If only people had acted on time!

For those who think why India lags, here is an example of how bureaucracy stifles implementation of critical projects and programs which can take India decades ahead in terms of being an innovator. Moreover, if India implemented at the pace of ideation, we would have been much better prepared for #COVID-19 #Coronavirus. Read this terse email I wrote to the Babus in North Block for sitting on the file for months. Also, despite follow up from the PMO, this project was never implemented. The total cost was Rs. 340 crore spread over three years. It was about setting up a 1500 seater doctor call center in 16- 22 languages across four zones. Imagine, had this been implemented along with NIN ( National Identification Number ) for all healthcare providers? India would have not only reduced people’s anxiety in times of #COVID but also provided timely interventions and advice, saving lives. Time to reform bureaucracy if we have to make India a world leader. I normally don’t share such communications in the public domain, but this was needed to expose who let India down. When India has all the capabilities, bureaucracy stifled it. Now we are grappling with the problem looking helter-skelter. Those who worked with me would know well that I give enough freedom and also support people who wish to deliver. But, those who find reasons for their laggardness, I am known to be blunt and ruthless to them. Such laggards let our Hon’ble Prime Minister down and kept India behind in terms of preparedness and growth. India does not have a dearth of money or ideas; it is the speed-breaker ( bureaucracy) that is taller than the Great Wall of China, stalling India’s march for development. Rest for you to decide.

From: “Rajendra P. Gupta (Advisor to Union Health Minister )” <advisor.healthminister@gov.in>

Subject: Meeting on 3rd May, on the ‘Doctor on Call’ project. 

Date: 15 June 2017 at 10:24:45 AM IST

To: daves@, adcost@

Dear Mr.Dave & Mr.Wadhawan,

Good morning !

I read this news ( pic attached ) yesterday, and remembered our meeting at your office on 3rd May wherein we had discussed the proposal of the ‘Doctor on Call’ project ( D/o Expenditure’s OM No. 18(21)/PF.II/2016 dated 18^th November, 2016 regarding thedraft SFC Memo for Doctor on Call (D.O.C) circulated by MoHFW vide OM of even number dated 04.10.2016) .  I wanted to write you in detail immediately after the meeting , but somehow , due to meetings and travels , i could not .The news and Pic in Hindustan Times yesterday re-kindled in me the need to write you.  But as they say, “its better late than never”. 

So firstly, i thank you both for giving us time to meet up with your good selves,  and to have a first hand experience of how things are handled in the Department of Expenditure  !  Here is what i have to express ( i am just putting our conversations on record without any addition ) ;

Mr. Rajiv Wadhawan mentioned that he had held the file for four months as he did not feel it appropriate for action . I think, it was no short of a criminal act to withhold the file for four months, and also Rajiv had the audacity to say this in the meeting .  May be, if our service was launched as per plan in Oct/ Nov 2016, the girl in the pic could have been saved ! 

What was discussed on 3rd May could have been done four months earlier !  I guess , you all acted after four months , and that too , as probably , the PMO pulled up information on the project ( if i am correct ,  this project was presented to the group of Secretaries and also to the Hon’ble PM by the new IAS trainee , who had worked on this project , and i was guiding this project all throughout within the Ministry ) . 

Now , coming to your queries Mr. Dave and my responses in the meeting :

Your First query : Health is a state subject , and so , you expressed, that we must leave it to the states to do it :

Let me tell you Mr. Dave,  that about 65+ percent of our 125 crore people stay in rural India and they have challenges in accessing quality healthcare . Also,  if my ministry keeps waiting for states to do it , it might happen in the next decade or may be not.  But , the poor people will die of the treatable illness like diarrhea , fever etc. like the one you see in the pic attached . With ‘Doctor on call’ project , we could have addressed many such cases if you had approved the file with the speed with which my ministry worked.  In three weeks from the ideation of the project, the file was with the Hon’ble Minister who approved it within minutes !!  I give the entire credit to the Hon’ble Health Minister & the team led by an extra-ordinary bureaucrat , Mr. K.B. Agarwal , Additional Secretary , MOHFW. 

Also, in this fight for centre and state subject , we forget that the money belongs to Indian government and is to be used to serve the people of India, whether we pay through centre or the states , it is the money of the Indian Government collected as taxes from the people of this country . Why should poor die because there are insensitive people like Mr. Wadhawan & superiors like your self ,  who have not bothered to check the status of pending files with your team mates ?  It is time we shed our inhibitions and do what is needed for this country as priority, and ‘health and well being’ is a high priority . Also , let us not forget ,today you are in the north block , if by chance you were staying in rural India and your child was suffering from diarrhea and with no medical advice available ! then , you would have realized the importance of this project, and your perspective would have changed and you would not have held the file for four months !!! 

Your second query ; People can die of the medicines prescribed on phone or advice given :

I must state that, this project has a pre-condition to deal with voice calls based on well defined standard treatment guidelines and protocols. Also, we are going to prescribe only OTC ( over the counter) medicines for common ailments , and no one dies of taking an OTC medicines ! Also, for serious cases , the helpline would refer the patient to the appropriate health facility 

Your third query : People in rural India are used to taking an injection for relief and visit quacks as they trust them 

I must say Mr.Dave , that you were bang on this one ! This is absolutely  correct . But do you know that this is a result of the decades of deficiency in our system ? Trust is built on a repetitive behavior based on practice and availability . So far, rural folks have had no access to qualified professionals and they got into the trap of quacks and it became a practice . If this ‘doctor on call’ can give them advice which provides relief , the word will spread based on positive experience , and we will be able to change the practices and behavior when we provide right guidance and relief to people .. So , whereas your statement is correct , but the statement if used as a justification for not approving the project , then it is terribly wrongly placed .

Also, studies have proven that 65-80 % of the time , people do not need to see a doctor face to face . But in absence of right information and preventive / primary care, people in rural and semi-urban areas rush to the district hospital . This not only leads to economic loss but also , floods the district hospitals and eat into the precious time of doctors, when actually people don’t need to see a doctor in most of the cases . It can be handled with such a service like ‘ Doctor on call’. When almost every family has an access to a cell phone and that was the precise reason why i initiated this project 

Please go through the pic i have attached here . It came in yesterday’s Hindustan Times . It pains to see a person is carrying the dead body of his niece who died of diarrhea ( which is a treatable illness, and this is the example i had given coincidently in our meeting ). I feel sorry for this family and for this little girl , who could have grown up and contributed to her family, country and this society, but sadly , she is no more ! 

I have heard umpteen times, that people sitting in the North Block are arrogant to the core and deal high handedly , as if other ministries are coming with a  begging bowl ! Yes, we do , but our intent is to make the lives of people better,  and we intend to use our positions to drive those changes that makes people of this nation  safer , healthier and productive . This is what our Hon’ble PM envisions .  But bureaucrats like you act as speed-breakers who hold files for months without any accountability . 

It is sad, that i had to invest my time in summing up our discussions but if i did not express my anguish, it would have remained pricking me for ever,   .. Apologies in advance if it was inappropriate . Lastly,  It is not an individual issue , it is a systemic problem. 

With best wishes

Rajendra Pratap Gupta

#covid19  #India

#COVID #CORONAVIRUS