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PRADEEP KUMAR KUNCHE, www.scribd/pradeep_kunche
Think Social Engineering Think Me

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INTRODUCTION As we all knew that population of India has crossed 1.2 billion with a GDP of Rs 43,59,762 Cr (2010-11 at 2004-05 pricing) and the per capital income is Rs 53,331 (2010-11 at 2004-05 pricing). Even though India has a rapid growth in the GDP and per capta income in the recent couple of decades, the conditions of poor did not changed much, still people below the poverty line accounts to 28.8 % of the total population, still majority of people lack basic needs like balanced diet, drinking water, sanitation, and health care is far reach for them. It is due to the fact that health care in government sector not increased at the rate GDP has increased, which lead public to send for health care at private hospitals. It is a fact that over 75 % of the medical services (hospitals & diagnostic centres) are under private operators and the total drug (medicine) supply, 85 % are sold through pharmacy retail outlets and only 15 % is distributed by the institutions. It is a fact that lack of social insurance in the health care sector forcing the poor to spend 70 % of their medical expenditure in cash for purchase of drugs. The economic surveys indicates due to medical expenditure alone 2 % of the population of the country are slipping below poverty line. It is mainly due to failure on the part of governments to create mandatory social health care, create social obligation to all stake holders i.e the government, the business establishments, and the income earning people, to be part in the process of creation of primary needs like health care, drinking water and sanitation, which is very necessary, as it is a fact that raise in per capta income is not the real purchase power of the majority population in India, the rise of per capta income is only due to rise of billionaires and milliners due to the rapid rise of trade and industrialisation in the last 20 years due to economic liberalisation. It is fact that the top 10% of Indias population enjoys 31.1% of the countrys income; the lowest 10% suffers with merely 3.6% only. It is also evident from Gini Index which is widely used for measuring the Income Inequality which shows India at 36.8 (2004), the higher rate of index the more the disparity. It is indeed a shame on our part that we being the emerging global super power nation but very low power as far as health care of people is concerned, the statistics speaks itself, as our country has only 0.95 hospital beds per 1000 population and 0.34 hospitals per very 1000 population. Also it is a fact even though near about 30,000 MBBS doctors are Graduating every year, it is really most unfortunate and a real national shame that only around 26,000
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doctors working in rural India, which accounts over over 80 crore population of the country. (i.e 68% as per 2011 census population). The poor condition of health care is mainly due to lack of systematic planning and lack of far sightedness by the governments, because as early as in 1948 Sir Joseph Bhore Committee or Health Survey and Development Committee recommend that proper planning needed to achieve 5.67 beds per 1000 population in 30 to 40 years from the position of 0.24 beds per 1000 population in 1946. However it's been 64 years since and we still haven't been able to reach the target of even 1 bed per 1000 population. Public health spending as a percentage of GDP is minuscule. Due to this India is being overly dependent on private sector. With lowest insurance penetration people are forced to spend out of their resources, the ratio of public health to private health investment is 1:4, in India the economic growth index is moving forward, the wellness index is dipping, our governments ignoring the fact that health is wealth and health of the citizen is the wealth of the nation. Indias public spending on health as a proportion of GDP is among the lowest in the world. All these factors leading India ranks among the top 10 countries for communicable disease, it is today, world leader of chronic diseases like diabetes, hypertension and coronary artery disease. As such he health care in India is become a premium for many sections due to lack of existence of adequate health care facilities, high cost of the services due to lack of systemic accountability, checks and balances, transparency in the system of governance the in health care sector. It is a fact to admit, appreciate that after UPA under Congress leadership came to power in 2004, realising the need of propriety of health care, boosted the pace of setting of health care infrastructure like medical colleges, nursing colleges, hospitals, and also providing health care schemes like National Rural Health Mission (NRHM), Jan Swasth Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSY), promotion of generic medicine to provide low cost medicine through Jan Aushadi and also the social insurance scheme Rashtriya Swasthya Bima Yojana (RSBY) to provide medical insurance for the BPL and low income group etc with an annual allocation of over Rs 90,000 Cr (2010-11) in the budget for health care which is 1.4% of GDP increased to 2.5 % of the GDP in the plan (2012-2017). Also to admit, still due the lack of control on pricing of the drugs, leads to high cost of medicine of life saving drugs leads to poor health care in India. It is really shocking, that the people was dying

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due to lack of medical facilities, unable to afford medicine due to their poorness, the pharmaceutical companies are earning huge profit margins, with difference in manufacturing cost and retail selling price ranges from 200% to over 1000% due to lack price control of government control on many drugs (only 74 drugs out of 348 drugs are under government price control). It is a great surprise to many people that how come many public representatives and media are ignorant of the real pain of common people due to the day light robbery by some of the private hospitals, nursing homes who are squeezing the money once entered such hospitals and nursing homes are performing all sorts of un necessary tests (irrational treatment) even though they knew the issue is very minor, which can be resolved with simple treatment and charging heavily which earn them huge profit margins. Also a great surprise to many that how come the so called media with great investigative journalism, which talks high about corruption, the top political class who constantly raise their voice for the welfare of down trodden, completely ignoring the dacoity by major pharmacy companies who are earning profits ranging from 200 to over 1000 % in some life saving essential medicines (the difference of cost of manufacture of the product and the cost of the product at the retail store) unfortunately some of them show in account books for taxation the shrinked margins.. It is high time for the UPA government under the congress leadership who are constantly advocating for and also dedicatedly extending the support for the welfare of the downtrodden sections of the people of the country should immediately need address the issues and bring more confidence to them, by regulating the pricing of services in the hospitals in a systematic way to ensure affordability for treatment all sections of people in all the hospitals across the country and also to regulate the pricing of the medicine to get within the reach of the common man by getting control of pricing of the drugs in uniform manner in the light of judgement, direction of Supreme Court division bench comprising Justices G S Singhvi and Justice S J Mukhopadhaya in November 2011, also adhering to the commitment by the government to Supreme court to control the prices of all 348 drugs in the National List of Essential Medicine (NLEM) from by bring balance 274 which are not under government price control (at present only 74 drugs are under the government control). In addition governments must fix uniform pricing for diagnostics and medical tests and also to bringing the mandatory

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health care education and mandatory health care obligation on the part of business establishments in the country. In order to achieve the desired results of the most magnificent welfare schemes of UPA government like NRHM, JSR, Jan Auahadi, RSBY, etc, government should mandatory regulate health care sector in all possible angles. Also to emphasise that the health care for all should be the collective responsibility of the governments and business establishments, government should make it mandatory that all business establishments to contribute from their side appropriately as decided by government to maintain equal treatment of business establishments of same nature. As business establishments are grown o the hardship of the employees, some of the industrial business establishments are directly or indirectly responsible for deterioration of health of millions of population due to the pollution of the air, water and land and also in many other ways. It is true, some state governments who are the implementing agencies understands the the potential need of health care , extents the free medical services to the BPL families to obtain multiple gains out of this. One is that all the BPL families will remain as their vote banks; second the free medical service in the form of reimbursement to the treatment is to be paid by the government to the some select, private hospitals due to shortage of government hospitals. To our shame majority of the selected private hospitals who are extending the medical services on the government reimbursement keeping the motto of the hospital i.e to service to the sick at the gravest level are becoming more or less like leeches, vultures squeezing the tax payers money that was extended to BPL families by performing Numerous unwanted tests (mostly irrational) for simple diseases, performing unwanted surgeries even in minor cases. It is a fact that this booty is shared among some of the public representatives, some public servants and some medical professionals and touts. It is a fact this is happing mainly due to lack of medical ombudsman system to monitor the prescriptions of the doctors, to monitor the treatment procedures etc to make them accountable for wrong diagnosis or over dose or error in dosage etc, ombudsman system will certainly create the accountability and increases the responsibility of the doctors to adhere to ethical practice of this noble profession. The medical ombudsman should a three tire system from the district level to the state level to the national level, with more number of panels at the district level working in the lines of judiciary to determine the correctness of the diagnosis and issue of medicine,

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treatment procedure etc, with option for either parties i.e the victim patent or the doctor to appeal in the next higher level if the patent is not satisfactory at one level. Also to ensure speedy justice to the sick patents the delivery of judgements should be done in a fixed time frame say less than 30 days in normal cases, for all emergency cases in less than 24 hours. It is nothing to degrade or de moralise the doctors / medical professionals or the hospital managements but it is necessary to keep the system clean and ensure justice to the people to build confidence in them towards professional ethics of this noble profession, as it is a fact to admit that some hospitals, nursing homes and some doctors are too much greedy, self centred and only motto is to earn money, totally ignoring the professional ethics of this noble profession and due to these few black sheeps the entire profession is being doubted by common people who are under the peril to visit even a private hospital leaving apart the government hospitals, as majority of which always lack of facilities and in most cases government hospital atmosphere itself makes the people sick?. Even though majority of the times the doctors want to be straight forward still they have to act under compulsion according to the hospital management as they are paying fancy salaries to them. It is more happing because the doctors and specialist doctors have to recover their money invested in their education. As it is an open secret that government colleges for medical education are limited in number, as such limited number of seats to study in government medical colleges, the admission into MMBS doctor seats in private medical colleges are not less than 25 lack rupees with maximum up to Rs 60 lakh and for the post graduation course in medicine for specialisation in any discipline in the medicine is not less than 40 lack rupees and ranges as high as Rs 1.5 crores. All the corporate hospitals and the hospitals and the nursing homes, especially in the cities expect the doctors with PG or specialisation. As such government should regulate the fee structure immediately making it at as low as possible with uniform fee structure throughout country. MEDICAL EDUCATION INFRASTRUCTURE The primary focus of the governments is to create infrastructure and facilities to the medical education especially the PG courses, it is most ideal that PPP mode is the best option. The private corporate make investment for the infrastructure and facility for the creation of

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the necessary infrastructure and facilities for the study, where government allocate land, soon after the construction is completed the management and administration is done by government with partnership to the private investor for some period till the investment of the private partner is recovered. The main motto of PPP is to provide more number of free seats to the study of MBBS course. As such there should be uniform procedure for calculating the percentage of seats to be given for the PPP private partner to collect the fees for recovering the investment and the rest of the seats to be given on merit to the students as per the reservation policy by the government at nominal price. The ideal ration of seats to government and private PPP should be 60:40 till the investment is recovered by the private partner in a fixed number of years say 10 or 12 years after which the entire infrastructure and authority on the 100 % seats should be with government. The numbers of years the private partner entitled to collect the fee is determined based on the investment made in the infrastructure and on maximum fee to be collected from the private student, (also there should be sealing on fee from private student). It will be ideal that all cities and towns above 10 lakhs population should have at least 3 medical colleges in PPP with not less than 600 seats at degree level having all the courses at adequate number in all levels and disciplines, more importantly in the PG courses. Also it will be more ideal to bring a change in the curriculum of the medical education to introduce 4 year medical course that will be allowed only to practice issue of general medicine and not eligible to go for operation theatres or specialisation. This is necessary as in order to increase the ration of doctors to population on par with the developed nations it may take over few decades, creating infrastructure in that pace will take several decades. As such all the existing private universities and select engineering colleges who are ready with necessary adequate constructed space, financial ability to create facilities for medical education as per the MCI standards should be given permission to operate the 4 year medical course, the teaching in all the 4 year course medicine should be ideal to adopt the e-learning on the interactive learning methods, the basic practicals can be made through tie-up with nearby hospitals and full-fledged medical colleges at the nearest place to the colleges.

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NEED FOR MORE HOSPITAL INFRASTRUCTURE Also it is necessary that government to set up hospitals to increase the ratio of hospital beds to the population. As per the WHO the total additional beds required in India are around 4,50,000 Since government alone cannot built such infrastructure in such a fast pace, government must involve private investors to add to the capacity building in the heath care infrastructure through PPP mode. In order ensure government and private investment have equal representation the government should provide land for the construction of the hospital infrastructure at prime localities in the districts and cities and towns to ensure that the value of the land is almost equal to the value of financial investment by the private for the construction of the hospital and setting up of necessary infrastructure. This will ensure that equal share for government and and private. All these hospitals should mandatorily cater the free treatment in beds as for the percentage as per the government share, the private percentage beds can charge the rates as per the pre fixed rates as normal as in the case of private hospitals. Also it should be most ideal and necessary that governments should set up super speciality hospitals in every discipline like heart care, cancer treatment, etc in every district in the country. More focus should be on establishing hospital exclusively for the heart care is very necessary, as there are several lacks of patents are suffering from heart issues of which majority of them belonging to down trodden and low income group without any treatment due to un affordable, high costs in private hospitals. As the studies shows out of the total population in India 3-4 % population in rural areas and 7-8% population in urban areas are suffering with Coronary Artery Disease (CAD) which is a serious heart disease which requires heart care and surgeries. Moreover, majority of the people prone for CAD in India are at younger ages (35-64 years old), during an individuals working years, and as a result, there is an extremely high loss of potentially productive years of life in India. As per World Health Organisation data, 16.7 million people die each year owing to heart attacks in India. The figure is one-third of the number of deaths worldwide. The estimates shows that at the current facilities for treatment of heart care, Among working-age adults (35-64 years old), nearly 18 million productive years of life are expected to be lost from CAD by 2030, as the estimates show likely there will be 65 million people in India by 2015 suffering with CAD. At present

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there are over 500 centres with facilities for heart care treatment i.e coronary angiography and coronary angioplasty in the country and mostly in cities and and to some extent in towns. But the treatment costs are very high not within the reach of even middle middle class leaving apart the BPL and low Income group people, which is a major hurdle for the economically deprived sections they have to depend on the government hospitals mostly situated in cities and due to lack of exclusive heart care treatment centres in government causing much un wanted delay in treatment causing the deaths. Similarly there should be government hospitals for exclusively for the treatment of cancer, as the study shows that more than 5,56,000 cancer deaths occurred in India in 2010 and 71.1 per cent of those who died were aged between 30 and 69 years, of which most of the men are more likely to die of oral cancers followed by stomach and lung cancers, the most fatal cancers in women are cervical, stomach, breast and oral. The number of cancer deaths in India are due to tobacco consumption, around men (84,000) and women (35,700) died of tobacco-related cancer in 2010 of the total cancer deaths in India, several millions of people are suffering from respiratory problems, chest infections etc. As such there should be a ban on cultivating tobacco, tobacco production and restricted sale of tobacco finished products with heavy excise duty to the tune of 1000 % to 5000 % on the finished tobacco products (there should not be any hesitation in levying such high tax on these dangerous products, when the governments allowed the pharmacy companies levy markups ranging from 1000 % to 5000% on basic manufacturing cost of essential life saving drugs by private pharmacy manufacturers), also governments much think that in the case of any death occurred in any accent even due to technical failure (most ideal example rail accidents) government announces few lacks of rupees compensation, in case of major accident causing death of few tens of numbers of people the cabinet minister is bound to resign ; then in the case of these tobacco cancer deaths crossing lacks in numbers how come government not compensate them, which cabinet ministers will resign, how many times they have to resign? Should be given very serious thought on this issue as the tobacco deaths are more or less equivalent to state sponsored deaths as governments are fully aware that there will be deaths due to tobacco cancer still it being allowed to sale just for the tax collection at the cost of lifes of few lacks population in the potential working group (the deaths of potential working group will lead to loss of production, which may be several

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times more than the revenue collection of the government, apart from governments expenditure on the health care), just providing a statutory warning on the pack of cigarettes does not control the cancer cases as long as it is available at affordable prices people will buy and get victimised, in case not available at affordable costs most of the urban smokers switches to the local tobacco cigarettes i.e Beedis and raw tobacco as in the case of rural population, as such complete ban on tobacco farming from production of tobacco on Indian soil is needed which is fully justified. It is true that the common people in India who are good hearted will not consciously accept the better infrastructure or welfare schemes at the cost of deaths of lacks of fellow citizens leaving utmost sorrow and misery for their family members, there are some crooks even in the common people who are self centred will agree that at any cost they should need all facilities. Apart from this also needed is construction of speciality cancer treat hospitals in every district with adequate number of beds. Also needed is to establish adequate number of tobacco de addiction centres offering free de-addiction treatment. The UPA governments allocation of Rs 125 Cr in 2011-2012 budget for the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is a welcoming step to begin with but need huge allocation and investment as the budget allocation is very meagre compared to the magnitude of the diseases. As per the WHO reports India may lose 5 % GDP on account of deaths due to lack of health care. REGULATION OF HEALTH CARE SECTOR In order to regulate the medical sector it is the mandatory duty of the government to must create & maintain the data bank of the all hospitals and nursing homes and diagnostic centres with each and every detail of the facilities, doctors etc, by making it mandatory to register with government to get registration number on applying online along with the required details. Also government must maintain the data base/ data bank of all medical professionals like doctors, nursing staff, lab technicians etc, by making it mandatory for all the medical education institutes to submit the data of their pass-outs and also the individual doctors to apply online to ensure that every one provided with a valid professional ID card. All the medical data bank should be permitted to access by all the hospitals and nursing homes for asserting the authenticity of the job seeking medical professionals etc. Also it should be made mandatory that the

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hospitals and nursing homes should up-load the date regarding the medical professionals working with them (both permanent and visiting regularly). Also should mandatorily submit the details of current equipment, its fitness status, any maintenance and repairs done. Also it should be made mandatory that all hospitals and nursing homes submit e-retunes on the details of number of patients treated, billing information day wise, income and expenditure break up statement every month. The data base will ensure that the hospitals and nursing homes provide the authentic services through authentic, trained professionals the income and expenditure break up etc. Also this will help in preventing the falls medical claims at the insurance companies and also all the medical reimbursements by the employees both in government and private. Also it is the mandatory duty of the government to determine the cost of medical services at all hospitals and nursing homes, which should be fixed, uniform for all medical tests and services based on the cost of the equipment, and the grade of the city i.e metro, city, town, and also based on the number of medical staff in the hospital/ nursing home. Also it should be ideal that government must mandatorily fix the doctor to supporting staff ration in every hospital/nursing home. Also it should be made mandatory that all hospitals and nursing homes maintain computerised system for billing and accounting in a standard uniform pattern as suggested by the government. Also government should made it mandatory that audit for all the hospitals and nursing homes is necessary for issue of licence and renewal of licence to run the hospital by asserting the accuracy of the data submitted by the hospitals and nursing homes. The audit should cover the details of number of doctors, their qualification, working hours, their official payment details, the supporting staff like nursing, lab technicians, helpers etc, the computerisation of hospital billing and more specifically the available equipment, the date of manufacture, the accuracy of results, the depreciation value etc. Also the audit should look into necessary external factors like adequate parking space for the visitors to the hospital / nursing home, also the fire safety, availability of water facility, hygenity of the sanitation facility, waste disposal system etc should be taken into account while extending the licence to run the hospital/nursing home. Also the all the costs of various diagnostic tests should be determined based on the cost of the equipment, the operational costs of the machine.

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Also it should be made mandatory that all the data of the patents treatment should be computerises and kept a record at the hospital for future reference, in addition copy of the data should be provided to the patent in a computer memory card in addition to printed paper reports. All the test reports should mandatorily contain details of the the machine on which the tests are conducted, the date of manufacture of the machine, date of installation at the hospital /nursing home, number of conducted on the machine till date, the life span of the equipment, the technicians name and details. All the machines that were depreciated should be withdrawn from operating and scrapped (either as per the books of accounts or as per the maximum life of the equipment), or alternatively if the equipment and machinery has still has the life span even after the depreciation can be allowed to be in operational, but the cost of the tests should be just restricted to the cost of consumables and operational charges (as the value of the machine is zero financially) that were pre determined by the Government, which will be far less than the tests on the new machines. Also strictly withdraw from the operations those machines and equipment which has been exceed the life cycle even before natural deprecation due to excessive use in short time. In order to provide clarity to the public regarding the difference in costs for similar tests made on the new and depreciated equipment which are still having working life span in the same hospital or different hospitals, it should be made mandatory the equipment details and the cost of services should be made available on the website of the hospital and nursing home for public knowledge. This will ensure that the public will go for the lesser cost hospitals for tests in case they want at a cheaper cost else the hospitals will scrap the equipment and purchase the new once the depreciation value of the equipment is zero. Also it should be made mandatory that all hospitals and nursing homes both in government and private should mandatory e-file the details of equipment and manpower periodically i.e every three months which will ensure that no were in the country the scrapped or depreciated machine will be used again. Also it should be made mandatory that all hospitals and nursing homes should maintain a web site and put the details of the building, the facilities in the hospital etc and the doctors list both resident doctors and visiting doctors with their timings, the details of number of beds available, the details of availability of the operation theatre up dated on daily bases etc. All these details should be supported by photographs taken in the actual location in the hospital. Also it will

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be more ideal to take a video of the installations and facilities both external and internal should be made available in the web. FIXED UNIFORM COSTS FOR MEDICAL SERVICES

Also it is a fact that all the tests like blood test with a single sample can get number of details can be extracted by a single titration or analyses details like sugar level, RBC, WBC, plasma etc but most of the hospitals/nursing homes and diagnostic centers are charging extra as per the number of parameters in the blood test as per the prescription. In fact the cost of test for one blood sample takes only 2 Rs if you add the cost of consumables and the operational cost, but unfortunately the hospitals/ nursing homes/ diagnostic centres are charging 100 rs to 2000 rs for the same just to provide the detailed analysis report, like wise all tests are charged much higher than the actual cost of the tests, which is nothing but extortion, As such the government need to fix the uniform cost for the blood tests, ECG, X-RAY etc. The costs of diagnostic tests will come down to affordable level on having a ceiling of the costs at a fixed rate, as per the cost of the equipment and the value of depreciation. All the tests should have uniform pricing whether it is in a super speciality corporate hospital or the nursing home or a diagnostic centre in a small town, Also most of the diagnostic centres are usually getting their breakeven in few years, and the depreciation value of the equipment is zero, in these cases the cost of the tests should be based on the operational and material should be charged only they should be barred from loading the cost of equipment etc.

Also it should be mandatory that the private hospitals and nursing homes should have a four tire service charge for their services rendered instead of uniform service charge, the first category should be for the BPL families with 30 % of the beds for treatment should be allocated to this category, the second category low income group & low middle and middle middle income group 40 % of the beds should be reserved for them, third category should be upper middle income group and 20% beds should be reserved for them and the forth category should be upper income group and 10 % of the beds

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for the upper income group. The fees should be decided based on the financial strength of population of these groups as well as keeping in view of the number of patents, and the breakeven of the investments made etc (In Business Financial Management, C- Class items are more in volume say 70 % but total costs only 25% of the total cost the unit, the B-Class items are moderate in volume say 20 % with total cost around 30% but the A Class items are 10% but costs 50 %; the business principles has universal acceptability and applicability, as such it should be applied to the health care in the larger interest of the people, as the economic disparities are so high in India due to several reasons), charging uniform rates for all is nothing but criminal, people who has large income should be able to pay for their health as they have adequate food, good shelter, and have all facilities in possession. Also the cost of the service charges should take into account of the depreciation value of the fixed assets like building, the permanent equipment like beds etc and the depreciation value of the backup power generator, fixtures, and other movable assets like ambulances etc, and most importantly the cost of land, as many corporate hospitals got land at very low price from the government, this procedure of determination of costs will certainly lead to reduction in the service charges of all the private hospitals, nursing homes throughout the country. As such basic cost of the treatment plus mark up profits should be very minimum (2% profit) for BPL, moderate (5 %) for Low Income, normal (10% to 15%) for middle income and high (20%-25%) for higher income group. Also the government should make it mandatory that in no case the percentage of allocation of beds should change for the upper classes, with exceptional that to real emergency; however if BPL/Low income group has more patents then their reserved % of beds they can allocate bed in the next higher class quota. The violation should be treated stringently. NEED FOR MEDICAL TOURISM Also it should be ideal that government should select private hospitals in metros and major cities for medical tourism, which are adhere to the international standards in the entire hospital i.e all beds in the hospital, all diagnostics, all staff etc (there should not be any discrimination either in facilities or treatment to local Indian patent and foreign medical treatment patent). All these selected hospitals in various specialities should be allowed to have 20 % of the total beds to the foreign patents under medical tourism category.

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The charges to the patents in the medical tourism category will be based on the average cost of treatment in those countries; it should be fixed at less than 50 to 70 % of the cost average cost of treatment in that country, added the cost of travel and the stay along with one attendant. (for example a Herat surgery in USA costs 1,50,000 dollers (i.e around Rs 80, lacks) where as in super speciality hospital with international standards in India costs maximum of Rs 4 lacks (all profit margins loaded), add to this travel in business class air fare for two people i.e patent and attendant and the stay for 10 days in five star hotel will cost maximum of Rs 10 lacks, if the cost of medical tourism patent from the USA is charged at 70 %less than of the cost of surgery in their country i.e 30% of 80 lacks is 24 lacks, even after recovery of the cost of surgery, travel, stay cost of Rs 14 lacks still the hospital makes Rs 10 lacks from a single patent of USA. Likewise each country specific rates should be fixed) It will certainly boost the revenues of the the so called corporate hospitals to recover their capital expenditure and the operational costs that may go down due to the slab system accommodating majority of the BPL &low income group which the cost of services should be basic costs of tests without any profit margin plus 5 % of the mark up. The medical tourism is a great boon to the corporate hospitals, at the same time doing great service and favour to the foreign nationals as the medical services are many fold higher than our Indian corporate hospitals and also the best of the doctors availability in India. The medical tourism will also be useful in revenue generation for the travel, and hospitality industry also.

Also it should be ideal that all the BPL families since government is reimbursing their medical bill the cost of services to them should be determined at very minimum profit margin to the basic costs of the services of both diagnostic tests as well as the service charges of the hospitals and nursing homes plus a profit margin of 5 % only, as the exchequer money is being paid for the BPL families in case the governments are extending free medical aid facility to them, and also otherwise keeping in view of large number of persons using the service. Also the government must make it mandatory that the category of service chargers should also be in accordance to the facilities in the hospital / nursing homes. All the hospitals and nursing homes of same category should uniform service charge

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structure based on the parameters like the built-up area, the available equipment, available man power, experience of the doctors etc and the location of the hospital/ nursing home. As such all the hospitals and nursing homes should be divided into 3 categories 1,2,3. It should be mandatory that all hospitals in that category should not charge more than the price fixed by the government. Without having service charges as per the classification of income group, without reserving the beds appropriately as per the income group of the population, expecting health care for all will forever remain as a myth. DOCTORS CONSULTATION FEE, SALARY Also it should be mandatory to regulate the doctors fee, make it a uniform structured fee according to the qualification of the doctor, experience of the doctor, location of the doctor (city, town, or village) and the income group of the patents, it is not for the individual doctors or the hospitals and nursing homes to determine the consultation fee/ salary of the doctor even in the super speciality hospital or the small nursing home or the private practice the fee should be same for all doctors with same qualifications, experience throughout the country. All the doctors working in the government and private with same qualifications and same experience should get the same salary. The doctors working in rural areas in government and private should get more salary than doctors who are working in city to encourage more doctors work in rural areas. Also for all the private doctors who are practicing independently, (not working, not receiving any salary, any consultation fee from private hospitals) in rural areas should be allowed to charge only Rs 10 Per patent, but to encourage them, the government should compensate the fee difference on par with doctors in metro based on the total number of prescriptions (the private doctors practicing independent should be provided with 1+1 carbon copy enabled bar coded prescription pads to retain doctors copy for claim from the government), which are subjected to the scrutiny by the authorities with the data of the prescriptions obtained through drug authorities sale of medicine on reading the bar coded prescription by retail pharmacy stores, also subjected to the ombudsman. This necessary as it is a fact even though near about 30,000 MBBS doctors are graduating every year, only around 26,000 doctors working in rural India

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MANDATORY DUTY FOR ALL DOCTORS TO SERVE IN RURAL AREAS Also it should be made mandatory that all doctors should be categorised in the four brackets as per their working experience category-A 1-5 years of experience, categoryB 5-10 years of experience, category-C 10-20 years of experience and the category D experience 21-30 or more years. It should be made mandatory that all categories should mandatorily serve in the rural areas in government hospitals, category-A should serve 6 weeks at a stretch or 8 weeks in three intervals, like wise category-B should serve 4 weeks at a stretch or 6 weeks in three intervals, like wise category-C should serve 3 weeks at a stretch or 4 weeks in three intervals and the category-D should serve 2 weeks at a stretch or 3 weeks in three intervals, during a calendar year to get their medical registration validity extension for one more year for practicing the medical profession irrespective of their working government or private. (in the lines of mandatory election duty for the government employees). Also there should be some relaxations to the surgeons in this regard due to non availability of the facilities for surgery in the rural areas. However if the facilities exists they also should be brought into the mandatory category to serve in the rural areas. To enable this and more transparency in the allocation of work in the rural areas the government must have a web registration and the allocation should be as per the state of preference or as per the voter list the state belongs, the other than the native district, any district of the state, the mandal / village PHC, should be allocated randomly by the computer itself to avoid any bias or favour to individuals to work at choice place. All the doctors should be provided the working space in the PHC, or a pota cabin built for them, Also since as per the NRHM so far has trained 2.55 lack ASHAs (Accredited Social Health Activists) out of total 8.09 lack selected people and the ANM (Auxiliary Nurse Midwife) and AWW (Anganwadi Worker) who can assist the doctors on rural duty. All the doctors should be provided with temporary accommodation made for their stay built on the fast construction method of structural steel and foam concrete panels pre fabricated buildings which can be constructed in less than couple of days with a plinth area of 300 Sq Feet with provisions for kitchen, bathroom, visitors area and the bed room with solar power for light and fan with less than 2 lack rupees which has a life of over 30 years. Also to encourage doctors to work in government at any point of their carrier, lateral entry should be created to switch from private to government.

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LATERAL ENTRY FOR DOCTORS TO GOVERNMENT SERVICE Also there should be provision for lateral entry for the doctors working in the private to enter into government hospitals, as both government and private doctors with same qualifications and experience have the same salary both in government and private. Also government should make the later entry encouraging by providing the pension benefits to them with eligibility for all the doctors who served in the government through lateral entry for more than 12 years in any two categories (i.e category A,B C D) at a stretch or in intervals, with at least 3 full years of service in rural area should be eligible to pension benefits on par with the normal government doctors. Also all the private doctors are allowed to get a percentage of treatment from the private hospitals and nursing homes as an incentive for better treatment. However the percentage of the incentive should not be more than 1% of the total revenues earned by the hospital divided equally to all the doctors working in those private hospitals, with maximum amount of incentive given should be less than 50 % of the basic salary per annum of the doctor. To compensate the doctors working in the government should provided subsidized canteen facility for getting food, beverages, accessories etc at a subsidized cost like military canteens. Also government must provide housing plot in that rural free of cost to all doctors who served in the rural area after serving a minimum of 10 years in any category either in the direct entry government service or through lateral entry. Also for all those doctors who wish to serve throughout there carrier under the bond to the government in rural areas , the government must provide free constructed house to the doctors, which will be transferred to the individual doctor after 20 years of service in that rural area at the choice place in any mandal of a rural area. This will ensure that fair treatment of all doctors, which will enable them to work more dedicatedly with more focus on the treatment and recovery of the patent whether they are serving in the government or private.

In order to get better cooperation to the doctors from the supporting staff i.e the nursing staff, assistants, etc it should be mandatory to that all staff with equal experience, qualifications should get equal salary in both government and private hospitals and nursing homes. Also it should be ideal that these staff should be

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paid 0.5 % of the turnover in the private hospitals as incentives, in government the subsidized canteen facility should be extended to the supporting staff of the doctors.

Also it should be made mandatory that all the hospitals/nursing homes/ diagnostic centres should conduct tests only on the reference of a registered medical practicenor only. All pharmacy retailers must issues medicine mandatorily only on the prescription of the registered doctor. In no case any single test should be conducted without the reference of the doctors through the bar coded prescription and no single medicine should be issued by the pharmacy. Also that the doctor/s fees and the referral doctors fee should be clearly mentioned in the medical bills provided to the patents, all these details should be submitted to the government in quarterly efiling return. It should be mandatory that all the hospitals and nursing homes submit the details of their income and expenditure should be submitted in the standard format online to the government every month. The details should contain the doctor, referral doctor, patent, the equipment the amount charged for the consumables the total cost of the tests, the cost of the services etc, if the tests were made in the other hospital/ nursing homes/ diagnostic centre the details should be extracted from the patents from the details given in memory card of the tests regarding the test details and the hospital/nursing home details containing the charges they have collected from the patents, the equipment details, the details of the technicians etc. Also it should be necessary to formulate stringent laws to ensure that all hospitals and doctors adhere to the ethical norms and strictly follow the fee structure and the procedures in prescribing the medicine and the test and the dosage by the doctors (to prevent the irrational prescriptions); the allocation of beds as per the income group, the charging of the bills as per the directions as per the classification etc by the hospitals and nursing homes. All violations should be made non-bail able offences and the punishments should be rigorous, apart from suspending the registration to practice as doctor, and for the hospitals heavy fine, in addition to rigorous imprisonment for the all members of the hospital management.

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REGULATING DOCTORS PRESCRIPTION It is fact that doctor profession is a noble profession; every one rich or poor, strong or weak has to visit on the doctor for treatment. As such we have to give utmost social respect to the doctors who are in the profession of service to the people. However there should be some system in place to control the corruption in the medical field, as doctors play a Vital key role, it will be more appropriate and ideal to control other factors in the health care through the doctors, also it is a fact that some crook elements exists in every profession with no exception to medical profession, as such the reforms in the medical profession is very necessary. SINCE DOCTORS PRESCRIPTION IS THE ORIGINATING MOTHER DOCUMENT FOR ALL HEALTH CARE INDUSTRY, ANY DIAGNOSTIC TESTS OR ISSUE OF MEDICINE DEPENDS ON THE PRESCRIPTION ONLY, AS SUCH IT WILL MORE IDEAL, NECESSARY AND APPROPRIATE TO REGULATE THE DOCTORS PRESCRIPTION WHICH IS THE MAJOR BASE FOR OTHER ACTIVITIES IN THE PROCESS OF TREATMENT, WHICH WILL CERTAINLY PROVIDE THE REQUIRED THRUST IN THE PROCESS OF CONTROLLING CORRUPTION IN THE MEDICAL PROFESSION WHICH INCLUDES THE PHARMACY RETAILERS, PHARMACY MANUFACTURERS, DIAGNOSTIC CENTRES, HOSPITALS ETC. AS SUCH IN ORDER TO ENSURE THE AUTHENTICITY OF THE PRESCRIPTION GOVERNMENT SHOULD PROVIDE BAR CODED PRESCRIPTION PADS AND MAKE IT MANDATORY THAT ALL DOCTORS SHOULD USE THE BAR CODED PRESCRIPTION PADS, WHICH WERE SUPPLIED BY GOVERNMENT ON THE REQUEST OF INDIVIDUAL DOCTORS WHO ARE REGISTERED FOR MEDICAL PRACTICE. THE BAR CODED LETTER PAD HAS EACH PRESCRIPTION PAPER WITH DIFFERENT BAR CODE WITH CERTAIN INBUILT SECURITY CODES FOR EACH DOCTOR, SO THAT NO ONE CAN TAMPER OR CAN GENERATE THE SAME PAD PHOTOCOPY, EACH PAGE HAS A DIFFERENT CODE INBUILT IN IT FOR USE. All the registered doctors should apply online to the government to obtain the same. All the doctors should apply in the prescribed format online mentioning their degrees, sizes of pads (should have only two standard sizes), number of booklets, address for delivery, the DD amount towards the charges for printing, stationary and delivery etc. The entire letter pad booklets will be mailed to the doctors mailing address, in case of

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non delivery at the address will be directed to the concerned district medical and health office, the concerned Doctor has to go and collect the same. The bar coded prescription pads is it not only for the betterment of the individual doctor but for several people, which has multiple advantages of its own, it is necessary since the doctors are dealing with individuals health i.e life as a whole, as we all knew that if money is lost can regain but if health is lost it is difficult to regain, since the bar coded prescription pads increase the responsibility of the doctors in dealing with patents and patents recovery will be more faster, of course the responsibility on the part of the patient to administer the medicine prescribed by the doctor. Also all the hospitals and nursing homes can apply for the doctors working with them on obtaining an affidavit from the doctors. This will ensure that all the prescriptions are authentic and mostly rational. The doctors who are net savvy can download the bar coded prescriptions permission codes free of cost, to be printed by themselves by providing the registration ID card number. ROLE OF PHARMACY RETAILERS ALSO MOST IMPORTANT ASPECT IN MAKING BAR CODED PRESCRIPTION PADS MANDATORY IS TO REGULATE THE ISSUE OF MEDICINES IN THE PHARMACY RETAIL STORES, AS SUCH IT SHOULD BE MADE MANDATORY THAT ALL MEDICINE SHOULD BE ISSUED AGAINST THE BAR CODING PRESCRIPTION ONLY AFTER DUE READING OF THE BAR CODE BY THE BAR CODE READER ELECTRONIC EQUIPMENT WHICH WAS CONNECTED TO THE BILLING COMPUTER SYSTEM IN THE PHARMACY RETAILER STORE. As such all the prescriptions which were made by fake doctors will not have any scope here after the introduction of bar coded prescription, as the system will not allow without bar coding prescription issue of medicine, and also the issue of prescriptions should be only made by the government of verifying the authenticity of the degree of the doctor. All fake bar coded prescription, can be detected by the system itself as all authentically issued bar coding are in the server of the system, also hardly any chance to tamper the prescription pads with bar coding and duplicate bar coding cannot be possible, in case of patent visits with duplicate of the original pad (colour photocopy of the same original or any fake doctor name) which was already medicine was issued, can be recognised as system will indicate that the prescription paper was already used, and such cases the retailer should immediately

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complain to the local police for further action. It is the responsibility of the doctor to preserve and use the pad carefully appropriately, the loss of blank original pad is the responsibility of the doctor. Also this will ensure that doctors cannot deny the prescription of medicine, tests were not recommended by them, over dosage of medicine or, unnecessary treatment of the patent is not possible. As the surveys reveals that in some places irrational prescriptions by doctors are as high as 69 % of the total prescriptions, leading to waste of money on the medicine, over charging of the patents will not happen as the prescription was written in the doctor in their own hand writing. Also it should be mandatory that all the pharmacy stores in the government hospitals and inside the private hospitals and nursing homes also should issue medicine based on the doctors prescription only. This will ensure that doctors will not prescribe un wanted medicine, all the medicine sold is original excise duty paid. Also this will curtail the government doctors from private practice. (the government doctors can use the pads in emergency for private purposes, all government doctors should be relaxed for 10 % use of the pads for private use, the use of the prescriptions of the government doctors can be identified from the pharmacy issue and the diagnostic tests, whether in government or in private a record of the prescriptions with the government) All the pharmacy retailers should mandatorily use the same computer format for generating the sale data. In case the prescription holder wishes to take part of the prescribed medicine for what so ever reason, the same should be allowed with an entry on the system as well as a rubber stamp mark on the prescription clearly mentions the remaining quantity of medicine to be issued. It is the mandatory responsibility of the pharmacy retailer to stamp the prescription pad for part issue. All the pharmacy should issue only the remaining part of the medicine in the prescription which was already used/issue; once the course prescribed in the prescription is fully issued the validity of the prescription should be nullified by providing the rubber stamp by the pharmacy retailer that the full course issued, further medicine only after obtaining the new prescription. The data of sale, stock in store should be submitted in the e-form on daily bases through online else on daily bases (as in the case of banking each branch that at the end of the day tally the account with withdrawal and deposits) to the district drug inspection authorities to integrate the data of all the pharmacy retailers in that district as per the doctor wise and prescription wise date wise which will certainly reveal if any excess of medicine issued either without prescription or with prescription.

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Violation should be seriously punished with stringent and quick punishment. Also the e-data of districts should be integrated to get the state data. It will more ideal that formation of national integrated pharmacy grid (Central Pharmacy Network) to issue medicine online every time with the information of sale on real time as patents can travel from one place to other and obtain medicine at any pharmacy retail outlet in any part of the country. The above method will certainly prevent the sale of under invoiced medicine, non excise duty paid medicine, sub standard, unauthorised and spurious medicine as every batch of the medicine issued is recorded in the bill and the national data integration will certainly identify any duplication excess manufacture of same batch number distributed to different states or wrong batch number or dis continued batch number of the medicine from the manufacturers end also, as per the revelations of comprehensive examination of Drug regulatory issues of DPCO, Ministry of Health Government of India shows that out of the total sale of medicine in the country 0.24% to 0.47 % medicine are spurious and 8.19% to 10.64 % are sub standard. The spurious and sub standard medicines cause extensive damage to health of the people who consume them. As such in this method there is hardly any scope for manipulation of what so ever manner. All the pharmacy stores should mandatorily issue the bills for the purchase containing printed details of the doctor who prescribed the details of the qualified pharmacist, the details of the licence to run the pharmacy, the batch number of the medicine, date of manufacture, date of expiry etc. This will ensure that all the pharmacy stores should have a dedicated qualified pharmacist all the times. All the pharmacy stores should maintain the records and submit on monthly bases the e- filing of the monthly sales of the medicine as per the doctor wise. This will ensure that doctors prescription is not mis utilised which can be easily found. DOCTORS MAINTAINING PATENT DATA Also it should be mandatory for the doctor to maintain the details of the patents and the prescription pad number and date and time of issue of prescription, the amount of fee collected in a log book (like books of accounts in any business organisation). All the doctors should be restricted to collect the fee to a maximum amount of Rs 10 from all the BPL families if the patient claims that he belong to BPL family on the production of the BPL card or the MNREGA card as

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this will certainly benefit over 5.49 crores people who are covered under the MNREGA scheme. All the doctors while issuing the bill should clearly mention the name of the patent, in case minor/dependent the guardian name, age of the patent, the place of their ward/village or any ID card number, contact number of patent/guardian. This system will be more transparency, more accountability of the doctors certainly encourage them to practice more ethically. Also it is the responsibility of the doctor to keep the prescription pads under his own custody to prevent any misutilisation and the individual doctor is responsible /accountable for the prescriptions. The issue of medicine mandatorily on the prescription will certainly boost the respect of the doctors in the public, also income of the doctors will be on raise as patents have to visit the doctor every time to obtain the medicine, as it is fact that majority of the patents do not visit the doctor for most of times, also in case visited one time never consult second time after the course of medicine completed as prescribed in the prescription. Also most of the patents living in slums in cities, in towns, and villages visit the pharmacy store and consult the pharmacist or the helpers in the pharmacy store and get the medicine, which may give temporary relief for them. This practice is dangerous and the bar coded prescription will certainly curtail/marginalize the issue of medicine unauthorised by the pharmacy retailer. As all the pharmacy retailers have to read the bar coded prescription by the bar coding reader which will verify the authenticity of the prescription by automatic online verification or otherwise has checks and balances by daily submission of sale and stock position in the prescribed format to the district drug authorities by the pharmacy retailer. MANDATORY DOCTORS SERVICE All the public places like bus stations, rail stations where large foot print is happing should compulsorily maintain a general physician round the clock. Also all the important pilgrim places and tourist places should have at least one general physician at all times. Also all the offices, factories and industries having more than 300 employees should have one doctor on regular bases visit for few hours. All factories and industries having more than 300-1000 employees working at a single place should maintain one doctor visit

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the office/factory/industry at least few hours daily. Offices and factories, industries having more than 1000 employees should mandatorily maintain one permanent doctor working in the organisation placed in the premises. The doctor should be preferably specialist in the general medicine. MEASURES TO BOOST DOCTORS MORALE FOR ETHICAL PRACTICE

In order to boost the morale of the all the doctors towards practice of ethical professional skills( as it is a fact that the un ethical practise of some doctors are curtailed to a maximum extent by the bar coded prescription, the slab system of consultation fee, salary); the income earned from their professional practice only should be subjected to minimum level of income tax, should be fixed at 50 % of the current income tax slabs charged for generally for all people, the concession on income tax should not be applicable to the income earned by doctors from other business other than the professional earning. All the doctors should maintain portable/handheld billing machine or computer billing machine for issue of bills to the consultation fee received from the patents to record their professional income. All the consultation fee of 10 Rs and above should be provided the bill, the doctors who maintain the assistant should pay the salary through bankers cheque and the 50 % of the amount of salary paid to the assistant should be exempted from the tax. The salary amount should not be more than Rs 1,20,00 or 50 % of the earning of earning whichever is the lower or a maximum of Rs 60,000 should be exempted from the income tax payable by the doctor for the payment towards the assistant.

Also it is more ideal that government must provide all the private individual doctors (who are not employed either at government or private hospitals) for self employed consultancy with subsidized space (a shop) for individual private practice at the rural areas and semi urban areas. Also the government should make it mandatory that at least one shop in each market yard at all places both urban and rural, and one shop in each shopping complex in the villages, small towns and semi urban areas should be allocated to doctors with minimum infrastructure required for the doctors to practice their

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regularly. Also it is a pre condition that doctors will charge minimum consultation fee i.e Rs 10 only or less than that from all the visiting patents in these subsidized places. Also it should be made mandatory that all the large private housing societies and building complexes and government housing societies and housing complexes should have mandatory provision of adequate space for the doctors, all private societies should mandatorily surrender the space designated for the doctors to the government. The government should invite the doctors in the nearby vicinity (as per the address in the voter ID card) to allocate the space on subsidized rent with required minimum infrastructure like table, chair, electricity, provision for running tap water etc. The selection should be purely on the bases of lottery in case more than two doctors wish to serve in the same place. It should be on the pre condition that the doctor visits the clinic regularly with at least 20 working days per month.

Also in order to extend more respect and honour to doctors it is ideal that the governments should extend the special preferential treatment to doctors, starting from the free vehicle parking, concession on the travel, preference to the admission in the schools and colleges with 1 % of the total seats should be given to the children of the doctors, free admission for doctors children in the welfare hostels run by the government with a pre condition that doctor visit and spend a day with the child at least monthly once and also look at the health condition of all other children in that hostel etc, preferential treatment for the doctors in the religious worship places based on their religious practices etc, concession on property registration, concession on the interest rates for the doctors who avails vehicle loan or housing loan (this concession should be restricted to onetime lone only),apart from concession in the income tax. This will ensure that doctors are not neglected or targeted; they will certainly work with more enthusiasm, and more dedicatedly maintain the true professional ethics that is the motto is to serve the people, speedy recovery at minimum burden to the patent.

Also it will be ideal that state municipal authorities should issue free parking pass/ card for one vehicle either two wheeler or four wheeler applicable in any part of the state at all points whether it is

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private property like malls, shopping complexes or railway stations, bus stations etc. This will ensure that doctors get preferential treatment to the doctors vehicle. All the doctors vehicles should clearly display that doctor symbol on the vehicle, and all the doctors should at all times help the patents in emergency at all places. As such it should be mandatory that all the doctors should carry first aid kits with them at all times in their vehicles.

Also all the doctors travelling in the road transport vehicles either government or private operated should provide 25 % concession on the fare charges, all the doctors who wish to avail this facility should provide the registered practiser number while reserving/purchasing the ticket for travel. Similarly Indian Railways should provide 25 % concession on the fare for the doctors travelling in the train, to avail these doctors should mention the registration number while reserving the ticket. By getting the concession on travel either by road or rail will automatically binding obligation on the doctors to serve the people in emergency situation if any arises during the journey, also all doctors availing should mandatorily carry a personal emergency medical kit along with them during the travel. It will be very ideal that in emergencies the first aid by the qualified professionals in the first few minutes of the accident which are more crucial moments for the survival of the accident victim. MEDICAL REIMBURSEMENT As we all knew and its is an open secret that majority of the claims of the medical reimbursement are falls, and simply the employees claim the reimbursement money by giving falls declarations and medical bills without actually purchasing the medicine. Actually medical reimbursement is meant for taking care of the employee and their family and dependents. The bar coded prescription, the bill from the doctor, the bill from the pharmacy retailer based on the prescription will marginalise the scope for falls claims by the employees and need for verification also minimised. In order to ensure all the claims of the medical reimbursements are genuine government must make it mandatory that all organisations must pay the medical reimbursement charges only on the verification of details submitted by their employees with data available at the government through the pharmacy retail sales data,

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the data of patents through the e- returns of the hospitals. For this government must create a medical reimbursement verification department in the government to provide information online to the required organisations. SOCIAL OBLIGATION ON BUSINESS ENTERPRISES TO CREATE HEALTH CARE INFRASTRUCTURE FOR THEIR EMPLOYEES Since the companies/ business establishments are earning profit apart from their capital investment, mostly due the hard ship of the employees it should be mandatory primary responsibility of the employees to take care of the health care of the individual employee as well as their family. As such it will be most ideal to make it mandatory that all the business establishments/organisations and industries, factories having more than 1000 employees in a single organisation/industry or in the same business group/industrial group of the same management, should have its own hospital setup to cater the health care of their employees, alternatively a group of different industries with different managements can club together to form a super speciality hospitals for their employees for providing free treatment. The hospitals can be either at the place of choice of the organisation, either in the cities for their corporate office employees or at the place of the factory or industry or near their employees residential places. Also it should be mandatory for all the industries whose turnover more than 500 crores or the industries having profit margin above 50cr which ever is applicable has to establish hospitals with all modern amenities like cathe labs operation theatres etc for their employees for providing free medical treatment. (all normal surgeries should be made at the company hospital only, for any major complicated surgeries should be shifted to other nearby government/ private corporate hospitals) The governments may allocate the land at a concessional rate for this purpose. This will be far better than the medical reimbursements put together and have also catering the social responsibility obligation on the part of the business people. Also it will be ideal that government to provide tax concessions on the total operational cost of these hospitals only, not on the capital investment as it is mandatory social obligation contribution, since these hospitals have expenditure on doctors salaries, consumables, electricity, manpower, medicine cost. Also it should be mandatory that all such hospitals exclusively built for their employees should be barred for commercial purposes. However in case of emergencies they should treat the local residents

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other then employees at nominal cost. Also make it mandatory that all the BPL card families residing in the vicinity of such hospitals should be given free treatment whenever there are vacancies of hospital beds. Also these business establishments should mandatorily maintain the emergency ambulances (minimum two vans, one to pick up normal patents, one to pick up patents in emergency equipped with emergency treatment machinery) to pick up the family members of the employees, it is ideal that they donate the van, integrate with the 108 service for better care, Also it is very ideal since most of the factories are in small towns and rural areas that these vans can be integrated with already existing Mobile Medical Units (MMU) of NRHM which has over 1031 number units in operation at present spread all over the county. Also this system will certainly reduce the load on the government and private hospitals. Alternatively those business houses who are not interested in setting up or maintenance of the hospitals on their own due to the fact that their employees are spread in small number throughout the country; even though their turnover has crosses 500 cr or having employees more than 1000 like banks and construction companies etc has to built the hospitals or contribute the fund equivalent to the capital cost, mandatorily. Also should contribute for the maintenance and operations to NGOs or the government or they should contribute onetime 2% of their turnover or the total turnover divided by 500 which will be number of single hospital to be constructed in their name (ex 10 Cr for a single standard hospital construction) should be contributed to government towards the building of hospitals and 0.5 % of the turnover thereafter for maintenance and operation. Also it is ideal that for every 1000 employees in every single district should have the hospital facility, in case of less than 1000 employees and more than 500 Cr turnover one single hospital in any district where maximum employees are working and the total turnover divided by 500 should be contributed for construction of hospitals in any choice district or the same amount should be contributed to government. Also for all those companies who contributed the fund yet their employees are placed not at the place of construction of the hospital can be adjusted for free medical service on par with other employees in their company through establishment of inter corporate adjustment system, which allows them to use other nearby similar free corporate hospitals. Also all other private business establishments who does not fall under the above criteria / category should mandatorily deduct 2.5 % of the salary amount of the employees and add 5 % of the salary equivalent from the employers

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side to pay to insurance companies for creating the medical insurance for their employees. MEDICAL INSURANCE Also the medical insurance is the sector government needs more focus. It is a known fact that there exists criminal nexus between some medical insurance companies and some hospitals, as a result soon the patent with medical insurance admits the hospitals the hospital authorities will ensure that all irrational tests are being performed on the patent, calling unnecessarily expert specialist doctors or only on billing statement the consultation fees for the experts, inflate the bill to an extent which crosses the limit of the medical claim, or just touches the claim limit. This is really a loss to the insurance company, especially the public sector insurance companies, it is happening due the corruption of the middle level executives in the insurance companies and the hospital administration greed, and also some doctors in those hospitals. This can be eliminated to a maximum extent by the bar coded prescription, and ombudsman system. Also it should ideal that the integration of data of the subscribers of all insurance companies is needed to ensure that each individual person should have only one company policy only. Also it should be made mandatory that have a insurance portability of the service provider, all individuals who are subscribers of one company insurance policy can have the option to switch to other companies with the protection of the amount of money paid by that individual client to the existing company, which should be transferred to the new company. Also it should be made mandatory that in case the client discontinues paying the amount of insurance, such amounts should be kept under suspense account, once the client resumes to pay for the same insurance company or the client subscribes to another companies policy after some period of dis continuation of the previous policy, the amount in the suspended account should be transferred to the new account of the other insurance company. The mis use of claim/ corruption, mal practices in the insurance claims can be marginalised by transparent billing due to bar coded prescriptions, rational treatment due to bar coded prescription, all tests to be conducted on prescription, and medicine issued under the bar coded prescription by the pharmacy retailer, with the bar coded prescription the individual doctor is accountable for the treatment. Also the insurance companies can

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pay a fixed fee to the medical ombudsman to examine the cases and provide their opinion. REGULATION OF GOVERNMENT HOSPITALS Also It should be mandatory that all government hospitals should issue biometric attendance system on entry and exit, also to install the CC cameras at the entrance and exit points of the all the government hospitals, all the the bio metric card readers and the CC camera feeds should be integrated to computer system, which should be transmitted to the district health office for monitoring all the hospitals in the district. This system will certainly improve the attendance in the government doctors. Also it should be the duty of the hospital superintendent to keep the hospital premises and the surroundings in hygienic condition at all times. In order to do achieve the DMHO should issues order to take a video of the hospital premises for assessing the hygenicness and cleanness of the surroundings, maintenance of the hazardous waste disposal methods etc instantly one day in every week. The hospital in-charge or the superintendent ensure that the video is made instantly on receiving the instruction, made through 3G camera mobile phone or through Video camera (which shall be provided by government to all the hospitals) and upload the same instantly to the DMHO office website, time of call from DMHO, the time of start of recording Video should not be more than 5 minutes otherwise the office superintendent should be liable for disciplinary action. Also sent the same through any messenger to the DMHO office or store it for record future observation. In order to ensure the video shooting made on the instructions of the DMHO, there should be a security code which has to be displayed throughout the recording of the video, Also it is more ideal that the surprise calls to every hospital by the DMHO every week on any random date and random time. In addition also there should be periodic inspection for the hygienicness at least once in a week by the the DMHO officials or local authority, most ideal the revenue authority (MRO and above) and submit the report to the DHMO. This method will ensure that the hospital atmosphere most of the times in hygienic condition. Also it should be ideal that the toll free number service installed (at least three points) in every government hospital to be operational at all times available to the patents to report / register a complaint against the staff or the doctor in case of the doctor dont attend the duty on time or leaves the duty before time in spite of the bio metric system of attendance

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and the CC camera, also any misbehaviour by the staff or in case of seeking bribery by any staff. The complaint will soon be transmitted to the superintendent of the hospital, the DMHO on their mobile phone and also a fax message to their office regarding the issue, and also recorded at the state office, all this automatically by the call centre, this will ensure that hierarchy will respond automatically in order to avoid the disciplinary action. This will keep the doctors and the staff on alert all the time. Keeping the toll free phone in the working condition is the responsibility of the hospital superintendent, one responsible official should call to the call enter every day at least three times to ensure that the toll free number is working condition, also from the end of the service provider can identify the non working phones and ensure the repair takes place in less than 24 Hr service. Also the toll free phone should have just one button to be pressed to activate and contained in a tamper proof box with speaker phones in built in it. Even in government hospitals the issue of medicine should be purely on the bar coded prescription which will ensure that accountability.

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REGULATION OF PHARMACEUTICAL MANUFACTURING REGULATION OF DRUG PRICES Also the government must urgently focus on getting the prices of drugs under the control of government, to be available to the people at affordable price. Also should ensure the prevention of dacoity of some of the pharmacy manufacturers who are earning profit margins as high as 1000 % i.e 10 times the cost of manufacture of the medicine. In addition the government must fix the cost of a particular medical formula at a uniform price by all manufacturers. All this in the light of direction of the Supreme Court division bench of Honble Judges, Justice G S Singhvi and Justice S J Mukhopadhaya in November 2011, and the commitment by the government to Supreme Court to bring all 348 drugs in the National List of Essential Medicine (NLEM) to be under government price control from the present position of 74 drugs which are under the government control. As it is a fact that estimates shows that the expenditure on medicine per annum in India touches over Rs 30,000 Crores i.e every citizen is spending on an average of Rs 1500 per year on medicine alone apart from the cost of the services in the hospitals and nursing homes towards doctors fee, diagnostic tests, hospital service charges etc. As of now free market is prevailing as far as 2/3rds of the essential drugs, with the prices of these drugs are merely at the wish, mercy and greed of the manufacturers as government does not have control over majority of the drugs. The price should be uniform for all the manufactures who are manufacturing the same formula in different names. The cost of the end sale price of drug product should not be more 100 % of the basic manufacturing cost at the ex-factory, also should fix the margin a maximum of 20 % profit to the manufacturer. As of now government has 74 drugs under its control , which allowed to add 100 % mark up price to the original manufacturing cost of the product to cater the expenses towards packaging, distributor margin, retailer margin and the transport expenses; even this mark up i.e 100 % also should be reviewed to bring down the % of mark up and thus bring down the cost of medicine; government must act immediately in bring all the 348 drugs under government price control with restricting the manufacturers of these 348 drugs to add mark ups less than 100 % of the cost of manufacture of the product while delivering it to retail sale. The costing of these essential medicine which will certainly come down, which will reduce the

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burden on common man, and also reduction of burden on the government where ever it is supplying free medicine. In addition Since Government is promoting Jan Aushadi i.e generic medicine which is much cheaper (many times less than price even in medicine with 100 % mark ups), it should bring much more medicine whichever is possible to bring generic, generic-generic version of medicine to be available to people, also should expand the Jan Aushadi stores to a maximum extent. It is a fact that the institution supply of medicine is only 15 % of the total production of the medicine and the retail sale accounts for the 85 % of the total medicine in India. Also it is a fact that still 81 % of the expenditure on medical care in rural areas in low income group and BPL is for medicine spending cash for medicines and where as in urban areas it is 71% towards medicine alone. Also it is a fact that a study by National Commission on Macroeconomics reveals that the there exists a huge variation of whole sale price to bulk purchaser through tenders to institutions mostly government and the retail price the price variation ranges from 100 % mar up for whole sale institutional supply to 5600 % mark ups for retail price for the same drug in some cases. It is a fact that even in 100 % mark ups to the basic manufacturing cost the manufacturer earns decent profit margins ranging from 17% to 21 %, due to the reason that as per the (Drug Price Control Orders) DPCO 1995 the whole sellers margins are fixed at maximum 8 % and the retailer margin of 16 %, 4% VAT (zero VAT in some states) but it is happening only on the 74 drugs which are under price control of government. In the case of remaining drugs in the total list of 348 drugs the free market prevails with mark-ups exceeding over 1000 % than the original manufacturing cost of the drug, which is evident from the recent study of Cost Audit Branch of the Ministry of Corporate Affairs which has found the essential life saving drugs are sold in the market at 10 times the manufacturing cost, suggested for regularisation of the prices of these products. As such it is learned that Shri Veerappa Moily, Minister Corporate Affairs, advised the Minister Chemicals & Fertilizers under whom the Department of Pharmaceuticals function and also the Minister Health seeking appropriate action on these pharmacy companies for curbing this practice to regularize the price control of these products by regularizing the profit margins of these companies to adhere to ethical practises). Since the profit margins are as high as 1000% these manufacturers are providing more margins to the pharmacy companies to promote their products , also providing the gifts and percentages to the doctors to prescribe these

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high cost medicine even though similar formula manufactured by other companies, their generis are available for lower cost. It is nothing but decoity by these pharmacy companies squeezing the blood and hard earned money of the people. It is more ideal and appropriate that government must review even the basic cost of the drugs by reviewing the cost of inputs, methods of manufacture etc to fix a uniform basic manufacturing cost of the products. Also to reduce the prices of medicine there should not be any tax from the state government side on the sale of the medicine should be exempted from the VAT preview. Even though the free market drugs are enjoying the huge margins with the difference of manufacturing and retails as high as 1000 % it appears while coming to the account books for taxation the margins are shrinking, causing a huge loss to the ex-chequer. As such there should be a closed monitoring and analysis of data of the inputs of the raw material produced in India/ imported has to have record and the utilisation of the raw material by various companies, the cost of raw material i.e Bulk drugs ( maximum margin of 14 % fixed for bulk drugs by the DPCO to ensure drug prices are under control) and the final product of the company produced, the wastage, left over stock should tally online at every time, also to ascertain that the production is fully duty paid and no under invoicing is happening. Also it will be ideal that the electricity department should submit the energy audit report every month in order to ensure that the machinery is operated in the shifts that were recorded by the company. In addition to note that any generators were in operation during anytime and the duration of generators operation. This will eliminate completely all unauthorised manufacture and sale of finished pharmacy products. There will be great scope to control the non standard, non approved products in the pharmacy sales counters. Also it should be mandatory that all pharmacy companies whose turnover exceeds over 50 Cr should have two excise official and two drug officials 24/7 on three shifts on weekly rotation in the manufacturing premises of the pharmacy company, it may be very negligible cost for the government but have great advantages. Also should have weekly surprise visits by all other pharmacy companies. Also there should be a vigilance task force for over all monitoring to ensure the officials and the manufactures on alert all times.

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MEASURES FOR MONITORING DRUG SALE AT PHARMACY RETAILERS In order to ensure that the pharmacy retailers sell the medicine as per the prescription, prevent unauthorised sale of drugs there should be regular inspections from the district drug authorities once in three months every retailer to be inspected and audited. Also there should be taskforce teams in appropriate number at the district, state and central level in the drugs department to conduct the audit of the stock at the pharmacy retailers and the distributors, a double check on a regular and random bases which were under periodic checks by the local drug authorities, the retail outlets should be selected randomly every time just before the reach of the teams in that particular area. The message should be sent through wireless to check the shops randomly selected by the district drug authorities in that particular locality to tally the stock present, the stock sold, the reflection of stock in the account books as per the official records and the stock is a legitimate stock, all sales are recorded in accordance to the guidelines, whether medicine sold strictly on the bases of the prescription of the registered doctor, which will be reflected in the bills strictly. In order to ensure that everything in order it should be made mandatory that all the drug manufacturers should send on daily bases the details of the manufactured goods, the batch number, the destination of dispatch of the batch i.e to various distributors across the country, and also the final destination of the batch of the product to the retailer to all the central drug authorities. The central drug authorities should send the details of the drugs with the batch number with date of manufacture and date of expiry of each company product to each state drug authorities as the records. The state authorities should in turn forward the details to district authorities as the location of the retailers the batch number of all the 348 drugs. The district drug authorities have the information of the batch, stock at each retailer. This method will certainly provide better results on periodic surprise inspections at the retail pharmacy outlets to ascertain the sale is as per the prescription, the stock is as per the books, no un authorised batch numbers or products without batch number or under invoiced products etc can be easily found, stringent action should be on the retailer immediately and investigation should be conducted to ascertain the culprits and drought to justice. Also to inspect for the storage facilities for the medicine storage at the retail out lets as some require to store in refrigerators, some

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at controlled temperatures less than normal room temperature so air conditioner is provided and generator to run the air conditioner and refrigerator is available and in working condition etc. In case the refrigerator, air conditioner is not there in the retail shop especially in rural areas only such medicine who dont require special storage conditions only to be allowed to be sold by the retailer, to ensure that everything in order all the pharmacy manufactures and distributors are given instructions to stop supply to these special storage products to retailers and also the medicine issued on the prescription of the doctor, the bill of sale clearly ensures that such stock will not be sold in these outlets Also there should be special cell at each district level drug authorities to collect the near to expiry drugs from the distributors and the retailers to destroy them. Also it should be made mandatory that all the distributors and retailers should surrender the medicine one week prior to the expiry date to the drug authorities. Failure to surrender the expired medicine either in the position of the distributor or the retailer should attract the non-bail-able offence with stringent punishment, with suspension of the licence to trade the medicine. As these expiries medicine may cause damage to the people who consume them. Also needed is to formulate stringent punishments for violation of any provision by the manufacturer or the retail pharmacy; the existing laws are so weak that these pharmacy manufacturers and retails never bother for action on them due to violation; as DPCO has not having any enforcement agencies except through state drug departments to monitor and control the system under the Essential Commodities Act. The law should be made in such a manner the violations of the drug act should lead to non bail able offence, with punishments ranging from rigorous imprisonment to life term in the case of the spurious medicine sale. Also the manufactures of the spurious medicine and sub standard medicine should be charged with attempt to murder case and punishments not less than life term rigorous imprisonment. Since UPA Government under the Congress Party is committed to the welfare of the all sections of people of the country, especially the common people and the down trodden it is necessary on the part of our government to regulate the prices of the pharmacy product and keep a sealing cap on the profit margins of the product

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manufacturing cost and product purchase cost. As such always the profit margins should be restricted to 15% maximum in all pharmacy raw material (bulk drugs),and pharmacy finished products 20 % maximum for all the 348 drugs. Also should create strict, transparent accountability and checks and balances in the supply of raw material for the manufacture of bulk drugs and the total production of the bulk drugs and the distribution of the bulk drugs to the pharmacy manufacturers, Also to regulate the pharmacy pricing of finished products i.e 348 drugs under the National List of Essential Medicine (NLEM) of different companies, restricting the mark up to a maximum of 100 % on the original manufacturing cost towards the cost of packing, distribution margins, retail margin and the transport costs, Also should restrict the promotional and advertisement expenditure to 5 % of the total turnover (to ensue un due favours to doctors in the form of gifts etc to make irrational prescriptions and promote only a particular company) by bringing National Pharmacy Policy (NPP). In addition to these English medicine, also the AYUSH products also should be brought under the DPCO mechanism and regulate the prices of all the Aurvedic, Unanani Medicine.

Also government should encourage indigenous R&D by contributing to the companies by providing reduced excise tax for all companies having R&D facilities, the difference of the regular tax and the concessional tax should be mandatorily utilised by the pharmacy manufacturer exclusively for the R&D only. Also the FDI in the pharmacy should be reviewed to ensure proper protection to the generic medicines while allowing the FDI, as the MNCs partners may pursue/pressurise Indian Partners to restrict, restrain or discontinue the existing Indian companies producing the Generic medicine, Generic-Generic medicines which are available at low cost compared to the products of other MNC manufacturers. The generic version of the majority of the 74 drugs who are under price control of government (only 100 % mark up)are much cheaper than the price of the drugs in the branded companies as such generics are real low cost life saving drugs needs to be promoted in large scale. Also the government should encourage the SSI units in the pharmacy sectors to produce generic medicines, Also should ensure their products are purchased by the institutions, government machineries mandatorily by amending the existing bulk procurement procedures rather than discouraging, since majority of the existing

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bulk procurement procedures are in such a manner which automatically disqualify the SSIs from participating and automatically favouring the high cost MNC products. METHODS OF DRUG DISTRIBUTION Also it is necessary all governments should to bring a model like which the State of Tamil Nadu following for pharmacy procurement and distribution through its state PSU Tamil Nadu Medical Services Corporation (TNMSC) which developed a unique drug distribution system (DDMS) with centralised procurement of medicine at the state headquarters and distribution to institutions at each district through district warehouses whose receipts and issues are recorded in computers and all the district warehouses are connected to state computer system for better monitoring and distribution of drugs, with the computerised distribution which will instantly reflect the flow of medicine, need of a particular medicine, the quantity from every mandal to district to the state centre is known. At present central government as well as most of the state governments are having de centralised procurement of the medicine by different institutions of working under it, which is certainly losing the advantage of bulk purchase and also the accountability of the flow of medicine. Also it is a fact the institutional distribution of medicine is about 15 % of the total manufactured medicine in the country. As such there a need to have a mechanism to monitor, regularise the distribution and sale of medicine. It is more ideal to extended monitoring of DDMS from warehousing to each government hospital and to the reach to individual patent for more transparency and to prevent misuse and corruption along with issue of medicine mandatorily on the prescription of the doctor with the bar coded prescription with scanning and storing the prescription copy in the computer system for record which will marginalise corruption to a maximum extent as far as distribution of medicine is concerned, also should make it mandatory that each other state follow more or less similar model, in addition all the drug manufacturers should follow the same till the retailer through a governing body at the central as there are many manufacturers distributing drugs at various states) as mentioned in my paper Simple and effective reforms for controlling corruption, black money and delivering good governance with existing anti corruption mechanisms.

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Also it should be made mandatory all the hospitals and nursing homes should maintain the data of the patents admitted, patents discharged, the treatment details and the bill payment details. All the details of the number of in patents occupied the rooms and the operation theatres availability etc should be made online to the Cntral Health Administrative Authority (CHAA) which will be up loaded to the system of CHAA website, and people can view on the web site the details of the available number of beds and the available dates for in-patent admission and operation etc (like the railway reservation online showing the details of number of available berths on different trains in different dates) the details of the hospitals should be as per the mandal, district, state wise after feeding the basic details of the patents in the website site CHAA. The above measure is very necessary since some of the state governments are extending free medical health care for all which will make the private hospitals and the nursing homes are also be part of the system due to acute shortage of beads in the government run hospitals. It should be mandatory to know the available beds, the dates and the patents who undergone the treatment, especially the BPL card and government reimbursement patents. HEALTH CARE FOR GOVERNMENT EMPLOYEES AND EMPLOYEES OF BUSINESS ENTERPRISES Also it should be made mandatory that 2.5 % of the salary should be mandatorily deducted from annual salary from all the employees both government and private to create a compulsory health insurance for the employee and the dependents., who dont fall under the category of 1000 employees or 500 cr annual turnover or 50 cr annual profit, for whom a dedicated hospital run by their respective managements is mandatory. This will ensure that all working class heath care needs should be taken care. All the employees should be provided with health cards that can be used in all the hospitals and nursing homes for treatment of their illness. Since medical ombudsman system is in existence, lot of checks and balances from the doctors prescription to the issue of medicine in the pharmacy to the online information of the patents and beds details to the CHAA and the quarterly report of the income statement of the hospitals and the nursing homes will certainly marginalise the

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scope for misuse by the hospital / nursing home. All the card holders should mandatorily use the card for obtaining the treatment. In case the employees and their family members are so healthy that no need for use of the health insurance card, once in every 7 years the money collected from the employee will be returned to them as a bonus to them for maintain the good health. The bonus should be cash reward or the gift coupons to the individual employee to provide it to their relatives, friends, etc who are not employees of government or private sector for certain period of time. The medical treatments that are under the cover should be specified. This will ensure that confidence in the employees families especially low income and middle income group that their health care needs will be taken care and in case they dont utilise the facility their money will be returned to them after some time. The money collected should be utilised to upgrade the facilities in the existing hospitals and also act as the corpus fund for creation of infrastructure in the PPP mode, as it is necessary to increase the population to availability of hospitals, the hospital beds, the population to the doctors ration uniform in all parts of the country at all cities, districts and in the mandals. TELEMEDICINE Also it is very necessary and ideal at this stage to encourage the telemedicine as it takes only few months to establish the telemedicine facility in each state to cater the needs of the rural, remote villages where the access to doctors is either not possible due to the shortage of doctors or due to the geographical location difficulties in transportation etc. As such the telemedicine is an excellent way to provide health care for the people living in remote habitations. What all to needed is to provide training to the nursing staff or the ASHAs, ANMs and AWW in the villages to operate the facility of video conferencing, also to issue the medicine as per the directions of the doctor or where the doctor sends a fax or computer operated prescription, Also the patents can buy themselves at the nearby pharmacy retail store with the prescription. Also it is very ideal that basic essential medicine should be kept at post offices in the villages and Gram Panchayats, also the drugs which are not available at the post office or with the ASHAs which are needed to be administered by the patents should be immediately delivered by post from the nearest town post office to that particular village post office of the patent to get delivered. Also it is ideal that the post

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office premises should be used for creating the telemedicine centre in the villages and Gram panchayats. With fixed timing, but in case of emergencies the post master/ postal official can open the facility and do the teleconference. The telemedicine centres should be acting like a call centres having video conference facility, having adequate number of doctors mostly general physicians, also paediatricians, gynaecologists and orthopedicins, with appropriate number from all the states of the country with all languages. Also since the major diseases in the rural area are tuberculosis, asthama, jaundice and malaria and other viral fevers; all the ASHAs and other activists should be thought about the basic identification of these diseases and calling the doctor is very ideal way. Also the drugs related to cure of these diseases should be kept available at the Post office or nearby pharmacy retailer and issued to the patents on the prescription of the doctor only. Also the telemedicine centre should have the Video conference (VC) facility with the specialists to get their opinion in case required to determine the emergency and urgency to get admitted in the hospital. Also it is very ideal to have mobile laboratories to conduct the blood test, urine test, ECG, etc. These mobile laboratories fitted in the vans with trained staff to take samples and conduct the tests and deliver the reports, to the patent as well as the doctor referred. All these mobile vans are stationed at mandal head quarters with GPRS to know the location and movement must visit the villages as and when required. Also it is ideal the 108 vehicles or MMU vehicles of NRHM to use for this purpose. All the doctors who are in contact with patents through telemedicine should do the follow up action with the ASHAS and the individual patents or their representatives to ensure the patent is recovered. NEED FOR MANUFACTURING CONSUMABLES BY GOVERNMENT OF ESSENTIAL MEDICAL

Also most import that the government should set up manufacturing units for the manufacture of essential consumables in the hospitals for the supply to all government hospitals. All the basic daily hospital consumables such as needles, syringes, cotton, gloves, anti septic lotions, spirits, IV fluids like glucose water, cleaning agents like phenol, nebulizers etc and basic fixed hard ware items like IV fluid stands, hospital beds, etc. at various strategic locations in the country to be distribute to all states which will save lot of government expenditure. Also it should more ideal and very

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necessary that government should manufacture oxygen in each and every district in the government with appropriate capacity of the plant as per the population, consumption in the hospitals in that district based on the previous records towards the expenditure on oxygen cylinders. It is a fact due to non availability of oxygen cylinders due to short supply by the private manufacturer there are many incidents that infants and patents are died due to lack of emergency oxygen). As the manufacture of oxygen to have supply of own oxygen cylinders is more cheap than buying from private manufacturer, in addition her will not be any break in supply of oxygen cylinders as the oxygen cylinders are manufactured in advance in accordance to the data of consumption in the hospitals. For example the setting up of oxygen plant with a capacity of 100 m3/hr which costs around Rs 60 lacks can provide 24 cylinders per hour number of cylinders per day will be 576, the cost variation is around 30 % less than purchase cost from private supplier (average cost of cubic meter of oxygen supplied by private supplier is around Rs 35 including the transport cost, whereas own manufacturing cost per cubic meter of oxygen is Rs 23 including the transport cost). Alternatively all big hospitals can have individual Liquefied Oxygen Plants in the hospital compound itself and can supply oxygen in pipes which will reduce the capital cost by 70 %. Like this in very other consumable in the hospital will have a substantial savings if manufactured and supplied by the government. Also the excess manufactured oxygen cylinders can be commercially traded to the private hospitals with pricing of the cylinders slightly less than the market price in that area, which should be strictly after due verification that the sufficient stock at all government hospitals exists as per the online stock position and the demand for the cylinders from the government hospitals is less than 50 % of the total production; in addition buffer stock should be maintained at the manufacturing unit. Also it is ideal to revive IDPL and other drug manufacturing units and also to set up drug manufacturing by government itself regarding certain essential drugs which are of mass perennial consumption like drugs related to the diabetics, heart care which required to be consumed by the patents for several years and in some cases the whole life time; As it is a fact that as many as over 50 % of the population in India is prone for Diabetics.

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Also it should be the duty of the state governments to provide the facilities for the people on the move i.e to create the emergency hospitals along the highways preferably adjacent to the cluster of small towns/ villages. Also all state should provide the facilities for creation of emergency ambulances operating on the GPRS like 108 services existing in some states. ROLE OF PUBLIC REPRESENTATIVES As stated in my earlier documents regarding the moral responsibility of the elected representatives both MP/MLA to contribute to the welfare schemes; also it should be ideal that all MP/MLA should mandatorily contribute 25 % of their MPLAD/MLALAD fund towards creation of medical facilities in their constituency like 108 emergency response teams, for creation of medical infrastructure in the rural areas and small towns etc. It will be more ideal and appropriate that MPLAD/MLALAD to create permanent assets for the health care in the constituency rather than spending on the roads, which are having short life because of lack quality construction leaving a remark on the MP/MLA even though they may not have much role in the construction of the road except sanction of the fund. EMERGENCY AMBULANCE Also the government must make it mandatory for the private hospitals and nursing homes to contribute 1 % of their turnover to create and operate the unified 108 facilities in the cities and towns and villages and also the facilities at highways (both state and national) in the territory of the respective state. Also it should be ideal that all the highway hospitals and the hospitals and nursing homes should have a permanent police post within the premises of the hospital with appropriate police personal to register the medico legal cases and ensuring quick medical treatment. Also these police personals should be provided with VC facility (or mobile video conference and record the statement of the injured) with the local judges to record the statement in emergency situations.

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Also the infrastructure for health care for the children should be built proportionately and All the government hospitals should have the required staff and the equipment for paediatric health care, as in recent times many children are dying due to lack of oxygen supply sue to shortage of cylinders and also due to lack of child care specialists. Also it will be ideal that the inventory in the hospitals should be made online on daily bases to ensure this kind of shortage does not arise. This will certainly help the patents in need especially in the ICU patents and child patents. Also all the hospitals should have the RO plants for purification of water to supply pure water at all times free of cost to patents in all government as well as private hospitals. All nursing homes should have the safe drinking water sully like water filters or bottled purified water supply.

Also it is ideal government should built, maintain exclusive hospitals at least 3 hospitals in each discipline per every 5 lack population in cities, towns, and semi urban areas for exclusively discipline wise like dental care and eye care, and diabetic care and also AYUSH hospitals with appropriate number of doctors and supporting staff. As the statistics of the International Diabetes Federation (IDF) shows India has the largest number of people 50.8 million suffering from diabetes in the world. India continues to be the diabetes capital of the world, and by 2030, nearly 9 per cent of the countrys population is likely to be affected from the disease, warns the fourth edition of the World Diabetes Atlas launched by the IDF at the 20th World Diabetes Congress in Montreal, Canada. This trend will continue till the next 20 years unless significant efforts are made to curb this disease. In India, the poorest people with diabetes spend an average of 25% of their income on private care. Most of this money is used to stay alive by avoiding fatally high blood sugar levels, All these statistics stress the necessity of exclusive diabetic care hospitals in government sector.

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HOSPITAL NORMS Also it should be made mandatory that all hospitals and nursing homes should mandatorily adopt green building norms. All existence buildings should be renovated where ever possible should be converted to green buildings for more ventilation, free flow of air, air circulation, saving on energy due to lights. All the hospitals should mandatorily have power backup for all the equipment and operation theatres and ICU through inverters and generators. All the hospitals should use solar power panels on the terrace for lighting the surroundings, corridors, and the rooms and for water heating. Also all the hospitals, nursing homes both government and private in rural areas should have the complete backup of power by solar energy or wind energy. Also it should be ideal that the hospitals surroundings should have plants and trees with medicinal values like neem trees, eucalyptus trees. Also ensure that all the surroundings of the hospitals are clean all the time.

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REFORMS IN OTHER SECTORS WHICH HAS SUBSTANTIAL INFLUENCE ON HEALTH OF INDIVIDUALS Also it is a fact that health care for all is possible if and only if the elements that are the primary root cause of illness/ decline of health/ case of deceases are controlled. Otherwise what so ever the governments efforts in bringing the health care for all is next to impossible, which will remain as just cosmetic in nature or more or less symbolic, vote bank tactics, in fact it is nothing but keeping the garbage in the house and spraying the perfumes and air fresheners which is purely a temporary phenomena and the investment in the money is will not yield the desired results. What all needed is a permanent cost effective solution, As such the collective efforts of other departments of the government is necessary after all governments are running for the well being of the people as such the excise policy should be stringent, the complete ban on cheap liquor, regulated sale of IMFL, complete ban on tobacco production, restricted sale of tobacco finished products, encouragement of use of bio fertilizers and bio pesticides in the agriculture providing subsidies for such production, coupled with liberal bank loans for formers for bio farming. Also in order to reduce the use of pesticides and for more production of the agriculture, the ideal solution to encourage Hydroponics (soil less culture) which uses the less water, less space more output as all the process is done in a controlled atmosphere especially for the vegetables and other spices production, may be initial capital expenditure is slightly on the upper side but has enormous benefits and most cost effective agriculture techniques which is a grand success in the cou ntries like Israel and other places. Also to extensively promote the production of paddy in (SRI) System Of Rice Intensification method of cultivation which the paddy is grown in with 90 % less seeds, 50 % less water, higher yields, less labour, more income to the tune of 60 % more than conventional yield income. Also needed is to extend the National Food Security Mission (NFSM) programme for more production. Also use of drip irrigation etc, as it is know that agriculture production mainly depend on water either through the river water or ground water, river water is at the mercy of nature due to monsoon, and the ground water at the mercy of state electricity department due to acute shortage of power due to various factors. The food produced from SRI, drip irrigation, hydroponics and the use of bio fertilizers and bio pesticides is really good for health as it does not contain any harmful substances in it.

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Also it is not only the responsibility of the government or the doctors but also more responsibility on the people to adopt the preventive measures rather than cure. As such the education of better health care should start from the school stage itself. As such health care should be thought in the school at least two periods in a week about basic foods to eat, personal care etc according to the class of the students. Also it should be mandatory that all schools to make periodic health check-up by qualified doctors of all the students once in 3 months and record the parameters like height, weight, BMI , eye site etc for analysis and necessary further steps. Also all the school children from class seven should be thought about the adult health care as it is the period of transaction from child to adult, all girl children should be thought about food intake, hygienic maintenance, skin care, care for protection of seasonal anomalies etc. Also it should be mandatory that all schools should make it mandatory that every day yoga as a subject for all students to perform for at least 30 minutes. Also sports should be a subject in the school as every day activity.

Also all the college going students should be thought about the foods and supplements needed for maintain the bone growth, the memory power increase, maintenance of the body, stress management, skin care, seasonal health problems, issues in long run due to smoking, consumption of alcohol, consumption of narcotics,, pre marital sex, etc all college going children especially 10+2 or intermediate and the professional degree students yoga should be made mandatorily, a daily activity for at least 30 minutes, which will certainly help them to get reduce the stress factor as well as increase in concentration on the subject etc. All the college canteens should mandatorily serve only health foods like salads, sprouts, coconut water, green tea, coffee, milk/flavoured milk, lassi, buttermilk, fruits, fruit juices, vegetable juices etc Also there should be ban of sale of soft drinks, pre packed food like potato chips, and fast foods like burgers, pizzas etc. Also the breakfast, lunch/dinner served in the canteens should have balanced nutritional values certified by the nutritional experts only. All the canteens should

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display the food chart and calories chart at all times covering the entire walls of the canteen. All the canteens should sell the food at minimum margin which should fit into every students pocket money, it will be ideal to run the canteens by the university / college managements or by NGO organisations. Also all the canteens should serve only RO water. Also it should be mandatory that all universities and colleges should have adequate facility for the sports and recreation facilities. Also it should be made mandatory that all the colleges and university students to spend every month on day for social service, not all at once but in batches as per their class of study. Government should create a website to register for social service with various kinds of service to be rendered by the schools and colleges to allocate the place, area of service for the choice of voluntary service in the district to avoid any confusion. Also it should be mandatory that all students above intermediate should be taken to villages once in three months to knew them about the hard ship& ground realities of different profession like pot making, agriculture, coconut plucking, food processing, different handicrafts making, nursery raising, dairy farms, sericulture, poultry, traditional weaving, traditional games, dances, etc Also ideal to have the visits where ever possible, or presentation of documentaries big screen regarding production of cement, steel, power, pharmacy, etc and construction works of dams, buildings, roads, etc and have interaction with the workers and management etc. Also all students should be thought of power production, power distribution, power savings etc.

All the government and private establishments, factories, industrial shop floors should mandatorily conduct health education time three hours in a week, one hour at a time every alternative day. The subject should be nutritional values required, how to preserve nutritional values while preparation of the food, the child rise, the issues of child care, the common illness/ deceases that occur like diabetics, hepatitis, heart attacks, obesity, adultery problems, issues due to smoking, consumption of alcohol, problems for the women like breast cancer, issues of 40+ women etc. Also it should be mandatory that all the employers in the government, PSU, Private sectors should provide the details of the occupational hazards and the preventive health care. A calendar chart should be prepared and provided a copy to them and thought them periodically. Also it should be mandatory that there should be health clubs in each office

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with basic equipment like the tread mill, cycles etc in appropriate number and allow the office staff to utilise at appropriate time 30 minutes every day during the office hours. Also it should be mandatory that the office canteens serve the health foods like salads, sprouts, coconut water, green tea, coffee, milk/flavoured milk, lassi, buttermilk, fruits, apart from the traditional foods, certainly ban the sale of soft drinks, potato chips or any other chips, pizzas, burgers and other deep oil fry foods like samosas, etc etc. Also the breakfast, lunch/dinner served in the canteens should have balanced nutritional values certified by the nutritional experts only. All the office canteens should serve the food subsidized, to encourage the employees to have the breakfast, lunch and tea in the office/factory premises only to ensure that certain nutritional values are provided by the employer in the form of coupons to be utilised by them equal number to all the employees irrespective of status of employee. All the canteens should display the food chart and calories chart at all times covering the entire walls of the canteen. All the establishments both government, PSU, private should organize the yoga camps and provide yoga training with mandatory condition that yoga certificate is must for getting the promotion, in addition all the employees who got training certificate should be given one single increment, single time as bonus. Also it is very ideal to make it a pre condition for promotion, that employee should obtain the fitness certificate from the doctor for maintaining their health in perfect condition, maintain the height to weight ratio, maintaining the body in perfect shape and conditions as per the normal standards in addition to providing of yearly incentive with a bonus of one single increment. All the employees working in the hazardous areas should be thought about the cleanliness and the personal health care. OCCUPATIONAL DISEASES Also it should be ideal that all the people in the occupations like sales persons, police persons in traffic duty, postal persons, courier persons on delivery duty and other service persons like municipal people, all security persons etc who are on the constant exposure to sun radiation and vehicular pollution should be provided with nasal masks, UV filter eye care glasses etc better protection for the heath care. Also it should be more ideal and mandatory that all the offices should provide to its employees doing the desk duties with the ergonomic tables and chairs, mostly the soft ware professionals, administrative jobs etc. All the employees doing the desk job should

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be provided with adequate working space as per the standards maintaining the ratio of employees per the floor area of the room space. All the employees in the factories should be provided the rest period periodically in regular intervals 10 minutes to relax and refresh in accordance with the International Labour Organisation (ILO) Work-Study methods, which will reduce the stress element and increases the production output. Also all the offices should have adequate lighting facility more preferably the natural sun light by converting the existing office buildings to green building and also maintain the Lux levels (the measurement of light, Lux levels of 500 is ideal for working atmosphere with minimum levels of eye stress) for safety of the eyes even after long exposure and working, and also facility for fresh air by providing the electronic air purifiers in all closed room offices. Similarly all the factories should maintain fresh air and green buildings and also should maintain the oxygen bars in the factory for getting refreshment for the workers by providing the fresh oxygen, this facility should be mandatory in the factories exposed to the pollution within the shop floor.

Also there should be adequate recreational facilities in each office space and the factories to get the workers relax and get engaged in sports like table tennis, chess, caroms, shuttle, volleyball, basket ball, squash, etc, all multi stories offices should have at least some indoor activity at each floor. In case the offices do not have enough space to provide the recreations it should facilitate in the open Terries of the office buildings, in addition should hire/ acquire space in nearby area to the office for facilitation of the recreations to their employees. This will certainly help the employees to get certain physical activities other than routine which will certainly reduce the mental stress, as it is a fact that majority of the employees spent half of their active life time in the office space or the factor premises only. Also it is ideal that the parking of the vehicles should be far from the main building and all employees should be made to walk few yards, similarly the lift facility in the multi stored buildings should start and stop at the second floor only, (Only those physically handicapped and not in a position and extremely sick should be allowed from the ground floor) this will ensure that all employees will walk through the steps to get some physical exercise. Also it should be made mandatory that offices maintain the office buses for pickup and drop of the employees, and make it mandatory that all the office

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staff should use the office bus only, instead of bring personal vehicles. This will reduce traffic congestion, traffic pollution to some extent, reduction of tediousness due to driving, increase in interpersonal relations among employees leading to better cooperation coordination in work area, and also all employees in general maintain standard working hours as office bus will has fixed timings leading to more productive work.

Also it should be ideal to advise all the employees to raise a pet animal at home, preferably the dogs which are really lovable and are true stress busters as they express unconditional love towards the master and other family members. As such not only employees but all the families in the country should be advised to raise a pet at home. Also everyone should be advised to raise garden at the homes, in case of apartments the terrace/balcony gardening. Also it should be ideal that all the, school, college, university and office compounds should be planted with neem, eucuplitus and other medicinal plants, also should have walk ways around the compound wall to make a habit for the students, employees to have brisk walk for good health. Also it should be ideal to make it mandatory that all colonies, gated communities, apartments should have walk ways inside their compound to make provision for its residents to walk a mile every day for good health. Also it should be mandatory that all the students from intermediate onwards and all employees in the government and private mandatorily have one day every month to have compulsory social service in the public like cleaning of roads, cleaning of lakes, water bodies, planting of trees, visiting the old age homes, visiting the orphan homes, visiting the welfare hostels, crating awareness in their area about the achieving good health, saving energy, water, awareness to reduce environment pollution, awareness towards reduction of use of plastic, polyethylene bags, reduction of paper waste, segregation of waste disposal on bio degradable and non bio degradable etc, which has multiple advantages on they are remained of social responsibility, also it creates freshness in the mind to serve in the open, also considerable exercise for them. Government should create a website to register for social service with various kinds of service to be rendered by various government and private organisations allocate the place,

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area of voluntary service for the choice of service in the district to avoid any confusion Also it should be mandatory that all the schools, colleges, universities, and office establishments both government, PSU and private, should provide RO water all the times and also to provide, maintain hygienic toilets with separate provision for females. As it is fact that majority of the deceases are water born, most of the health risks are occurring due to lack of toilets irrespective of gender with more health risks in the females.

Also all the public places should mandatorily have the RO and toilet facility in areas like rail stations, bus stations, shopping complexes, shopping areas, market places, hotels, restaurants where there is lot of frequency of peoples movement, gathering happens, should mandatorily have the RO drinking facility at the cost price Rs 1 for 500 ml. Also it should be mandatory that all the restaurants and food courts and canteens should have power back up either inverter or generator to preserve through refrigeration its essentials like milk, yogurt, cheese, pinner etc for having the shelf life without getting soiled by bacteria. In addition there should be toilet facility maintained hygienic at all times, by the local government authorities offered free of cost or with a donation box to leave it to the wisdom of the user to donate. Also should ensure that RO water and the hygienic toilet maintenance, lack of provision, lack of hygienic maintenance should be heavily penalised. All the NGOs and volunteers services should be taken for periodic inspection of all the public areas, schools, and colleges universities. For this there should be a public health registered voluntaries group formed by inviting individuals to register for free for free service. All the volunteers should be given a day or two for formal training for the inspection and reporting to the authorities. The volunteers should be mostly the retired employees, NGOs as it will be ideal that the retired employees should get involved in some social activity which will give them more satisfaction, time pass, and help for the public. Also the volunteers should inspect the toilet facilities in all the 4.9 lack villages throughout the country where ever possible for them, as NRHM has issued an amount of Rs 10,000 to 4.9 lakh villages till date towards the fund for the construction of community toilets in the village under the total sanitation programme.

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HEALTH AWARENESS Also the government should conduct awareness meetings and camps starting from villages to cities periodically regarding the health care issues like diabetic care, heart care, issues related to consumption of alcohol, smoking of tobacco, consumption of tobacco products, cancers, food adulteration, issues arise due to food adulteration, etc. RESTRICTION ON SALE OF TOBACCO PRODUCTS, BAN ON TOBACCO CULTIVATION IN INDIAN SOIL Also it should be mandatory duty of the government to ban tobacco cultivation in Indian soil, especially state governments to ensure that there farmers should not rise tobacco crop, all the farmers raising the tobacco should be thought of alternative farm production that suits the soil conditions of the tobacco farms should be made and encourage them with more subsidies for non tobacco product raising in the farm. Also all the workers who are working in the allied industrys using the tobacco products like cigarette, gutaka etc may have the apprehension that tobacco production ban may reduce the employment due to limited production of the manufacturers through import of the raw material or no production, all those ex-workers of the tobacco industry should be given skill training in eco friendly paper bags making, paper boxes i.e corrugated box manufacturing, and other handicrafts etc. Also there should be ban on import of finished products of tobacco like cigarettes, gutka, cigar etc, only raw tobacco import should be allowed with heavy duty on the raw material as well as on the manufactured product. Also it should be mandatory that the state governments should ban the sale of tobacco products in the vicinity of schools, colleges, universities, government office complexes, private office complexes, in the vicinity of hospitals and in bus stations, railway stations, all pilgrim places, all religious places and all public places in the villages and towns adjoining the state highways and national highways, in the rest areas and daabas in the highways and also near to bus stations, railway stations. All the hucca centres in the cities and towns should be banned to operate, as it becomes an increasing fashion for the urban youth to get hucca and addicted to it, which is leading to the other anti social activities by the youth and completely spoiling the health and the future of the youth. The sale of tobacco products should be like the sale of liquor

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in exclusive shops only. Also it is very necessary to have tobacco de addiction centres in all important places in the city and town to ensure that all those people who are under indirect forced control will get to the normal stage. All the tobacco de addiction centres should be operated by the government / NGO and operate without any monitory benefit, deliver free service to the people who joins the de addiction centres. Also to this there should be extensive advertisements regarding the de addiction process in the print and visual media. RESTRICTION OF SALE OF ALCOHOLIC PRODUCTS, BAN OF SALE OF CHEAP LIQUOR Also the governments should completely ban sale of cheap liquor/ country liquor, as it is an open secret that the quantity of natural cheap liquor available is very low as it has to be collected from the trees and brewed, or from the extracts of molasses, un refined distilled spirit as such in order to make huge money at the cost of the life of the down trodden, all the cheap liquor suppliers, sellers are using dangerous drugs like dizopharm , or illicit liquor which is made of industrial methylatde which will provide the required drowsiness and the kick to the consumers of this liquor, but it will spoil the health very rapidly, impact on the brain, kidneys and all other organs thereafter, much faster depletion of health than any other liquor consumption As we all knew that majority of the people living in the rural areas consume cheap liquor and the tobacco which will spoil their health faster as majority of them belong to BPL families and whose food intake dose not contain sufficient nutrient values, as such does not possess the normal body resistance.

Also it is very necessary and more ideal that governments regulate the sale of IMFL liquor or completely ban sale of liquor by adopting alternative revenue earnings rather than depending upon the cheap liquor, liquor sale for gathering funds for implement the welfare schemes. The governments should not think of loss of revenue as compared to the bad effects of the liquor consumption of the majority of the BPL, low income and middle middle income group spoiling their personal health, added financial crunch in the family as up to 45 % of the earnings are spent for drinking liquor, Also 85 % of the domestic violence cases are due to liquor consumption, the

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children education is suffering, the family health care is suffering, there is acute mal-nutrition, under-nutrition in their children, families due to financial crunch, all the females in their families are prone to anaemia, all these leading to backwardness in education of their children, again the entire family, their children in future are living in poverty and again depend on the welfare schemes of the government, how far the present governments run this vicious circles? As such If the governments have real intention of the welfare of the down trodden they should completely ban the cheap liquor, in addition levy heavy duty on the finished product, the excise duty ranging from 1000 % to 5000 % ensuring the cost of liquor is not within the reach of majority of the people i.e BPL, low income group, it should made that liquor consumption is a luxury only for the BPL and low income and low middle income group, in addition regulating the sale by restricting the sale points is the only solution. The higher rate of excise duties will certainly bring down the sale quantity but will provide the same revenues as earlier; Also there should be uniform duty structure in all states otherwise smuggling activities will take place due the rate difference; Now people especially the female family members of the families of liquor consumer are able to understand the negative impacts of the liquor on the entire family, future of their children they are of the opinion that state governments not banning liquor and collecting large amount of revenue and providing soaps of welfare schemes is nothing but giving a penny from one hand and swindling booty from the other hand and pretending as if governments are for the welfare of all especially the down trodden, but in reality for the welfare of select section of the people who are elite, belong to the upper echelons of the society many be a political class or the business class or the touts. As majority of the liquor lobbies, shop owners are either local elite in the village, mandal or the city and also have the strong nexus/ partnership with the politicians and bureaucrats. In some cases all the liquor business is operated by the political class irrespective of party, in their kin and kith name. This opinion of the women towards governments will have great impact in the electoral politics, as women play a decisive role in the election mandate.

As such all the governments must either follow the four states namely Gujarat, Manipur, Mizoram and Nagaland where ban on sale of liquor is in existence or at least control the sale of IMFL liquor and

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completely ban cheap liquor, it may lead to some loss of revenue but the state governments must adjust their budgets accordingly in the larger interest of long term welfare of the people of that state. For example if there is a shortage of available electric power in the state due shortage of production either due to shortage of coal or gas or due lack of water in the dams etc the governments are adjusting with the available power, people are also adjusting to it even though there is some protest, likewise government should adjust the shortcomings of revenue, also should find alternative sources of revenue rather than depending on the blood money of the downtrodden, since our country is the birth place of great economists like kautalya and our country does not have dearth for economists, all our economists are of top class in the world, the governments should entrust the job to these economists to find alternative ways of getting the revenues which was deficient due to the ban of cheap liquor, restricted sale of liquor.

As mentioned above regarding the restricted sale of liquor, it is most ideal and mandatory that government should ban the sale of even liquor in villages and towns with less than 10 lack population. Also mandatory ban of sale of liquor near the vicinity of the hospitals, factories, industrial zones and slum dwellings should be banned at least 3 kilo meters from the outer radius of these establishments. Also governments should ensure ban of liquor in the villages and towns adjoining the state highways and national highways and also near to bus stations, railway stations. Also to down size the number of sale points and restriction of sale timings, Also it will be ideal to fix the timing of sale of liquor between 10 am to 5 pm in the evening during the working days (Monday to Friday) only, Also the sale of liquor should be banned on Saturday, Sunday and all other state government and central government holidays and during the festivals. As it will ensure that the working class will be mostly restricted to access the shops, also it will restrict the college going youth to access the liquor as the studies indicate the average age of consumption of liquor in India is 19 years in some cities it is much less than this average age. Also the sale of liquor below 25 years should be banned. This will help that youth will not be addicted to liquor and will consume on their own personal earning. Also the sale of liquor should be banned locally during the big possessions and rallies and darnas within the mandal /block during that particular

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day. Most important the sale of liquor should be banned during the election period soon the election dates are announced till the election results are declared. This will certainly help in electing the right candidate. Also at all times the sale of liquor should be mandatorily through bio metric finger print of the purchaser, and not more than two bottles or 1000 ml of liquor should be given to any individual at a time and not more than 3000 ml in a month, for this all the liquor shops should be computerised and the sale of liquor should be integrated district wise in that state. Also it should be mandatory that the bars will not be permitted in towns less than 10,00,000 population and the number of bar permits also should be restricted, the maximum number of bars should be less than 50 % of the number of licences wine shops in that district/city/town. Also the minimum age for entry to bars should be 25 years. All the bars should operate only during evening hours between 7 pm to 10 pm, on all working days with relaxation on Sundays to open from 10 am to 10 pm, with exemption on restriction of timing to in house bars in the hotels. In-house bars should be permitted only in 3 stars and above hotels.

Also it is very necessary to have alcohol de addiction centres in all important places in the city and town to ensure that all those people who are under indirect forced control will get to the normal stage. All the alcohol de addiction centres should be operated by the government / NGO and operate without any monitory benefit, extend free service to the people who joins the de addiction centres. Also to this there should be extensive advertisements regarding the de addiction process in the print and visual media.

The ban alone is not sufficient unless there is tight control on the production of the IMFL in the distilleries and breweries, the first step is to restrict the number of licences to production by heavily increasing the licence fee, second to have tight monitoring of the production and distribution by exclusively dedicating couple of excise officers on all the three shifts on weekly rotation bases preferably from other far way districts; third to make it mandatory all the bottles are bar coded; and the entire chain from the manufacturer to distributor to the retailer to sale to the individual consumer should

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be computerised with online status of data, all sale should be only on the production of ID card, the name of the customer as in the ID must be entered along with bio metric fingerprint of the customer to issue the liquor with the bill, fourth there should be straight vigilance and enforcement wing to ensure all rules are strictly followed, in addition imposing heavy penalty with rigorous imprisonment and for violating the rule. All the offences of violation of any rule should be a non bail able offence with rigorous imprisonment for the offender; in case the officials are involved or there is a negligence on the part of the official the punishments for the officials in the entire hierarchy should be not less than the suspension from the present position for not less than 5 years and in serious cases dismissal from the service. Also there should be punishments equal to life imprisonment for illegal manufacture, distribution, sale of either IMFL or the cheap liquor, All the cases related to this should be non bail able offence. All these on implementation will improve the overall family health of millions of people. TRANSPORT SECTOR

Also the governments should make it mandatory duty of the public passenger transporters both government and private to carry the emergency medicine kits like emergency medicine, emergency oxygen with nebulizers both adult and child in appropriate number and other consumables. There should be periodic certification of the existence of the medical kits, and the content in it, by the concerned authorities otherwise the medical kits will be more symbolic and namesake. Also it should be mandatory that all driving licence holders should obtain the fitness certificate once in every 6 months from the medical doctors after undergoing the body checks like Eyes sight, hearing ears, physical stamina/ grip of the hands, legs, spine, and complete blood test etc, more or less like vehicle fitness certificate). It should be mandatory to undergo once in 3 months for all the drivers of the public transport from rail, to buses to Lorries to taxies. It should be mandatory duty of the employer (Government, PSU or Private) of the driver to get the medical tests in order to continue him to drive the vehicle. In order to prevent the fake fitness certification without having proper check up, lack of fitness of the candidate, strict action should be taken with punishment equivalent

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to death sentence in case of death due accident because of lack of fitness of the driver both on the driver and the issuing doctor. Also it should be mandatory that passenger travel vehicles like cars, taxies, vans etc should carry the emergency first aid medical kits with them at all times. All the taxi operators and drivers should be given mandatory training by the doctors in the presence of the police to act in the emergency situations, all the taxi drivers who attended should be given certificate, and all taxi drivers should carry the certificate with them at all times. Not having the certificate should be penalised heavily apart from seizing the vehicle, as such all persons driving any vehicle should mandatorily carry the fitness certificate with them all the times.

It should be ideal that professional drivers of the private vehicles should undergo the mandatory medical fitness certification once in 6 months at the cost of the employer whether the owner of the vehicle is an individual or business enterprise, the fitness certificate must be obtained from the medical doctor after undergoing the body checks like Eye site, hearing ears, physical stamina/ grip of the hands, legs, spine, complete blood test etc. UN ORGANISED WORKERS CONVERSION TO ORGANISED WORKERS FOR SAFETY, SECURITY, PROVIDING HEALTH CARE

Also in order to bring the unorganised professions to organised professions is the primary task of the government. People who are working as professional driver, house made/ domestic help, watchmen, ayas, sweepers etc are low income unorganised sector. They might have migrated from different parts of the country. Their income is not sufficient to take care of the daily needs, so it is really a great difficulty for them in case of medical emergencies. In order to bring them under one cover the government must make it mandatory that all the people who employed these category people has to register with the government and the local police (more ideal) for verifying the credentials and also to issue an identity card and a bank account. It should be made mandatory that all salary payment should be bank payment (by cheque or cash deposit). As majority of the drivers working in passenger transport and goods transport other

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than the government and PSU are totally un-organised, does not have uniform salary, uniform working hours, no health care, and no track record of the drivers, as such in order bring them into some sort of organised sector with more social security it should be made mandatory that state RTA should have a special cell to register the private professional drivers i.e other than the employees of government & PSU. All the drivers have to register them self with their driving licence, bank account, local address proof/affidavit (all three are mandatory) in RTA office near the place of work, all such drivers will be conducted a driving test by the local RTA and on passing the test will issue a private professional driver licence. Also there should be uniform fixed salaries throughout the country for all drivers based on the years of experience, their age, the vehicle type, type of duty i.e public taxi, private taxi, passenger transport or goods transport etc. All private employers (other than government) should provide job to registered private drivers only. To employ a private driver the employer should registration with the RTA for along with the details of the owner of the vehicle and the details of the local RTA registration copy of the private driver, then the RTA should issue a permit to the owner of the vehicle on agreement duly signature by the employer or owner of the vehicle, and the driver in presence of RTA officials regarding the minimum salary as per the standard fixed as per the guidelines, salary to be paid through bank and the number of working hours, number of working days in month, the mandatory responsibility of the owner for medical check up condition of driver once in 6 months as pre conditions of employment. A copy of the agreement should be forward by the RTA to the local police for record. It has multiple advantages in the security angle as well as prevention of accidents, having resting period, adequate timely salary to cater the family needs; health check up of the individual is the duty of the employer. It should be applicable not only to the four wheels and above vehicle drivers but also to the three wheelers if the three wheel vehicle owners employ the driver to run the vehicle. This facility will help several lacks of people in the country as majority of the four wheels have drivers and the three wheel owners are third party. If the vehicle either four wheeler or three wheeler run by other than the owner should be treated as driver. The driver not registered by the owner should be treated as violation should seize the vehicle with heavy penalty.

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Also there is a need to bring the All the maid servants/ domestic help who are unorganized to organised sector in the similar lines of the drivers by registering mandatorily at the local labour department with a special cell at labour department to resister the domestic help/servants with them on the production of a valid ID proof and bank account to obtain the registration certificate with a number. All the households who wish to employ maid servants/ domestic help should employ only the registered maid servant or domestic help, by getting the agreement with the special cell of labour department regarding the place of work, address, the owner, the working time, number of working hours and the salary, on obtaining the agreement with the owner the labour department should send the same to the local police for record. All the salary payment should be decided per hour minimum 30 Rs/hour, i.e with daily one hour per month salary is 900 Rs per month with Sunday holiday, with extra payment for Sundays. (5 hours per day work will get them a salary of Rs 4500.) The maid servants are at the liberty to serve at as many houses as possible based on their stamina after the fixed working hours of the agreed house is completed. If the work performance is not satisfied the employer can make a registered remark at the local labour department special cell and remove them with payment of full salary if they work for more than 15 days and half salary if they work for more than one week, less than that only for those days. Also it should be the responsibility of the employer to deduct 10 % of the salary every month and pay to the insurance account at the labour department towards the family insurance of the domestic help. The government must contribute equal amount for them to issue health card for them, which can be used anywhere in India for themselves and their family members. This will have multiple advantages, one the security angle, second the domestic help will get security of the health care, the responsibility of the individual and government ensures that part of the reduction of burden on the government. This will certainly cater the needs of urban poor in the unorganised sector.

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Like the above all unorganized semi skilled and skilled work force can be brought to the semi organised work force. This includes the private electricians, private plumbers, private vehicle mechanics etc, who are not working under the government or PSU, should get registered mandatorily with the labour department of the government, they should be given registration card after testing them for their basic skills in their respective profession ( the testing of the skills should be recorded in camera, otherwise there will be a huge chance for mal practice, corruption, allowing every other individual to get a profession card) , a copy of the registration details will be sent to the local police for record. Also they should be given training for a day or two for the skill up gradation/ skill perfection and also safety measures need in performing their work. Also it should be ideal that there should be a mandatory cess of 1 % on the manufacturers of the products related to the respective professions like all electrical manufacturers like bulbs, chokes, fans, electric cables etc, and all motor vehicle manufacturers and spare part manufacturers should mandatorily contribute for the skill development, up gradation of people in these sectors and also for the government will contribute from the fund for their social health insurance to all the semi skilled persons who are not employed in any of the private establishment and who are either not running any individual private business. As for the entire people employed in private establishments it is the responsibility of the employer to take care of the health of their employees. Also government should decide the minimum remuneration for the private employees based on the grading of the skill and experience if they are passed out from any ITI or any recognised skill training centre, and also for the individual private self employees the fixed uniform service charge throughout the country and all the individuals who own a shop has some source of income, in case the income of the self employed is below 60,000 Rs per month as per annum as per record, the government should contribute from the part fund collected from the manufacturers. For all unemployed trained semi skilled labour government should contribute from the fund collected from the manufacturers related to that profession.

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Also in the similar lines of the above unorganised category, few more categories can be included to bring more semi skilled people in un organised sector to semi organized sector. The gold Smiths, black smiths, cobblers who are practicing independently, also who are having small establishment under loan from SC finance corporation, tailors who are practicing independently and all the weavers in textile looms who owns small looms, etc Also it is ideal to bring the un organised professionals like qualified priests who has no income or low income as most religious places are run privately has very meagre income, qualified teachers/tutors in rural areas and slums not working in any school etc. Also it will be more ideal to bring all the hawkers selling in the streets, news paper boys, the milk deliver boys, the street fruit and vegetable hawkers selling on non motored carts, etc. HEALTH CARE FOR FARMERS Also in order to provide health security to the farming community which are over 116 million in number, out of the total farmers majority of them lack financial ability to take care of their family needs, certainly health care is far reach for them, as over 61 % of the framers are small farmers with less than 1 hector of cultivatable land with a total cultivated land by these small farmers is around 18% of the total cultivated land in India. As such in-order to provide health care security to these small and marginal farmers, it should be made mandatory on the part of the fertiliser companies, the pesticide companies should contribute 2 % of their annual sale turnover to the farmers welfare fund, similarly all other companies related to agriculture and farming should contribute 1% of the turnover. The fund should be used to create the family health cards for all the farmers in the country especially small and marginal framers. This is necessary as by administering the fertilizers, the pesticides, and long working hours in open skies leads to lot of health issues. All the agriculture labour should get registered with the labour organisations in their respective village/mandal/district to obtain the job card; all the labour in the unorganised sector should be given healthcare by the government free of cost.

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HEALTH FOR ELDERLY AGED PEOPLE Also government must mandatorily take the welfare of all the people who are either retired, aged above 65 years, all senior citizens to take care of the medical needs. It is necessary because the health insurance for all senior citizens is at high premium. Even though government providing old age pension, unfortunately the old age people getting only Rs 200 which is not at all sufficient to take care of their monthly needs, of-course it is certainly helping them to some extent. It is a fact to admit that due to urbanisation majority of the people are having nucleus families, very rarely seen joint families. Also it is a fact to admit that due to the high cost of living majority of the children after grown up are self centred and completely neglecting the aged parents leaving them to be taken care by themselves or by the almighty. Also it is a fact that due to geographical location. As such government must provide free medicine / subsidized medicine for the aged people. Also government must construct appropriate number of old aged homes in the rural areas in villages mandals to take care of the old aged people who wish to leave their home and take shelter there. The old age homes should be like ashrams having lot of space, greenery, gardening etc all the buildings are only ground floor only. The ashrams should have one doctor 24/7 available. Also for all those who wish to stay at their home or their childrens home they should be provided with the health card. All the medical expenses should be borne by the government only. In order to create the responsibility & respect, in the children towards their aged parents, and pay their gratitude towards the elderly parents, because of the parents they are in the current position of what so ever earning the bread and shelter, the government must collect 2% of the income of all the employees both in government and private sector deducted from the salary. Government, private business establishments should mandatorily contribute 2% from their side to create the old age homes, maintenance of the old aged homes and also providing the free medical treatment for the old aged. This will certainly improve the work output of the employees as majority of the employees has the concern for their parents at least to some extent but they are enable to take care of them due to the indifference attitude of one of the spouse (mostly non employed), or due to their busyness in the work being workaholic, in these cases they are totally relived of the stress due to the worry of not taking care of the parents. To ensure this the government must get a declaration on stamp paper from the

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employers about the details of parents, whether they are alive, their where about, their source of income, the chronic diseases if any, etc and all falls deceleration should lead to suspension from the position, and at least 6 months imprisonment. Also if the old aged people who are getting pension due to retirement from any government service, if they wish to contribute should be taken for the welfare fund of the old aged. Also government must form a trust to get any donations from the corporate or individuals to contribute other than mandatory contribution. Also if the Corporate come forward to create the facilities government should allot the land free of cost for such a noble purpose. Also government must involve NGO and all the old aged persons who still have the ability to work to get involved in the process of managing the individual old age homes at the mandals and small towns. Since majority of the old aged are from the villages only, they feel that they are back to their child hood got freedom from the concrete jungles. If government does not make this happen majority of the elderly old people will certainly think that the people in the governments do not have the respect for their own parents. As such since UPA Government is supporting for the well being of the elderly by providing old age pension, should take a step further in this and ensure the old aged elderly people has been taken care properly, which will certainly get appreciation from all the people and also government will get lots of blessings from these elderly soles.

Also government must maintain the hostels for the child orphans and the ensure all the child orphans are given good education and the health care of the orphans is the mandatory responsibility of the government alone, government must provide free medical service to all the orphans who are not having the appropriate income by providing the free medical insurance card. CLEANLINESS OF SURROUNDINGS Also it should be the duty of the state to have adequate manpower to ensure cleanliness of the city, town and the village at all times by ensuring no blockages of drains, all drains should be closed, adequate hygienically maintained public toilets, adequate disposal of garbage, adequate provisions for recycling of municipal waste, generation of power from the municipal waste etc with

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regular periodic cleanliness of the lakes, water bodies in the vicinity of the residential areas especially in the villages, small towns, slums. ENVIRONMENT POLLUTION CONTROL FOR BETTER HEALTH OF INDIVIDUALS REGULATING OF RADIO SIGNALS RADIATION OF MOBILE PHONES IN EDUCATION PLACES, IN WORK PLACES Also it is ideal to prevent the side effects long exposure ration emission from the mobile phone towers and mobile phone instruments. The mobile phones are crossed over 65 crores in India, still does not enforcing the implementation of international standards of instruments for radiation emission norms. As only very few percentage of the 65 crore mobile instruments adhere to international radiation emission norms. Also need to enforce the cell towers radiation norms strictly. The government must make it mandatory to install mobile phone jammers in all schools, colleges, universities, office establishments both in government and private, in factories and in the hospitals, auditoriums, movie theatres, restaurants etc as these places does not deserve the mobile phone, unnecessarily emitting radiation from so many phones in the closed area. As mobile phone is meant for communication on the move, where as schools, colleges and university campuses does not require mobile phones till the students are in campus and similarly all the offices the employees are performing the desk job which has land phone does not require a mobile phone, like wise in the hospitals, restaurants, etc. Also it will be ideal to keep cell phone storage racks in the class rooms in the schools colleges and universities to make the students in the class deposit their cell phones in the safe racks allotted to them in the class room itself, this will ensure that the students will switch off the mobile phones during the class hours and also lake the scope for playing games, viewing the pictures and videos etc. In offices also there should be safe racks for cell phone storage where each employee should deposit in switch off mode and take back at the end of the office hours. Also in hospitals, in offices certain staff where ever required they can use the wireless phones / HAM radio phones with short frequency within the compound for the staff in urgent duty. Also government must make it mandatory that all mobile operators to have the provision for minor phone and major phone in the system to be self declared by the phone users to declare the

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phone is for self or for the minor i.e students. Also alternatively all the parents wish to provide mobile phone should provide mobile phone to their children below 18 years under declaration the phone is for minor use. All the minor use mobiles should be basic phones without internet. Alternatively all the minor phones should be barred from mobile internet surfing. Also it should be made mandatory all the parents should submit declaration to the school / college that the phone was presented to their children for use by them and they will be responsible for any misuse. All the children bringing phone to the school/ college without parental declaration should be confiscated and the number should be forwarded to the mobile operator to de activate immediately. It should be made that all non registration of mobile number for child use should be suspended for holding a mobile from any operator for one year and fine of Rs 10,000. Also all the schools, colleges should collect the numbers from the children bringing the phone to the school / college to allocate the safe rack in the class room for the storage of the mobile phone based on the mobile number and name of the student. I t should be the duty of the schools to forward these numbers to the mobile operators to completely block the internet surfing facility for the numbers submitted by the school/ college. The children can surf the internet at their home or any place in the computer system but not on the mobile phone. Also the schools should advice the parents to provide the basic instruments without camera for the school children, as they require only communication if any. Also government must make it mandatory that all the mobile numbers used by minors below 18 years of age should have a maximum length of permissible talk period of two minutes only (both incoming and outgoing calls), after two minutes the phone should automatically must get disconnected, not more than two consecutive calls at a time. Also the total talk time in day should be fixed for 30 minutes only. This will ensure that students and children must use the phone only for few minutes only, it has multiple advantages, the children exposed to cell radiation will be minimal, concentration on studies, they are prevented from mobile addiction, which is very dangerous addition than any other narcotics ( it completely distracts their concentration, as even if ring tone somewhere heard they are searching for their mobiles, it is becoming an integral part of the body, every time checking for messages, get depressed when they dont receive any call etc which will have long term neurological and psychological diseases,). Also it will be ideal that schools, colleges, universities, office establishments and factories should have EPBX phone system with more lines

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connected. The number should be provided to the parents of the students to provide any urgent message to the students only during emergencies. Similarly the office establishments should provide the EPBX number to the employees to be passed on to their family members to pass on any emergency messages. This will ensure all flow of communication will occur as and when required. The above installation of jammers, child lock for surfing the internet on mobile phones of children will certainly improve the results in education as students will have more concentration on the lessons thought by the teachers, also in case of the office establishments improve the work output as there is no disturbance, scope for unnecessary chit chatting, wasting the productive working time. Also this will improve the physical and mental health of the people to a great extent. Also government must make it mandatory that mobile phone tariff charges are fixed based on the time of use. The more the mobile use at a time whether incoming call or outgoing call after 2 minutes of use the special user charges to be applicable. All the mobile phones should be allowed first two minutes of talk at normal rate, from third minute on wads the tariff should be doubled every minute (from third minute the incoming call should also be charged), this will ensure that the reduction in use of mobile phone by all individuals. Also the maximum usage of mobile should be 10 minutes continusally. Also the maximum talk times for any individual mobile both incoming and outgoing should fix at 90 minutes per day. All this will lead to good health of all the people. VEHICULAR POLLUTION, URBAN DEVELOPMENT PLANNING As we all knew vehicular pollution cases acute health hazards mostly causing respiratory diseases like bronchitis, asthma etc. It is mainly due to the high content of carbon monoxide, sulphur dioxide and lead residues in the air, which is due to abnormally high vehicular traffic in the cities and bigger towns. It is mainly due to lack of multi modal mass transport systems, also due to the predominant older vehicles, maximum share of two stroke two wheelers, lack of maintenance of vehicles, maximum number of diesel vehicles etc leading to maximum pollution in the cities and big towns caused by vehicles as the statistics indicate out of the total pollution in cities as high as 72% is due to vehicular emissions, 20 % due to industrial pollution and 8 % due to domestic pollution. Also the statistics indicate out of the total traffic of vehicles and

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maximum number of trips of vehicles is for education and work purpose. As such we have to reduce the vehicular traffic in the cities in order to preserve health of the people living in the cities and big towns. As such the first step is government must make it mandatory that all schools, colleges mostly in the private have to mandatorily provide bus transport to the students, ban students from coming in individual vehicles, they have to plan the school/college bus stops at places they can gather maximum number of students. Also the government must make it mandatory that all business establishments having more than 100 employees should maintain the employee pick up bus. Also all the office complexes having various business establishments in less than 100 employees should have a bus pooling and engage bus to maximum possible employees. Also the private business establishments should get some concession from the governments for encouraging their employees to use mass road transport. Also all the government offices must mandatorily either maintain the bus for the employees or should have a tie up with the state road transport bus services to operate exclusive buses during the office timings. In order to reduce the traffic density both the schools, colleges and universities should have different timings for different schools in the same area, different timing for different levels of students, this will reduce the traffic congestion. Also the government must make it mandatory that the office establishments timings should be variable from 6 am in the morning to 9 pm in the evening, for business establishments in the same location for reducing the traffic density. In order to ensure that the business is not disturbed, government must ensure that all the banks will operate from 6 am in the morning to 9 pm in the evening, otherwise make all the business banking transitions online to be operating 24/7. Also the government must keep a ban on the number of vehicles per individual, family. All the individuals should be charged heavy tax for the second vehicle. The government must make it mandatory that al the vehicle whose age is above 10 years should be scrapped, else has to pay huge tax to keep the vehicle in operation. Also the government must permit vehicles as per the registration number of the vehicle, all even and odd number vehicles should be permitted on alternative days. Also government must lift all the subsidies on the fuel both petrol and diesel to the passenger vehicles and the same should be passed on to the public transport, mass transport vehicles. This will ensure that people will prefer to travel by mass transport provided by the school/college/ business office etc, or will prefer to travel by public transport. This

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will certainly reduce the vehicular traffic in the cities. Also need to implement transport sector reforms. (Refer Transport sector reforms in my paper Simple and effective reforms...). Also government must ensure the density of the roads is increased by expanding the roads or construction of flyovers at the major junctions and also make multimodal transport system is available. The estimates of population in the urban in India is around 31.8% at present will rise to over 50 % in next 3 decades. The government must plan the urban development keeping in view of the density of the pollution migration from the rural India to urban cities. (Unlike health care infrastructure from 0.24 hospital beds per 1000 in 1946 still 0.95 hospital beds per 1000 population in 2011 when required at least 3 per 1000). All this is very necessary in order to have a good health and also ensuring the future generations are safe, as the vehicular emissions are the major cause of global warming, which has very adverse effect on the entire mankind due to the rise in temperature by 1 degree centigrade will lead to rise in sea level, as in the globe is surrendered by 2/3 water which will submerge the coasts, having terrible impact on the habitations. Also the rise in temperatures causes, variation in food production as certain foods are grown in certain temperatures only, also causes many diseases to the humans especially skin, many species will vanish from the sea etc. This will have great negative impact in the entire mankind. REDUCTION OF FUEL ADULTERATION TO REDUCE POLLUTION As we all knew that even though the vehicles are maintained periodically for the fitness, large extent of pollution is caused by the adulterated fuel use. As it is a fact the some of the oil is adulterated from the stage of the transport from the oil companies to the retailers en-route the so called oil mafias who are well organised and established are pilfering the oil from the tankers and filling the adulterated fuels like kerosene and other cheap oils to maintain the quantities at the delivery points. In addition some of the retailers are also adulteration of the fuel either them self or they are hand in glove with the oil mafias. There are many incidences of death of honest government officials who try to prevent these oil mafias. As such government must plan like completely automation of the transport of the oil, with electronic locking system and GPRS enabled system with hiring of the private security personal from the retired army people to accompany the transport lorries, along with and regular periodic checks at stressed points during the transport for

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ensuring the seal is maintained un tampered, also ensuring the electronic lock of the tanker is decoded only on the delivery point by ensuring the reach of the vehicle at the delivery point through the GPRS and confirmation by the delivery point officials, the regular online updates from the delivery points for the quality checks and also mandatory for the delivery points to daily do the quality analysis till the stock is lost in the presence of customers randomly at random timings and up load to the system. Also government must completely ban the loose sale of fuel on the streets, ensuring that all fuel stations dispense fuel only in the vehicle, in case loose for emergency can be issued on taking the written declaration that the vehicle was stranded in so an so place due to lack of fuel, the minim quantity of fuel required to reach the nearest fuel station is so and so quantity. It will more ideal, necessary to follow the suggestions made for creation of National Petro Fuel Network Authority (NPFNA) for better issue of fuels and ensuring mandatory maintenance of vehicles(as per by views suggested in Simple and Effective Reforms for controlling corruption and delivering good governance) In addition government must frame stringent laws for fuel adulteration and implement it very strictly, making the offence of fuel adulteration a non bail bale offence and make it life imprisonment for fuel adulteration, which will certainly reduce the fuel adulteration leading reduced pollution leading to reduced health hazards due to vehicular pollution. INDUSTRIAL POLLUTION As we all knew that pollution cases lot of health problems from respiratory issues, to skin diseases, to eye site to neurological issues, polluted water consumption has much more negative impact on the health. A survey conducted by IIT Delhi and the Central Pollution Control Board (CPCB) for ranking of selected 88 industrial clusters across the country for Comprehensive Pollution Ranking based on the level of water, land and air pollution on ranking based on the environment sensitivity revels the shocking truth, as out of the 88 industrial clusters 33 clusters are critically pollutant, 32 clusters are seriously polluted and 10 clusters are under warning zone. The results of the sample can be extended to all the industrial clusters, which means that majority of the industrial zones are emitting dangerous pollutants. As such it should be the most priority duty of state government to have adequate manpower in the state pollution control departments to have a periodic inspection of the

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industries which are causing huge health hazards for the people in the vicinity as many industries which are emitting untreated effluents to the nearby open areas, or in drains, or in the water bodies and lakes some times in rivers. Polluting the ground water table, polluting the water supply lakes, polluting the species like fish in the lakes and rivers,(consumption of such polluted fish leading to health illness), apart from this enormous air pollution due to industrial emission release which has the adverse affect to several kilometres in the vicinity of the factory causing acute respiratory and neurological health issues. All these can be controlled to tolerable extent by enforcing stringent laws, to ensure the industries will treat the pollutants to become neutral and release them at safe, designated places which are far from the habitations, this is possible through periodic inspection for which recruiting adequate number of pollution control staff is necessary along with proper checks and balances to ensure all industries follow the proper treatment procedures, also to prevent the undergoing corruption practices to regulate the factories and industries strictly implement the pollution control norms also needed is adopting the stringent punishments for the officials who are corrupt who let off the factories to act causing environment pollution coupled with stringent punishments to the top managements of the industries and factories who are causing the pollution. Also CPCB identified 17 major pollutant industries such as Aluminium, Caustic Soda, Cement, Copper Smelter, Distilleries, Drugs & Intermediaries, Fertilisers, Integrated Iron & Steel, Tanneries, Petro chemicals, Drugs & Pharmaceuticals, Pulp & Paper, Oil refineries, Sugar, Thermal Power Plants and Zinc Smelting majority of them are located in the mostly in critically polluted industrial clusters in the country. As such the government must mandatorily levy 2 % General environment protection tax (GEPT) on the turnover of these companies and should be used small portion of the fund (10 % of the total tax collected) for creating necessary infrastructure for pollution control boards, and also sizable portion (30 % of the total GEPT ) for neutralizing the already effected water bodies, etc and the major portion of GEPT fund i.e 60 % of the total collected should be used for creating the health care, medical infrastructure like hospitals, etc for the people living in the vicinity of these industrial clusters. For all these industries operating their own hospitals in the category of 500 cr turnover or 1000 employees also should mandatorily pay the pollution tax. Also it should be ideal and mandatory that government must classify industries and factories as per the emission of pollution, also in each category the

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quantity of pollution as per the capacity of the factory / industry. All the industries and factories are charged with Special Specific Pollution Tax (SSPT) as per the category of harm of pollution can cause to the public, and the quantity of emission, the effect of extent of the territory and the quantity of people in that vicinity that are victims of these harmful pollutants. The taxes should be in addition to GEPT. The SSPT should range from minimum 1 % to maximum of 5 % on the total turnover. Also it should be ideal that pollution control board should make it mandatory that all the industries and factories causing pollution should keep on the website the nature of the effluents, emissions, the treatment process, procedure, the efforts for the processing of effluents to neutralise the side effects of effluents causing the pollution, etc. Also government should have strict vigilance and enforcement to have periodic checks on the factories and also in the surroundings pollution levels should be checked and certified by the pollution control authorities and also it will be ideal that all the pollution inspections should be conducted in the presence of the local people, local elected representatives, leaders from all parties and the NGO representatives to ensure transparency in the inspection process. MINING POLLUTION Also all the mining activities should pay the environment degradation tax of 15 % on the turnover. As it is an open secret that more than the turnover they extract the material and sell under invoiced, so it is ideal to put on the turnover minimum of 15 % environment tax in addition to regular taxes. Also it is a fact that mining causes lot of pollution in the nearby areas where the habitants have serious health problems due to environment pollution, also pollution due to the transport of the excavated mining material, As it is open secret that mining industry is known for its unaccountability, also the royalties levied by the governments are very nominal compared to the profit margins earning by the private mining operators, as such there should not be any hesitation in putting the tax. Also this environment tax should be applicable for the captive mining too as mining activity is mining activity causes environmental degradation. All the taxes should be on the turnover only and certainly not on the profit margins, as even though they are making losses the industry / factory are causing environment pollution health hazards by emitting hazardous pollutants in the atmosphere, and also degrading the environment in case of mining.

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FOOD ADULTERATION Also it is a fact that food adulteration causes serious long term health problems in millions of people. As such it should be the duty of the state health department to control the adulteration of the food items both raw and cooked food. The recent reports show that over 70 % of the milk supplies in the cities and towns are adulterated. Some of the common adulterated foods are milk and milk products, atta, edible oils, cereals, condiments (whole and ground), pulses, coffee, tea, confectionary, baking powder, non-alcoholic beverages, vinegar, besan and curry powder which needed to be controlled. Also need to prevent the adulteration in fruits. Also in most of the restaurants and food courts , canteens in the colleges, hostels, offices, factories in many cities and towns the hygienic conditions dose not prevail, most of the food are stored for more than its shelf life most of them are preparing from the rotten raw materials, especially the non vegetarian, the oils are being re used multiple number of times, also lack of the hygienic conditions of the cooks, the people serving etc causing illness in the urban and semi urban people who are consumers of food prepared under these conditions. The condition can be improved if there are stringent laws coupled with periodic inspections as such state governments should recruit adequate number of food inspection teams and control this situation apart from these framing strict laws with stringent punishments for food adulteration. MILK ADULTERATION, PREVENTION MEASURES, SUPPLY OF PURE MILK TO CHILDREN IN ANGANWADIES, WELFARE HOSTELS As mentioned above milk is being adulterated mainly due huge variation in the demand supply gap. The demand is increasing and the supply is not increasing at the pace of demand. The adulterated milk is mainly made of UREA and other vegetable oils. Consuming them will have an effect long term on the entire function of the body metabolism due to the accumulation of urea in the kidneys. In order to prevent this adulteration the strict vigilance and monitoring alone is not sufficient, in addition to it to ensure safe milk is available through the strict vigilance and monitoring also need to increase the milk production to a great extent by bringing the milk revolution. Since milk is the primary requirement in the food that will provide the vitamin A useful in the better eye care, calcium deposit in the bones and the cured provides the pro biotic bacteria useful in the

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digestive system in the body and many more uses of milk. As such it will be ideal for the government to bring in more In Vetro Fertilisation (IVF) and In Vitro Production (IVP) centres that cater embryo technologies to produce more milking cows through test tube. The government must at first phase provide the set of few cows in appropriate number to all the welfare hostels, to the anganwadi Kendras, and the old aged homes to provide the milk for the children in the welfare hostels of SC,ST and BC, children in the anganwadi and the elderly old aged people.. Also the community cow centres should deliver the milk to the anganwadies. As such all the children will get the required nutrients at least through adequate fresh milk. Also in future to provide milk to the old age homes those were built in the select villages. In order to ensure that the supply of milk will take place for the welfare hostels, anganwadi Kendras and the old age homes the milking cows should be supplied by the government in appropriate number based on the strength of the children, old aged people, which are to be maintained at the community cow centres to be operated by the gram panchayat. It should be the duty of the Gram Panchayat to maintain the Rural Community Cow Centres (RCCC) and provide the milk and the accountability of the milk supply etc. It the responsibility of the Village revenue official (VRO) and Mandal Revenue officer (MRO) to monitor the supply of the milk to the welfare hostels, anganwadi Kendras and the old aged homes, also ensure the RCCC is maintained hygienically etc. Also the government must provide free veterinary service for all the community cow centres. There should be proper accountability of the milk collected and supplied by creating accountability to the Gram panchayat and with proper checks and balances. Also the government must ensure milk production at all the places are improved substantially. In order to ensure the milk supplied is genuine and original and pure, government must make it mandatory that all the milking supplying units to get the registered with the government Milking Cattle Information Centre (MCIC), through the help of the animal husbandry department at each and every village and the dairy farms. Government must maintain mandatorily the cow census to arrive the population of the milking cows and the total natural milk production in the country based on the average milk production of each cow, in order to achieve this cattle should be given a specific number tagged with Radio

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Frequency Identification Device (RFID) tag which cannot be duplicated locally as each tag has unique number which can be read only by the electronic reader (this will help the cattle owners to identify their cattle when it is missed), All the cattle owners (more than 12 million) shall be given a electronic card to be swiped at the village dairy cooperative societies (over 1,10,000) while delivering the milk to record the milk provided by the individual owner of the cattle. All the data of the milking cows should be separated and the average milk production can be arrived. All the dairy milk suppliers should mandatorily supply the milk in the packs only. All the milk supply should be registered in the MCIC about the collection details from the individual cattle owners and the dairy from. This will ensure that over production of the milk supply is natural, safe pure milk is supplied to the consumers. Also this will ensure fair price for the milk is paid to the owner of the cattle. Also this will ensure that the milk production enhancement by artificially by injections of banned oxytocin (The Prevention of Cruelty to Animals- PCA Act of 1960 has made indiscriminate use of oxytocin, a punishable offence of Rs 1000 fine, 2 years jail) to the milking Cowes will be drastically reduced as the original data of the cow is known to the MCIC and will asses that which breed of cow will give what quantity in normal circumstances on an average. Also due to mandatory prescription of the doctor to deliver the medicine at the pharmacy centres will ensure such medical drug injections which will boost the milk production temporarily will be curtailed totally. Also government must bring stringent law for the adulteration of milk in what so ever manner. Also government must make a long plan to achieve the milking cattle at each BPL population, can be achieved with providing the milking cattle to each BPL family in the villages to be maintained in the Rural community cow centres (RCCC). In order to provide the cattle with nutritious feed to yield good milk production the government must provide the free seeds of high nutrient grass like Napier etc which has posses high nutrient values and resistant to pests (there is an acute shortage of green fodder over 60% and dry crop residues over 20%, as such the government must mandatorily allocate / reserve over 100 acres of land in every village for the cultivation of fodder to the cattle.) to the CCC to be maintained by the Gram Panchayat. The cow ruminants (cow dung) should be used to produce the gober gas and the slurry can be used as a fertilizer to the nearby fields. As far as the urban poor is concerned the government must form the Urban Community Cow Centres (UCCC) in the villages adjacent to the towns and cities. All these UCCC should cater the needs of the

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children in the slum dwellings and the anganwadi Kendras in the towns and cities. The maintenance of these UCCC should be the municipal administration as well as the group of the slum dwellers on rotation bases. FRUIT ADULTERATION As we all knew that fruits are excellent nutritional values and indeed many people consume fruits daily. The main fruit is banana as it is all season fruit and also poor peoples meals, since the ripe bananas has short shelf life due to the transportation, storage and other reason the fruits are plucked when it is raw, much before it is about ripen naturally, this will forcing the traders to ripen artificially by using the chemicals like calcium carbide, similarly traders/vendors are ripening other fruits like mangoes, papaya, apples etc which are regularly consumed by people, apart from seasonal fruits like checkoo/sapota etc. These artificial ripened fruits have chemicals, though used in small amounts; the chemicals used for artificial ripening contain carcinogens, arsenic and phosphorus which cause cancer. As such governments must enforce the Food Safety and Standards Act 2006 (Rules 2011) which imposed ban of artificial repining of fruits. By keep a regular monitoring of market yards and all the fruit vendors. Also should ban sale of calcium carbide in open market as it is an industrial raw material used in production of acetylene gas which is used for welding and many other purposes. Also to bring public awareness about the artificial ripening, the appearance of the fruits (will be shiny, flawless in appearance) and Symptoms of poisoning include vomiting, diarrhoea, burning or tingling sensation, numbness, headache and dizziness etc. NON-VEGETARIAN RAW FOOD (LIKE MEAT) ADULTERATION As we all knew that majority of the Indians are non-vegetarian consumers majority of them consume either goat or lamb, chicken or other birds like duck, eemu, etc. Since there is no specific standards for the meat sellers, majority of the meat sellers do not follow standards and sell the meat in un-hygienic conditions, some of them sell the meat mixed with other animal meats. Also majority of the restaurants are serving the stored bacteria generated non vegetarian food. As such government must issue the mandatory hygienic conditions to be maintained, measures for containing the non-vegetarian food adulteration, as it causes acute health disorders

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HYGIENIC READY MEADE FOOD AT RESTAURANTS, FOOD COURTS, CANTEENS ETC Also it should be made mandatory that all the restaurants and canteens the food preparation areas should be installed the CC camera and should be integrated to the website of the food adulteration prevention department for the public view and the scrutiny by the officials. Like the traffic police observing the CC footage remotely and acting on violations, the food inspection officials will monitor all the food preparations from the start of the preparation to the cleaning of the food preparation area in the closing time should be observed closely. This method will certainly help in achieving the better results. Also the governments should give more focus on the maintenance of hygienic of street foods preparation & serving, as many of them are causes of health disorders. To regulate the street food sale it should be mandatory for the the street food sells to get registered locally with the food authorities to obtain the licence card. Also there should be mobile teams to have regular and periodic inspection of street food vendors for the quality, preparation in hygienic atmosphere, use of water filtered water, use of standard edible oil etc and more important about the health condition of the perpetrators and the server of the street food should be observed for skin deceases, any communicable deceases etc and all unhygienic outlets should be seize immediately and allow them to continue after maintain the standards. Also most important is that the governments should control the food stalls in the public places like bus stations, rail stations and more specifically at the pilgrim places of all religions where mass movement is existence and short stay or eat and move, which are the main centres where substandard, unhygienic conditions of the food preparations are in existence. This has long run impact on the health of the people who are consuming food at such places, such food consumption leads to gastro entities, hepatitis. The CC cameras should be made available in these places of food preparation and service in all the public places mentioned above. The governments has to realise the fact that small expenditure in the other sectors with straight implementation of law, rules and regulations in other sector will certainly help in a great extent

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towards the achievement of health care for all. Also the state governments should prepare a white paper on number staff in the pollution control board, the periodic inspection chart, the staff is adequate proportionate to the existing industries and factories, also the municipal staff adequate to the amount of garbage, drainage, sewage facility maintenance, are the food inspectors adequate proportionate to the restaurants and canteens and food processing industries and to prevent the adulteration in the food products, what are the steps taken for containing the adulteration of food products, what are the checks and balances and accountability of the officials involved in the above process etc. REGULATION OF FOOD STORAGE, SUPPLY

Health care for all can be achieved if every person has proper affordable nutrient diet; this can be achieved if and if the food grains are available at affordable, relatively cheaper prices. This is possible only through proper long term storage of the farm production. It is indeed shame on our part that many children, BPL families are dying with hunger and malnutrition, at the same time the food in the godowns is rotten due to in-adequate facilities or due to non existence of covered godowns for the storage of food grains. Also it is due to failure on the part of governments to identify the places of mass agriculture production of crops like onion, potato, tomato, ginger, turmeric, garlic etc and construct the cold storages and also encourage the food processing industries in that areas, instead the food processing industries are far away from the places of mass agriculture produce. In order to ensure that proper supply of food grains, vegetables, etc at normal price at all times even during the draught or other natural calamities which are beyond human control, the government has to construct the proper storage facilities for the food grains. As such large food silo bins should be constructed as per the international standard to preserve the food grains in the controlled atmosphere and cold storages for the vegetables for long storage. The construction of godown and Silo Bins (Most ideal for food storage as long storage without deterioration or loss, no access to insects and rodents, occupies 1/5 area of the conventional godown) should be made in the PPP mode with the tri-party agreement of the government, private investor and the local farmers association (not the middle men) to get operated on WIN-WIN

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bases. Also should build the food processing industries in the vicinity of the mass agriculture production areas to ensure that the farmers will get the minimum support price for their produce. Also should have the railway lines near to the godowns for easy transportation. It should be mandatory that minimum support prises for agriculture produce should be determined as per the local conditions in that district; however the price difference should not me much more compared to other parts of the state or the country as different climate conditions, different soils conditions and different methods of agriculture prices determine the yield. This will ensure that justice to the farmers as uniform pricing is leading the formers in debts due to non recovery of even capital expenditure made. Also it is ideal that government should procure the perishable agriculture produce i.e vegetables and fruits from the farmers directly at the villages, add mark up for transportation and handling and a little margin for the operation cost, sell to the people in the cities, towns through exclusive stores operated in each ward at least one such store, along with adequate number of mobile vegetable stores. (Where ever farmers are willing to setup own agriculture markets in nearby cities and towns government must provide space and also subsidized transport). This will provide fair price for the farmer as well as the consumers; in addition this will generate employment for the youth also. To ensure this system operate successfully there should be proper supply chain management, all the farmers village wise should be identified and enter agreement with them for supply at the appropriate fair price depending on the local conditions, this will ensure adequate supply of the material produce is assured, then all the collection from the villages should be brought to mandal headquarters, from there to the towns and cities, as per the pre requirement ascertained through automation of supply chain management system. The logistics should utilise the Operations Research methods to optimize the transport distances, save time and maximum delivery in most efficient cost effective manner. Then there should be warehouses in the mandal head quarters / cities at important locations and the shopping areas at the each ward in the city / town. The vehicles which are carrying the vegetables to the city/town should be used as mobile vegetable shops in the city and towns in the large colonies. This will save the expenditure on the vehicles and maximum output can be drawn from the investment in the vehicles. Also from the purchase of vegetables from the farmers stage to the sale of vegetables to the individual consumers, the entire process should be computerised with online, this will record

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the movement of the stock, the procurement and the storage etc, also brings the required transparency in the system. A little investment from the government on this will give permanent solution for better food, better health of the people.

Also in addition to this the primary need is to regulate the pricing of the inputs of the farming like seeds, fertilizers and the pesticides, also to ensure the fair supply of the seeds and fertilizers a totally automated supply chain management system should be adopted from the manufacturer to the local retailer in the villages with online recording of the movement of the stock, material i.e seeds and fertilizer, as many places the seeds are not available in required quantity and duplicate seeds are in circulation which does not yield as per the normal standards causing huge loss due to crop failure, also the required fertilizers to boost the yield are not available to the farmers most of the time not at the actual cost price of the product at the retailer end, most of the time farmers buy on premium price in black market due to the creation of artificial deficiency of stock by the local dealers and the retailers to gain more profit, this can be completely eliminated by the total automation of the supply chain management and very pack of the seed/ every bag of the fertilizer sale should be against the entry of farmer name as in the the kissan card. Also most important is the water supply to irrigation, since most of the rivers are passing through several states, the is always water disputes to be shared by the farmers of different areas. The governments must act in the large interest of the nation and the farmers to resolve the issues related to irrigated water supply in all the states. Also government must make the removal of the silt in the water cannels, creation of more water pits to conserve the rain water, maintain the tanks in clan environment by preventing the industrial effluents mixing in the tanks and river irrigation (to make it possible all the governments must maintain the data of water bodies, lacks, their capacity, removal of silt data, nearby industries which can cause pollution etc and appropriate action plan should be implemented). This will ensure that the farmer will produce the agriculture output at more less price, then the sale price will be less, the elimination of the few middle men and direct purchase by the government from the farmers will ensure the agriculture produce is sold at very reasonable, affordable, economic price to the consumer.

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This will enable all income group people have the access to the nutritional diet, thus improvement of health of all the citizens. All This will ensure that food prices are stable all the time, and thus the inflation under control. SAFE DRINKING WATER SUPPLY Also since majority of the diseases are water born, it is the duty of the government to supply the portable drinking water to all the people. In urban areas and towns the water supply is through the water supply boards mostly presumed to be treated to some extent, but on reaching the individual consumers sometimes it is contaminated due to leakages in the main supply lines and mixing of drainage water etc. As such all water supply boards ensure that pure drinking water is supplied, they should use the Supervisory Control and Data Acquisition (SCADA) technology to find out the flow parameters of the water in the pipeline system to detect any leakages. Also since the cast iron/ iron/ steel pipes are prone to corrosion, scaling and formation of blue green algae etc causes long run health diseases to the consumers, as such all the piping at the entry of the colony to each house should use the Multi Layered Flexible Piping System which are made of Poly Ethylene and Aluminium layers has the properties of non corrosion, non scaling, no bacteria formation in the flow system, which will certainly help to a great extent for healthy water. In order to ensure that adequate portable drinking water is supplied to the rural areas, all two lack gram panchayats should have mass RO system running on the solar power (as power supply is a major issue in rural India) to achieve this the help of the CSR, MPLAD/MLALAD and also by the government should be made starting from the villages having acute water problems due to salinity, alkalinity, and fluoride affected areas and also areas where water table is far deep in the ground. Also all slums in the urban areas should have the mass RO system for supply of water for drinking at nominal price for the cost of operation. The cost of operation is as low as 20 Pisa per litre. Which will be affordable for the families in the slum dwellings to consume the RO purified water rather than suffering with diseases. CONTROL OF SEXUALLY TRANSMITTED DISEASES Also it is most important that due to the lack of sex education in upper primary schools and colleges in India, major percentage of

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youth is including in pre mature sexual acts (mostly un protected) which has long term affects on their health affecting their future life. It is mainly due to the physical and metabolic changes among them during the transaction period from becoming adult leads to natural curiosity towards sex, added to it the influence of the cinema films (which are supposed to be either a social message carrier or provide entertainment to get relaxed from the stress, but strangely the kind of semi nude exposure of artists irrespective of gender and the way of picturisation of the present cinemas irrespective of sensor certification, are more or less acting as stimulants to the youth) and added to the cinemas free access to prone sites in internet, mobile downloads and also due to the negligence of parents. As such it should be ideal that safe sex education should be part of curriculum from (most ideal from 8th standard on wards) the intermediate or the 10+2 stage as it is very necessary as the recent reports of surveys shows that the average of sex in boys 17.4 and girls at 18.2 years as per the National Institute of Health and Family Welfare, a quarter to a third of Indias young people indulge in premarital-sex with 17% among them schoolchildren; 33% among young working class in Indian-population, With 60% of them had sex rarely or sometimes; 14% frequently with 3-4% had multiple partners and 50% of females and 45% males never used a condom. Also it should be mandatory that all colleges and universities for students of intermediate, 10+2 and the graduation students a uniform decent dress-code on all working days and the PG students should be allowed to have casual dressing. As it is a fact that the casual dressing in the ultra modern outfits will distract the section of students as all are not economically sound to wear the branded and expensive clothes like few elite children do, also some sections are wearing very voluptuous dressing irrespective of gender which will certainly distract the concentration on studies and leads to unwanted things. Also all the schools (above 7th standard ), colleges and universities permit only basic mobile phones having only receiving and making calls and sending SMS only, should make complete ban of students carrying mobile phones with advanced features like with camera, internet facility in the campus. Also the class rooms/ college compound should be fixed with mobile jammers. As the advanced mobiles has more radiation effect than the basic phones as the advanced phones to receive more data which will emit more radiation, also due to surfing mobile internet for watching the pornography or through the memory card, possible only in advanced phones, which will certainly affect the child

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psychology, lead to bad health. All the above guidelines are certainly not the talibanisation as was termed by the media for inculcating the good manners, but very necessary in the context of safe sex education in the 10 +2 students and to keep the children grow under disciplined atmosphere. All the children should be given freedom in the controlled atmosphere as the age of transition from teenage to adult will have lot of distractive thoughts, if directed properly will lead to good health, constructive and bright future of the child. The parents should be thought about the negative implications of more freedom, as these children are in the transition period needs more concentration on education then the gossips and un-wanted stuff surfing the internet on the mobile phones. The children should be given access to internet at home in the PC or Laptop computer with pornography filters and regular observation of the parents. NEED FOR MARGINALISATION OF FLUSH TRADE IN INDIA Also the safe sex education should be thoroughly thought to the youth. Also the STD awareness should be created among the public, especially at the rest areas of the transport Lorries etc. The governments should give utmost priority to marginalize the flush trade in Indian soil. Also the government should ensure that all the redlight areas and the prostitution should be brought to closure. As many females and young girls in millions are under this flesh trade and getting spoiled their health to the gravest level being caught in the bondage of sex racks, sex mafia and also acts as agents of carriers of STD and AIDS. The Ministry of Home Affairs (MHA) Government of India reports says yearly as many as 3 lacks girl children in India are every year forcibly entering in to this trade by the organised mafia. In order to provide justice to the girl child and women victims and to bring a change in the society to have good health for all it is necessary to bring stringent non bail-able offence with laws equivalent to the murder case to keep the culprits who are forcing the women to flush trade. Also since it is evident from the MHA reports that police are unable to tackle this serious issue, the flush trade in the redlight areas should be dismantled by engaging the army to rescue the victims to conduct raid on the red-light areas in the states. It is really and indeed should be treated as a national shame since over 3.5 million Indian women are in this forced flush trade as per the MHA report, majority of the victims of this heinous trade belong to the downtrodden sections of the society belonging to

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SC,ST, and Minority (over 50 % SC, ST and 27% BC). Also it is real surprise for many to see that open advertisements for flush trade is happening in cities, towns appearing in the news papers even in leading national dailies with captions relax your body and mind, full body massage, and the friendship clubs with caption join today to date with & enjoy with high class female, entry for joining free for all females its a naked truth that 9 out of 10 advertisements are meant for flush trade, prostitution? All this un stoppable continually happening flush trade in India leaving doubt for many about system of governance due the inaction of governments, callousness of law enforcement agencies, disability of media investigative journalism and the lack of real zeal and commitment of women rights organisations ? Also many people are of the the thought that it may be part and parcel of cosmopolitan culture, useful in boost of tourism?. In order to ensure confidence to all people about the system of governance the government must act quickly on dis mantling the redlight areas, ensure that such advertisements which are meant for the flush will not appear in the news papers and also at the same should ensure the web sites promoting the flush trade in Indian soil should be blocked, and also to ensure that such flush trade will not take place through social media, ensure stringent laws for enacted and enforced to curb the flush trade, Its is high time government to completely dismantle of all the red-light clusters across the country by deploying the army as many state police are enable to fight against this mafias in the red light areas. Also to achieve total marginalisation of flush trade the governments must form special department Anti Flush Trade Task Force (AFTTF) like ACB / CBI in each state with at least 10% of the total police force at all levels should be working round the clock for crushing flush trade, to free the flush trade victims and do justice to them, provide appropriate free medical support, coupled with psychological counselling to build confidence in them, and the government must provide some sort of lively hood for them This is certainly bring the desired results in public health as the cases of STD, AIDS will be drastically come down, as many of the public sex workers are major carriers of many diseases causing a huge health damage to themselves and the temporary partner, their family of the temporary partner. The budget allocation for AIDS prevention is Rs 1700 crore for the National Aids Control Programme with the objective of halting and reversing the HIV epidemic in the country by integrating programmes for prevention, care, support and treatment. Even 50 % of the amount spent on the dismantle of the redlight areas and

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creating the re-habitation of the sex workers will not only save the budget allocation on the AIDS in future decrease the expenditure of many in the for the treatment and medicine, but also decreases the number of deaths in the AIDS cases, also increase the productivity due to increase in the work force as most people who effected AIDS are in the working age group. The above steps are very necessary to inculcate the confidence to the public that governments have real intention in the protection, safety, security and dignity and welfare of the women especially females belonging to downtrodden. Otherwise governments should legalise the prostitution with mandatory pre conditions of health check-up both the partners i.e both female and male in this unholy heinous flush trade activity on daily bases, In the larger interest of health care for all. PREVENTION OF ADVERTISEMENT OF SELF MEDICATION, MAGIC CURE IN PRINT AND ELECTRONIC MEDIA Also It is very unfortunate that the government allowing the media to air the advertisements for the health care products which are not certified for the authenticity of the claims and the product standards, their usefulness in the health care, for example many products with claims grow hair, grow height, get slim in few minutes, get fitness in few minutes, reduce fat in few minutes, increase your chest dimensions, get endurance and vitality stimulants etc, does not possess the necessary health care certification from appropriate government regulatory body like Food and Drug Administration (FDA), Indian Standards Institute (ISI).It is a fact that these advertisements tend to cause the ignorant and unwary consumer to resort to self-medication or to resort to quacks who indulge in such advertisements for treatments, which cause great harm. It was therefore found necessary in the public interest to put a stop to such undesirable advertisements. As such It appears mostly all these advertisements are violation of spirit of the Drugs and Magic Remedies (Objectionable Advertisements) Rules, 1955. As The main object and purpose of the Act is to prevent people from self-medicating with regard to various diseases. Self medication in respect of diseases of serious nature mentioned in the Act and the Rules has a deleterious effect on the health of the community and is likely to affect the well being of the people, by using such products people health may deteriorate due to side effects, just the

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testimonials of some few who might have benefited due to what so ever reason cannot be universalised unless it is scientifically proven for its universal applicable principle, as such airing/publishing of such advertisements should not be entertained. Giving media self regulation is very much in need and very much acceptable as far as the presenting of news and views are concerned to keep the public informed and also to keep the executive and legislature alert at all times. It is not appropriate that media airing / printing this kind of objectionable advertisements of such un-standard products just putting the statutory warning message that the claims of the product are not endorsed by the media is not at all sufficient. Government must restrict all advertisements related to health care and fitness to obtain necessary approval from the appropriate department for the claims, especially all products of food, fitness and health care mostly from FDA of government. All these product advertisements should be aired/printed only on production of certification from the appropriate government authority for the quality and the claims of the company product are genuine on conducting appropriate scientific tests, also the products are not having any side effects on the health and the product is as per the international/Indian health standards. All such test reports regarding the claims of the products should be kept in the website of the government for more detailed view by the public. REGULATION OF BLOOD BANKS AND ORGAN BANKS

Also government should focus on blood banks and organ banks. As blood is required in heart surgeries, cancer therapy, talasima treatment and also in major accent cases where blood loss occurred, needed same group blood to be transuded to the patent to ensure the proper function of the brain and body metabolism. It is fact that awareness about blood donation is still needed as "People still believe that they will become weak and anaemic if they donate blood. People should know that anybody aged 18-65 years can donate blood. A healthy person can donate blood once every three months." As stated by many elders that charity should start from home, lip service will not serve any purpose unless set an example for others. Keeping in view of the precious words of the elders, as such all public representatives (Netas) and public servants (Babus) should be made to contribute to the blood donation and organ donation mandatory. All the employees of Government, PSU

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especially male employees especially the IAS, IPS, allied services, Group-A, GroupB and Group-C only, should donate blood at least once in two years, all Group-D employees should be exempted from mandatory donation, but if they wish they can voluntarily donate the blood, organs. Since most of the Group-D employees are either mal nutritional or under nutritional due the limited financials. Likewise in armed forces should donate blood at least once in two years, certainly making the real meaning of Civil Service. Also it should be ideal to make it mandatory all elected representatives, government employees and personal in armed forces should to make organ donation compulsorily. Also it should be mandatory criteria in the electoral system; people who wish to contest the election to be a public representative should mandatorily have contributed the blood donation camp least once during the last two previous years before the nomination, in addition a declaration on court stamp paper for organ donation agreed and witnessed by their spouse or parents, both the copy of the blood donation certificate and the self declaration for organ donation should be attached to the nomination form, without which the nomination of the candidate should be invalid. since all prospective candidates are willing to represent the people to serve them, work for their betterment, if the candidate does not have the heart to donate 350 ml of blood in 2 years, their organs after their death, how can he claim that he will work for the welfare of the people in the territory, their speeches or statements or lip service saying that their life is for peoples service, they wish to bring change in the system which is not alone sufficient but their real contribution is necessary?, all persons who wish to contest local body elections should have donate blood at least one time in last 2 years before nomination, all MLA candidates at least 2 times in last two years before nomination, all MP candidates at least 3 times in last 2 years before the nomination, which reflects the TRUE SPIRIT OF SERVICE TO THE PUBLIC, which will set example for many followers of these leaders and common public.) Also it should be mandatory that all public representatives both elected and nominated on election should donate the blood at least twice during their tenure as a member at what so ever level may be (a Gram Panchayat member, to Member of Parliament) it will be the mandatory criteria for re-nomination in the next general elections, Also it should be made mandatory that organ donation of the diseased public representative is the criteria for consideration of the family members for future nomination in the elections (either byeelection or general election). Also it should be mandatory criteria for

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nomination in next elections and also for obtaining any nominated position in the government. Similarly it should be made mandatory for all the civil servants/ government employees at least 2 times blood donation is the minimum mandatory criteria for considering the promotion of the civil servant / government servant. Also this should be applied to the private sector. This will certainly help all sections of the people in emergencies, also improves the respect for the public representatives and public servants.

Also all the recognised political parties should make it mandatory that all the party office bearers at all level from ward/village to the mandal level should donate blood at least once in two years. It will be more ideal that all ruling parties should set an example for others by making an initiative in this regard. Also it should be the duty of the government to establish blood banks at all districts in the state covering all major cities and towns having more than one lacks population. The statistics shows India has around 2545 bloods banks of which 996 are operated by government and 1549 are operated by private, NGO, Charitable trusts. There is a need to increase more blood banks under government covering all districts and placing the blood banks at strategic locations. Also government must review the re frame rules regarding the setting up of the blood banks by the private, and also regarding maintenance of the blood banks (government & private) by appropriately amending the Drugs Rules of D&C Act (1940)( DandC Act) as all the blood banks are governed due to advancement in transfusion science and new practices coming into the routine blood bank management, and Central Drugs Standard Control Organization (CDSCO) which is the government of India regulatory body of blood banks headed by the Drugs Controller General (India) to ensure safe blood available in all corners of the country, whatever blood and components are issued out of any blood bank, whether government, NGO or corporate, it should be made safe by implementing quality standards. Also ideal to computerise the data of stock at each blood bank and integrate the data district wise and make it available on the web to be accessible to all hospitals and nursing homes. Also it should be made mandatory that all the highway health centres and hospitals should have the facility of mini blood bank and also possess blood of all groups in adequate quantity to cater emergency needs.

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PROPAGANDA OF BELIEF IN SELF FOR SPEEDY RECOVERY Also it is more ideal and advantageous to many if all the schools, colleges, universities, offices, factory workers should thought about the power of sub conscious mind and power of positive thinking to infuse the ultimate confidence in them to act right. Also all the hospitals and nursing homes should view/provide the preachings of elders about the power of sub conscious mind and power of positive thinking for better healing and their seedy recovery from the illness; as the teachings of the above subjects are universally applicable and do not contain any religious matter/content in it. This will boost the confidence in the people as well as in patents, it is fact that they will be perform well in case of normal people and in case of patents will recovered faster than normal. As a famous quote the doctor dresses the wound, but the god heals it. The god hears their prayers in their sub conscious mind and favours them with seedy recovery. CONCLUSION The fact even though UPA under Congress Leadership has already implementing health care schemes like NRHM, JSSY, Jan Aushadi, RSBY etc which will certainly benefit large section of the population of the country, also likely bring Health Care for All by providing substantial increase in health care budget, which may not provide the desired results until unless all the government brings in all the stack holders directly or indirectly responsible for the health of the people of the country. It is the fact that health care is not only the responsibility of the government alone, but also the business establishments who earn profits on the hardship of the employees, in certain cases the industries are the cause deterioration of health of large sections of people due to environment pollution, Also some business establishments causes the food adulteration directly or indirectly causing deterioration of health, as such it should be the primary responsibility & duty of all the business establishments to take care of the health of the employee and their family, either by contributing to health insurance in case of small and medium business enterprises or by construction of hospitals exclusively for the employees in all big business establishments, also those business establishments which spreads pollution unavoidably causing the deterioration of health of people, has to take care of the victims through government by contributing the environment pollution tax. This method will certainly reduce the burden on the

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government; also reduce the load on the existing hospitals due to the exclusive hospitals for sizable population. Also since the governments are extending the facilities like tax concessions, bank loans etc to the pharmacy industry, the industry is only surviving on the consumption by the sick, but the pharmacy companies are mercilessly squeezing the money from the sick and downtrodden by charging over 10 times the manufacturing cost earning huge margins creating inevitable circumstances, as we know that majority of the population does not have the real purchasing power even though the per capta income is high, the fact is the rise in per capta income is only on paper and a mere economical calculation, as statistics shows still 1/3 of the population is below poverty line, in order to ensure that every citizen has access to affordable medicine, as such in order to achieve health care for all the government to must mandatorily bring the prices of the medicine by regulating the pharmacy manufacturing cost, profit margins of all drugs manufactured and sold in India, Also need to regulate the hospitals and nursing homes to collect the service charges at a limited margin by fixing uniform cost for diagnostic tests and service charges in hospitals of same standard, also government must ensure fair treatment of the sick by preventing irrational treatment through bringing ombudsman mechanism in the health care sector. As we all knew that entire health care sector is dependent on the doctor, more specifically on the prescription of doctor. As such government must bring in a system to regulate the prescription by bringing the introducing mandatory use of the bar coded prescription paper to prescribe the medicine or tests which the blank bar coded prescription pads for each doctor are issued by the government will certainly prevent the irrational prescriptions and also should ensure the delivery of the medicine mandatorily on prescription of doctors will ensure all pharmacy retailers sale of medicine is regulated , added to this monitored regularly and the integration of data of the retailers sale prevent the spurious medicine, non excise paid medicine etc. Also since the doctors are the core of the health care to ensure that all doctors work in all places both in urban and rural areas and ensures practice of professional ethics government must ensure that all doctors of equal qualification and equal experience will get equal salary/ professional fee in case of independent practice irrespective of their service in government or private, added to this allowing later entry to government from private and mandatory service of all the existing doctors for few weeks on rotation to serve in the rural areas will certainly ensure all people in the country will get the required

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health care. It is a fact that health care for every individual is not possible unless the individual maintains the disciplined life, and adopt health practices. Like having health care food with nutritional values as far as possible, regular exercises and also not inclined for any addictions like smoking and consumption of alcohol and adhere to legitimate sex. To make the individuals practice discipline government also ensure that other avenues closed except the fair health practices in all aspects of life. As such government must ban tobacco farming in India and very restricted sale of finished tobacco products, also the government must regulate the sale of the alcohol products and ensue that these products which are the major health distracters for all people especially the downtrodden, as such the government must ensure the sale of the tobacco and alcohol is not within the reach of the common person by restricting the sale points and enhancing the duties on them to the maximum extent. Also the governments must ensure that maximum people adhere to legitimate sex in their life by completely dismantling the flush trade in India. To ensure all the individuals practice good health habits in life the government should ensure that all stake holders i.e the educational institutions, the business establishments, will compulsorily cater time to discuss and share thoughts about the good health practices for the benefit of the individual and their family members. Also government must ensure that the practices of good health habits are infused in the minds of people living in villages through regular discussions at the Gram Sabah. All the above suggested measures on implementation will certainly lead to achieve Health Care for All , will make maximum population in the country are healthy throughout their lifetime, due to drastic decline of illness of people unnatural deaths will decline sharply, which increase the working force population of our country for the reason as per the current census over 2/3 rds of population in India is youth, with our country being known for natural talent & nature to work hard, our country will excels in all areas which are needed for betterment of the planet earth, making India the real Super Power Nation in the World. ***


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