had warned Adhyayan about Kangana '''
+While smoking (a risk factor for CVD) was more prevalent in poorer households and rural areas, wealthy households and urban locations faced risks from high body mass index, high blood glucose and high systolic blood pressure.
-TNN | Apr 28, 2016
+=Cath-labs, coronary interventions=
+==2010-15: sharp increase==
+[http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=Number-of-cath-labs-in-country-up-100-04052017015013  Sushmi Dey, Number of cath-labs in country up 100% in 5 years, May 4, 2017: The Times of India]
-The shocking details revealed by Kangana Ranaut's ex-boyfriend Adhyayan Suman are blood-curling indeed. But the star kid admits that he was forewarned, none other than Aditya Pancholi. It is said that Kangana and Aditya were in a tumultuous relationship, one that she has on many occasions has referred to as an exhausting experience.
+[[File: Cath-lab centres, coronary interventions, coronary interventions per centre, total stents and stents per procedure, 2010-15.jpg|Cath-lab centres, coronary interventions, coronary interventions per centre, total stents and stents per procedure, 2010-15; [http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=Number-of-cath-labs-in-country-up-100-04052017015013  Sushmi Dey, Number of cath-labs in country up 100% in 5 years, May 4, 2017: The Times of India]|frame|500px]]
+[[File: Infant mortality and doctors.jpg| Infant mortality and the availability of doctors. See also [[Infant mortality: India ]] |frame| 500px]]
-When rumours of their link-up were doing the rounds, Kangana and Adhyayan had attended a party together where they'd bumped into Aditya. He narrated to DNA, "A film called 'Haal-E-Dil' was releasing and she had come for the premiere. I remember Aditya Pancholi was standing at the exit and Kangana was just walking out. He stopped me, looked into my eyes and said, "Welcome to the circus my friend and all the best!" I didn't understand at that time. Kangana clarified saying that Aditya did that to intimidate people with her. I told her I am not scared because we are not doing anything wrong. At the time we were getting to know each other, but we hadn't made it public."
+[[File: shortage of skilled manpower.jpg|Shortage of skilled manpower in government hospitals as a percentage of requirement, Graphic courtesy: [http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=Reform-medical-education-transform-healthcare-23032015012021 ''The Times of India'']|frame|500px]]
+[[File: vacant specialist seeds in various medical departments.jpg|Vacant specialist seeds in various medical departments, Graphic courtesy: [http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=Reform-medical-education-transform-healthcare-23032015012021 ''The Times of India'']|frame|500px]]
+[[File: India and the world, India is the 103rd healthiest country.jpg| India and the world: India is the 103rd healthiest country ; Graphic courtesy: [http://epaperbeta.timesofindia.com/Gallery.aspx?id=15_11_2015_019_067_002&type=P&artUrl=PUTTING-INDIA-ON-THE-MAP-15112015019067&eid=31808 ''The Times of India''], November 15, 2015|frame|500px]]
-How he now wishes that he had paid heed to the word of caution...
+'''Coronary Interventions Rise By 51% In Just One Year: Study'''
-==Adhyayan Suman==
-''' Adhyayan Suman: ''' The two met on the sets of their film, Raaz 2 and love blossomed. Kangana had broken up with Aditya Pancholi and reportedly found love in the arms of Shekhar Suman's son, Adhyayan Suman. The two were going steady for a while but things seemed to turn sour and the duo called it quits. Some media reports allege that it was Adhyayan's dad, Shekhar Suman who was against the relationship and wanted his son to marry the daughter of a prominent builder. However, in spite of what rumour mills were saying, the two parted ways. In an interview to The Times Of India, Adhyayan said, "Yes, we've moved on from this relationship. I guess this was how long it was meant to last. At this point, I really want to focus on my career and professional commitments. Sustaining a long-distance relationship of this intensity is tough." Kangana also admitted that they had moved on, and that she was shocked by Adhyayan's decision. "Adhyayan and I had a talk about our relationship and it was his decision to move on. It came as a shock to me. But I guess he has other priorities now, and many options in terms of people to be with. It's an amicable break-up and I wish him the best".
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Adhyayans-parents-disclose-more-disturbing-details-about-his-relation-with-Kangana-Ranaut/articleshow/52091919.cms ''The Times of India'']
+Cath-labs and coronary interventions in India are increasing exponentially , adding substantially to healthcare expenses.While cath-labs have more than doubled in the last five years, from 251 in 2010 to 630 in 2015, coronary interventions rose 51% within a year, between 2014 and 2015, a new study by a thinktank shows.
-''' Adhyayan’s parents disclose more disturbing details about his relation with Kangana Ranaut '''
+Increased interventions have resulted in a higher number of stents being used in procedures. The data shows 4,75,000 stents were used in 2015 for 3,75,000 coronary interventions. The figures stand out as just 1,46,719 stents were used in 1,17,420 cardiac interventions in 2010.
-Rachel Baker | TNN | May 3, 2016
+A paper published by Observer Research Foundation (ORF), based on analysis of data from different sources, highlights the potential role of price control in keeping health care costs in check. Acknowledging stent price capping is a significant step by the government, it suggests India needs greater transparency in costing systems, outcomebased measurements and evidence-based policy-making.
-Adhyayan Suman and Kangana RanautAdhyayan Suman and Kangana Ranaut
+Authored by Ramesh Bhat, former professor at IIM Ahmedabad and president of the Indian Health Economics and Policy Association, and Denny John, Evidence Synthesis Specialist at Campbell Collaboration, the study says any analysis of the implications of economic regulations, including price controls, will need a detailed appreciation of market forces.
-To state that the Hrithik Roshan - Kangana Ranaut legal battle is getting murkier by the day is an understatement. And to add fuel to the fire, Kangana's former flame, Adhyayan Suman made some startling revelations about his relationship with the National Award winning actress. In an interview with DNA, Adhyanan alleged that the 'Queen' actress had abused him and performed black magic on him during their year-long courtship.
+Cardiovascular diseases are now the leading cause of mortality in India, with a quarter of all deaths in 2015 attributed to the disease. According to the Global Burden of Disease (GBD) 2015 study , death rate due to heart diseases in the country stood at 272 per 100,000 population. Even with such figures, the paper suggests, cardiovascular diseases in India remain highly under-diagnosed though the number of coronary interventions like angioplasty are growing every year.
-Now, Adhyayan's father, Shekhar Suman and his wife, Alka have lashed out at Kangana for allegedly hypnotising and abusing their son. In an interview with ABP News, Shekhar said, "One day my wife opened Adhyayan's drawer and she found supari, some coins and other weird things in it. She called me and asked 'kya hai yeh?' I hope he is not doing something crazy." Alka added, "We called the pandits and spoke to them. Even the pandits said she had performed 'vashikaran' on him...don't know how much of it is true, but he was completely obsessed with her. From his eyes, he looked as if he was drugged or under someone's spell."
+Moreover, the findings show, the use of expensive high-end drug eluting stents (DES) has also gone up contributing to the increasing healthcare costs. According to the paper, the share of DES in the total use of stents has reported a compounded annual growth rate (CAGR) of 53.52% between 2002 to 2015, whereas total stent usage has grown by 22.86% in the same period.
-He then continued, "One day, he came home completely bald. When we asked him why he chose to go bald, he replied by saying 'you won't understand fashion.' We later learnt that Kangana ji had made him do this. She told him that he looked nice this way." Narrating the Filmfare incident Shekhar said, "We were watching the function, Kangana was walking ahead and Adhyayan was walking 15 feet behind her as though he was her bodyguard and she was giving interviews and he was standing just like that, and I felt so horrible for my son. I must have died a thousand deaths... Eventually, she went on stage and thanked everyone, except Adhyayan. She also refused to pose with Adhyayan for any photo shoot or magazine cover."
+It also highlighted the sources of financing of coronary procedures in India, which has a great deal of impact on household expenditures as majority of it is still borne out-of-pocket. The findings show over 43.9% of the financing of the coronary procedures in 2014 were conducted through out-ofpocket expenditure. Analysis of the NSSO 71st round done in the paper also show that one-fifth of hospitalisations due to CVD were paid for by borrowings or sale of personal assets. The same survey found that 53% of the population suffered from `catastrophic' health expenditures.
-He further added, "One day he (Adhyayan) called us up at 2 - 3 am and was crying. We asked him what happened and where he was. We were so worried. He told us that Kangana had locked him out of the house and that he was crying to let him in. I then asked Adhyayan to let me speak to Kangana and request her to take him in. When I spoke to her, she said 'I won't let him in and let him stand out the whole night, I can't allow him in.' I was emotionally disturbed and I got very angry. How could anybody do this to my son?"
+The study says severity of penalty is essential to price control and in determining compliance. Besides, the government or the regulator will also need to create an ecosystem to ensure effectiveness of such regulation.
-Adhyayan's mother, Alka added, "She was horrible ya... At Hrithik Roshan's party, she abused my son with MC - BC gaalis and threw her chappal at him. She was completely drunk. She created a huge nuisance... I think Adhyayan was in Mumbai and Kangana was out of India shooting for 'Kites,' when he stumbled upon some of her intimate messages which she had sent to Hrithik." Shekhar added, "She led Adhyayan to believe that such messages were very normal, very casual. But that's when he made up his mind that he was being taken for a ride."
+Advocating for more effective monitoring of quality of medical products, the paper says, “Given the fact that currently the market for medical devices is poorly regulated, and there is no formal system to monitor quality of care, price control could have a negative impact in terms of entry of inferiorquality and outdated products in market“.
-==Other men==
-''' Ajay Devgn: ''' Kangana Ranaut allegedly got involved with Ajay Devgn when the two were shooting for Once Upon A Time In Mumbaai. The two actors reportedly got along well and soon their camaraderie seemed to blossom into a love affair with no strings attached. Ajay Devgn was married to Kajol and their love story is also of epic proportions. As per media reports, it was a casual romance where none expected anything from the other. It is also alleged that at Ajay's insistence, Kangana was cast in films like Rascals and Tezz. Vidya Balan was reportedly the original choice for Tezz but allegedly, Ajay Devgn convinced director, Priyadarshan to cast Kangana. But things reportedly seemed to get out of hand when Kangana got emotionally involved with Ajay and this did not go well with him as he had no intentions of leaving his wife, Kajol. In a controversial interview to Stardust magazine, Kangana even went on record to say that getting involved with a married man was a mistake.
-''' Nicholas Lafferty: '''  Kangana Ranaut was said to be in a rebound relationship with UK-based doctor and scientist, Nicholas Lafferty. While she was initially mum about her romance with the doctor, she went on record on Simi Garewal's show to say that she indeed was dating the 28-year old and they were in a long distance relationship. Kangana was spotted with Nicholas at several events in Mumbai and the two were going steady but to everyone's surprise, the duo called it quits. Maybe it was the distance between them made their affair a short-term one.
+The paper recommends setting up of a Medical Technology Assessment Board (MTAB) to initiate evidencebased health policy process.
-=Hrithik Roshan- Kangana =
+=Charity hospitals=
-==THE ALLEGED RELATIONSHIP==
+==Many misuse tax breaks: CAG==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=No-clear-definition-of-charitable-21082017011015  `No clear definition of charitable', August 21, 2017: The Times of India]
-== Kangana’s friend claims Hrithik proposed in 2014==
-[https://www.indiatimes.com/entertainment/celebs/a-new-twist-in-the-tale-hrithik-proposed-kangana-in-2014-right-after-his-divorce-announcement-252131.html   ISHA SHARMA | A New Twist In The Tale, Hrithik Proposed To Kangana In 2014 Right After His Divorce Announcement! | MARCH 17, 2016 | IndiaTimes/ ''The Times of India'']
+Income tax exemptions worth hundreds of crores have been given to hospitals claiming to be charitable institutes, but they may be doing little or no charity , according to a recent report of the Comptroller and Auditor General. CAG has asked for measurable parameters to assess the extent of charitable activities by hospital trusts availing tax exemptions as the public exchequer could be losing crores without any public benefit.
-As if the legal tussle between Hrithik Roshan and Kangana Ranaut was less bizarre that now there is another twist in the tale! From calling each other mentally unstable and insane to passing sly comments about each other on social media platforms, we indeed have never seen such an ugly side of a break-up.
+While various sections of the Income Tax (I-T) Act allow hospitals, nursing homes and medical research institutes to avail of relief and incentives, many institutions that charge patients claim and get exemption by virtue of the fact that they are registered as trusts, the report pointed out. The fact that the I-T Act has no performance-spe cific definition of what is “charitable“ is part of the is “charitable“ is part of the problem, says a CAG report .
-After publically declaring their hatred and dislike for each other by slapping legal notices at each other, some more bizarre details of their love affair have emerged! A close friend of Kangana revealed that Kangana and Hrithik were all set to marry each other. It was after Hrithik announced his divorce in 2014 that he proposed to Kangana in Paris! Yes. Like a dreamy proposal.
+Many charitable trusts receiving significant amounts in gross receipts were not being selected for scrutiny by the I-T department, according to CAG.The report examined cases completed from 2012-13 to 2015-16.
-After meeting his parents in London, Hrithik flew over to meet Kangana in the French capital along with the ring, this was the proposal:
+Even when measurable parameters exist for assessing the extent of charitable activities, the I-T department is unable to deny exemption, said the CAG report. For instance, the Bombay Public Trusts (BPT) Act, which governs charitable trusts in Maharashtra, required trusts to fulfil certain conditions -including setting aside 10% of beds for free treatment of the poor and 10% for treatment at concessional rates and putting 2% of total billing into an indigent patient fund to treat the poor. The CAG audit of 10 trust hospitals registered under this act found that a majority did not fulfil these conditions.Since the I-T Act does not identify non-compliance with the BPT Act as grounds for denying exemption and has no measurable parameters of its own, these hospitals continue to get exemption worth crores despite flouting the conditions.The audit found that these 10 hospitals alone had “availed non-justified exemption“ that amounted to Rs 77 crore.
-"You may think this is coming out of a rebound. But I have no doubts about our future happiness because you are the only person who has never judged me. And I have felt a strong connection with you from day one."
+The audit cited the example of a charitable trust in Kolkata that was “functioning as an intermediary of a corporate hospital“. In another case, a trust was collecting fees for a threeyear postgraduate course in a Mumbai hospital. The course itself had been declared illegal by the Medical Council of India. Despite these violations, the I-T department could not deny exemption “for carrying out unauthorised business in the garb of charity“.
-And then things turned ugly. The source added that:  “She was on top of the world as he also told her he wanted to marry her after the divorce. In the first week of February, soon after he resumed shooting for Bang Bang, Hrithik stopped communicating with her. Kangana took off for a vacation in New York where she heard rumours about his growing closeness to his Bang Bang co-star Katrina Kaif. On February 14, she confronted him about the rumours when Hrithik called her and asked him, to be honest with her. He only wanted to know if anyone was aware of the engagement. When Kangana told him that she had informed her family about it, he said that she had misunderstood his intentions."
+Section 80G of the I-T Act, which provides exemption to donations that charitable trusts receive, stipulates that receipts issued to the donor should bear a reference number and date of the order. However, the audit found that section 80G certificates were available in just 10% of 87 cases in the standalone hospital category . For instance, a Pune-based trust involved in education and the medical sector received a corpus donation of Rs 19.4 crore in 2012-13, of which Rs 16 crore was shown to be received from one company that has an authorised and paidup share capital of just Rs 5 lakh. The financial statements of this donor were not available.Despite a preponderance of such violations of the conditions of section 80G, no action was found to have been taken, noted the report.
-==THE SPAT/ 2016==
+= Charter of Patients’ Rights=
+==Draft charter, 2018==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F09%2F18&entity=Ar01305&sk=C4CE1153&mode=text  Charter frees patients from grip of hospitals, September 18, 2018: ''The Times of India'']
-[http://epaperbeta.timesofindia.com/Gallery.aspx?id=19_04_2016_008_016_008&type=P&artUrl=Hrithik-gives-more-proof-cops-to-meet-Kangy-19042016008016&eid=31808 The Times of India]
-''' Hrithik- Kangana spat: Major developments between 25 Feb and 18 April 2016. '''
-==The highlights==
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/This-is-how-Amul-describes-the-ugly-Hrithik-Kangana-saga/photostory/51458367.cms  ''The Times of India'']
+If the draft Charter of Patients’ Rights put out by the health ministry is implemented, it would give patients the right to buy medicines from any registered phar macy and get diagnostic tests from any accredited diagnostic lab instead of being forced by a hospital to use its in-house pharmacy or lab. The charter, including this and 17 other rights, has been put up on the ministry’s website seeking comments and suggestions from the public.
-The ugly war between Hrithik Roshan and Kangana Ranaut has shocked and saddened the people of India. However, in today’s era, people start seeing the funny side to almost every incident. The makers of Amul are very well known for their quirky and witty cartoons based on the most trending issues. And they have come up with a funny take on the Hrithik-Kangana case in their unique style, as always. As is seen in the picture above, both actors are seen in their ‘Krrish’ attire. The picture is captioned, “Krrish and tell?” and “Never ranaut of it.”
+The charter also includes the right to emergency care without demanding payment, right to have all originals or copies of inpatient records, investigations and case papers within 24 hours or
-The Hrithik Roshan-Kangana Ranaut war has got to be the ugliest one Bollywood has ever seen, what with the two slamming legal notices on each other! However, according to a report on Spotboye.com, Hrithik seems to have received the worst end of the stick. The report quoted Kangana’s lawyer, Rizwan Siddiquee explaining how Kangana can get Hrithik jailed for 10 years under section Section 67 – Publishing of Information which is obscene in electronic form – of IPC. Siddiquee further went on to say that Hrithik can also be charged with sections Section 499 and 500 (Defamation and the subsequent Punishment) and Section 506 (Punishment of Criminal Intimidation to impute unchastity to a woman) of IPC.
+a maximum of 72 hours, right to all information regarding diagnosis, modality of treatment to be given and cost of treatment along with a detailed itemised bill at the end of treatment and right to second opinion from any doctor the patient chooses. If the charter were to be implemented as it stands, hospitals would also not be able to refuse to let families of dead patients take the body without paying the bill.
-Hrithik Roshan and Kangana Ranaut's attempts to keep their torrid love affair under wraps have gone in vain. Not only is their affair out in the open but is headed towards a nasty path with both parties filing lawsuits against each other. A source close to the actor told DNA that Hrithik had sensed this coming and has been preparing for a legal battle since the past two months. The source revealed that "Hrithik was expecting it" and that "he had a closed-door meeting with some of the top officials from the Mumbai Police regarding the matter." So far both the parties have left no stone unturned to malign each other. We earlier informed you that the two have slammed legal notices to each other where Hrithik has accused that Kangana spammed his mail box with “50 mails a day” and even alleged that she suffers from Asperger’s Syndrome, while Kangana has blamed Hrithik of hacking into her account and deleting certain emails.
+According to the notice on the website, the ministry plans to implement the charter through state governments. The charter was drafted by the national Human Rights Commission after the National Council of Clinical Establishments, a statutory body under the Clinical Establishments Act, recommended that it be framed. Feedback on the draft can be given till September 30.
-'''Hrithik's proposal to Kangana: ''' After Hrithik Roshan and Kangana Ranaut slammed legal notices on each other, the murky details of their tumultuous love life is taking everyone by surprise. However, a close friend of Kangana has now spilled the beans on their relationship. In a Mumbai Mirror report, the source has been quoted as saying that, "It started out as a friendship between two people who were both going through a rough patch, during the shooting of 'Kites' in 2009. His marriage was in trouble and his relationship with his 'Kites' co-star, Mexican model-actress, Barbara Mori, wasn't working out. Kangana was going through troubles of her own and they found solace in each other's company and became good friends. The friendship blossomed into something serious when Hrithik began pursuing her for 'Krrish 3,' his home production. Even though Kangana's career was not exactly shining at the time, she said no to Hrithik. She felt rather uncomfortable with the attention he was showing. Hrithik, however, wouldn't take 'no' for an answer. After being pursued for six months, Kangana said 'yes.' That's when they got into a relationship after he confided in her that he and his wife slept in separate bedrooms. However, Kangana could never talk about the relationship openly as Hrithik had told her categorically that he would never divorce Sussanne." The source further added that, "In December 2013, a call from Hrithik took her by surprise. He told her that he was divorcing Sussanne. Kangana was in Switzerland at the time and Hrithik in the US."She was on top of the world as he also told her he wanted to marry her after the divorce. But doubts cropped up in her mind. She didn't know whether Hrithik was serious or not. She kept saying that maybe he wanted to be with her on the rebound. To put all her doubts to rest, Hrithik popped the question when she was in Paris, the city of love. But From then, the relationship mostly went downhill."
+The NHRC draft recommends mechanisms for implementing the charter.
-'''The Asperger's syndrome: '''Hrithik Roshan has also alleged that the 'Queen' actress suffers from Asperger's Syndrome. However, in an interview with Mumbai Mirror, a friend of Kangana has gone on record to rubbish and clarify the whole issue. According to the report, it all started when Kangana was approached for Reema Kagti's 'Mr Challu' where her character would suffer from Asperger's Syndrome and hence, could not lie. The friend further explained, "Hrithik visited her that night and she told him about Reema's script ('Mr Challu'). He responded by pointing out that she also had the same problem and couldn't lie about their relationship. After that he often provoked her by mentioning the syndrome, even bringing it up in the notice, despite knowing that it is not a bipolar, medical condition and only reflects a rare straightforwardness."
+=Cost of hospitalisation=
+==2016-17==
+[http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F11&entity=Ar00122&sk=03900850&mode=text  Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: ''The Times of India'']
-'''Hrithik's allegations: '''Hrithik Roshan has alleged that he has a record of 1,439 mails from Kangana, most of them "senseless, personal and absurd." The notice reads that the actor tried to ignore the emails for the longest time before it got out of hand. Hrithik’s notice further states that Kangana was so obsessed with him that at one point she called his father, Rakesh Roshan. She gave him advice on how to handle his son, who is chasing her via mails and phone calls. However, Rakesh explained that she misunderstood the situation and that his son had no interest in her. The notice also accuses Kangana of having used Hrithik's name to garner publicity. It reads, "Since quite sometime you have been insinuating and trying to create an image within the film industry through print and social media and in public at large that there was some relationship between our client and you.”
+[[File: Average cost per case of hospitalisation, state-wise.jpg|Average cost per case of hospitalisation, state-wise <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F11&entity=Ar00122&sk=03900850&mode=text  Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: ''The Times of India'']|frame|500px]]
-'''Kangana reacts: ''' Kangana claims that she is not some dim-wit teenager who has been smitten thereby causing her to send one-sided love messages. Her legal notice reads, "She is not some dim-witted teenager who has been smitten and that whatever happened between the two of them was with full consent of both parties." She went ahead to claim that Hrithik had hacked into her email account to delete mails that could have complicated his divorce proceedings. As for the allegation that she is suffering from the Asperger's syndrome, Kangana has accused Hrithik of having his own mental issues. Kangana believes that there is no need to call any press conference as per Hrithik’s unwarranted and uncalled for demand to clear the air. The notice states that she never needed Hrithik’s name to garner publicity and that she has achieved stardom on her own.
+[[File: Average cost per case of hospitalisation, urban, state-wise.jpg|Average cost per case of hospitalisation, urban, state-wise <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F11&entity=Ar00122&sk=03900850&mode=text  Rema Nagarajan, 1 in 5 urban families forced to borrow to fund hospital stay, December 11, 2017: ''The Times of India'']|frame|500px]]
-'''When things unraveled: ''' It all started over the casting of 'Aashiqui 3.' When Kangana was asked as to why wasn't she a part of the film, she commented, “Yes, many lame rumours are doing rounds, even a dumb ass can tell where these rumours are coming from. I don’t know why exes do silly things to get your attention. For me that chapter is over and I don’t dig graves." To this, Hrithik had tweeted a reply that read, "Ther r more chances of me having had an affair with d Pope dan any of d (Im sure wonderful)women d media hs ben naming.Thanks but no thanks." This apparently didn't go well with both sides and led to them filing legal cases against each other.
+About a quarter of all rural households and one in five urban families in India are forced into debt or sale of assets to meet hospitalisation costs. This is true across income levels, revealed the National Health Profile 2017 published recently by the Central Bureau of Health Intelligence.
-==Hrithik Roshan is lying: Kangana Ranaut’s lawyer==
+In rural India, about twothirds — ranging from 65.6% in the poorest to 68% for the richest — depend on household income or savings, while 27% of the poorest households and 23% of the richest households depend on borrowings for hospitalisation costs. In urban India, 68% of the poorest and about 80% of the most well-off households depend on their own income and savings.
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Hrithik-Roshan-is-lying-Kangana-Ranauts-lawyer/articleshow/51451295.cms PTI | Mar 18, 2016]
-Bollywood star Kangana Ranaut's lawyer has claimed statements made by actor Hrithik Roshan against the actress are nothing but efforts to "gain public sympathy". Advocate Rizwan Siddiquee said Hrithik cannot wash his hands off the matter now after "criminally" threatening the 28-year-old actress.
+As they get richer, their reliance on borrowings goes down from 22% among the poorest to 14% among the richest. In rural India, about 1% of the population, whether rich or poor, meet hospitalisation costs through sale of assets. This is negligible among urban households.
-"Hrithik's statements made to the media are nothing but efforts to gain public sympathy. He cannot wash his hands off the matter now after having criminally threatened my client and having intimidated her, without any provocation. He also cannot deny the fact my client never named him anywhere and it was he himself who claimed to be "Silly Ex" in his notice," the lawyer said in a statement tonight.
+'''Hospitalisation most expensive in rural Guj'''
-"Besides his own acts of stating in the media that he would rather 'date a Pope' gave enough fodder to the media to start speculating. How can he blame my client for all his own acts of commissions and omissions?" he added.
+Roughly 5% of rural and urban households are helped out by friends and relatives to meet the cost.
-Hrithik (42) had sent a notice to Kangana asking her to hold a press conference and tender an apology and make it clear it was not him she meant in the recent comments about a 'silly ex'. Kangana, however, retaliated with a 21-page reply, charging Hrithik with intimidation and threat.
+The data on hospitalisation was from the health expenditure survey conducted by the National Sample Survey Organisation from January 2013 to June 2014. The data also shows that getting hospitalised was most expensive in Gujarat for rural households and in Assam for those who lived in towns and cities. The average cost per hospitalisation case in rural areas was Rs 32,500 in Gujarat, over four times as expensive as in UP. Similarly, each hospitalisation in urban Assam cost on an average about Rs 52,368 nearly seven times as much as in urban Delhi.
-Siddiquee said Kangana is a big star herself and does not need Hrithik's name to garner publicity. "He needs to immediately realise that my client Kangana Ranaut does not need Hrithik Roshan's name to garner publicity or attention, as she is a renowned public figure herself..."
+Next to Assam, the urban areas of Goa and Himachal Pradesh were the most expensive places to get inpatient treatment, costing over Rs 37,000 and Rs 35,200 per hospitalisation case.
-The lawyer said the notice which the 'Dhoom 2' star sent to Kangana was "absolutely baseless". "Most importantly I would like to point out that at least Hrithik Roshan should have bothered to ensure that he has a good reason to send a legal notice to my client."
+Interestingly, in states with very high total per capita sending on health, such as Himachal Pradesh, Uttarakhand, Kerala and J&K, the average expenditure on each hospitalisation was not among the highest. This could be due to higher spending on out-patient costs. In many of these states, the presence of a robust public hospital network could also be the reason for lower expenditure on hospitalisation as several of them also have the highest government spending per capita on health.
-"As expected, the notice is absolutely baseless, unsubstantiated, unwarranted and uncalled for. There is not even a case of defamation made out against my client and he is issuing a notice for defamation without application of mind."
+==Out-of-pocket expenses exceed 10%/ 25% of income/ consumption==
+[http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F15&entity=Ar02207&sk=DADE21A2&mode=text  Radheshyam Jadhav, Healthcare costs land 5cr Indians in poverty, December 15, 2017: ''The Times of India'']
-Siddiquee refuted the claim of Hrithik of not knowing Kangana socially, and said the actor had attended the actress' private party and was now "lying".
+[[File: Coverage of essential health services in India.jpg|Coverage of essential health services in India <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F15&entity=Ar02207&sk=DADE21A2&mode=text  Radheshyam Jadhav, Healthcare costs land 5cr Indians in poverty, December 15, 2017: ''The Times of India'']|frame|500px]]
-"He specifically claimed he does not know my client socially at all. If that were the truth, then how was he attending my client's private birthday party with his entire family and my client was attending his party besides his sister's and his father's birthday party as well. There is enough proof on public platform, which sufficiently proves that Hrithik Roshan is lying," Siddiquee said.
+''50% Of World Population Can’t Afford Services''
-==‘Actress’ lawyer obtained call records illegally’==
-[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/?olv-cache-ver=20180315062505#    Nishikant.Karlikar| Actress’ lawyer got call records of actor after their public spat? | 18 March 2018| The Times of India]
+At least half of the world’s population cannot obtain essential health services and each year about 100 million people, including in India, are being pushed into poverty because they have to pay for healthcare out of their own pockets.
-Thane: The Thane crime branch probing the illegal procurement of phone call records by arrested celebrity lawyer Rizwan Siddiqui for actor Nawazuddin Siddiqui suspect that he may have sourced records in similar fashion for a Bollywood actress too. The actress, the police said, was engaged in a high-profile spat with another popular face from the film industry last year which led to allegations being traded publicly by both sides.
+‘Tracking Universal Health Coverage: 2017 Global Monitoring Report’, a new report by the World Bank and the World Health Organization released on Wednesday has revealed that currently 800 million people spend at least 10% of their household budgets on health expenses for themselves, a sick child or other family member. For almost 100 million, these expenses are high enough to push them into extreme poverty, forcing them to survive on $1.90 or less a day.
-Call detail records, or CDRs as they are called, may be of help to the actress to establish her case against the one-time colleague on the sets, a police officer said. At the time of Siddiqui’s arrest on Friday for allegedly sourcing CDRs of Nawazuddin’s wife from a private detective for sorting out a matrimonial dispute, police had seized two laptops and three mobile phones along with CCTV footage from his office. Police will soon look into their contents. “If the lawyer has sourced CDRs of other celebrities or any other person, he could be in serious trouble,” the officer said.
+The report looks at “catastrophic” spending on health on the basis of out-of-pocket expenditures exceeding 10% and 25% of household total income or consumption. About one-sixth of households in India (exceeding 10% household income) and 3.9% (exceeding 25% household income) bear such spending exceeding a household’s ability to pay without reimbursement by a third party.
-However, Thane police commissioner Param Bir Singh told TOI that Nawazuddin had “no direct role” in the case and police would examine the evidence and also the possible involvement of his brother Shamas.
+Among the Brics countries, South Africa, which spends 8.7% of GDP on health, and Russia, which has a predominantly state-funded healthcare system, had just 0.1% and 0.6% respectively, of households spending over 25% of their income on healthcare. This figure was 0.8% in the US. China had the highest proportion (4.8%) and in Brazil it was 3.5% of households.
-Rizwan Siddiqui was on Saturday sent to police custody till March 23. Advocate Rizwan Merchant, who opposed police custody, said his client was also an advocate and had been made a scapegoat. He said police had violated SC-set procedures for probe and arrest. “Rizwan wanted to cooperate with the investigating agencies. He had no role to play in the CDR scam,” Merchant said.
+According to the report, 808 million worldwide incur catastrophic health spending at the 10% level. Latin America and Asia have the highest rates of people with out-ofpocket expenditures exceeding 10% or 25% of total household consumption or income.
-He said that when the police wanted certain evidence about the lawyer’s clients, he had written a letter to the Bar Council of Maharashtra and Goa seeking nod. But Nitin Thakre, senior inspector with the crime branch, claimed the lawyer was not cooperating with authorities. Thakre justified the arrest saying the lawyer could have destroyed evidence and said that in another case, an accused had got all data on his cellphone erased at a remote location. Outside the magistrate’s court, Merchant alleged that senior Thane police officers were trying to protect Nawazuddin Siddiqui.
+The report states that 4.2% and 4.6% households in India, based on two different poverty lines, are impoverished by spending on health. Given that there are about 24 crore households in India, that would mean around a crore households or a population of nearly 5crore being impoverished. In these cases, a household is forced by an adverse health event to divert spending away from things like food, shelter and clothing, to an extent that its spending on these items is reduced below the level indicated by the poverty line.
-== Hrithik breaks his silence==
+The levels of health service coverage vary widely between countries. The Universal Health Coverage (UHC) service index is highest in East Asia (77 on the index) and Northern America and Europe (also 77). Sub-Saharan Africa has the lowest index value (42), followed by Southern Asia (53). The index is correlated with under-five mortality rates, life expectancy and the Human Development Index. UHC means that all people receive the health services they need, including public health services designed to promote better health, ensuring that the use of these services does not expose the user to financial hardship.
-''' Hrithik Roshan finally breaks his silence on the Kangana Ranaut issue '''
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Hrithik-Roshan-finally-breaks-his-silence-on-the-Kangana-Ranaut-issue/articleshow/51444181.cms  TNN | Mar 17, 2016]
-Over the last few days, Hrithik Roshan and Kangana Ranaut have been in the news for the wrong reasons. The news about their alleged break-up was followed with both actors slamming legal notices on each other. The affair got murkier after Hrithik reportedly alleged Kangana to be suffering from Asperger's Syndrome. However, there wasn't any official statement from any of the two. But now, Hrithik has finally broken his silence and issued an official statement on the matter.
+Incidence of catastrophic payment has been increasing between 2000 and 2010.
-He has said, "Anything private that becomes public gives rise to speculation and unnecessary controversies simply because the general public are not privy to the whole truth. Out of respect for everyone involved, I followed the legal path to resolve the matter in question so as to keep it private. It was a breach of ethics to reveal the contents of a private legal notice. Dignified silence is dignified up to a point, but there comes a time when the silence needs to be broken to protect one's name, family and image."
+=Death, the main causes of=
+==2018==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F03%2F17&entity=Ar00400&sk=55188681&mode=text  March 17, 2020: ''The Times of India'']
-He continued, "The crux of the matter is that the mail id hroshan@email.com does not belong to me. I had filed a complaint in this regard with Mumbai Cyber Crime cell on 12 December, 2014 when I learnt of this impersonator communicating with said person. I have absolutely no connection with this ID. The entire issue stems from a case of identity theft which has carried over to me. My complaint was reactivated on March 5, 2016 and the crime unit has made headway in tracking this person down. Once that is done, the matter can be laid to rest."
+[[File: The Top 10 causes of Death in India in 2019; Deaths by swine flu in India, 2015- 2020.jpg| The Top 10 causes of Death in India in 2019 <br/>  Deaths by swine flu in India, 2015- 2020 <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F03%2F17&entity=Ar00400&sk=55188681&mode=text  March 17, 2020: ''The Times of India'']|frame|500px]]
-He signed off, "And finally, I believe that mental health is a grave and crucial issue which merits serious discussion. I would never address it flippantly nor use it as a personal attack. Any allegation to the contrary is a misrepresentation of facts. I was requested to keep silent and I did so for 2 years."
+'''See graphic''':
-==The controversial e-mails==
-''' Kangana-Hrithik's mail trail that's shocking B-town '''
-TNN | Apr 22, 2016
+'' The Top 10 causes of Death in India in 2019 <br/>  Deaths by swine flu in India, 2015- 2020 ''
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Kangana-Hrithiks-mail-trail-thats-shocking-B-town/articleshow/51942161.cms ''The Times of India'']
+==Air pollution==
+===2019===
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F10%2F22&entity=Ar00310&sk=71886D37&mode=text  Vishwa Mohan, October 22, 2020: ''The Times of India'']
-In Bombay Times earlier, we shared a few emails allegedly sent by Kangana to the impostor and from Kangana to Hrithik (on his real email id). Here are some more emails allegedly sent by Kangana and a few exchanged between her sister Rangoli and Hrithik. However, the actress' lawyer and a source close to her maintain that her account was hacked.
+[[File: Deaths due to air pollution in 2019.jpg|Deaths due to air pollution in 2019 <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F10%2F22&entity=Ar00310&sk=71886D37&mode=text  Vishwa Mohan, October 22, 2020: ''The Times of India'']|frame|500px]]
-Hence, it is not confirmed if these mails were actually sent by Kangana
+Long-term exposure to air pollution contributed to around 6.7 million deaths globally from stroke, heart attack, diabetes, lung cancer, chronic lung diseases, and neonatal diseases in 2019 with China (1.8 million) and India (1.6 million) together accounting for more than half of such deaths, says the annual 'State of Global Air 2020' report.
-[Scanned copies of these mails have been reproduced on this page ]
+While stating that air pollution is globally the fourth highest cause of death, the report says it is the largest risk factor for deaths for India, followed by high blood pressure. The report, however, notes the success of the ‘Pradhan Mantri Ujjwala Yojana Household LPG’ programme, saying it helped dramatically expand access to clean energy, especially for rural households and helped reduce “household air pollution exposure”. “Overall, air pollution is now the fourth highest cause of death among all health risks,”said the report. .
-Here is a barrage of emails that Kangana allegedly sent to Hrithik's real email id. When asked why there were no replies to her emails (barring a few replies to her sister, Rangoli), a source close to the actress said, "Hrithik was sending emails to himself to build a case that Kangana was in love with him, and he was not. When these supposed emails were sent, they were not in a relationship." Hence, we cannot confirm whether Kangana was the one sending these emails to Hrithik's real id. The contents of these emails talk about...
+''' Air pollution kills 1.2L infants in India in 1st month of life: Study '''
-''' The alleged 'Paris proposal' '''
+Air pollution is now the fourth highest cause of death among all health risks, ranking just below high BP, tobacco use and poor diet,” said the report, released by the Health Effects Institute, an independent, non-profit research institute funded jointly by the US Environmental Protection Agency, industry, foundations, and development banks.
-On March 17, 2016, a tabloid had quoted Kangana Ranaut's friend who said that Hrithik proposed to the actress in January 2014 in Paris. The 'proposal' came after Hrithik and Sussanne split in December 2013.
+While the report identifies air pollution as the top risk factor for India, the Indian government has in the past rejected numerical estimates, saying that though studies have identified such pollution as a cause or contributory factor for ill-health, making projections or establishing direct linkages for deaths lacks sufficient evidence. The HEI, which for the first time did a comprehensive analysis of air pollution’s global impact on the newborn, found that “outdoor and household particulate matter pollution” contributed to the deaths of nearly 5,00,000 infants globally, including 1,16,000 infants in India, in their first month of life.
-On his part, Hrithik has denied not only proposing to her with a ring but also claimed that he did not travel to Paris around that time. Through his legal team, the actor has conveyed that his passport doesn't have the relevant stamps, which should be the case if he had travelled during the mentioned period. A source close to Kangana said, "He can refuse what he wants to, she is okay with it."
+The report noted that nearly two-thirds of those deaths were linked to use of solid fuels like charcoal, wood and animal dung for cooking, saying the most deaths for the youngest infants were related to complications from low birth weight and pre-term birth. Though it said India’s National Clean Air Programme has spurred action on air pollution sources across India, it said the levels were still stagnant for outdoor PM 2.5. It noted that over half of these deaths in India were associated with outdoor PM2.5.
-''' Who is faking it? '''
+“This evidence is a reminder of continuous worsening of health risk from air pollution in India. Not only the absolute death burden from PM 2.5 is high, but it has also increased the maximum — by as much as 61% between 2010 and 2019,” said Anumita Roychowdhury, air pollution expert and executive director of the Centre for Science and Environment. “The interaction of Covid-19 with the continued global rise in chronic illness and related risk factors over the past 30 years has created a perfect storm fuelling Covid-19 deaths,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at University of Washington, Seattle, USA.
-From the onset, Hrithik's legal team has been saying that it all began with Kangana corresponding with a fake email id created by an impostor. They maintain he was oblivious about it till May 24, 2014, when she mentioned about it at Karan Johar's party. Reportedly, that's when he told her that the id she had got the mail didn't belong to him and he shared his 'real' mail id. They further claim that after this, she started corresponding with him on this id.
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-To this, a source close to the actress states, "At Karan's party, Kangana told Hrithik that she found her mail id was hacked. She suspected him of misusing her account and threatened to take action. She shut that account and broke up with him because he denied everything they ever shared. After that, she opened another account, but soon started getting google alerts, which made her suspicious that the second account was also hacked. Through her account, he was sending emails to himself to build a case that she was in love with him and he wasn't. When these supposed exchange of emails happened, they weren't in a relationship."
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-No pictures of Hrithik-Kangana together!
+=Delivery (of babies)=
+== Cost of delivery at govt hospitals==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F02%2F14&entity=Ar01607&sk=F55B3FDB&mode=text  Shivani Azad, Cost of delivery at govt hospitals highest in Manipur, Delhi: Survey, February 14, 2018: ''The Times of India'']
+[[File: Top 10 states and Union Territories where cost of delivery is highest in government hospitals.jpg|Top 10 states and Union Territories where cost of delivery is highest in government hospitals <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F02%2F14&entity=Ar01607&sk=F55B3FDB&mode=text  Shivani Azad, Cost of delivery at govt hospitals highest in Manipur, Delhi: Survey, February 14, 2018: ''The Times of India'']|frame|500px]]
-== Hrithik didn't answer Kangana's mails: forensic report==
+In 2011, the Centre had started the Janani Shishu Suraksha Karyakaram (JSSK) under which a pregnant woman was entitled to free delivery at government hospitals across India.
-[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Hrithik-didnt-answer-Kanganas-mails-Pvt-cyber-forensic-22042016028048  ''The Times of India'']
-Apr 22 2016 : The Times of India (Delhi)
+But a state-wise breakup of delivery costs according to the Niti Ayog’s ‘Healthy States Progressive India Report' says that delivery at government hospitals continues to cost the poor a lot of money. Manipur tops this list, with Rs 10,076 being required to deliver a child at a government hospital. This is followed by Delhi, at Rs 8719.
-''' Hrithik didn't answer Kangana's mails: Pvt cyber forensic report '''
+Dinesh Arora, director (health), Niti Aayog, said, “Our analysis of out of pocket expenditure for various states is based on the National Family Health Survey-4 data, which was released in 2015-16. We are sure that in the last two years things have improved significantly.”
-Swati Deshpande
+In West Bengal, the cost, according to the report, is Rs 7,782; Kerala Rs 6,901, and Arunachal Pradesh Rs 6,474. In contrast, in Dadra and Nagar Haveli a family had to spend just Rs 471.
-Mumbai:
+Taking note of the fact that the Centre had been spending crores on improving maternal and child care in India, authors of the report have asked the states to buck up. The report read: “Given the number of National Health Mission (NHM) interventions targeting pregnant women, such as Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakaram (JSSK), and Referral Transport to ensure free delivery at public health facilities, the states should aim to reduce the OOP expenditure.”
-A cyber forensic report, sought by Hrithik Roshan and submitted to Mumbai Police, has said he did not respond to even a single mail from the hundreds sent to his genuine email address by former co-star Kangana Ranaut over a six-month period starting July 2014.
+Though the reason behind higher cost of delivery at government facilities in the north-east has largely been attributed to geographically challenging terrain and unavailability of trained staff, Delhi, Mahasthra and Karnataka’s charges have left many wondering.
-The report conducted by a private cyber security agency had collected Hrithik's Apple laptop and other electronic assets from Hrithik, at his request, on April 14, and run a two-day cyber forensics. It concluded that the actor never used or accessed any email id from the `email.com' servers. “We found no digital footprints nor any fingerprint...The digital evidences were intact, not forged.“
+Sharing the reasons behind increased delivery costs in “richer” states, Uttarakhand family and health welfare society director general Dr Archana Srivastava said, “Round-the-clock availability of drugs, diagnostics and transport facilities play a major role in determining OOP expenditure.”
-It said that only images of Kangana, barring a few of related to their films, were “the ones sent as attachments to him on email...directly from her iPhone 5s...to be in a relationship of sorts...“ and significantly added, “it is analysed that Hrithik Roshan did not entertain the emails nor accessed them until recently for forensics analysis.“
+=Drug- resistant superbugs=
+==2019/ Methicillin Resistant Staphylococcus aureus in Gujarat==
+[https://timesofindia.indiatimes.com/city/ahmedabad/drug-resistant-superbug-is-invading-gujarat/articleshow/67812650.cms  Paul John, Drug-resistant superbug is invading Gujarat!, February 3, 2019: ''The Times of India'']
-Many were retrieved, unread, from a junk folder or flagged as spam. “There is no digital evidence to the claims from Kangana that she had been receiving emails from Hrithik through the email.com account,“ said the report.
-==2017: Refusing to let go==
-[http://photogallery.indiatimes.com/celebs/bollywood/kangana-ranaut/kangana-says-hrithik-tried-to-sabotage-my-career/articleshow/56984590.cms     “Hrithik went & cried to the entire industry, tried to sabotage my career” – Kangana Ranaut,  Feb 5, 2017, The Times of India]
+Gujarat has been a sitting duck to the emerging threat of deadly superbugs. Now one such bacteria, the drug resistant Methicillin Resistant Staphylococcus aureus (MRSA), a ‘hospital superbug’, is spreading fast and turning up even in poultry, milk and fish products in Gujarat. It is one of those rogue bacteria that can thwart curing properties of most known antibiotics and prove life-threatening.
-The Hrithik Roshan-Kangana Ranaut controversy seems to be getting uglier by the day. The spat between the actors has taken a fresh turn as Kangana Ranaut revealed new instances and levelled allegations on Hrithik during an interview.
+MRSA is being reported by government veterinary and agriculture institutes, fisheries and even by a study of a poultry product. MRSA infects skin and soft tissue, the bloodstream, and may cause pneumonia in humans.
-Kangana says ‘Hrithik tried to sabotage my career'
+The story of MRSA (or ‘Mersa’ as its pronounced) in Gujarat goes back to 2008, when the Gujarat Cancer Research Institute (GCRI) began disease surveillance as part of the Indian Network for Surveillance of Antimicrobial Resistance (INSAR). GCRI approached OPD patients and collected 722 Staphylococcus aureus samples from skin and soft tissue infections, blood stream infections and respiratory infections. Of these samples, 57% turned out to contain MRSA.
-In an interview, Kangana said, “Though there were instances when he (Hrithik) was going and crying to the entire industry, wanting them to sabotage my career, and people were calling me and saying — ‘He met us, he has showed us proofs and (do you) want to meet us because we want to know your side of the story as well?’ But I was like, it is none of your business. I was trying to figure things out and felt that it didn’t make sense seeking closure from others.”
-Kangana also spoke about being getting threatened while being told that she would be exposed.
+As recently as in February 2018, at SSG Hospital, of 40 low birth-weight newborns with sepsis — a potentially life-threatening condition caused by the body’s response to an infection — nearly 17 showed presence of MRSA.
-Kangana said “The threats were quite open, weren’t they? They said they would release some statements, they would reveal something, say something… ‘We will expose her and everyone will be shocked’… something along those lines… It is not that I knew this sort of game plan that would be unleashed against me. So I thought there would be some reveal but there was none and obviously those were just threats.”
+Since the drivers of antimicrobial resistance include antimicrobial use and abuse in human, animal, and environmental sectors, researchers have now demanded a ‘One Health’ approach — which envisions a collaborative effort of multiple health science professions for people, domestic animals, wildlife, plants, and our environment.
-== Hrithik broke his silence in Oct 2017==
-[https://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/hrithik-roshan-breaks-his-silence-on-the-infamous-spat-with-kangana-ranaut/articleshow/60953796.cms      Shreya Thakur | Hrithik Roshan breaks his silence on the infamous spat with Kangana Ranaut | Oct 6, 2017 | IndiaTimes/ ''The Times of India'']
+Ahmedabad’s NHL Medical College’s department of microbiology studied 1,002 bacterial isolates from wounds and pus samples of various patients in April 2018 and 96 samples were found to have MRSA. In Bhuj, from a total of 186 children reporting urinary tract infections (UTIs) between December 2016 and June 2017, 10% of urine cultures were found to contain MRSA.
-'' On Oct 6, 2017, Hrithik Roshan took to his Facebook page and poured his heart out. The actor shared that he has never met the "lady in question one on one" (Kangana) and also asserted on the fact that an alleged 7-year long, passionate affair between two high profile celebrities had no trail left behind. "No evidence, no paparazzi pictures, no witnesses, not even a memento," he wrote. ''
+"In nature, about 10% of bacteria are gram positive, and MRSA is one such bacteria," says disease expert Dr Bhavini Shah. She adds that the bigger challenge is the growing antibiotic resistance in the 90% gram negative bacteria, as most people get infected by them in India.
-'' While Kangana spoke her mind in various interviews before the release of her recent film 'Simran', Hrithik has now broken his silence. Here's what he wrote: ''
+"To fight antibiotic resistance, we need coordinated action in society," says Shah. She adds, "In MRSA cases, we have strict treatment policies. Patients with previous history of MRSA and those who have freshly contracted it are given the antibiotic Vancomycin, an uncommon antibiotic," Shah said.
+Today, almost a decade after it was first noticed in Gujarat, studies suggest that MRSA was found in poultry meat in Anand district when tests were conducted by the Anand Agriculture University in February 2018.
-"I choose to be on a path of creativity, productivity and constructive work. Anything that isn't in alignment with that, I tend to ignore, sidestep and treat as a distraction.
+From salt-treated ribbonfish in Veraval, the Regional Centre of ICAR-Central Institute of Fisheries Technology isolated a gene that causes resistance in MRSA. From 55 milk samples taken from animals having Staphylococcus aureus-caused bovine mastitis — persistent inflammation of the udder tissue — by the Department of Veterinary Microbiology of Dantiwada Agricultural University, 11 were found to have MRSA.
-I believe that ignorance, non reaction and staying on the path of dignity is the best way to discourage any persistent unwanted intrusions. But Just like a nagging health issue sometimes ignored can turn malignant, this situation for me has unfortunately turned malignant.
-In case of the matter at hand, it seems the media has no intention of letting go.
+'''WHAT IS MRSA '''
-I don't see any grace in adding to this circus by testifying in defence of my character in a situation that I have no involvement in whatsoever.
+Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of staphylococcus resistant to many antibiotics. Normally, the bacteria lives in the nose and on the skin and generally doesn’t cause any harm. However, when they go resistant like MRSA and multiply uncontrollably, it could be dangerous.
-I have been dragged into a dirty perverse mess without a choice in the matter. This is something that is not of my making.
-The truth is, ''' I have never met the lady in question one on one in my entire life. ''' Yes, we have worked together, but there has been no meeting in private. Thats the truth
+'''In MILK: Nov 2017 '''
-Please understand, I am not fighting against an allegation of an affair. Or being childish trying to uphold a 'good guy" image. I am very aware of my faults, I am human.
+Agency: Department of Veterinary Microbiology, Sardarkrushinagar Dantiwada Agricultural University,
-I am in fact protecting myself from something far more serious, sensitive and destructive than that.
+Staphylococcus aureus (S.aureus) causes bovine mastitis. The study investigated the incidence of MRSA in milk samples collected from animals having bovine mastitis. Of 11 milk samples, 4 tested positive for MRSA, which also showed presence of mecA gene that showed maximum identity with the Human MRSA isolates which indicated that cross species spilling of MRSA had rendered it as one of the important zoonotic bacteria
-Sadly, very few from the media or the public seem to be interested in the truth. This has been a hard-learnt fact for me.
-If the people are comfortable with a lie because it doesn't threaten their model of the world where a girl is the victim and the man the aggressor then so be it. I am ok with that too.
+'''In FISH: Aug 2017 '''
-Women have suffered centuries of abuse at the hands of men and it infuriates me how some men can be so brutal and they deserve the harshest punishment. But by that logic if it ordains that one man can't be vulnerable and one woman can't be a liar, so be it. I'm ok with that too.
+Agency: The Regional Centre of ICAR-Central Institute of Fisheries Technology, Veraval,
-An alleged 7-year long, passionate affair between two high profile celebrities with no trail left behind.
+A draft genome sequence of a methicillin-resistant Staphylococcus aureus (MRSA) was isolated from salted dried ribbonfish from Veraval in Gujarat. Scientists at the CIFT institute isolated methicillin resistant mecA and femA genes from the fish samples
-No evidence, no paparazzi pictures, no witnesses, not even a memento in possession like a selfie taken at the alleged engagement which is claimed to have happened in Paris in Jan 2014. Nothing that constitutes an exchange or any sort of proof of a romantic relationship.
-Yet we want to believe the other party because the rhetoric is -why would a girl lie.
+'''In POULTRY: Feb 2018 '''
-My passport details show no travel outside the country in Jan 2014, which is the date that this alleged engagement supposedly took place. In Paris.
+Agency: Department of Veterinary Public Health and Epidemiology, Anand Agricultural University
-The only so-called proof presented of this alleged "relationship", was a photoshopped picture in the media. This was immediately exposed, the very next day by friends including my ex-wife.
+The study investigated occurrence of MRSA in raw poultry meat. A total of 23 Staphylococcus aureus isolates were obtained. Among the 23 isolates, 4 (1.6%) tested positive for MRSA and the mecA gene — found in bacterial cells, which allows bacteria to resist antibiotics such as methicillin, penicillin and similar drugs.
-These questions are not even asked, because we are taught to protect the woman, as we should. I myself have been brought up to think the same way, by my parents and the wonderful women in my life who have been my rock and support system. I'm deeply grateful to them. I will do my best to teach my children the same values of family and dignity. And yes, I will teach them to stand up for women. Always.
+Symptoms: Most often, the staph bacteria causes mild infections on the skin, like sores or boils, but once they turn resistant they can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract. MRSA is very contagious and can spread through direct contact.
-There are 3000 one sided mails which either I have sent to myself or the woman in question has sent to me. The Cyber-Crime Dept. can prove or disprove either story, in just a few days. Towards that purpose, I have surrendered all my devices including laptops / phones etc which are still lying with the cyber cell , but the other party has refused to do so. The investigation hasn't been closed.
-This is not, and I repeat, not a lovers spat. I humbly request people to stop labelling it as one and, for a second, try and see it for what it really is.
+''' ''IN HOSPITALS '' '''
-I have been harassed by this for 4 years and the well meaning and probably necessary social bias toward women has deemed me helpless in defending myself.
-I am not angry, I have seldom allowed anger into my life. I have not had a single fight in my life, with a man or a woman. Even in my divorce, there was no fight. I, and those around me, have always chosen peace.
+'''SURENDRANAGAR: November 2017 '''
-I am not here to accuse or judge anyone, but it's time I defend the truth because when truth suffers the collective consciousness of society suffers. Civilization suffers. Closer to home, families suffer. Children suffer."
+Agency: Microbiology Dept, GMERS Medical College, Junagadh
-== Farhan Akhtar analyses the evidence==
-[https://www.facebook.com/farhanakhtarlive/posts/908392775975031    Farhan Akhtar wrote on Facebook on 8 Oct 2017]
+In a study at the government tertiary hospital in Surendranagar, 194 Staphylococcus aureus bacterial samples from patients were isolated. Of these, 69 were positive for MRSA. Overall prevalence of MRSA was 35.56%. The greatest occurrence of MRSA was in the medicine ward (45.31%), followed by the surgery ward (21.87%) and the orthopedic ward (15.62%). MRSA occurred most often in pus samples (43.75%) followed by urine (26.56%), wound swabs (12.5%), sputum (10.93%), blood (3.12%) and body fluids (1.56%).
-Today I read an open letter written by a man I know about a woman I know, professionally, at best. Although a controversy about them is going around since a while now, to my best knowledge this is the first time this man has expressed his point of view.
-For a moment, lets put aside emotion, prejudice, biases, our understandably protective instincts and
+'''AHMEDABAD: '''
-look at the facts as they exist today.
+March-April 2018
-She claims they had an affair lasting 7 years and during that period, they exchanged a number of emails.
+Agency: Department of Microbiology, NHL Medical College
-While he denies ever mailing her, he has filed an official complaint, shared and submitted all necessary information and documents, handed over his personal phone and laptop to the concerned authorities.
+In a study of 1,002 bacterial isolates from pus and wounds of patients, 261 samples were found to contain Staphylococcus aureus and of these, 96 had MRSA. These were 100% sensitive to antibiotics such as linezolid and vancomycin, 65% sensitive to gentamicin and 74.6% sensitive to doxycycline.
-The woman has not. Apparently, she has avoided, till date, submitting her personal communication devices citing some reason or the other.
-In some past cases, this lack of cooperation has been deemed to be obstruction of justice.
+'''VADODARA: February 2018 '''
-Handing over her phone and computer is not only the right thing to do morally and legally but is also the best possible way for her to prove she’s telling the truth. So why refuse or delay?
+Agency: Department
-Apparently, he has over a thousand emails from her official email account which are intimate and sexual in their content. She claims not to have written them but alleges that he hacked her account and mailed himself.
+of Pediatrics, SSG Hospital, Vadodara
-If they were in a 7 year long mutually agreeable relationship, why would he need to do that? Does it not defy logic?
+Almost 40 newborn babies with suspected sepsis were tested. The most common bacteria for early onset of sepsis were Klebsiella, Pseudomonas and MRSA, contributing 17% each to the bacteriological profile.
-Also, did he reply to any of her emails?
-As far as we know, No. Not one single time.
+'''RAJKOT: November 2018 '''
-Pause here and ask yourself..
+Agency: Department of Microbiology, PDU Medical College
-If a woman was to receive these sort of emails from a man and she claimed harassment, what would your immediate reaction be?
+Some 300 samples taken from various sites in the hospital were found to have Staphylococcus aureus. Of the 300 samples, 76 (25%) were found to have MRSA. Hospital-acquired MRSA was more common than community-acquired MRSA. All the clinical samples were resistant to penicillin, 48.68% to ciprofloxacin and levofloxacin, 23% to cotrimoxazole, 9.21% to tetracycline, 6.57% to gentamycin, 3.94% to chloramphenicol. All the samples were sensitive to linezolid, vancomycin and rifampicin.
-Would you have given the man the benefit of doubt by believing him if he said they were in a relationship and she had hacked into his computer and sent herself the mails..?
+=Encephalitis =
+==2010, 2017==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Encephalitis-killed-over-500-across-country-this-year-16082017010020  Encephalitis killed over 500 across country in 2017, The Times of India], Aug 16 2017
-Chances are you wouldn’t.
+'''Disease Wreaks Havoc In UP And Assam'''
-There’s more.
+The deaths of scores of children in a Gorakhpur hospital have put the focus on Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) but these deadly diseases have been creating havoc in UP and other states for years.
-She posted a picture of them together claiming it was taken during the years of their alleged affair. That picture was proved, beyond doubt, to have been manipulated.
+As per the data on the website of the Directorate of National Vector-Borne Disease Control Programme (NVBDCP), since January 1 to August 13 this year, 1208 cases of AES have been reported in UP , and of these 152 resulted in the death of the patient. In the same period 112 cases of JE were reported in which three lives were lost, the data says.
-The actual image consisted of a group of friends including the man’s wife (now ex-wife) standing together in a party.
+According to the data, another state which has been badly affected is Assam where 1534 cases of AES were reported, and 128 patients lost their lives. The state reported 482 cases of JE of which 67 resulted in death, as per the data.
-Why were the others intentionally cropped out?
+Overall, 5,926 cases of AES have been reported in the country till August 13 this year, of which 406 deaths have been reported. The country also witnessed 93 JE deaths this year, out of 903 cases reported in the same period.
-She has no messages and no photographs to prove that she was in a 7 year long relationship with this man. Not even a picture of their alleged engagement in Paris, an event which he denies.
+According to additional director, health, Dr Pushkar Anand, 139 deaths of patients, mostly children have been reported from the paediatric ward of state-run Baba Raghav Das Medical College, this year in UP . Six cases of deaths were reported from August 12 to August 14, he added. In UP , the most severely affected dis tricts are Gorakhpur, Maharajganj, Kushinagar, Basti, Siddharthanagar, Sant Kabir Nagar, Deoria and Mau.
-Furthermore, he has asserted that his passport does not bear any stamp of travel to France during the time she alleges the engagement occurred nor are there any credible witnesses to this event.
+NVBDCP data reveals that in 2010, UP reported 3540 cases of AES, which claimed 494 lives.In 2015, as many as 479 lives were lost due to AES of which 2894 cases were reported. JE claimed 42 lives from the 351 reported cases, according to the official data. In 2016, 3919 cases of AES were reported in which 621 lives were lost.The death toll due to JE stood at an all time high of 73 out of 410 cases reported. Apart from UP , this year, AES and JE deaths were reported from Assam, Bihar, Manipur, Odisha and West Bengal.
-Don’t all these inconsistencies raise questions in your mind about the authenticity of the accusations?
+=Government funding=
+==2015-20==
+[[File: Government expenditure on healthcare, as a percentage of the GDP and in per capita terms, 2015-20.jpg| Government expenditure on healthcare, as a percentage of the GDP and in per capita terms, 2015-20 <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%252F2020%252F04%252F16&entity=Ar01103&sk=A74AD2D6&mode=image  April 16, 2020: ''The Times of India'']|frame|500px]]
+'''See graphic''':
-= Kangana/ Rangoli vs. the Rest of the World=
+'' Government expenditure on healthcare, as a percentage of the GDP and in per capita terms, 2015-20 ''
-In many small towns and villages, in the dark by lanes, there often are crotchety old maids, living alone all by themselves, sitting on their doorstep and picking up fights with and making rude comments on every passer-by. After a while people start taking the longer route to avoid these cantankerous old maids because, after all, '' sab ko apni izzat pyari hai '' (who wants unpleasantness?). This delights the quarrelsome old ladies further, giving them a sense of importance because now everyone is adjusting their lives to them, and they now are at the centre of the village’s attention.
-==vs. an unnamed predator, an FIR at age 16==
-Kangana Ranaut said in 2019 that she filed her first FIR (first information report at a police station) for sexual assault at the age of 16.
-==vs. Anurag Basu==
+==2014-18==
-Kangana and Anurag had a fallout during the shooting of 2010 film Kites. Kangana lashed out at the director for giving Barbara Mori more screen space than her. The two did not speak to each other for a very long time and reconciled in 2014.
+[[File: The availability of hospitals, medical colleges, doctors and other medical professionals in India- 2014-18.jpg|The availability of hospitals, medical colleges, doctors and other medical professionals in India: 2014-18 <br/> From: [https://epaper.timesgroup.com/olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIM%2F2020%2F02%2F01&entity=Ar01906&sk=D7C335DB&mode=image  February 1, 2020: ''The Times of India'']|frame|500px]]
-== vs.  Apurva Asrani ==
-Writer Apurva Asrani expressed dissatisfaction over how Kangana took an additional credit for the story in the 2017 flop film “Simran“.
-[http://www.huffingtonpost.in/2017/05/18/kangana-ranaut-on-accusations-of-stealing-credits-being-diffi_a_22096892/  Ankur Pathak | Kangana Ranaut On Accusations Of 'Stealing Credits,' Being Difficult To Work With, And Why She Doesn't Care |18/05/2017 |Huffington Post]
+''' See graphic''':
+'' The availability of hospitals, medical colleges, doctors and other medical professionals in India:  2014-18 ''
-Simran writer Apurva Asrani accused the lead actress of the film, Kangana, for snatching his credit and  taking away from his hard-work.
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-"For 2 months, [director Hansal Mehta] and his co-producer Shailesh tried to arm twist me into giving her a co-writer credit. The details of which I will reserve for the future," he wrote.
+=Government expenditure on health=
+== 2012==
+[http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=STATOISTICS-NATIONS-HEALTH-25052015007009 ''The Times of India'']
+[[File: government expenditure on health.jpg| Government’s expenditure on health, India and the world: 2012; Graphic courtesy: [http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=STATOISTICS-NATIONS-HEALTH-25052015007009 ''The Times of India''], May 25 2015|frame|500px]]
-Then writer Sameer Gautam Singh, in a Facebook post, said Apurva tried to take writing credits for the National Award-winning Shahid, while only coming on-board as editor.
+When it comes to government expenditure on health, India's is among the lowest in the world. In 2012, at 60 PPP* dollars per capita, it was barely 1.4% of the US government's per capita health $ expenditure of 4,153 PPP dollars.Despite having such a high per capita public expenditure on health, the extremely high cost healthcare system in the US means the government covers only 47% of total healthcare costs. In the UK and Japan, more than 80% of the cost is covered by government. In India, government expenditure is only 30.5% of total expenditure on health *purchasing power parity Source: WHO; Research: Atul Thakur; Graphic: Sunil Singh
-(On one occasion, the director Hansal Mehta spoke to this writer [Ankur Pathak] saying he's completely on Kangana's side. Asrani has called him 'spineless' for not standing up for him, and the duo, who've been collaborating for years, have parted ways.)
+==2014-15==
+[http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11%2F30&entity=Ar01307&sk=90571BD4&mode=text  Rema Nagarajan, Health: Govts spending less force people to fork out more, November 30, 2017: ''The Times of India'']
-Kangana Ranaut: ‘When I was shooting for Tanu Weds Manu Returns in Gurgaon in December 2014, Hansal Mehta came to me with Sarbjit. A 15-page draft. I did not like it. He told me he'll improve on it and we jointly decided to work on it. Eventually the project never flew and someone else made it. … When [Hansal Mehta] was in the US, he called me and mentioned a BBC documentary on a woman who took to a life of crime. He said he wanted to develop it with me in the lead. I agreed . Apurva was nowhere in the picture. When I asked Hansal who's writing it, he told me he usually collaborates with his editor, Apurva Asrani. Hansal assured me about his credentials saying he 'almost' wrote Shahid and Aligarh.
+[[File: Health spending, per-capita, state-wise, 2014-15.jpg|The per capita expenditure of Indian states on health, 2014-15 <br/> From: [http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F11%2F30&entity=Ar01307&sk=90571BD4&mode=text  Rema Nagarajan, Health: Govts spending less force people to fork out more, November 30, 2017: ''The Times of India'']|frame|500px]]
-‘Apurva's story was this dark thriller about a drug-addict who goes into a life of crime. It also had a lot of flavour of Wolf of Wall Street with share market jargon thrown in.   With the kind of script we had  it'd appeal to very limited people. Hansal then told me that I was free to talk to Apurva and get the script tweaked to make it more accessible.
+''Per Capita Healthcare Spend In HP 6 Times As Much As In Bihar''
-‘I told Hansal that we need a team of writers and this guy cannot deliver. Yes, he did write 9 drafts but they became so many drafts because both Hansal and I shot them down.
+The government spent more than Rs 2,000 per person per year on health in Himachal Pradesh while in Bihar per capita government spending was just Rs 338, about one-sixth as much. This wide disparity in government spending between states also results in a corresponding variation in how much people are forced to spend from their own pockets.
-‘Nobody can take away from the fact that if Simran today is a story of a divorced woman, it's entirely introduced by me. If the film has feminist undercurrents, I included that. The father-daughter track, the lover's track in the film -- these are subplots that I added. Finally, Hansal and I agreed that we'll fine tune this in the US (they reached there about a fortnight in advance) and I'll write the dialogues on sets.
+Government spending includes what’s spent by all levels of government, but about two-thirds of the total nationally is by the states. These facts emerge from the National Health Accounts 2014-15 just uploaded on the union health ministry’s website.
-In Apurva's draft  she wasn't even Gujarati or a housekeeper!
+In Himachal, people had to pay only about half the total health expenditure from out of their own pockets, while in Bihar their share was 82%. The national average for households’ share of the total spending was less than two-thirds.
-Ankur Pathak ''' Why wasn't Apurva kept in loop of the drastic changes that had been made? '''
+The pattern of low government spending leading to a very high share of the burden of health expenditure being borne by the people is clear in the case of states where government share of spending was the smallest. As a share of the total health spend, Andhra Pradesh had the lowest, 15.4%, leaving people to shoulder 78%. In Bihar, the government’s share was just 16.5%. Shockingly, in Punjab, considered one of the most prosperous states, government spending was just 17% of the total health expenditure, while people spent 79.3% from their own pockets.
-I was warned not to get into it as he's a nightmare to deal with when it comes to credits. While in the US, I got into a car accident. My MRIs revealed that I had suffered some level of damage. I couldn't physically write after that. I told Hansal, 'please call Apurva as we need someone to do the writing'. Hansal didn't want to. He said if he calls him now, Apurva will lose it and not let us proceed with the shooting as the changes are significant. I didn't get into it as I thought Hansal will deal with it on his own as he shares a very long association with him. The guy who was tutoring me in Gujarati eventually wrote the lines of dialogues that I dictated. Hansal's son Jay Mehta also helped. I'll ensure both of them get credited under 'Special Thanks.'
+The two figures do not add up to 100% because total health expenditure also includes private or government-funded health insurance, spending by NGOs and by external donors. Thus, in some states, despite a low share of government in total health spend, the share of households is not too high. For instance, while in Maharashtra the government spends only 17% of the total, the households’ share is only about 60%, the remaining 27% being accounted for largely by insurance.
-Ankur Pathak ''' As any writer, he feels it's largely his work while yours is a contribution expected out of any good artiste. '''
+So where is all this money going? According to the NHA, private hospitals (26%) and private clinics (5%) accounted for almost a third of the total health spending, while pharmacies raked in another 29%. The share of government hospitals and clinics was just over 20%. Diagnostic labs and patient transport accounted for about 5% each. Inpatient care was 35% and outpatient care about 16% of the total health expenditure, while medicines and medical products accounted for almost 30%.
-Do you really think I don't understand the distinction between giving suggestions and sitting and writing lines of dialogues? There's a fine line between giving direction to a script and actually, physically writing it. I did the latter. Initially, whatever happened, I don't claim credit for it. But based on what happened in the US, I very much do.
+Another revealing statistic that emerges from the NHA is that a mere 5.3% of the total was spent on preventive healthcare.
-When we had the conversation about sharing credits, he lost it completely and drove everyone insane. This was when the nepotism controversy had broken and this man tells me, "Do you really need another controversy?" It was a threat. Basically he was saying if I don't shut up, he'll go ahead and tarnish my image as a 'trouble-maker' which is exactly what he has done despite getting the credit!
+===2014-15, government expenditure on health===
+[http://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2017%2F12%2F03&entity=Ar00102&sk=57311D40&mode=text  Rema Nagarajan, Govt’s aam aadmi health spend: ₹1,100/yr, December 3, 2017:  ''The Times of India'']
-Ankur Pathak ''' How were you processing all this? '''
-We sat with him (Hansal and producer, Shailesh Singh) and signed off the legal paperwork where his credits were in place. He harassed us a lot during this. I was done. All I told my team was I want him out of the film. He was supposed to edit the film. Now he no longer is. He kept telling Hansal and everyone that I don't admire or respect him. Which is true. I cannot fake my admiration or respect for someone I have neither for. I have never done that. All Apurva is after is his two-minutes of fame. And try to plaster his name on my work. He can try to do that, but he won't be able to.
+If what the central government spends on providing healthcare for its own employees is a measure of what decent healthcare costs, what governments (central and states put together) spend for the ordinary citizen is a paltry sixth of that amount. The recently released National Health Accounts (NHA) 2014-15 shows that the average government spend per citizen per year was just Rs 1,108, against almost Rs 6,300 per central government employee.
-Ankur Pathak ''' Considering your past experiences with Aanand Rai and Vishal Bhardwaj, would you agree that your inputs are not always appreciated and that you can be challenging to work with? '''
+Even the most generous government spending among states, Himachal Pradesh at just over Rs 2,000 per capita, doesn’t come close to matching this. According to the NHA, India’s health expenditure in 2014-15 worked out to Rs 3,826 per person. Of this, what people had to spend from their own pockets was Rs 2,394 (63%). The government’s expenditure on Central Government Health Services for serving and retired babus, current and ex-MPs, the judiciary and so on was Rs 2,300 crore.
-At times, they aren't appreciated. And that is fine. I back off when I am told that my inputs aren't required. What can you do? (Kangana was offered Sultan but Aditya Chopra wasn't up for Kangana's involvement and hence they let go off the film). You know me long enough to know that I have never played to the gallery and said no to several so-called blockbuster films. Even this controversy is baffling as I have nothing really to gain to share credits with a writer who isn't exactly the best in the business.
+Health minister J P Nadda informed Parliament on February 27, 2015 that CGHS had 36.7 lakh beneficiaries. That makes it about Rs 6,300 per CGHS beneficiary.
-Ankur Pathak ''' Do you not think that the manner in which you are going, you'll end up isolating yourself? Eventually, it's a small industry and while it's admirable that you've constantly challenged the status quo and questioned the patriarchal undertones of it, you do need some people by your side, don't you? '''
+'''Per capita spend on ESIS was ₹379 in 2014'''
-I feel that isolation already.
+This is close to the figure of Rs 6,376 per beneficiary given by Nadda while replying to a Parliament question in December 2015. “This expenditure, however, does not include expenditure for hospitalisation in respect of serving government employees, which is borne by the departments/ministries,”
-I feel I have become a victim of my own image. With the Simran controversy, people didn't even wait to hear my side of the story and jumped to make conclusion. They had already decided I'm a vamp here, using my stardom to corner a helpless writer. But I'm glad that for now, my director and producer stood by me.
+stated Nadda. Thus, the actual per capita spending on CGHS could be much higher.
-== vs.  Deepika Padukone==
+In 2014-15, the Union government’s expenditure on the National Health Mission meant to boost the public healthcare system was Rs 20,199 crore. Spread it over a population of roughly 1.25 billion and you get a paltry Rs 162 per head.
-The cold war between the two divas began in 2014 when DP won the Best Actress award for Happy New Year, but dedicated it to Kangana for her brilliant performance in Queen. Kangana reacted unexpectedly to the gesture and said that Deepika should have told her in person. Soon after, Deepika tried to make amends and called Kangana to clear the air. Things turned colder when Deepika could not make it to the screening of Tanu Weds Manu Returns. Kangana told DNA, "I did extend an invite to Deepika, but I never got a response. I have always been supportive of my contemporaries and will continue to be, but it is hurtful when you don't get the same kind of support." Deepika, who had maintained a dignified silence all this while, opened up about the cold war and said that it was just one-sided and she has no time to think about all this. Buzz has it that Kangana hiked her own fee when Deepika became highest paid actor last year.
-==vs. Diljit Dosanjh==
+If NHM had spent the same amount per capita on citizens as the Centre spent on its own employees, it would have needed a budget almost 40 times bigger, or about Rs 8 lakh crore, or almost half of the entire government budget for that year.
-[https://www.hindustantimes.com/bollywood/kangana-ranaut-diljit-dosanjh-fight-turns-ugly-she-calls-him-karan-johar-s-pet-he-says-she-has-no-tameez/story-78WeBLv7ftMB0THrw93acL.html     Kangana Ranaut-Diljit Dosanjh fight turns ugly: She calls him Karan Johar’s pet, he says she has no ‘tameez’ | Hindustan Times, New Delhi | Dec 04, 2020]
-[https://www.timesnownews.com/the-buzz/article/this-time-kangana-got-a-perfect-reply-diljit-dosanjh-wins-netizens-support-in-spat-with-kangana-ranaut/690851      This time Kangana got a perfect reply’: Diljit Dosanjh wins netizens’ support in spat with Kangana Ranaut | Times Now Digital |Dec 05, 2020]
+A 2011Planning Commission report on health insurance models had noted that CGHS spending was mostly driven by high-end tertiary care provided by big corporate hospitals. It noted that the average hospitalisation expenditure per beneficiary was the highest under CGHS. Though CGHS and the Employee State Insurance Scheme (ESIS) are the only insurance schemes providing comprehensive healthcare coverage, including outpatient care, preventive/wellness care and hospitalisation, the per capita spending on ESIS was just Rs 379 in 2014. ESIS covered 5.6 crore people at the time, including workers and their families. If the National Health Mission aspired to provide ESIS kind of coverage, it would only have to increase its budget about two and a half times.
-Diljit slammed Kangana for misidentifying an elderly Sikh woman, who participated in the ongoing farmer's protest in Delhi, as Bilkis Bano of Shaheen Bagh. The Udta Punjab actor further shared a video of the elderly lady in question, saying that she was in fact Mahinder Kaur.
+The Planning Commission report stated that ESIS was probably managing to keep costs down because it relied heavily on its own facilities, unlike CGHS, which has increasingly become dominated by private providers. This appears to have reduced whatever little incentive legislators, bureaucrats and judges might have had in ensuring a wellrunning public health system. CGHS is primarily funded by taxpayers. Contributions from employees form a small fraction of what is actually spent.
-Although Kangana had deleted her post, she hit back at Diljit, calling him filmmaker Karan Johar's “pet.” She thus launched into a tirade against Diljit Dosanjh. Kangana Ranaut had addressed Diljit Dosanjh as "Karan johar ke paltu".
+For the common man, healthcare spending has become the second most common reason for indebtedness and impoverishment.
-“Ooo Karan johar ke paltu, jo dadi Saheen Baag mein apni citizenship keliye protest kar rahi thi wohi Bilkis Bano dadi ji Farmers ke MSP ke liye bhi protest karti hue dikhi. Mahinder Kaur ji ko toh main janti bhi nahin. Kya drama chalaya hai tum logon ne? (Karan Johar’s [domesticated pet’, the grandma who was protesting in Shaheen Bagh for her citizenship, the same grandma was seen protesting with the farmers. I don’t even know who is Mahinder Kaur. What is this new drama?) Stop this right now,” she wrote in a tweet.
+[[Category:Development|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIAHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
-In another tweet, she wrote, “Listen you vultures, do not consider my silence as my weakness. I see how you are instigating the innocent by lying to them and are using them. Just like Shaheen Bagh, the truth behind these protests will soon be out. Then I will write a brilliant speech and leave with your faces black,” she wrote and signed off as ‘Babbar sherni’.
+=Hospitals, private=
+==If built on government land: SC verdict==
-Diljit retaliated saying, “Tuneh Jitne Logon Ke Saath Film Ki Tu Un Sab Ki Paaltu Hai...? Fer To List Lambi Ho Jaegi Maalko Ki..? Eh Bollywood Wale Ni PUNJAB Wale aa .. Hikk Te Vajj Sadey Jhooth bol kar logo ko badhkana aur emotions se khailna woh toh aap achey se janti ho (Are you the pet of all the people you have worked with? Then the list of your bosses must be long. This is not Bollywood but Punjab. Manipulating people by lying and playing with their emotions is something you know very well).” He added that he is not from Bollywood but from Punjab and will give it back to her manifold. He said that he is not the one struggling in Bollywood. It’s film producers who bring him work, asking him to join their movies.
+The Times of India, Sep 2, 2011
-Kangana responded, “Oh chamche chal, tu jinki chat chat ke kaam leta hai, main unki roz bajati hoon,jayada mat uchal,m ain Kangana Ranaut hoon tere jaisi chamchi nahin jo jhoot boloon, maine sirf aur sirf Shaheen Baag wali protestor pe comment kiya tha (You are a bootlicker, the one you try to please, I take them to task everyday. I am Kangana Ranaut, not a bootlicker like you who would lie. I only spoke about the Shaheen Bagh protestor), if anyone can prove otherwise I will apologise.”
+''' Treat poor for free: SC to pvt hospitals '''
-Diljit said that Kangana has no manners. “Bolan Di Tameez Ni Tainu.. Kisey di Maa Bhen Nu.. Aurat Ho Ke Dujeyq Nu Tu 100 100 Rs. Wali das di an.. SADE PUNJAB DIAN MAAVA SADEY LAI RAB NE.. Eh tan Bhoonda De Khakhar nu Shedh Leya Tu.. PUNJABI GOOGLE KAR LI (You have no sense how to speak to someone’s mother or sister. You are a woman yourself and are calling another one would work for Rs 100. Our mothers of Punjab are like God to us. You have poked the hornet’s nest. Google this Punjabi now,” he wrote.
+New Delhi: Poor patients will get free treatment in 40 private, state-of-the-art multispecialty hospitals in Delhi without exception and for any disease or ailment, Supreme Court said.
-Things took a nasty turn as Kangana again said she was talking about the Shaheen Bagh ‘dadi’. “Oye dumbo baat wahi hai jab kisi ki citizenship gayi he nahin toh Saheen Baag dadi ne kiske kehne pe protests kiye? Jab MSP hataya he nahin toh phir wahi dadi kiske bhejne pe Farmers protests mein hissa le rahi hai? Kaun usko peeche se prompt karta hai when she speaks ? (When no one lost their citizenship, Shaheen Bagh’s dadi protest on whose behalf? When MSP has not been removed, who sent the same dadi to farmers’ protest? Who prompts her when she speaks to the media?”)
+A bench of Justices R V Raveendran and A K Patnaik asked these private hospitals, which had got land at concessional rates from the government, to reserve 10% of their
+inpatient department (IPD) capacity and 25% of OPD for free treatment of poor patients.
-Replying to her, Diljit said, “Oye Bad Dimag Batmeez... Gal HO RAHI JIS MAA NU TU 100 rs. Dihadi wai Keh ke foto paee c.. Os Bebe Da JAVAB Sun Leya c Yaan Dobara Bheja.. Avi gal na ghumaa Hun.. GAL KAR NI BHAJJI DA .. Jod tod Bollywood ch chalda hona Tera.. Punjabi’an Naal Ni Chalna (Go away fool. We’re talking about the elderly woman whose photo you shared and said she protests for Rs 100 a day. Did you hear her answer or do I need to send it to you again? Your manipulations will work in Bollywood but not in Punjab.)”
+Though 27 private hospitals had fallen in line, 10 hospitals had challenged a Delhi HC order asking them to provide free treatment to poor. The court dismissed all the petitions.
-In another tweet he said, “What school taught you to demean people’s mothers and sisters and call them labourers who’d protest for Rs 100.”
+''' Good work by small hospitals swung case '''
-Responding to a tweet by Congress MP from Ludhiana Ravneet Singh Bittu, who has asked Punjab Chief Minister Amarinder Singh to initiate FIRs against Diljit and singer Jazzy B among others for being 'Khalistani elements' hijacking the agitation,Kangana said he was revealing the truth about "terrorists". "… Sycophant and terrorists want to divide this country. They are dragging dadi without any reason to set their agenda. Shame on tukde gang..." she said.
+Many private hospitals in the city argued against free treatment to the poor in court. But appearing for Delhi government's Directorate of Health Services, Dr R N Das turned the tables on the reluctant hospitals by presenting before the court bills of poor patients running to over Rs 1 lakh being borne by small super-specialty hospitals like National Heart Institute.
-In response, Diljit said it was she who stood to gain something here and everyone knew she was going to join politics. When Kangana called Punjab "the heart of the country" which needed to be rid of "terrorists", Diljit said India was not hers alone. He also accused Kangana of trying to derail a peaceful protest. “You’ve no other work than spitting nonsense 24 hours. What sort of nationalism teaches you to insult the country’s elders? You play the nationalism card every time,” he wrote.
+However, it accepted senior advocate Rajeev Dhavan’s suggestion and said, “Our order will not come in the way of hospitals making arrangements on their own by way of sponsorships or endowments, the bottom line being the patients should not be charged with the burden of treatment.”
-After a day-long online war, Kangana said she stands with farmers. "I am with farmers, last year I activity promoted agroforestry and donated for the cause as well, I have been vocal about farmers exploitation and their problems also I worry a lot so prayed for resolves in this sector, which finally happened with this revolutionary bill," she said.
+With Fortis Escort Heart Institute, two Max Super Specialty Hospitals and Bhagwati Hospital falling in line, the court had on August 25 asked the seven hospitals which were reluctant to provide free treatment to poor patients to submit a fresh proposal and asked the government to hold discussions. These hospitals had challenged the HC's March 2007 order passed on a PIL by an NGO through advocate Ashok Aggarwal.
-In the second tweet, she said she was certain that the government will sort it out. "This Bill is going to transform farmers lives for better in many ways, I understand the anxiousness and effect of many rumours but I am certain government will address all doubts, please be patient. I am with my farmers and people of Punjab hold a special place in my heart."
+The government said the HC order had directed these hospitals to provide 10% of IPD and 25% OPD free of cost to all eligible poor patients in all respects including all diagnostic, imaging and laboratory investigation facilities available in the private hospitals.
+These tests include X-ray, ultrasound, CT scan, MRI, among others. Sir Ganga Ram Hospital, National Heart Institute and Batra Hospital were spending over Rs 50,000 on each poor patient, the government said annexing copies of bills.
-In another tweet, she said the latest reports suggest that the talks with the authorities are yielding results. "My request to Farmers across the nation is don't let any communists/Khalistani tukde gangs hijack your protests. Latest reports suggest that the talks with the authorities are yielding results. I wish everyone all the best. Hope peace n faith prevails in the nation again, Jai Hind," she said.
+The 27 hospitals had provided free treatment to 29.26 lakh poor patients in OPD, 99,681 of them in IPD, the government informed the court in its latest affidavit
-Earlier in the day, Diljit had tweeted at Kangana, slamming her for her comment on an elderly Sikh woman. Kangana had seemingly misidentified her as Bilkis Bano of Shaheen Bagh protests, saying that she had also joined the farmers’ protests for just Rs 100. She soon deleted the tweet.
+== If built on subsidised land: SC verdict==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F07%2F10&entity=Ar00703&sk=E3B76D5A&mode=text  AmitAnand Choudhary, SC: Pvt hospitals on subsidised land have to treat poor for free, July 10, 2018: ''The Times of India'']
-Sharing a video of the Sikh woman, Mahinder Kaur, Diljit had said that Kangana ‘says anything’ and that one ‘shouldn’t be so blind.’
-In an another tweet, Kangana said that Mahinder Kaur was brought into the controversy from ‘don’t know where’, not accepting that she had featured in the original tweet that she had posted. “I had only commented on Shaheen Baag dadi cos they instigated riots there even that tweet was deleted almost immediately, I don’t know from where they brought another elderly lady in to the picture and now endlessly spreading lies.Vultures trying to instigate mob against a woman,” she wrote.
+In a big relief to poor patients who cannot afford costly treatment in private hospitals, the Supreme Court on Monday held that all hospitals which were provided land at subsidised rates by government authorities would have to provide free treatment to the economically weaker sections with 25% of OPD and 10% of IPD (in-patient department) reserved for poor patients.
-Kangana has been sent a legal notice as well by advocate Harkam Singh for her comments against Mahinder Kaur. In the legal notice dated November 30, he suggested Kangana should have authenticated information before posting it on social media and demanded an apology over her tweets, in which she allegedly misidentified the woman.
+The apex court passed the verdict on a batch of petition filed by private hospitals of Delhi, but the order would have implications in other states where hospitals and nursing homes were given land at concessional rates by the government. Some of the aggrieved hospitals had approached SC challenging the Delhi HC order which had directed them to provide free treatment to poor patients.
-Diljit's direct responses to Kangana's allegations and that too in the Punjabi language have made him a star on Twitter. In fact, some users said that they wanted to learn the Punjabi language to understand what exactly the man said.
+There are over 50 hospitals in Delhi which were given land at concessional rates by DDA after the management of the hospitals promised to provide free treatment to poor patients. But as they didn’t honour the commitment, Delhi-based NGO ‘Social Jurist’ filed a PIL in the Delhi High Court for implementation of the agreement.
-Meanwhile, Ranaut has been slapped with a legal notice for her post that has been viewed as ‘derogatory’. Besides that, another even filed a writ petition in the Bombay High Court seeking direction to get her Twitter account suspended.
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+Delhi HC, in a series of orders since 2002, had held that the hospitals were obliged to reserve 25% of OPD and 10% of IPD for poor patients and provide free treatment including free admission, bed, medication, treatment, surgery and nursing facilities, consumables and non-consumables. The court, however, exempted some hospitals in 2014 whose agreement with the government authorities did not have the provision to provide free treatment. The Centre, thereafter, approached SC against the 2014 order.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-== Javed Akhtar==
+Senior advocate Ajit Sinha, appearing for the Centre, contended that the hospitals were given land at “throwaway” prices to ensure that poor patients would be treated free-of-cost and the hospitals would reserve beds for the poor even if the agreement did not mention the provision for free treatment.
-[https://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/javed-akhtar-files-complaint-against-kangana-ranaut-over-comments/articleshow/79025364.cms    PTI | Javed Akhtar files complaint against Kangana Ranaut over comments| Nov 3, 2020]
-Javed Akhtar files complaint against Kangana Ranaut over comments
+After hearing the contention of hospitals and the Centre, a bench headed by Justice Arun Mishra held that all hospitals, built on land given at subsidised rates would have to provide free treatment to poor.SC said lease of the hospitals would be cancelled if they failed to comply with the order.
-Bollywood lyricist Javed Akhtar filed a criminal complaint against actor Kangana Ranaut in a local court for allegedly making defamatory and baseless comments against him in television interviews. According to the Mumbai Mirror report, Akhtar filed the complaint before the Andheri Metropolitan Magistrate, seeking action against Ranaut under the relevant provisions of the IPC for defamation.
+The bench even decided to monitor the functioning of the hospitals and directed Delhi government to report periodically on compliance of its order. It said the hospitals which failed to comply with its order would face contempt proceedings.
-As per the complaint, Ranuat had recently made certain baseless comments on Akhtar which has caused damage to the reputation of the veteran poet-lyricist.
+=Infrastructure=
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Drop-the-archaic-invest-in-new-tech-13122016003028 ''The Times of India''], Dec 13 2016
+[[File: Ventilator, some information about the types of ventilators.jpg|Ventilator, some information about the types of ventilators; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Drop-the-archaic-invest-in-new-tech-13122016003028 ''The Times of India''], Dec 13 2016|frame|500px]]
-It added that Ranaut dragged Akhtar's name while referring to a "coterie" existing in Bollywood following the death of actor Sushant Singh Rajput in June.
+''' `Drop the archaic, invest in new tech' '''
-She had also claimed that Akhtar had threatened her to not speak about her alleged relationship with actor Hrithik Roshan, it said.
+DurgeshNandan Jha
-All these statements made by Ranaut have garnered views in lakhs and thus tarnished Akhtar's reputation, the complaint said.
+In a big and heavily populated country like India, it's very difficult to narrow the gap between demand and supply . It always strains the infrastructure. Healthcare is one area where the available infrastructure isn't enough to meet the ever-rising demand. But doctors at AIIMS Trauma Center say investing in newer technologies could at least prevent a crisis-like situation.
-==Cocky with Karan ==
+Ambu-bags are archaic.“We don't use ambu-bags at all.We have purchased disposable ventilators for emergencies, which cost Rs 5,000 (approx), and which run on their own,“ said Dr Deepak Agrawal, senior neurosurgeon, AIIMS.
-===Calls Karan 'movie mafia,' 'flag-bearer of nepotism’===
-Condensed from   [http://www.misskyra.com/celebs/kangana-ranaut-accuses-karan-johar-of-nepotism/articleshow/57075741.cms    Sakshma Srivastav | Did Kangana accuse Karan Johar of nepotism? Feb 10, 2017  | '' Miss Kyra '' ]
+Apart from providing life support during transportation (within or outside the hospital), the disposable ventilators also help wean off patients from regular ventilator support, Agrawal added.
-Things got fiery [on Karan Johar's chat show 'Koffee With Karan’] when Kangana accused Karan of nepotism. "Kangana told him that if she ever writes a biography, she will see to it that it will have a chapter on nepotism written by Karan!"
+Mohammad Javed is a case in point. The 15-year-old boy from Hazaribagh in Jharkhand has been on ventilator support since 2013, when he suffered a spinal injury . “He doesn't require full life support. So, we put him on a disposable ventilator so that he could go out of the hospital,“ Dr Agrawal said.
-{Kangana [also] called Karan a 'movie mafia'}
+Adult respiration is about 12 times per minute, while children breathe faster. Venti lators do that for patients who can't respire on their own.
-=== Karan asks Kangana to leave [Filmistan]===
+Dr U K Valecha, director, department of anaesthesia at BLK Super Specialty Hospital said ambu-bags are primitive and mustn't be used at all. “At our hospitals, we have ICU ventilators that are interactive. The key parameters like oxygen saturation and respiratory rate are adjusted in these machines automatically as per the patient's requirements,“ he said.
-Condensed from [http://www.misskyra.com/celebs/did-karan-johar-just-ask-kangana-ranaut-to-leave-bollywood/articleshow/57488818.cms    Sakshma Srivastav | - Mar 6, 2017| Did Karan Johar just ask Kangana Ranaut to leave Bollywood?! | '' Miss Kyra '' ]
+While ICU ventilators are ideal, their cost is exorbitantly high and trained personnel are required to monitor them 24x7.Private hospitals charge a lot for these services. Many ICU experts say basic ventilators with controls to monitor parameters could be used in less critical patients. “No developed country or even the developing nations use manual, hand-held devices as a replacement for mechanical ventilators,“ Dr Valecha added.
-Many weeks later Karan said, "She has the right to have an opinion…What is nepotism? Am I working with my son, daughter or nephew? What about those 15 filmmakers who are not from the film industry? No one will talk about Tarun Mansukhani, Shakun Batra, Shashank Khaitan or a Punit Malhotra … who came from no film background. I think that is the reverse of nepotism. As far as actors are concerned, I have launched just two of them i.e. Alia Bhatt and Varun Dhawan. Sidharth Malhotra was just 1/3rd of them and had nothing to do with the movies. So I really didn't get what she meant."
+In his address at the 56th International Respiratory Congress of the American Association of Respiratory Care, Robert M Kacmarek, an expert in respiratory care, said the current generation of ICU ventilators are the most complex and versatile of any mechanical ventilator ever manufactured. “The ICU ventilators of the future will be able to integrate electronically with other bedside technology; they will be able to effectively ventilate all patients in all settings, invasively and non-invasively; alarm systems will be smart and decision support will be available,“ he added.
-He further added, "What does she mean by 'movie mafia'? What does she think we are doing? Sitting here and not giving her work? I do that because maybe I am not interested in working with Kangana and that does not make me movie mafia, it makes me a man with an opinion. … People said 'she gave it off to Karan' and I would say of course, but I was gracious enough to keep everything. I cut none of it and I do edit so much of stuff from the show. I was like let the world see her opinion. … I want to conclude by saying I am done with Kangana playing the woman card and the victim card. You can't be a victim at every point of time who has a sad story to say as to how you have been terrorised by the bad world of industry. If that's the case, leave it."
+==Ambulances (government)==
+'''See graphic''': ''Total ambulance services under National Health Mission and number of people per ambulance, state-wise''
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+[[File: Total ambulance services under National Health Mission and number of people per ambulance, state-wise.jpg|Total ambulance services under National Health Mission and number of people per ambulance, state-wise; [http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=STATOISTICS-Kerala-has-the-least-number-of-government-12122016006026 The Times of India], Dec 12, 2016|frame|500px]]
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-==vs. Ketan Mehta==
+=IVF clinics =
-([http://www.koimoi.com/bollywood-news/kangana-ranaut-receives-legal-notice-from-director-ketan-mehta-heres-why/   KoiMoi.com])
+==Less than 20% are registered==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Only-20-IVF-clinics-2-ART-units-registered-21082017011011  Sushmi Dey, Only 20% IVF clinics, 2% ART units registered with ICMR, Aug 21 2017: The Times of India]
-Filmmaker Ketan Mehta sent a legal notice to Kangana Ranaut for conniving with producer Kamal Jain and others to hijack '' Rani of Jhansi – The Warrior Queen, '' his most ambitious film project. According to Mehta, he had approached Kangana to play the role of Rani Lakshmibai of Jhansi in his film in June 2015. The actress had publicly committed to doing the project with him in 2015 but later she announced another film titled '' Manikarnika – the Queen of Jhansi '' [slated to release in April 2018, and being directed by Krish].
+'''Centre Plans To Regulate Such Centres'''
-“We also shared the script [with Ranaut], certain research material and a lot of discussions had happened. After this, suddenly we hear that she is doing a project with some other producer. I find this completely unethical,” he added.
+Less than 20% IVF clinics and a miniscule 2% ART centres operating in India are registered with the Indian Council of Medical Research, prompting the government to consider making enrolment of such facilities with the council mandatory.
-== vs.  Lisa Haydon==
+In a move to regulate mushrooming infertility clinics and make them more accountable for services and costs, the government is planning to issue a notification.Though the provision is part of the pending Assistant Reproductive Technology Bill, the health ministry is looking at a separate notification to roll out the regulation. While there are over 20,000 ART clinics across the country providing IVF (In Vitro Fertilisation) and IUI (intrauterine insemination ) services, merely 1,500 clinics have applied for registration with ICMR so far. “A comprehensive ART registry will be the first step to transparency in costs and quality ,“ R S Sharma, senior deputy director general, division of reproductive biology maternal health and child Health told TOI.
-The bond between Lisa and Kangana in Queen was lauded by critics and fans, but there was no warmth between the actors off screen. Lisa, in an interview, revealed that Kangana did not become friends with her during the film sets and was quite aloof. She told Mid-Day, "She (Kangana Ranaut) was in her own zone. She would just turn off. So, even if the chemistry is good in the film, it's because of the characters and not because we were bonding."
-==vs. [[Prabhas]]==
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/Baahubali-2-The-Conclusion-Times-when-the-S-S-Rajamouli-epic-made-headlines/-Rohit-Shetty-showers-praise-on-Baahubali-2-The-Conclusion/photostory/58604564.cms    Shivkumar.H | Kangana Ranaut recalls working with Prabhas and how they hated each other | IndiaTimes/ ''The Times of India'']
+Of this number, only around 390 have actually completed the enrolment process, ac cording to the ART registry set up by ICMR in 2013. A single IVF cycle can cost anywhere between Rs 1.5 to Rs 2.5 lakh.
-Kangana Ranaut recalled the time she worked with [[Prabhas]]  in the 2009 film ‘Ek Niranjan’. Remembering their unpleasant days on the sets, Kangana said that at that point, they used to fight a lot and that there was even a time when the two had a really intense argument and stopped talking to each other altogether.
+The demand for IVF and ART services is rising and could be linked to emerging demographics. There is a rise in the proportion of women in reproductive age of 20-44 years (a 14% increase estimated between 2010 to 2020). The rise is skewed towards women in the age bracket of 30-44 years (20% estimated increase in same period). The latter display lower fertility rates.
-==vs. Pratap Sarnaik, Shiv Sena MLA==
-''The Times of India'' Dec 2020
-Shiv Sena MLA sends ‘breach of privilege’ notice against Kangana to Maha speaker
+Enrolment means compliance with ICMR guidelines like submitting documents related to infrastructure, trained manpower and procedures as per a prescribed format.“ART registry is the first step to ensuring quality treatment. We identify ART clinics ourselves too and ask them for documents but they are not meeting requirements. It is a major challenge in bringing in any kind of transparency ,“ R S Sharma, said.
-Shiv Sena MLA Pratap Sarnaik, who is under investigation by the Enforcement Directorate, on Monday said he had sent a breach of privilege notice to legislative assembly speaker Nana Patole against Kangana Ranaut and several media and social media outlets for claiming that Pakistani credit cards were found at his residence, reports Priyanka Kakodkar. “Ms Ranaut tweeted that Pakistani credit cards had been found at my home during ED raids. This is untrue and defamatory,” he said. Sarnaik had earlier been critical of Ranaut’s statement comparing Mumbai with POK. He had also initiated a breach of privilege motion against Republic TV founder Arnab Goswami for his remarks against chief minister Uddhav Thackeray. Sena has alleged that the raids were vendetta for this action.
+The large numbers of clinics and their misuse for sex determination is a major concern for the government. In the absence of a detailed regulation, a “grey market“ of unprofessional ART clinics are operating taking advantage of couples looking to have children.
-==Wanted physical, not regular relationship with Ranbir Kapoor==
+There is also no benchmark for pricing. Some clinics charge exorbitant fees while others indulge in unethical practices that adversely affect the recipient of the treatment, medically and socially , experts say.
-[http://photogallery.indiatimes.com/celebs/bollywood/kangana-ranaut/kangana-ranaut-faces-problem-in-kissing/articleshow/56885245.cms     Did Kangana ask Ranbir if he’d be interested in a physical relationship? | Oct 5, 2017 | IndiaTimes/ ''The Times of India'']
+According to a 2015 Ernst & Young report, an estimated 55% of treatments take place in eight metros. Most of the insurance schemes do not cover such procedures or treatments, leaving such couples with huge out of pocket expenditures. The report also concludes that the absence of a regulatory framework leads to poor treatment outcomes and patient care.
-Controversy queen Kangana Ranaut has surprised everyone with another shocking revelation, which has come to fore through her emails sent to Hrithik Roshan. She reportedly mentioned in the email that she had asked Ranbir Kapoor to get into a physical relationship with her.
+=Medical devices=
+==Import of devices, 2014-16==
+See graphic.
-In the email, Kangana wrote, “He never paid any attention to me before queen, on few occasions I even got brotherly vibes from him but after he saw 'Queen' footage in phantom’s office he approached me on my bbm and started dropping funky links to videos and other random stuff.”
+[[File: Medical devices that were imported in 2014-16 and the share on China in those imports.jpg| Medical devices that were imported in 2014-16 and the share on China in those imports; [http://epaperbeta.timesofindia.com/Gallery.aspx?id=31_05_2017_026_027_012&type=P&artUrl=Domestic-med-devices-hit-by-cheap-imports-31052017026027&eid=31808 The Times of India], May 31, 2017|frame|500px]]
-“When I was shooting in Gwalior for revolver, he made slight straight-forward approach and in its response, I told him that I am in love with someone and I am distressed all the time (that was the time when you’d come to my b’day and tension between us was at its peak, I didn’t take your name but I thought if I tell him this, he will understand me better),” she added.
-“Then again we lost touch when I was in NYC, he texted asking howz NYC? and I asked him if he’d be interested in a physical relationship with me, he got a little intimidated and asked why not a regular relationship, to that I said because I am in love with someone and I think he felt bad about it,” Kangana further added.
+=Medical negligence cases =
+==2017: Cases on the rise==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=CALL-FOR-HUMANE-TOUCH-Medical-negligence-cases-rising-27032017008011  DurgeshNandan Jha, Medical negligence cases rising: Study, March 27, 2017 The Times of India]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-==Badmouths Salman Khan, Uday Chopra, Nargis… ==
+'''Most Plaints For Wrong Treatment, Finds AIIMS Dept'''
-[http://www.misskyra.com/celebs/kangana-ranaut-blames-salman-khan-leaked-mails-hrithik-roshan-bollywood/articleshow/61037049.cms?utm_platform=Web&utm_source=TOIHP_Web&utm_medium=Referral&utm_campaign=TOI_MissKyra_articleshow    Alisha Alam |Kangana blames Salman Khan for abusing her, in leaked mails to Hrithik |Oct 11, 2017| Miss Kyra]
+Wrong treatment is the most common reason for people to complain about medical negligence, followed by lack of care, no treatment and forced discharge, a study by AIIMS forensic department has revealed.
-A few of the actress' supposed emails have also been leaked and these ones target none other than Salman Khan and Uday Chopra.
+The study involves interviews of families of 20 patients who died due to alleged negligence. While 13 cases involved private hospitals, seven were from government ones in and around south Delhi.
-In the mails, the actress has reportedly blamed Salman Khan for abusing her because she supposedly turned down a film he had offered her. She also alludes to Nargis Fakhri and Uday Chopra's failed relationship. Here's what she wrote:
+Dr Abhishek Yadav, who led the study , told TOI that allegations were found to be more common in age groups of children and adolescent (50%) with a declining trend with increase in age. “The super-specialty hospitals are accused of negligence in 65% cases,“ he added.
-"You went for Big Boss. That's great, it's good to give BB that post-release promotion. I am glad you didn't meet SK [Salman Khan]. He's weird. When I said no to that film, he said, 'Kareena was doing that film, but I gave it to you because it won't help her, but it can make your career'.
+The allegation against the hospitals, both private and government, is in the ratio of 1.8:1, Yadav said. “Wrong treatmentprocedure was the main reason (45%),“ he added.
-"My jaw dropped. Is he crazy? Kareena's role in Bajrangi Bhaijaan will make my career? Which world does he live in? Which of his heroine's career is made?
+Recently , Delhi Medical Council deregistered two orthopaedic surgeons for six months for operating the wrong leg of a 24-year-old man who was admitted at Fortis Hospital in Shalimar Bagh after fracturing his right foot.
-"Everyone told me not to do it. And I am loved because I never worked with him. Does he even know, people who have put their money on me, directors, producers, studios pleaded with me not to do his films because it will harm my brand. He used to make fun of me. Once he told me, why do you act so much? People like you end up nowhere. Look at Katrina, she is the perfect actress material; looks good and ''' keeps her mouth shut. ''' I told him he is very 19th-century, and I am not interested in becoming Katrina or Salman. He got pissed and started abusing me. After that, we didn't see his face for two years. He called, messaged, but I never replied. Then he called me for his birthday, I told you about that time I saw him for five minutes. After Queen, he has been wanting to meet me, but I just don't feel like it, and this film offer is just a desperate attempt. This is the thing with unpleasant people, you just don't want to see them. [sic].
+Dr Sudhir Gupta, professor and head of forensic sciences department, AIIMS, said incidence of alleged negligence has gone up signi ficantly over the past few years. “People are more aware about their rights. Also, recent court rulings in favour of the complainants where there is proven case of negligence has encouraged others to take up their grievances,“ he said.
-"Baby, you have made me so proud. Just read this news on Miss Malini that you were hanging out with Nargis and Uday. I was thinking about how hurt Uday must be because since you have been giving Nargis attention on Twitter, she's broken up with him. They weren't going very strong, but after she had hopes with you, she's been in her lalala land... must be making Uday feel really bad. But you sensed that, you made things clear to him. I am so touched, I am almost in tears. Isn't that heroic, jaan? He would've lost faith in love, friendship and people. But you didn't let that happen, you were wrong first, but are great now. That's real heroism. I am a fan now."
+AIIMS has recommended that doctors working in emergency and ICUs should be trained in declaring death of the patient to the relatives or a counsellor may be appointed for it.
-== vs.  Shahid Kapoor==
+Doctors said lack of communication between the doctors and patient is a major cause of discontent. “Doctors should refrain from ma king vague promises of complete recovery and should always explain the complication or unforeseen danger associated with the treatment procedure,“ said a doctor at the institute.
-[http://indiatoday.intoday.in/gallery/kangana-ranaut-shahid-kapoor-cold-war-rangoon-fights-bollywood-hrithik-roshan/1/18989.html#photo1   Living with Shahid was a nightmare, says Kangana. Here's why she is the Queen of cold wars    | Feb 2017| ''India Today'']
+Dr Girish Tyagi, registrar of Delhi Medical Council, said they get 20-30 complaints of negligence every month. “The number has gone up significantly in the past few years,“ he said.
-It's been a year that Kangana Ranaut's ''' catfights, cold wars and legal battles ''' with other Bollywood celebrities have made headlines.
+As per a report published in British Medical Journal, medical error is the third leading cause of death in the US, accounting for 2.5 lakh deaths every year. But no such data is available in India. Patients often allege that doctors try to save each other even when the case is referred to medical boards for investigation.
-And the recent to add to the long list of fights is her cold war with co-actor Shahid Kapoor on the sets of their upcoming film Rangoon. Buzz has it that the two shared cold vibes during the filming of Rangoon, and Kangana clarified her stand by saying that ''' she doesn't go to film sets to befriend her co-actors. '''
-If this wasn't enough, she recently added that sharing a cottage with Shahid during the shooting was a nightmare. She told Mid-Day, "We were shooting in a remote location where a little makeshift cottage was erected. Shahid and I were sharing the cottages with our respective teams. Every morning, I would wake up to this mad hip-hop music. And he would exercise listening to crazy trance and techno songs blasting from the speakers. I was fed up and wanted to shift out. Sharing the cottage with Shahid was a nightmare."
+=Medical, surgical advances=
+==Uterus/ womb transplant/ 2017==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=RAISING-HOPE-Pune-doctors-pull-off-Indias-first-19052017009029  Umesh Isalkar, RAISING HOPE - Pune doctors pull off India's first womb transplant, May 19, 2017: The Times of India]
-Her cold war with Shahid is not a one-of-its-kind event. Here's a look at the other ugly fights that Kangana was a part of.
-==vs. Urmila Matondkar, Jaya Bachchan==
+A team of doctors from Pune successfully performed the country's first uterus transplant on a 21-year-old woman from Solapur on Thursday . The breakthrough surgery was also the world's first laparoscopically (keyhole and minimally invasive) assisted live uterine transplant. The previous successful transplants were done only through open surgery .
-[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F09%2F18&entity=Ar01900&sk=811E056A&mode=text   Jaya’s remarks in Parliament trigger an unparliamentary war of words | From the Times of India, 18 Sept 2020]
-Right after [Jaya Bhaduri/ Bachchan] and [Ravi Kishan put forth divergent views in Parliament [on 16 Sept 2020], the ongoing public debate on the rights and wrongs of Bollywood resumed outside the House where the opinions – on TV or online – were far more aggressive
+The woman, who suffers from a congenital uterus absence, was fitted with her mother's womb, which was retrieved mainly through keyhole surgery .The subsequent transplant of the uterus was done through an open surgery . The entire operation lasted nine hours.
-''' Kangana Ranaut said: '''
+The surgery has opened a new gateway to motherhood for women who do not have a uterus, or those who have uteruses that do not function.The only options hitherto for such women were surrogacy or adoption.
-“I want to know from Jaya Bachchan ji who says ‘hamari industry Ganga ki tarah pavitra hai’,we have a murder on our hands. Why can’t they see us?”
+Pune's Galaxy Care Laparoscopy Institute (GCLI), where the surgery was done, was granted a licence by the state's directorate of health services to carry out the transplant. “The surgery was successful. Both the recipient and the donor are stable. However, the next 48 hours are crucial for determining the success of the surgery ,“ said oncosurgeon Shailesh Puntambekar and cardiovascular thoracic surgeon Sanjeev Jadhav who performed the surgery along with a team of 10 other doctors.
-“One does not have to be a genius to figure, it is not very difficult for me to get a ticket, I don’t have to play with my life or have my property ruined. Even Urmila Matondkar, she is a soft porn star, I know it’s very blatant, but I want to ask you, she is not known for her acting for sure, what is she known for? For doing soft porns, right? If she can get a ticket, why won’t I get a ticket?”
+Incidentally , Jadhav, who hails from Pune, has become the first transplant surgeon in the world to have performed transplants of the heart, lung, kidney and uterus.
-“Sushant (Singh Rajput) hamesha kehta tha ki mujhe yahaan par bully kiya jaa raha hai,mujhe Bollywood se nikaala jaa raha hai. Uske saath atyachaar hue, anyaay hue, toh kya yeh log (Bollywood) nahi keh sakte thay ki hum aapka dukh samajhte hai... Kya voh uss khoon mein hissedaar nahi hai?”
+=Pre-natal tests=
+==PG in imaging tech essential: SC==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F03%2F15&entity=Ar02111&sk=88F9C6DB&mode=text  PG in imaging tech must for conducting pre-natal tests: SC, March 15, 2018:  ''The Times of India'']
-“Liberal brigade once virtually lynched a renowned writer into silence for saying people like Sunny Leone should not be our role models, Sunny is accepted by the industry and entire India as an artist, suddenly fake feminists equating being a porn star to something derogatory (sic)”
+The SC mandated that only a postgraduate in ultra-sonography or imaging techniques could be allowed to conduct pre-natal diagnostic tests, staying the Delhi HC’s order which had quashed the Centre’s rule prescribing qualification for conducting such tests.
-''' Urmila Matondkar replied: '''
+The HC had ruled that Section 2(p) of the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, defining a sonologist or imaging specialist as a person possessing postgraduate qualification in ultra-sonography or imaging techniques, was bad because there was no such qualification recognised by MCI and the Act did not empower the statutory bodies to devise and coin new qualification.
-“Someone as senior as her (Jaya Bachchan), a torch bearer of heroine oriented cinema and an elderly colleague, it is not in good taste to speak like that about her children and her. It does not go well with our culture and upbringing. I was brought up to respect the field and people who make me”
+A CJI-led bench said Parliament had conferred rulemaking authority upon the Centre to specify minimum qualification for persons to be employed for conducting the tests and the HC was not right in interpreting the law.
-“Kangana should come out of all these things once and for all, instead of going on and on and on... You have to decide do you want to constantly play the victim card non-stopand say main toh victim hoon, victim hoon,victim hoon”
+“Parliament which has the unquestioned authority and legislative competence to frame the law considered it necessary to empower the Central government to frame rules to govern the qualifications of persons employed in genetic counselling centres, laboratories and clinics. The wisdom of the legislature in adopting the policy cannot be substituted by the court in the exercise of the power of judicial review,” the bench said.
-“You (Kangana) can be a certified Rudaali (those who are called at funerals to cry) of the film industry... Sanitary workers descend into the gutter to clean it so if an actress earning millions is doing that, we should post her picture in every office of every city and every state”
+=Private expenditure=
+==2015-16: Private expenditure outstrips government==
+[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F12%2F27&entity=Ar00400&sk=242AC653&mode=text&fbclid=IwAR2FlVn1V4uybMi4R1PY-HsNSZXz_XlK8qZQ4FGqp5Co9S3Wp4Adba4io6Y  Sushmi Dey, Govt’s shrinking footprint in India’s healthcare, December 27, 2018: ''The Times of India'']
+[[File: Health expenditure as % of state GDP (2015-16).jpg|Health expenditure as % of state GDP (2015-16) <br/> From: [https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2018%2F12%2F27&entity=Ar00400&sk=242AC653&mode=text&fbclid=IwAR2FlVn1V4uybMi4R1PY-HsNSZXz_XlK8qZQ4FGqp5Co9S3Wp4Adba4io6Y  Sushmi Dey, Govt’s shrinking footprint in India’s healthcare, December 27, 2018: ''The Times of India'']|frame|500px]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+''Across States, Out-Of-Pocket Expediture On Healthcare Outstrips Stagnant Govt Spending By A Significant Margin''
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+The public health expenditure in India, or what the government (Centre and state combined) spends on health, has remained constant over years in most states and is even less than the national average of 1.2% of GDP, making India one of the biggest private spenders on health among the low-middle income countries, latest data from National Health Accounts (NHA) show.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+India’s public expenditure on health in 2015-16 was Rs 1,40,054 crore.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+In major states like Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh, the government’s share in the total health expenditure continues to hover between 1.1-1.3% of gross state domestic product (GSDP), despite a substantial increase in healthcare costs. Public health spending in Maharashtra stood at a mere 0.7% of GSDP in 2015-16, against a total health expenditure of almost Rs 57,000 crore. Consequently, increasing the out-of-pocket burden.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+Even in Kerala, where the health indicators are better than other parts of the country, public health spending as share of GSDP is limited to merely 1%, whereas the total health expenditure stood at 4.5% of GSDP.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-[[Category:Cinema-TV-Pop|K KANGANA RANAUT
+Jammu & Kashmir accounted for the largest share of public spending on health at 1.7% of GSDP in 2015-16. However, the total expenditure in the state was also high as a percentage of its GSDP at 4.2%.
-KANGANA RANAUT]]
-[[Category:India|K KANGANA RANAUT
-KANGANA RANAUT]]
-=Taking on powerful forces=
+In Gujarat, the home state of PM Narendra Modi, the government spent 0.8% of GSDP in 2015-16, much below the national average. However, the state also accounted for a comparative total lower health expenditure as percentage of GSDP at 2%.
-== Karni Sena: ‘I'm Rajput, Will Destroy You’==
+The data was recently presented in Parliament by minister of state for health Anupriya Patel during the ongoing session.
-[https://www.ndtv.com/entertainment/kangana-ranaut-to-karni-sena-on-manikarnika-row-im-rajput-will-destroy-you-1979536  Kangana Ranaut To Karni Sena On Manikarnika Row: I'm Rajput, Will Destroy You NDTV] Jan 2019
+Around 67.8% of total expenditure on health in India is paid out of pocket. The world average is 18.2%.
-Four historians have certified Manikarnika, she said
+This assumes significance as the Centre has proposed to raise the public health expenditure to 2.5% of GDP by 2025.
-Kangana has also directed parts of Manikarnika
+Experts say the target is too ambitious given the current spending by states and the lack of resources for generating revenue. “There is no doubt that the government needs more investment for creation of healthcare infrastructure but looking at macroeconomic fundamentals, there is very little money whereas the liabilities are huge,” says Sujatha Rao, former health secretary.
-Manikarnika is based on the life of Rani Laxmi Bai
+Rao says unless the Centre is able to expand the taxpayers ratio and states are able to give around 8% of its revenue expenditure for health, compared with 3-5% currently, it would not be possible to meet the target.
-As per an ANI report, the Maharashtra wing of Karni Sena wrote a letter to the filmmakers in which they allegedly said that if the "image of Rani Laxmi Bai is maligned in the film or if she is shown to be the lover of some Britisher then the makers will face consequences." (Shri Rajput Karni Sena, threatened protests if Manikarnika: The Queen of Jhansi was not screened for the outfit before theatrical release. [https://www.news18.com/news/movies/if-karni-sena-doesnt-stop-harassing-me-over-manikarnika-ill-destroy-them-kangana-ranaut-2006567.html]) Rani Laxmi Bai, whose real name was Manikarnika, was born into a Marathi family living in Varanasi before marrying the ruler of Jhansi.
+The government expenditure on healthcare has increased to 1.18% of GDP in 2015-16 from 0.96% in 2005-06. In 2014-15, the total expenditure incurred on health as a percentage of GDP was 3.89%, whereas the government share stood at 1.13% of GDP.
-Actress Kangana Ranaut hit back strongly at Rajput fringe group Karni Sena who, she claims, are 'harassing' her over new film Manikarnika: The Queen Of Jhansi, which is based on the life of Rani Laxmi Bai. Kangana, whose film releases next Friday and for which she has obtained a certificate from the Central Board Of Film Certification, issued a statement saying that she too is Rajput and will "destroy" the Karni Sena if they continue to "harass" her over the film's release. "Four historians have certified Manikarnika, we have got censor certificate as well, Karni Sena has been conveyed this but they are continuing to harass me. If they don't stop then they should know I am also a Rajput and I will destroy each one of them," Kangana Ranaut said in a statement.
+At present, the Centre shares around 30% of the total public health expenditure, the rest is borne by states.
-=2020=
+With India not meeting its previous public health spending goals, healthcare experts are apprehensive about the current targets. The National Health Policy, 2002, had set a target of 2% of GDP by 2010; the United Progressive Alliance government, in 2004, had set a goal to increase publichealth spending to 2-3% of GDP over a five-year period; and the Centre’s 12th five-year plan set the target at 1.87% of GDP by March 2017.
-=Aug/ Sept: Ranaut polarises politics=
-== Maharashtra government hits back==
-[https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/shared/ShowArticle.aspx?doc=TOIDEL%2F2020%2F09%2F09&entity=Ar00102&sk=CEDADFA4&mode=text   Bhavika Jain & Priyanka Kakodkar| Maha home min orders probe into allegations on Kangana’s ‘drug link’ | 9 09 2020 |   The Times of India] and [https://timesofindia.indiatimes.com/india/breaking-news-live-updates-september-9/liveblog/78008271.cms    The Times of India]
-The actor has been engaged in a bitter war of words with Shiv Sena MP Sanjay Raut after her remarks that she feels unsafe in Mumbai and has no trust in the Mumbai Police after the death of Sushant Singh Rajput.
-Ranaut had slammed Shiv Sena MP Sanjay Raut for telling her not to return to the financial capital, claiming that the remark seems like an open threat to her. "Sanjay Raut Shiv Sena leader has given me an open threat and asked me not to come back to Mumbai, after Aazadi graffitis in Mumbai streets and now open threats, why Mumbai is feeling like Pakistan occupied Kashmir?" Kangana had tweeted.
+Despite these targets, India’s public-health expenditure is amongst the lowest in the world, lower than most low-income countries.
-Trouble mounted for actor Kangana Ranaut as Maharashtra home minister Anil Deshmukh said   that the Mumbai police would probe allegations that she took drugs. Talking to reporters outside Vidhan Bhavan on the last day of the monsoon session, Deshmukh said actor Adhyayan Suman, who was in a relationship with Ranaut earlier, had in an interview in 2016 claimed she consumed drugs and even forced him to take it.
+The Centre has proposed to raise the public health expenditure to 2.5% of GDP by 2025. But it would be impossible to meet the target unless states raise revenue expenditure on health to 8% from 3-5% currently.
-Sena MLAs Pratap Sarnaik and Sunil Prabhu had raised the issue with Deshmukh. “They have submitted that in an interview in 2016, Suman had alleged that Ranaut consumed drugs...,” he said.
-The Mumbai civic body issued a 24-hour notice to Kangana seeking a reply on the ''' “illegal alteration and construction” on the premises of her recently renovated bungalow.bb  If she fails to reply, it will demolish the unauthorised portion
+=Shortcomings=
+==Government facilities inadequate; private expensive==
+[[File: health infrastructure.jpg| |frame|500px]]
+''' Where State Drives Patients To Private Wards '''
+[[File: Beds per 1000 people in government hospitals in major states (2013) and a comparison with some other countries.jpg|Beds per 1000 people in government hospitals in major states (2013) and a comparison with some other countries; Graphic courtesy: [http://epaperbeta.timesofindia.com/Gallery.aspx?id=19_09_2015_011_007_002&type=P&artUrl=STATOISTICS-UNHEALTHY-SITUATION-19092015011007&eid=31808 ''The Times of India''], September 19, 2015|frame|500px]]
-The next day: Brihanmumbai Municipal Corporation (BMC) officials carried out demolition at Kangana Ranaut's office.
+Rema Nagarajan
-The  development came two days after a BMC team paid a surprise visit to her office and surveyed the premises at Bungalow No. 5, Chetan Row House, Nargis Dutt Road, Bandra west.
-The survey was followed by the notice to Ranaut to stop the ongoing works within 24 hours, but after her staffers refused to accept it, the notice was pasted outside her office of Manikarna Films
-''' Actor’s comments show she’s a traitor: Cong MLC '''
+[http://epaperbeta.timesofindia.com//Article.aspx?eid=31808&articlexml=REALITY-CHECK-HEALTH-Where-State-Drives-Patients-To-19092014004011 The Times of India ] Sep 19 2014
-Actor Kangana Ranaut took to Twitter to state "my Mumbai is POK now" and posted photographs of city municipal corporation officials demolishing her property in the city.
+==Availability of doctors==
+''' `More docs, not health centres, save lives' '''
+[[File: Central Health Service, sanctioned posts and vacancies, 2016.jpg| Central Health Service, sanctioned posts and vacancies, 2016; Graphic courtesy: [http://epaperbeta.timesofindia.com/Gallery.aspx?id=28_05_2016_011_008_010&type=P&artUrl=IMA-Raising-docs-retirement-age-now-hike-PG-28052016011008&eid=31808 ''The Times of India''], May 28, 2016|frame|500px]]
-They (Sena MLAs Pratap Sarnaik and Sunil Prabhu) have submitted that in an interview in 2016, actor Adhyayan Suman had alleged that Ranaut consumed drugs and forced him to take the substance too. Mumbai Police will look into the matter,” Maharashtra home minister Anil Deshmukh said.
+Himanshi.Dhawan @timesgroup.com
+New Delhi
-Congress MLC Bhai Jagtap, who moved a breach of privilege motion in the state council against Ranaut for ''' comparing Mumbai with Pakistan-occupied Kashmir, ''' also referred to the same interview. Jagtap said he was willing to provide proof about the interview. “Her comments on Mumbai show she is a traitor to the city and state. It is a betrayal of the martyrs of the Samyukta Maharashtra movement who fought to keep Mumbai in Maharashtra,” he said.
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=More-docs-not-health-centres-save-lives-19082014010005  ''The Times of India''] Aug 19 2014
-BJP leader Ashish Shelar said that he does not agree with those who compare Mumbai to Pakistan even if the person is Kangana Ranaut
+''' Higher No. Of Medics Help Check Crib Deaths: Study '''
-Ranaut had recently said that she feared the Mumbai police more than the ‘movie mafia’, and would prefer security either from Himachal Pradesh or the Centre. She was provided Y-plus security by the Centre on Monday.
+Do hospitals translate to better healthcare? Not necessarily . States with more doctors have better healthcare indices than those with better infrastructure, data analysed by thinktank Swaniti reveals.
-Deshmukh said the irresponsible statements made by Ranaut discredit the city from where she got name and fame. “No one can tolerate such insult of the state and the city. She has insulted the same Mumbai police that caught Kasab (26/11 terror attack accused), and had officials like Hemant Karkare, Vijay Salaskar and Vijay Kamte who died in the line of duty,” he said.
+While better health outcomes depend on multiple reasons, it appears that doctor to population ratio had a far higher impact on infant mortality rate (IMR) or maternal mortality rate (MMR) than better infrastructure.Tamil Nadu that has fewer primary health centers (PHCs), one per lakh of population, as compared to Chhattisgarh and Odisha that have two PHCs is better placed in health outcomes.
+Tamil Nadu has one doctor for 789 patients and an infant mortality rate of 21 and maternal mortality of 97.
+In sharp comparison, Chhattisgarh has one doctor for 6,221 patients and witnesses 47 infant deaths for every 1,000 live births and 269 maternal deaths per 1,00,000 live births. Odisha that has one doctor for 2,500 patients, too, suffers from high infant and mother deaths. It has IMR of 53 and MMR of 258, respectively.
+Interestingly , states like Andhra Pradesh, Goa, Karnataka, Kerala and Tamil Nadu alone account for 42% of all medical colleges in India thereby producing most of India's doctors. Not surprisingly , these states also have the best Doctor Population Ratio (DPR).
+These states show no shortfall of doctors at PHC level and have already met the Millennium Development Goals (MDG). At least three of the five -Kerala, Goa and Tamil Nadu -have IMR below 21. Incidentally , West Bengal has one of the highest per capita coverage of primary health centres -nine per lakh population.However, it has just one doctor for 1,508 patients and IMR of 32 while its MMR is 145.
+In comparison, north Indian states of Madhya Pradesh, Bihar, Uttar Pradesh, Odisha and Chhattisgarh have very few medical colleges, a fact which reflects in their DPR.
+Unsurprisingly , most states with poor DPR also had a relatively high shortfall of doctors at the PHC lev el. For example a state like Bihar has one doctor for every 2,785 people. This translates to IMR of 43 and a MMR of 261.
+When these numbers are viewed against the MDG target of 27 for Infant Mortality Rate in India by 2015, it becomes clear that these states need to act urgently to improve their performance in public health.
+“It is important to go beyond merely having doctors and invest in improving the quality of healthcare professionals in India. National Healthcare Policy , another promise by the new government, should hopefully lead to greater public investment in healthcare, and improve the quantity and quality of healthcare in India while reducing regional disparities.
+Some of the other factors are efficient utilization of funds, good quality of human resources in healthcare, and finally awareness among people.'' Rwitwika Bhattacharya from Swaniti said.
+===Shortfall of doctors: 2015===
+[[File: Shortfall of doctors, 2005-15, shortfall of rural medical centres or hospitals.jpg|Shortfall of doctors, 2005-15: Shortfall of rural medical centres/ hospitals|frame|500px]]
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=After-10-yrs-of-rural-health-mission-doctor-10092015012015 ''The Times of India''] , Sep 10 2015
+Subodh Varma
+'''After 10 yrs of rural health mission, doctor shortfall up'''
+At the country level, there is a staggering shortfall of 81% of specialist doctors, 12% of general physicians, 21% of nurses and 5% of auxiliary nurse cum midwives. Among technical support staff, shortfalls range from 29% for pharmacists to 45%for laboratory technicians and 63% for radiographers.But since a decade ago, many of these shortfalls have increased except for nurses and ANMs.
+A bizarre aspect of this data put out annually by the ministry of health is that in many categories of health personnel, some states have surplus appointments while others have shortfalls. For example, at the country level, 25,308 doctors are required going by the Indian Public Health Standards (IPHS), which says that one doctor is needed for every primary health centre (PHC).But actually , there are 34,750 doctors sanctioned. 25 states have surplus doctors, the total surplus working out to 5,115.On the other hand, the remaining states have a combined shortfall of 3,002 doctors.
+T Sundararaman, professor at the Tata Institute for Social Sciences and former executive director of the National Health Systems Resource Centre says, “IPHS recommended two doctors and one ayush doctor per PHC. In 2011, the doctors per PHC was revised downwards. But doctors are -unlike ANMs -paid only by the states. So many states, like Tamil Nadu, have two doctors per PHC as sanctioned. The `required' number is the statistics department's interpretation of IPHS to mean that only one doctor is required per PHC. They have no basis to do this, and one doctor per PHC is not viable. The short falls are genuine -the over appointments are not,“ he told TOI.
+The surpluses in healthcare personnel arise because goal posts are shifted by lowering requirements. In reality the shortages are all round.
+===Doctors, in rural areas===
+[http://epaper.timesofindia.com/Default/Client.asp?Daily=CAP&showST=true&login=default&pub=TOI&Enter=true&Skin=TOINEW&AW=1393708348876  Times of  India]
+Funds fail to draw docs to villages
+[[File:  doctor.png | |frame|500px]]
-The Ministry of Home Affairs approved Y-plus security Ranaut after she received threats for comparing Mumbai with Pakistan occupied Kashmir.  Ranaut has been given Y-plus category security and will be protected by about 10 armed commandos who will work in shifts around the clock.
+Despite 42,000cr Kept Aside For Rural Medical Care, Rs 10,000cr Lying Unspent
+Subodh Varma TIMES INSIGHT GROUP
-''' Polarised politics '''
-The BJP   lashed out at the Shiv Sena-led MVA dispensation over razing of "illegal alterations" at the bungalow of actress Kangana Ranaut by the Mumbai civic body, terming the development "vendetta politics" and a kind of "government-sponsored terror" in the state.
+As the country awaits another central government Budget, there is a growing demand for more financial muscle on several fronts. But, is throwing money at complex problems really a solution? A look at the progress of a crucial program of the government, the National Rural Health Mission (NRHM), indicates that money can’t buy everything.
+One of the biggest bottlenecks facing policy-makers is that of medical personnel. Recently released data by the ministry of health and family welfare shows a shocking shortfall of doctors, nurses, health assistants, radiographers, pharmacists and other personnel in the rural health delivery structure. This is despite over 82,000 new personnel being appointed under NRHM in the past four years and many villages getting to see a doctor for the first time.
+The situation is worse for qualified doctors. Just 20% of required pediatricians and only about 26% of surgeons, obstetricians and gynaecologists, and general physicians are in place. They are needed at the Community Health Centres (CHC), each serving a population of 1.2 lakh. Among technical personnel, only about 40% of the required radiographers and 47% of laboratory technicians are in place to run diagnostic labs. There is a shortfall of about 25% for pharmacists, and 16% for staff nurses.
-BJP Rajya Sabha MP Subramanian Swamy backed Kangana Ranaut He tweeted: “Tell Kangana to keep the faith. We are with her in this struggle.”
+Even at the lower rungs of the medical service hierarchy, like the health sub-centres and primary health centers, many of the key personnel are not yet appointed. Nearly a quarter of 46,000 male and female health assistants are missing, while over 60% of health workers are not yet in place. The situation is much better for the auxiliary nurse and midwife (ANM) with about 90% appointments having taken place, but that still leaves nearly 16,000 ANM posts vacant. Two ANMs are required at the primary level in order that delivery cases are handled day and night. Just about one third of the PHCs are functioning with two ANMs.
-Karni Sena [which had threatened her on Manikarnika] supported Kangana Ranaut, held protest against Sanjay Raut in Delhi.    The Karni Sena, also popularly known as Shri Rajput Karni Sena (SRKS), is an organisation based in Rajasthan
+Expenditure data shows that the problem is not of resources. Out of the Rs 42,000 crores released by the central government in the past four years for NRHM, nearly Rs 10,000 crore is lying unspent with state governments. In addition, all state governments together have allocated an eyepopping Rs 1,06,388 crore for health and family welfare in their respective states.
-RPI (A) leader and Union minister Ramdas Athawale had declared that his party workers will protect Kangana while she is in Mumbai.
+Yet, progress under NRHM, has been uneven, and the country is still far from achieving goals set for various health indicators.
+“Spending money jazzing up an auto-rickshaw is not going to convert it into a car”, says public health expert Dr Amit Sengupta. A thorough revamp of the infrastructure is needed and the government needs to think afresh about it, he says.
+But why are medical personnel not in place? “An indifferent political leadership and bureaucracy, deficient medical education infrastructure, especially for technical and paramedical staff, low salaries for doctors, and frustration among them in rural postings as there are no drugs, no support staff and erratic infrastructure, are some of the problems,” Sengupta said.
+“Sadly, doctors prefer lucrative private incomes in urban areas or foreign lands, rather than serving people in the villages,” he says.
-Himachal Pradesh chief minister Jai Ram Thakur condemned the demolition of a portion of Kangana Ranaut's Mumbai bungalow by the civic body, saying she "is a daughter" of the state and she should get a "proper atmosphere" to work in her field.
+===Statewise availability of doctors===
+====Karnataka, TN, Andhra, Maharashtra best====
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Karnataka-TN-Andhra-Maha-have-46-of-countrys-23052016012033 ''The Times of India''], May 23 2016
-LJP chief Chirag Paswan came in support of Kangna Ranaut, appealed to all people from Bihar and other parts of North India to stand with the actress
+Chethan Kumar
+India is struggling with a doctor-patient ratio of 1:1,681. This poor state of affairs is hindering healthcare services across the country. But even among the 9.5 lakh doctors, the distribution is so skewed that just four states -Maharashtra, Karnataka, Tamil Nadu and undivided Andhra Pradesh -have nearly 46% of all doctors registered in the country.
-The demolition of a part of the residential office of Kangana Ranaut was also condemned in Varanasi, Prime Minister Narendra Modi's parliamentary constituency, where the residents staged a protest. Eunuchs threw slippers at the posters of Shiv Sena leader Sanjay Raut and Samajwadi Party (SP) leader Abu Azmi. Raut had earlier got into a spat with Kangana.
+This leaves bigger states like Rajasthan, Madhya Pradesh, Uttar Pradesh and others with few doctors to share between them.
-Maharashtra NCP chief Jayant Patil on Wednesday took a dig at BJP leader Devendra Fadnavis after the latter targeted the state government in Hindi on the partial razing of actress Kangana Ranaut's bungalow by the Mumbai civic body. Tagging Fadnavis on Twitter, Patil sought to know why the former chose to speak in Hindi when this issue was related to Maharashtra.
+“The number of doctors in the country is just a portion of what's required to meet the minimum requirement and some states are not even in line with the national average,“ said Singhal, an associate professor (ENT) and head and neck surgeon at SMS Hospital, Jaipur.
+According to the mini stry of health and family welfare, out of 9,59,198 doctors registered in the country , 4,36,910 (45.54%) are in the four aforementioned states .
+Rajasthan, MP and Uttar Rajasthan, MP and Uttar Pradesh have a total of 1,31,554 doctors, making up for 13.7%, while only three of the seven northeastern states have doctors registered with them and add up to only 22,201. The rest are shared between all other states.
+Experts say the situation is worse than what the ministry's statistics reveal.
-= Black magic woman?=
+“There's no doubt that there's an overall shortage and skewed distribution.The problem is that doctors register with the Indian Medical Council or in the respective states when they pass out from the courses and there's no real update.Many of these 9.5 lakh doctors may not even be in the country ,“ Dr Upendra Bhojani, assistant director, Institute of Public Health (IPH), said.
-''' Does Kangana really practice black magic? '''
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/Does-Kangana-really-practice-black-magic/articleshow/52021904.cms TNN | Apr 28, 2016 The Times of India]
+That the four states have the maximum number of doctors should come as no surprise though, as they are among the states with the highest number of medical colleges. Together, they ac count for 69% of all the colleges in the country or 290 colleges out of 422.
-Well, her ex-boyfriend surely believes so. In an interview to DNA, he has let out some spine-chilling details about the 'Queen' actress Kangana Ranaut. He being a metropolitan guy could have never believed in it but he had to believe otherwise. he narrates the series of incidents that led him to buy into it. "One day Kangana called me at home in the night to do some puja. I reached at 11.30 pm as the puja was to start at 12. She had a small guest room in her apartment and she had covered it in black, including black curtains. There were some random statues of God, fire all around, some scary things kept puja. She asked me to chant some mantras, and locked me in. I was terrified. I didn't do it and I came out and told her that I had. Then she started taking me to Pallavi frequently. One day, Pallavi said go to the graveyard at 12 am and throw these certain things. I was chilled to the bone! I didn't go."
+Karnataka, which has the highest number (50) of medical colleges in the country , has 1,01.273 doctors (third highest in the country), while Maharashtra, which has the second highest number of medical colleges (48) has the highest number of doctors at 1,53,513.
-I have no grudges against Kangana: Adhyayan Suman
+Tamil Nadu has 1,11,325 doctors and 46 medical colleges, while Andhra Pradesh has 70,799 doctors and 46 colleges. Also, as experts point out, these are also states with a considerable urban population and a good network of private hospitals.
+“It's not just the private hospitals that make the difference. Many choose places considering the opportunity to run clinics which is more lucrative in urban areas. Also, they look out for other support infrastructure, like schools and so on, that is good for their families ,“ Bhojani said.
-This obviously was a cause of worry for his parents. He added,"My mother was very worried and she called the family's Panditji to come home and meet me. The first thing he asked me was: "Khana banati hai tumhare liye?" When I said yes, he said, "Apna impure blood milati hai khaane mein black magic ke liye. Being a metropolitan kid studying in London and New York, I was always away from things like astrology and black magic. I remember going to my Tarot reader after she started making me doing pujas. She told me she sensed a woman from pahadi region doing black magic on me. I knew only one person back then, my girlfriend Kangana, who used to go to Himachal for certain pujas there. My Tarot reader said she saw something really bad happening and warned me to get out of the relationship.
+=== Availability of specialist doctors in CHCs===
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Only-19-specialist-docs-in-Indias-health-centres-05022017007052  Rakesh Prakash, Only 19% specialist docs in India's health centres, Feb 5, 2017: The Times of India]
-She told me, "You feel you want to come out of it and every time you make a decision of wanting to come out, you fail and are back at it again." I would tell people who said anything negative about her to f*** off. The physical violence had become so frequent in my relationship with her that any other guy would have hit her back. But I couldn't. Every time I was hit, I wanted to retaliate but my hands would just stop. I was scared as hell. I would cry to my PR every single night. I would drive down Marine Drive with a bottle of scotch on my lap, drunk. I got into a phase where I could not accept reality and thought it was better to be perpetually drunk all the time. I had reached a stage where I would have either died because of an overdose of alcohol or gone mental. My mom prayed a lot for me.
-The same Pandit later on came on Salman's Dus Ka Dum also and he looked at Kangana in the middle of the show and said "Aap Pisachini (demoness) hai." She treated it as if it was a joke. It's there on national TV. My career stopped completely. I had a successful film 'Raaz 2' behind me but nobody wanted to talk about me. I started seeing this decline. My films were shutting down while she was achieving more success. Even talking about it scares me now..."
+India's elemental healthcare infrastructure seems to be in a `critical condition' with a meagre 19% availability of specialist doctors in the community health centres (CHCs) across the country .According to the statistics released by the Union health ministry on Friday , there is a shortfall of 17,854 medical specialists including surgeons, physicians, pediatricians, obstetricians and gynecologists.
-[[Category:Cinema-TV-Pop|K
+CHCs, which are located in towns and serve as referral centres for patients coming from the primary health centres (PHCs), are vital to improving the country's healthcare landscape. The total number of specialist doctors working at CHCs across the country is 4,186 against the current requirement is of 22,040.
-KANGANA RANAUT]]
-[[Category:India|K
-KANGANA RANAUT]]
-=Thus spake Kangana Ranaut'=
+Among the states that face a shortfall of specialists, Uttar Pradesh (shortfall of 2,608 doctors) tops the list followed by Rajasthan (1,787), Tamil Nadu (1,464), West Bengal (1,271), Odisha (1,154), Gujarat (1,140), Madhya Pradesh (1,047) and Maharashtra (935).
-[http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/Kangana-hits-back-at-Karan-Johar-says-she-was-playing-the-badass-card/photostory/57786912.cms   Kangana Ranaut's boldest statements  March 23, 2017 | IndiaTimes/ ''The Times of India'']
+The situation in Karnataka is relatively better with the availability of specialists at CHCs at 60.43% against the required strength of 824.
-After Kangana called Karan Johar the “flag bearer of nepotism” on his chat show, Karan shot back saying that he was fed up of seeing her play the ‘woman card’ and the ‘victim card’ and that if the actress had such a problem with the way Bollywood functions, she should think about quitting it.
+The only place that has reported a surplus of specialist doctors is Chandigarh (UT) with 14 doctors in the CHCs against the requirement of eight.
-Kangana, in conversation with Mumbai Mirror, she said, “Why is he trying to shame a woman for being a woman? What is this about the 'woman card' and the 'victim card'? This kind of talk is demeaning to all women, particularly the vulnerable because they are the ones who really need to use them. The 'woman card' might not help you become a Wimbledon champ, or win Olympic medals, or bag National awards. It might not even land you a job, but it can get a pregnant woman who feels her water is about to break a 'ladies' seat on a crowded bus. It can be used as a cry for help when you sense a threat. The same goes for the 'victim card', which women like my sister, Rangoli, who is a victim of an acid attack, can use while fighting for justice in court.”
+The shortfall of specialists in CHCs reiterates the clichéd argument that private hospitals continue to be more lucrative for doctors.
-She also added that she played the ‘badass card’ on his show and not the ‘victim card’ as he had mentioned. Kangana landed the final blow by saying that the industry is not a small studio given to Karan by his father and that KJo is “nobody” to tell her to leave it.
+But the question is who will crack the whip? Union minister of state for health Fagan Singh Kulaste told Lok Sabha on Friday , “Health is a state subject and the primary responsibility to ensure availability of doctors and other health professionals in public health facilities lies with the respective state governments.“
-On her alleged affair with heartthrob Hrithik Roshan, which ultimately led to a nasty court battle.
+But recruiting specialists is not an easy task for the state governments.Speaking on the shortage of specialist doctors recently , Karnataka's health minister K R Ramesh Kumar had said: “Though we have been offering a salary of Rs 1.25 lakh and additional incentives to specialists, not many are coming forward to serve in rural areas“
-In a recent interview with a portal, Kangana was asked about her views on the same and trust her to be unabashed about it. Admitting that it was only a matter of time before the matter came out in the open, Kangana said that “being naked” and revealing her stance to everyone has brought her closer to people.
+==A shortage of hospitals==
+[[File: States, UTs with more than 1 bed in government hospitals per 1000 people.jpg|States, UTs with more than 1 bed in government hospitals per 1000 people; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=STATOISTICS-In-Bihar-every-10000-people-have-access-09082016011024 ''The Times of India''], August 9, 2016|frame|500px]]
-The ‘Rangoon’ star went on to say that she has become “besharam” now. Kangana added that people continue to love her even when she is “a psychopath, wh**e, witch or a cheat”, and continue to respect her, which she considers an achievement. It is their love and respect that make her feel like she has finally arrived in the industry.
+[[File: Worst states in terms of availability of government hospital beds per 1000 people.jpg|Worst states in terms of availability of government hospital beds per 1000 people; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=STATOISTICS-In-Bihar-every-10000-people-have-access-09082016011024 ''The Times of India''], August 9, 2016|frame|500px]]
-Trust Kangana Ranaut to speak her mind without a trace of doubt even when in public. The firebrand actress was completely nonchalant as she clarified her stand in the Hrithik issue. She said she was under feminist pressure to tell the world the sob story that she had. But she didn’t do so as she was in a consensual equation with an individual and she was capable of dealing with the stuff. While she never once did name Hrithik, the reference was evident. She further said that she does not want him to acknowledge their relationship in public anymore, and nor does she believe in keeping, sperm panties and gifts as ‘potential evidence for the future when he is trying to escape or say no.’ She believes that if any individual wants nothing to do with her and feels ashamed of her, to get rid of her, the only thing she will say to that individual is goodbye.
+An expensive private sector has stepped in where govts failed -delivering health facilities that are often suspect. The trend grows while state facilities struggle to cope
-In a recent interview to Mumbai Mirror, the 'Queen' actress revealed how the entire legal brouhaha had taken a toll on her. "The last two months have been nerve-wracking. It came at a time when I had begun to question my own identity, doubt my achievements. It is my 10th year in the industry where I've made a place for myself on my own. I feel like I have been given another life."
+Public health infrastructure is wanting by even government's own assessments. This is true of subcentres at the lowest rung to community health centres (CHCs) and district hospitals. There's a shortage of about 7,000 primary health centres (PHCs). In some states, the shortages are staggering -66% in Jharkhand, 58% in Bengal and 42% in MP . Only two-thirds of the required number of CHCs are in place.In Bihar, against a need of 774 CHCs there are just 70, a 91% shortfall. Assam has less than half of what it needs, UP 40% less.
-On being asked about her beliefs, she said that she is an ardent Hindu and a staunch believer of Swami Vivekananda's teachings, the Gita, the Sanatan Dharma - and quantum physics. She also said that she feels extremely hurt when people have zero tolerance for other's religious beliefs. She said, "When people show a kind of xenophobia to others' religious practices and call them names and give them a bad light, that hurts. You know, within this country, we have so much shame and blame when it comes to religious practices. Why not? I'm very proud to be Hindu, I do puja, I do Navaratra puja in my house, Durga Maa's paath is essential, and I do upvaas also. So like I said, I love Sanatan and life is incomplete without the four yoga teachings of Swami Vivekananda. But nobody wants to talk about it."
+There's an even bigger crisis of health personnel: A shortfall of 2,225 doctors in PHCs, and the gap's growing bigger. Over 36% PHCs were without a lab technician, 23% without a pharmacist. There is a 53% shortfall in radiographers. Considering just the existing infrastructure, there was a shortfall of all kinds of specialists including 72.2% of surgeons, 64.7% of obstetricians and gynaecologists, 82.1% of physicians and 73% of paediatricians. In effect, even in the existing infrastructure isn't staffed. In many states, health indicators of the urban poor are far worse than their rural counterparts, revealing how underserved the urban poor are. In the mostlyurban Delhi, there's massive shortage of subcentres, PHCs and CHCs.
-Although Kangana's family is delighted right now, it wasn't the case when she was born.
+The bulk of healthcare in India is provided by the private sector, that's meant escalating costs. In states like Rajasthan and Tamil Nadu, governments demonstrated how providing ''' free drugs and diagnostics ''' in public facilities could significantly bring down health expenditure. Yet, neither the Centre nor other states replicated these programmes. In the name of universal healthcare, government is being persuaded to become the payer for healthcare provisioned by the private health sector and administered by insurance companies. In most states, these insurance programmes have been riddled with corruption and inefficiencies such as the epidemic of hysterectomies done on hundreds of women by hospitals in Andhra to collect government money for the procedure. There's concern among health activists that state funds that could be used to strengthen public health infrastructure are getting diverted to the private sector.
-I was a pain, not the kind of child an Indian parent would like to have'
+==Inadequate Government funds==
+In absolute terms, the money allocated for health by government has gone up more than 13 times from Rs 2,000 crore in 2000-01 to Rs 27,500 crore-plus in 2013-14. Yet, health expenditure is short of 1.5% of GDP though successive governments have promised that spending would touch 3%. If the promised 3% had been allotted, perhaps the public health sector could have been revolutionized to deliver quality service.
-Kangana quipped, "I have struggled for the last 10 years." Talking of her initial days of struggle, the actress was quoted in an IANS report as saying that, “It was no fairytale. I was nothing like I am today – I couldn’t speak a word of English. In England, people might be understanding of that, but in Mumbai if you don’t speak English, people would ask 'How does she expect to work in Hindi films?' Today I am who I am because my understanding of myself never changed.” Having grown up in a small town, Kangana asserts that as a girl she was at odds with Indian culture. "Perhaps the only expectation is that you grow up as a presentable young woman and get a decent spouse. I was a pain, not the kind of child an Indian parent would like to have," Kangana confessed.
+==Better healthcare still out of bounds==
-Kangana Ranaut : “Meri cleavage na kisiko dikh jaaye, bachaa lo mujhe”
+[http://epaper.timesofindia.com/Default/Client.asp?Daily=CAP&showST=true&login=default&pub=TOI&Enter=true&Skin=TOINEW&AW=1393708348876  Times of  India]
-In a recent interview, the Queen of Bollywood Kangana Ranaut revealed some hilarious details on shooting some intimate scenes for the film Katti Batti. Kangana said that she reacts to an intimate scene as soon as she reads it. If she’s convinced about it and if she’s gets her character right, then it simply flows through. The bold actress also mentioned that as soon as she completes an intimate scene she does not go like ‘shawl kahan hai meri izzat bachaa lo! meri cleavage na kisiko dikh jaaye, bachaa lo mujhe!’
+[[File: Types of ambulance services under National Health Mission.jpg|Types of ambulance services under National Health Mission; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=STATOISTICS-Kerala-has-the-least-number-of-government-12122016006026 ''The Times of India''], December 12, 2016|frame|500px]]
-Kangana Ranaut's advce on break-ups
+New Delhi: India may be among the fastest growing economies in the world, but the UNDP’s Human Development Report 2006 shows that this growth hasn’t translated into better public healthcare for the citizen, at least not as yet.
+For instance, there are only seven countries — of the 177 that the HDR looks at — with a lower share of public expenditure in total health expenditure. These seven — Guinea, Congo, Myanmar, Cambodia, Armenia, Tazikistan and Burundi — are not exactly those with whom India would like to be compared, but they are the only ones in which the government accounts for less than a quarter of total health expenditure. For India, the share of public expenditure in the total is exactly one-fourth or 25%.
-In a recent interview with Movies.ndtv.com, Kangana doled out some sound advice on going about with a break-up. The actress was quoted in the report revealing her classic break up line, Kangana said that while saying a good bye one should mention that they were on a charity project. She was further quoted in the report saying that one should binge on sugar and salt to flush everything out of their system.
+The low share of public health expenditure is not surprising, given the fact that only 13 countries spend a smaller proportion of the gross domestic product (GDP) on the health sector than India’s level of 1.2%. Apart from six of the seven mentioned above, these include Pakistan and Bangladesh in our neighbourhood as well as Azerbaijan, Georgia, Ivory Coast, Equatorial Guinea and Indonesia.
+One result of this low level of government spending on healthcare is that people have to spend more from their pockets to keep themselves in good health. Thus, India’s private spending on healthcare at 3.6% of GDP is higher than most. In fact, only 33 of the remaining 176 countries has a higher level on this count.
-In some recent interviews and media interactions, Kangana has stressed a lot on the unhealthy competition prevailing in Bollywood. She mentioned that her colleagues are conspiring against her and trying to pull her down. She also stated that other actresses, who are her contemporaries, have had no growth in whatever platform they were launched. According to a report on Pinkvilla.com these statements haven't gone down well with Bollywood actress Divya Dutta who tweeted "Did she really say that. Only one gets the oppurtunity to get the right thing at the right time. Be grateful coz there's a lot of talent around."
+However, the high private expenditures are clearly unable to bridge the gap when it comes to things like immunisation, which are typically public programmes in most parts of the globe. Not surprisingly, India’s immunisation rate for those who are one-year old against measles is worst in the world, with just 13 countries doing worse. A similar picture emerges if we look at the numbers for full immunisation of one-year olds against tuberculosis. Again, there are a mere 20 of the 176 others who have a lower rate.
-Kangana Ranaut plans to write an autobiography
+What highlights all of this as a glaring failure of our governments is the fact that India’s pool of roughly 6.5 lakh physicians is the third biggest in the world after China, which has about twice as many, and the US, which has only a few tens of thousands of doctors more than India, although for a population that’s only about onethirds the size of India’s.
-She also frankly discusses the dark, dingy side of the tinsel town and her experience as a newcomer here. She reveals that hers was a journey of a thousand miles and that she didn’t fly first class into Mumbai. She had travelled in buses, taxis and trains, and even walked a lot. She further reveals that she had slept on the pavement, because she didn’t have a house. The daring actress boldy opened up how she was caught in traps and that she lodged police complaints against people. She claims to have seen the ugly side. However she very happily compares her past with her present saying that on the other hand she has also been awarded by the President twice, and that she is the highest-paid actress today.
+== Shortfalls in Primary Health Centres ==
+[http://indiatoday.intoday.in/story/bihar-public-health-infrastructure-fake-doctors/1/682903.html Amitabh Srivastava , Licence to murder “India Today” 1/6/2016]
+[[File: States and UTs with the biggest percentage shortfalls in Primary Health Centres .jpg| States and UTs with the biggest percentage shortfalls in Primary Health Centres |frame|500px]]
-Highest-paid actress Kangana Ranaut feels her fee is justified
+=Surgeries=
+==Not allowed if there is no ICU==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=SC-No-ops-in-nursing-homes-without-ICU-08092017001023  Dhananjay Mahapatra, SC: No ops in nursing homes without ICU, September 8, 2017: The Times of India]
-Actress Kangana Ranaut, who is reportedly currently Bollywood’s highest-paid actress, says that her fee is justified. Rumours are rife that post the success of Queen and Tanu Weds Manu Returns, Kangana has signed a film for a whopping Rs 11 crore. At an event, Kangana was asked as to how did she feel being tagged as the highest-paid actress to which, Kangana replied, “I think the kind of roles or films I do it literally takes a year… so, I think it is justified.”
-'Amitabh Bachchan is very childlike on the sets'
+The Supreme Court has said nursing homes without an intensive care unit facility cannot carry out surgeries because ab sence of an ICU poses danger to the patient's life.
-Kangana is a confident girl but admits to an attack of nerves when she recently shot for a commercial with Amitabh Bachchan. “It can get really nerve-racking when someone thinks so highly of you as a performer and has so much regard for you. I confided to Raju sir (Rajkumar Hirani) that I have never been so nervous working with any other actor. But Mr Bachchan, he's very childlike on the sets, he chats up everyone and that relaxed me. I hope some day we get to do a film together. Even Raju sir is keen to work with me and we're looking at scripts," she said.
+A bench of Justices Adarsh Kumar Goel and U U Lalit gave the ruling on a petition filed by Bijoy Kumar Sinha, who lost his wife due to the alleged medical negli gence of Dr Biswanath Das who conducted a hysterectomy surgery at Ashutosh Nursing Home in Kolkata.The nursing home did not have an ICU facility. The Supreme Court's ruling in a case, based on a plea filed by a man who lost his wife due to alleged medical negligence of a doctor who had conducted a surgery on her at a Kolkata nursing home which didn't have an ICU, has implications for beleaguered homebuyers of Jaypee Infratech projects.
-Lashing out at journalists
+The petitioner, Bijoy Kumar Sinha, died while fighting a lengthy 23-year-long litigation over his wife's death, in consumer forums before his son Soumik pursued the case to get justice for his mother in the Supreme Court.
-Kangana Ranaut has not just come a long way on the career front but has also matured in real life. Setting an example of how to deal with media, Kangana gave a journalist a befitting reply on being asked a strange question during the promotions of her film Tanu Weds Manu Returns. When asked on which song she will dance at Ranbir Kapoor or Virat Kohli’s wedding, the Queen actress instantly burst into laughter and then went ahead to answer the media person. She asked the journalist, “Kya aap meri khilli udaa rahe hain? Main kya seedhi saadhi lagti hu aapko? Kuch bhi answer dungi kya?" (Are you making fun of me? Do I look naïve to you? Will I answer anything you ask?)
+The SC said that the Consumer Protection Act was an additional remedy , thereby indicating that proceedings against a realtor under the Insolvency and Bankruptcy Code 2016 wouldn't bar recourse to parallel action in consumer forums. This will boost hopes of all homebuyers facing harassment at the hands of truant realtors.
-Refusing to endorse fairness creams
+A bench of Justices Adarsh Kumar Goel and U U Lalit said, “Provisions of the Consumer Protection Act, 1986, are in addition to and not in derogation of any other law. Thus, the Act provides for additional remedies. The authorities under the Act exercise quasi-judicial powers.The award of damages (in the case filed by Sinha) is aimed at bringing about qualitative change in the attitude of service providers.“
-Kangana was offered a whopping Rs 2 crore deal to endorse a fairness cream but she turned down the offer. Talking to Hindustantimes.com, she clarified that she never understood the concept of fairness and that she did not want to set a bad example for the youth by endorsing a fairness cream brand. She added that even her sister, Rangoli, is dusky, yet beautiful and going ahead with this deal would mean that she was insulting her.
+While absolving Dr Biswanath Das of medical negligence for deciding to perform surgery on Sinha's wife, the court awarded a compensation of Rs 5 lakh to Soumik.
-Strained relationships and heartbreak
+This ruling means that even if a realtor has been proceeded against under the Insolvency and Bankruptcy Code, people won't be barred from taking recourse to consumer forums to claim relief for deficient services.
-In an interview with Mumbai Mirror, the Queen actress made a pretty bold statement when asked about her relationship status. She said, "It's good when you're in one (relationship) and not bad when you're not. Right now I'm not but I enjoy my time alone. Being in control of your libido is the best thing that can happen to you. I know the pain of a break-up, what it's like to be without work and food, to fail repeatedly. Some days I asked myself why I was the 'unlucky one'. But I didn't lose heart even when I was left with a broken heart. My troubles have made me a better person."
+The apex court said though an alternative dispute redressal mechanism for settlement of disputes outside courts was applicable only to civil cases, “there is no reason to exclude its applicability to consumer fora“.
-Wedding and marriage plans
+“It will be open to the national commission and the state commissions to coordinate with the national legal services authority and state legal services authorities for settlement of disputes by resorting to alternative dispute redressal mechanism,“ the Supreme Court said.
-The actress also asserted that one should not enter into wedlock due to any social pressure. “It (marriage) is an individual choice… whether he or she wants to get married or not. I believe it should be a choice and not a compulsion. I think we should not pressurise girls or boys for their future, marriage or anything. What do you want to become in life, do you want to get married, how do you want to live," the report quoted Kangana. “I think these things should not be forced upon due to society, as future of both the parties is spoiled. So one should get married when one feels like and not due to social pressure,” added the actress.
+=Techniques used=
+==Digital interaction==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Most-doctors-now-prefer-digital-interaction-30012016013027 ''The Times of India''], Jan 30 2016
+[[File: Modes of doctors’ digital interaction in India, 2015.jpg| Modes of doctors’ digital interaction in India, 2015; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Most-doctors-now-prefer-digital-interaction-30012016013027 ''The Times of India''], Jan 30 2016|frame|500px]]
-Gender equality in the film industry or the lack of it
+''' `Most doctors now prefer digital interaction' '''
-Kangana Ranaut, who had won a National Award for her performance in Queen, says she will ensure someday that the wage disparity between men and women is bridged. According to a report on Movies.NDTV.com, the actress was quoted saying that that few people were trying like her and that it was still a very male dominated industry and that she was hopeful that at some point the pay between male and female actors would be equal and that she would ensure it.
+Rupali Mukherjee
-Being an A-lister in B-grade films
+Over 60% of doctors in the country now prefer, one out of three times, digital interaction with their patients as against the traditional face-to-face interaction, indicating a trend where WhatsApp, text messages and emails are increasingly being used for consultations.This is slightly lower, but in keeping with the trend in the US, Japan and China, where a greater number of healthcare professionals (HCPs) -in certain markets, over 90% -have switched to the digital medium, using WeChat, blogs, email and text messaging to engage with patients for follow-up consults.
+Also, a majority of doctors -globally 60% -de mand drug companies combine the use of digital tablets and iPads along with direct interaction when medical representatives (MRs) are detailing the portfolio of medicines. These findings are part of the Digital Savvy HCP (Healthcare Practitioner) 2015, an annual global survey on the digital habits of doctors across the US, Japan, China and India, by healthcare so utions firm Indegene, sha red exclusively with TOI.
-Kangana Ranaut knows her worth and does not mince her words while putting it across. "When you are doing larger-than-life films with superstars, you don't get equal opportunities. Roles are written for them because the audience goes to watch them. But I want a role which is of equal importance," she said in an interview with Mumbai Mirror. She further added, "At 18, I wanted to work with the creme-de-la-creme because I thought that was the only way to be successful. But I don't think any A-lister has done as many B-grade films as I have. Today, all I want is 50:50 on paper."
+The survey involved more than 1,600 healthcare profes than 1,600 healthcare professionals across the globe, with 67% speciality doctors, and the remaining 33% general practitioners. In India, over 300 doctors were part of the survey with more than 10 years of experience, practising in tier 1 and tier 2 places across the country .
-=Awards=
+The survey found that 76% doctors in the US prefer personal interaction (of field force) along with detailing with the tablet, while the corresponding figure in India is 90%. “Doctors in the US have a higher digital adoption rate, and are more comfortable with remote detailing channels (through Skype, etc).This also works well with pharmaceutical companies in terms of costs, as well as adherence to ethical marketing code,“ Gaurav Kapoor, EVP (emerging markets), Indegene, told TOI.
-* 2006: Star Screen Award Most Promising Newcomer - Female for Gangster
-* 2007: GIFA Best Female Debut Award for Gangster
+As against this, doctors in India prefer a face-to-face detailing with their digital tablets, wherein they meet MRs in their clinics and the latter are equipped with detailing on their tabletsiPads.
-* 2007: Filmfare Best Female Debut Award for Gangster
+Dr Upendra Kaul, ED, academics and research (cardiology) in Delhi-based Fortis Escorts Hospital, says, “As doctors, our bandwidth is committed to treating more and more patients and improving their health outcomes.In this pursuit, technologyled information sharing on new drugs, new indications and peer information on emerging treatment protocols is of tremendous benefit to the medical fraternity . It frees up our time for patients and at the same time, keeps us updated on the latest medical information.“
-* 2007: Stardust Superstar of Tomorrow - Female for Gangster
+Globally , drug companies are increasingly switching to digital channels like emails, websites, webinars, apps and text messages due to compliance requirements, the survey says, adding 34% of physicians globally value the smartphone as a key resource in seeking medical information. Other devices used by doctors are laptops, PCs and tablets. India sees less than half the global usage of smartphones (by doctors), while the most preferred device for doctors here is laptops (34%).
-* 2007: Zee Cine Award Best Female Debut for Gangster
+In terms of overall digital engagement across channels, globally pharma companies are far ahead, with MSD at the top, followed by GSK, AstraZeneca and Pfizer. In India, Abbott leads the pack as the top digital engager, who doctors believe is effectively leveraging technology to reach out to them for providing drug information. Abbott is followed by MSD, Pfizer, Novartis, GSK and Sanofi.
-* 2007: IIFA Star debut for Gangster
+Most MNCs here use digital technology and have equipped their field staff with tablets to engage with physicians for scientific and product communication. “For instance, Abbott's `Knowledge Genie Portal' has a host of data that can be easily accessed by physicians at their convenience, across multiple therapy areas,“ Bhasker Iyer, VP, Abbott India, said.
-* 2007: AIFA Awards, Best Debut - Female for Gangster
+==Use of allopathy, on a rise==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=90-of-Indians-prefer-allopathy-over-AYUSH-08072015015022 ''The Times of India''], Jul 08 2015
+[[File: Choice of treatment.jpg|Choice of treatment; Graphic courtesy: [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=90-of-Indians-prefer-allopathy-over-AYUSH-08072015015022 ''The Times of India''], Jul 08 2015|frame|500px]]
-* 2007: Bollywood Movie Award - Best Female Debut for Gangster
+Mahendra Singh
-* 2008: Stardust Breakthrough Performance Award (Female) for Life In A... Metro
+''' 90% of Indians prefer allopathy over AYUSH '''
-* 2014: Filmfare award for Best Actor (Female) for ''Queen ''
+'' Alternative medicines more popular with urban men ''
-* 2016: National Film Award for Best Actress · '' Tanu Weds Manu Returns ''
+Despite the government's attempt over the years to popularize AYUSH (ayurveda, yoga or naturopathy , unani, siddha and homoeopathy), the people at large are still inclined towards allopathy treatment both in rural and urban India.
+The NSSO survey has found higher inclination towards allopathy treatment-around 90%-in both rural and urban areas. Only 5 to 7% usage of `other' type of treatment including AYUSH has been reported both in rural and urban areas.
-=Filmography=
+Interestingly , a higher usage (1.5 percentage point) of AYUSH treatment by urban males than their rural counterparts was noted, while less usage of the same (0.8 percentage point) by urban females as compared to rural females was observed.
-==As an actor==
-Gangster
-Woh Lamhe
+The use of allopathy was also most prevalent in treating the hospitalized cases of ailments both in rural and urban settings of the country irrespective of gender. Surprisingly , use of AYUSH for hospitalized treatment in urban areas (0.8% for male and 1.2% for female) was more than rural areas (0.4% for male and 0.3% for female).
-Life in a Metro
+Moreover, un-treated spell was higher in rural (both for male and female) than urban.
-Shakalaka Boom Boom
+The relationship between the percentages of untreated spells of ailments and level of living was also revealed. Untreated spell was less in those with usually higher monthly per capital expenditure for both rural and urban sector.
-Dhaam Dhoom
+The survey found that private doctors were the most important single source of treatment in both rural and urban areas. More than 70% (72% in rural areas and 79% in urban areas) spells of ailment were treated in the private sector, consisting of private doctors, nursing homes, private hospitals and charitable institutions. The number of people reporting sick is more in urban India compared to rural areas, found the survey.
-Fashion
+==Stenting==
-Ek Niranjan
+[[File: heart attack.jpg|Top causes of death in India: 2010-2013;Graphic courtesy: [http://epaperbeta.timesofindia.com/Gallery.aspx?id=11_01_2016_008_020_002&type=P&artUrl=STATOISTICS-THE-HEART-KILLS-THE-MOST-INDIANS-11012016008020&eid=31808 ''The Times of India'']Jan 11 2016|frame|500px]]
-Raaz: The Mystery Continues
+[[File: Usage and cost of stents in India, as in Jan 2017.jpg| Usage and cost of stents in India, as in Jan 2017; [http://epaperbeta.timesofindia.com/Gallery.aspx?id=12_01_2017_030_008_001&type=P&artUrl=INDIANS-SPEND-ON-STENTING---40-OF-12012017030008&eid=31808 The Times of India], January 12, 2017|frame|500px]]
-Vaada Raha... I Promise
+=Trends, region-wise=
+==2012-16: Delhi==
+'''See graphic'''
-Knock Out
+[[File: Patients with mosquito-borne diseases in Noida, 2012-16.jpg|Patients with mosquito-borne diseases in Noida: 2012-16; Graphic courtesy: [http://epaperbeta.timesofindia.com/Gallery.aspx?id=13_09_2016_002_037_008&type=P&artUrl=Filth-mounts-drains-choke-disease-spreads-in-NCR-13092016002037&eid=31808 ''The Times of India''], September 13, 2016|frame|500px]]
-Once Upon a Time in Mumbaai
+==Rural-urban==
+[http://timesofindia.indiatimes.com/india/Urban-India-more-sick-than-rural-pollution-bad-diet-blamed/articleshow/51786019.cms ''The Times of India''], Apr 12, 2016
-Kites
+Mahendra K Singh
-No Problem
+'''Urban India more sick than rural; pollution, bad diet blamed'''
-Double Dhamaal
+''The survey found that 13.5% of women, as compared to 10.1% of men, fell sick in urban areas.''
-Miley - Naa Miley - Hum
-Rascals
+Urban India is more sick than the rural hinterland despite the mushrooming of health and wellness clinics and super-specialty hospitals, besides better per capita earnings. And this could well be attributed to increasing pollution levels and unhealthy dietary habits.
-Ready
+A government health survey has revealed that around 11.8% of urban and 8.9% of rural population reported ailments during a 15-day reference period.
+Women were found to be more vulnerable to diseases in both cities and villages.
-Tanu Weds Manu
+The survey found that 13.5% of women, as compared to 10.1% of men, fell sick in urban areas, while the figures were 9.9% and 8%, respectively, in rural India.
+What's worrisome is that a high chunk of the population (86% in rural and 82% in urban areas) remains outside any scheme of health expenditure support.
-Game
+The NSSO survey released on Monday also reiterates that people rely more on private hospitals, with over 70% spells of ailment (72% in rural areas and 79% in urban areas) being treated in the private sector. Also, private institutions dominated both rural (58%) and urban areas (68%) in treating inpatients.
-Tezz
+Allopathy remains the preferred treatment in rural as well as urban areas. The survey found that over 90% of rural and urban population relies on allopathic treatment despite the government's efforts to promote alternative medicine.
-Krrish 3
+The survey found that around 97% of urban and 96% of rural population was administered some treatment, which included selfmedication, use of medicines taken on chemists' advice and AYUSH treatment. In previous surveys, 'treatment' administered on medical advice was considered as 'treatment'.
+It was found that financial constraints (57% in rural and 68% in urban) were the key reasons for going for treatment without any medical advice.
-Rajjo
+==2015: EAG states improve ==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Good-news-Laggard-states-see-huge-progress-in-05032017019021  Sushmi Dey, Good news! Laggard states see huge progress in health, March 5, 2017: The Times of India]
-Shootout at Wadala
+[[File: Under five mortality rate, mothers who had full prenatal care and institutional births, state-wise.jpg|Under five mortality rate, mothers who had full prenatal care and institutional births, state-wise; [http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Good-news-Laggard-states-see-huge-progress-in-05032017019021  Sushmi Dey, Good news! Laggard states see huge progress in health, March 5, 2017: The Times of India]|frame|500px]]
-I Love NY
+''' Bihar's Sex Ratio Among India's Top 5 '''
-Revolver Rani
+Several of India's socio-economically backward, or Empowered Action Group (EAG), states, namely Jharkhand, Rajasthan, Odisha and Chhattisgarh, have made great strides over the last decade with regard to some of the key health indicators.
-Ungli
+For instance, all EAG states (Bihar, Jharkhand, MP, Chhattisgarh, Odisha, Rajasthan, UP and Uttarakhand), and Assam have witnessed an increase of over 40 percentage points in institutional births, according to the National Family Health Survey-4. A rise in the number of institutional deliveries is crucial as it helps reduce maternal and infant mortality , besides ensuring better health for women and children in the long run. This is also evident in the 20 percentage point drop in the infant mortality rate in Jharkhand, Rajasthan and Odisha. “As a step towards ensur ing equitable health services across regions that suffer from disparities, special efforts were made to allocate more resources in backward states and regions,“ a health ministry official said. In 2015, the health ministry had identified 184 poorly performing districts where more resources were infused and focused programmes launched to bring about sharper improvement in outcomes.
-Queen
+Though the survey findings, released by the health ministry earlier this week, do not contain data for pollbound UP on account of the model code of conduct, the state registered the maximum decline, 1.1 child per woman, in the total fertility rate over the last 10 years.
-Tanu Weds Manu Returns
+Among the five states with the highest infant mortality (death within one year of birth per 1,000 live births) and under-five mortality (risk of death by age five, per 1,000 live births) rates, four are EAG -Chhattisgarh, Madhya Pradesh, Bihar and Jharkhand. Though Bihar features among the top five states vis-a-vis sex ratio, it fares the worst in female literacy rate and financial inclusion of women.
-Katti Batti
+==2014: Delhi healthiest==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Delhiites-are-healthiest-says-report-20052016006018 ''The Times of India''], May 20 2016
-Rangoon
+''' Delhiites are healthiest, says report '''
-Simran
+If the latest statistics on social consumption on health is anything to go by, people living in the capital are healthier than those residing in other parts of the country.According to the data for January-June 2014, 48 out of 1,000 people fell ill in rural areas and 50 in urban areas in Delhi. This is much lower than the national average of 89 for rural and 118 for urban areas.
+Deputy CM Manish Sisodia said the comparative figure in urban areas of Punjab was 170, Haryana 75, Himachal Pradesh 51, Jammu and Kashmir 41, Rajasthan 83, Uttar Pradesh 91and Gujarat 103.
+The report brought out by the directorate of economics and statistics of the Delhi government is based on the result of the National Sample Survey 71st round on health and morbidity . It said that proportion of ailing persons was highest among the 60-plus age group followed by persons falling in the 45-59 year age group.
+The report said that out of total estimated births, 5.02% were reported in rural and 94.98% in urban areas. In Delhi, 62.5% of births were reported in public hospitals.
+Sisodia said the old age dependency ratio in Delhi is 6.97 which indicates that every 100 people in the age group of 15 to 59 years were supporting, physically or otherwise, about seven aged persons in the year 2014.
+=All India Medical Service cadre=
+==Brief history==
+[http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Five-decades-on-govt-may-form-medical-service-04072017010011 Five decades on, govt may form medical service cadre|Jul 04 2017: The Times of India (Delhi)]
+Five decades on, govt may form medical service cadre
+TIMES NEWS NETWORK
+More than five and a half decades after a central committee had recommended the setting up of an All India Medical Service cadre along the lines of the Indian Administrative Service (IAS) or the Indian Police Service (IPS), the central government has moved a proposal to create such a cadre. Health being a state subject, the union health secretary has written to the chief secretaries of all states soliciting the views of the states.
+“The creation of an All India Medical Service under the All India Service Act 1951, like IAS, IPS, etc. for creating a body of professional doctors across the country has been under the consideration of the government for quite some time. Considering the fact that health is a state subject and the major requirement of health professionals is at the state level, it has been decided to solicit the views of all state governments on this issue,“ stated the letter sent to the states.
+The letter, dated June 9, went on to state that doctors of the Central Health Service (a Group A service under the health ministry dealing with monitoring of various health programmesschemes) have never worked in the states and hence “do not have an appropriate perspective of the problems being faced by the state governments“. Creating the All India Medical Service could help bridge this gap and “improve technical leadership and management both at the Centre and state levels,“ the letter said.
+The Health Survey and Planning Committee, better known as the Mudaliar Committee, which submitted its report in 1961 had observed that three areas -provisioning of adequate medical care, both preventive and curative; training of medical and paramedical personnel; and those for dental care and for research --were interlinked and that it was only through a coordinated programme of action in which centre and states cooperated “satisfactory and speedy results“ could be achieved.Hence it had recommended the formation of a central health cadre in which senior posts in the Central and state health ministries would be included.
+Such a central cadre, which existed before independence, the Indian Medical Service (IMS), was abolished in August 1947. The committee's report noted that most of the highest administrative and specialist posts in the states were manned by officers of IMS, the Women's Medical Service and the Medical Research Department, who were officers of an all-India cadre.
+More recently , in 2005, the report of the National Commission on Macroeconomics and Health (NCMH) had stated that it was necessary to take a bold decision “to constitute an All India Cadre of Public Heath Services, on lines like the IASIPS“.
+“It is a great move if the government can pull it off.This is much needed, as those in the existing Central Health Services have no experience in the states and are often restricted to Delhi postings or to central government institutions in the states. They have no clue about rural health or how public health is delivered through the various tiers of the government health system. They get no training or an all-India perspective like the IAS or IPS officers receive in Mussoorie followed by their postings to rural districts,“ said former health secretary Sujatha Rao, who was also a member of the NCMH.
-==As a writer ==
-Queen (dialogues/ co-writer)
-==As a producer==
-The Touch (Short)
-==As a director==
-The Touch (Short)
 =See also=
-[[Rangoon (2017)]] (with pictures)
+[[Public Health And Vital Statistics: India]]
+[[Public Health And Vital Statistics, 1909: India]]
+[[Public Health And Vital Statistics, India: 2014-2016]]
+[[Public Health And Vital Statistics, India: 2016-2017]]
+[[Healthcare: South Asia]]
+[[Healthcare: India]]
+[[Healthcare and public health: Delhi]]
+[[Healthcare: Rajasthan]]
+[[Healthcare: Tamil Nadu]]
+[[Healthcare: Uttarakhand]]
+...and on several other states
+[[Cities of India: the best and the worst]]
+[[Dengue: India]]
-[[Private lives of Indian (Mumbai) stars]]
+[[Category:Development|HHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:Health|HHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]
+[[Category:India|HHEALTHCARE: INDIA
+HEALTHCARE: INDIA]]

Kangana Ranaut, Healthcare: India

Revision as of 10:17, 16 December 2020

Contents

Antibiotics

‘64% of antibiotics sold are unapproved’

Use of antibiotics, India/ the world: 2000-2015

Breastfeeding

Caesarean-/ C- sections

HC: ‘Unwarranted C-sections violate rights’

2018/ Incidence is higher in private hospitals

2018: the extent of the practice

2019-20

2019/ maternal deaths from C-sections high in developing countries: Lancet

Cardiovascular diseases

2012-14: Risk of cardiovascular diseases, state-wise

Cath-labs, coronary interventions

2010-15: sharp increase

Charity hospitals

Many misuse tax breaks: CAG

Charter of Patients’ Rights

Draft charter, 2018

Cost of hospitalisation

2016-17

Out-of-pocket expenses exceed 10%/ 25% of income/ consumption

Death, the main causes of

2018

Air pollution

2019

Delivery (of babies)

Cost of delivery at govt hospitals

Drug- resistant superbugs

2019/ Methicillin Resistant Staphylococcus aureus in Gujarat

Encephalitis

2010, 2017

Government funding

2015-20

2014-18

Government expenditure on health

2012

2014-15

2014-15, government expenditure on health

Hospitals, private

If built on government land: SC verdict

If built on subsidised land: SC verdict

Infrastructure

Ambulances (government)

IVF clinics

Less than 20% are registered

Medical devices

Import of devices, 2014-16

Medical negligence cases

2017: Cases on the rise

Medical, surgical advances

Uterus/ womb transplant/ 2017

Pre-natal tests

PG in imaging tech essential: SC

Private expenditure

2015-16: Private expenditure outstrips government

Shortcomings

Government facilities inadequate; private expensive

Availability of doctors

Shortfall of doctors: 2015

Doctors, in rural areas

Statewise availability of doctors

Karnataka, TN, Andhra, Maharashtra best

Availability of specialist doctors in CHCs

A shortage of hospitals

Inadequate Government funds

Better healthcare still out of bounds

Shortfalls in Primary Health Centres

Surgeries

Not allowed if there is no ICU

Techniques used

Digital interaction

Use of allopathy, on a rise

Stenting

Trends, region-wise

2012-16: Delhi

Rural-urban

2015: EAG states improve