India Virtually Eliminates Tetanus as a Killer

http://www.nytimes.com/2015/09/01/health/india-virtually-eliminates-tetanus-as-a-killer.html

by Garbage • 11 years ago

84 36 11 years ago

This news and polio eradication is good news from India.

hackuser2• 11 years ago

The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments — including some to a 60-year-old woman registered as having been pregnant five times in 10 months.

I'm uncomfortable with the meme of corruption in public welfare programs (and I may be overreacting to the author's implication, but I still think my point applies more generally). There is corruption in every program and institution, from private business to religion to government to little league baseball. If you have thousands or millions of people involved, some will behave badly; it's the nature of humanity. We can't wait to do things until the institution or the people it services are saints.

Not all corruption is equal, and absolutely we should find ways to minimize it (which usually involves looking in the mirror and making systemic changes, not complaining about the inevitable, well-established consquences of our current system). But considering the string of massive corruption scandals on Wall Street, for example, I'm surprised when people think government and welfare programs are particularly corrupt.

merpnderp5• 11 years ago

In the US there have been recent papers discussing how roughly 10% of the medicare budget goes to people who live less than a year, with the implication that perhaps we shouldn't be spending so much on people with so little time.

It is a well established fact by the CBO (Congressional Budget Office) that roughly 10% of the medicare budget is wasted on fraudulent claims (even though their rejection claim rate is roughly 1000 times that of most private insurance).

So there are some cases where the status quo is untenable, fraud is blatantly obvious, and people could die untreated do to a lack or resources.

Yes, fraud and corruption should always make the headlines and should always be a priority to eradicate.

[EDIT for typo of medicaid instead of medicare]

akashya• 11 years ago

Sources?

sophacles• 11 years ago

Fraud should be a concern, however at some points, the attempts to eliminate it outweigh (in terms of cost and effort) the effect of its existence. At that point it becomes a morality issue rather than a practical one.

For comparison, I wonder if the CBO was given full investigatory power into private insurance, would they discover a higher or lower fraud percentage? It would not surprise me if they were higher, and that at some point they just accepted that fraudulent claims would be cheaper to ignore than to uncover, based on dollar amounts and so on. It similarly of course wouldn't surprise me if they were lower being able to deny more people at the outset, or were able to use more information to find high risk claims (that privacy concerns prevent the government from using for the exact same purpose).

nostrebored• 11 years ago

Exactly. Fraud is terrible in both cases, and should be a known factor so that we can evaluate how to procede.

For instance, aid to Sub-Saharan Africa constitutes roughly 70% of the budget of SSA countries. Illicit outflows of that aid money is increasing at a rate of 20% per year. I'm struggling to find the data about how much aid actually reaches the intended location, but it's significantly lower than one would hope for.

Sure, I think that foreign aid to developing countries should happen. But clearly the way that we're doing it right now is encouraging a self-perpetuating corruption economy. Burying my head in the sand about corruption of foreign aid wouldn't help anyone, just like merpnderp is saying.

DougWebb• 11 years ago

Expanding on sophalces' point:

Assuming the figures you quoted are correct, how much of the medicare budget is spent on fraud prevention? That includes:

* time spent by Congress and Medicare deciding what is and what is not covered, * deciding who is and who is not covered, * what the rules and processes are for preventing and discovering fraud, * what the process is for handling fraud * the actual time needed to enforce these rules and follow the processes * time spent by care givers and patients complying with the rules

I suspect that all of that adds up to more than 10%, and it would go much higher if Medicare tried to reduce the fraud rate below 10% through further enforcement.

hackuser2• 11 years ago

So there are some cases where the status quo is untenable, fraud is blatantly obvious, and people could die untreated do to a lack or resources.

I agree in general; I seem to have given another impression. Absolutely we should reduce corruption and there are cases where it causes serious problems.

But if by "untenable" you mean Medicare should be shut down rather than continue like this, I'd disagree. You describe a serious problem, but worse would be to let all those people suffer. But I agree that 10% is a huge waste (in an enormous budget) the opportunity cost - the people who go untreated - seems high; reducing that waste should be a high priority (I'm assuming they are correct; I have no personal knowledge).

EDIT: Make wording a little more precise

aussieindian• 11 years ago

> I'm uncomfortable with the meme of corruption in public welfare programs

Its a story about a developing country.. it would be a brave editor who approves a piece without the story sticking to the dominant narrative about the country.

Not sure if there are any Journo's who can comment on my insinuation but that is how i see many media pieces. not sure if it is forced by editor or comes from a journo's own biases.

rm_-rf_slash2• 11 years ago

India has reduced cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem."

One in one thousand of over a billion is still a rather large number. Shouldn't the WHO use proportional statistics for populations over, say, 100 million?

GFK_of_xmaspast2• 11 years ago

"One billion" is not the live birth rate.

rm_-rf_slash2• 11 years ago

At the risk of being further downvoted: no shit.

PhearTheCeal• 11 years ago

Now if only they could eliminate defecating in the streets. [1]

  In India, nearly half of the population 
  - more than 590m people - 
  relieve themselves in the open

[1] http://www.bbc.com/news/health-33980904

GFK_of_xmaspast2• 11 years ago

People say the same thing about California.

neduma2• 11 years ago

You mean homeless peoples urinating in SF..

adventured• 11 years ago

No people don't say the same thing about California.

In California it's a rare occurrence among the 38 million people that live there, caused by a tiny fraction of the population - almost exclusively a subset of the homeless.

In India, it's ~45% of 1.2 billion people.

neduma2• 11 years ago

This really bothers me. Any ideas to cure this issue with local/government support. I would like to explore more about current solutions in terms of what worked and what not worked so far (with numbers, of course).

Thinking of starting some kind of kickstarter campaign to solve this in few villages and let the community/government to replicate this model to everywhere in India.

harshnisar• 11 years ago

Here: https://en.wikipedia.org/wiki/Sulabh_International

afarrell2• 11 years ago

This was also a problem among the colonial militia camped outside Boston in 1775. It was difficult to solve because people don't like being told where to shit by officers they elected a few weeks ago.

titomc• 11 years ago

India is an extremely large country with democracy + huge diversity in terms of culture. India will slowly but surely get there.

univalent• 11 years ago

This is very cool. I remember as a kid every time I had a cut or scrape my parents would rack their brains for the date of the last 'booster shot'. I was also told cautionary tales of tetanus seizures (?) that could break major bones because of the stress of the convulsion.

India Virtually Eliminates Tetanus as a Killer

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