Report - Wada Na todo Abhiyaan

Millennium Development Goals
in India, 2010
-A Civil Society Report
Wada Na Todo Abhiyan
September 2010
Wada Na Todo ABHIYAN (WNTA) is a national campaign to hold the government accountable to its promise
to end Poverty, Social Exclusion & Discrimination.
WNTA emerged from the consensus among human rights activists and social action groups who were part of
the World Social Forum 2004 (Mumbai) on the need for a forceful, focused and concerted effort to make a
difference to the fact that one-fourth of the world’s poor live in India, and continue to experience intense
deprivation from opportunities to learn, live and work in dignity.
WNTA aims to do this by monitoring the promises made by the government to meet the objectives set in the
UN Millennium Declaration (2000), the National Development Goals and the National Common Minimum
Program (2004-09) - with a special focus on the Right to Livelihood, Health & Education.
WNTA works to ensure that the concerns and aspirations of Dalits, Adivasis, Nomadic Tribes, Women, Children,
Youth, the Differently Able and people living with HIV-AIDS are mainstreamed across programs, policies and
development goals of the central and state governments.
We are represented by a network of more than 4000 rights action groups across 31 states of India, who have
come together to link social groups and engage policy makers on issues of strategic relevance.
WNTA is also an affiliate of the UN Millennium Campaign (UNMC) and the Global Call to Action against
Poverty (GCAP).
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Contents
1. Preface
5
2. A Comprehensive Review of the Millennium Development Goals in India
„
K. R. Venugopal (Formerly Secretary to the Prime Minister and Special Rapporteur,
National Human Rights Commission)
7
3. Shadow Reports to MDGs in India
„
Goal 1: Eradicate Extreme Poverty and Hunger
-Biraj Patnaik
21
„
Goal 2: Achieve Universal Primary Education
-Anjela Taneja
34
„
Goal 3: Promote Gender Equality and Empower Women
-Wada Na Todo Abhiyan and Partners
43
„
Goal 4: Reduce Child Mortality
-Save the Children India
54
„
Goal 5: Improve Maternal Health
-Jan Swasthya Abhiyan
60
„
Goal 6: Combat HIV/AIDS, Malaria and other Diseases
-Jan Swasthya Abhiyan
67
„
Goal 7: Ensure Environment Sustainability
-Indira Khurana, WaterAid India
74
4
Preface
The dichotomy that exists in India has been a subject of debate for many
development practitioners and sociologists. On the one hand, while the Indian
economy continues to register an impressive and consistent growth at an average
rate of 7 to 8%, it is still grappling with age-old issues related to poverty, gender
discrimination, education etc. According to a 2005 World Bank estimate, 42% of
India falls below the international poverty line of $1.25 a day. According to the
criterion used by the Planning Commission of India 27.5% of the population was
living below the poverty line in 2004–2005. A study by the Oxford Poverty and
Human Development Initiative using a Multi-dimensional Poverty Index (MPI)
found that there were 421 million poor living under the MPI in eight north India
states of Bihar, Chattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar
Pradesh and West Bengal. This number is higher than the 410 million poor living in
the 26 poorest African nations. It is not just the issue of poverty alone, India is still
battling with other issues of maternal and infant mortality rates, undernutrition,
gender inequality etc. India has among the worst infant and child mortality figures
in the world with a high infant mortality rate of 57 per 1000 live births and an
under-five mortality rate of 74.3 (National Family Health Survey-3, 2005-06.
What is particularly disappointing is that these figures continue to be with us even
after we have adopted the Millennium Development Goals (MDGs) years back. In
the year 2000, MDGs were welcomed with great enthusiasm as it was widely
believed that these would make the governments more accountable and
committed to address these issues. However, a review of these goals after ten
years casts a gloomy picture as we continue to grope in the dark with issues of
poverty, maternal and infant mortality.
Those who are aware of the complexity of the unique socio-cultural dynamics of
India have consistently maintained that MDGs, in themselves, do not make an
antidote it its larger structural issues. It is primarily because the right based
dialogue and articulation is absent in MDGs as they do not speak about people’s
right to work, food, natural resources etc. Hence there is fairly a general
agreement and consensus that India requires a broader, comprehensive and indepth framework to look at the issues of development of this country. In the
absence of such a framework, MDGs do have a specific and unique role in India’s
development.
However, despite the ‘limited’ objective of the MDG’s, even these ‘limited’
bechmarks have not been addressed by the successive governments as is evident
from the recent developments of Special Economic Zones, mining and other
initiatives rooted in neo-liberal ideologies. It can be categorically stated that
MDGs in India has consistently suffered from a clear lack of political will and
systemic issues.
Given the fact that we are left with only five more years to meet these targets, the
need of the hour is to have a paradigm shift in perspectives, priorities and
prerogatives. We need to place a sharp focus on these targets to bring them to a
satisfactory conclusion. There is a need to harness all the energies together and
put them behind these targets with clear and unambiguous political will. Secondly,
5
unless governments in power do not have the courage and will to relook at the
entire framework like, Mahatma Gandhi National Rural Employment Guarantee
Act (MNREGA), right to food and other right based entitlements of citizens, there
is little scope to come somewhere close to the targets, leave alone meeting the
deadlines. Those in power should be willing to provide a constructive space for all
the stakeholders like civil society and other state actors to engage in the dialogue
of development. Finally, what is needed is a paradigm shift in the realm of policy
direction which is rooted on the human rights perspective.
We have been disappointed with the India Country Report on MDGs 2009. It has
been a mere statistical exercise without any consultation with the stakeholders. In
this context, we are bringing out an alternative report of MDGs in India. The
outputs to this report have been provided by the different consultations on MDGs
held across the country. Various thematic experts engaged in the concerned fields
too have given their valuable contribution towards this report.
The intent of this report is not just to monitor the MDGs in India, but also to
challenge the MDG review process. We believe that this would open up windows
of opportunities for a substantial engagement between governments and civil
society. As mentioned earlier, the need of the hour is to have a paradigm shift in
the areas of policy making and implementation which would eventually lead to a
constructive mechanism and space to seek the solution that we have been looking
for.
We remain indebted to all our partners who extended their valuable support in
terms of organizing national consultations across the country and we also record
a word of gratitude to all those who took the pain to pen down their perspectives
and thoughts on MDGs in India. In this context, we would like to make a special
mention about the contribution of Mr. K. R. Venugopal who was formerly the
Secretary to the Prime Minister and Special Rapporteur, National Human Rights
Commission. His review of the MDGs in India is quite comprehensive and we
believe this would be an asset to all those concerned policy makers and
development practitioners. We also thank Biraj Patnaik, Anjela Taneja, Renu
Khanna, Save the Children India, Jan Swasthya Abhiyan and Indira Khurana,
WaterAid India, for sharing their valuable insights with us to complete the report.
6
2. A Comprehensive Review of the
Millennium Development Goals in India
-K. R. Venugopal
Introduction
eighties like BIMARU states (an acronym I do not
personally like) would testify. The reason why there is
need to hark back to the past is to show that nonachievement of the MDG targets can not be justified on
the basis of a so-called limited window of opportunity,
in terms of time.
This India Country Report 2009 is a mid-term statistical
appraisal. Statistics do not always tell us everything and
this the Report acknowledges in saying that “the
available statistical evidence in terms of measures of the
outcome indicators of the MDG frame work is not all
that current for most of the targets”. The Report also
acknowledges that unlike the previous two reports, it
does not speak of the programmes that are part of the
strategic plans of governments at different levels to
meet the over-arching objectives of the MDGs. It needs
to be said at the outset that there cannot be a
meaningful appraisal of the achievements or the
projected path towards targets without a reference to
at least the most important among programmes.
Further, while critics are always familiar with faults in
implementation, often the point is missed that a policy
itself can be so faulty or inadequate that it does not lend
itself to proper or adequate implementation. So we
have to look not only at implementation issues but also
at policy to identify why outcomes do not happen the
way they should and what could be done. This paper
does not do this at length but mentions the ICDS as an
illustration, in a small way.
Goal-1: Eradicate Extreme Poverty and
Hunger.
Target 1: Halve, between 1990 and 2015, the
proportion of people whose income is less
than 1 dollar a day.
The Country Report says the according to the Planning
Commission the incidence of poverty declined to 27.5%
in 2004-05 from 36% in 1993-94. The Report states
that the reduction of 8.5 percentage points from 199394 to 2004-05 is estimated by the URP method.
According to the alternative MRP method of
consumption distribution, the decline was 4.5
percentage points from 1999-2000 to 2004-05. The
Report concludes that according to the MRP India is on
tract with respect to the target of halving the
proportion of people below poverty but that, however,
by the URP method India is slightly off tract. The URP
trend rate of decline is 0.8% during 1993-04 to 200405. The rate of decline based on thin sample estimates
of consumer expenditure for the year 2005-06 is 1.4%.
If the improvement in the rate of decline in poverty as
observed during 2004-05 to 2005-06 is maintained in
the subsequent years or further improves, the Report
expects that India will achieve the 2015 target. The
Report also adds that to achieve the target of 18.6 % of
poverty headcount ratio (PHR) by 2015 with reference
to 1990 base year PHR of 37.2 %, India has to achieve a
PHR of 22.09 % by 2010-11.
The Country Report claims that “with the emphatic
shift to larger social sector investments in the Tenth
Plan that started in 2002, followed by an enunciation of
a political agenda of social development by the
government in the year 2004 to achieve ….. targets
(which over ached the MDGs), the development
process in India was left with just 10 more years (sic) to
reach the MDG targets,” set for 2015. This is both
defensive and self-serving because programmes related
to poverty, hunger, primary education, child and
maternal morality, malaria, drinking water and
sanitation precede the Tenth Five –Year plan by several
years. The Report rightly makes essential reference to
some of the strengths and many of the weaknesses at
the “sub-national” level through its findings, as also to
the urban–rural divide and the gender divide. Again,
however, it would bear mention that these are not new
as many of us familiar with the acronyms of the late
The first point that needs to be made is that the
Report reflects on information that is outdated. In its
issue of December 19, 2009 the Economic and Political
Weekly (EPW) editorially reported that the Expert
Group to Review the Methodology for Estimation of
Poverty set up by the Planning Commission chaired by
Suresh Tendulkar has revised the estimate of poverty
7
certain minimum entitlement of food grains in the PDS
under the proposed National Food Security Act, 2010,
the Planning Commissions figures (quoted in this Midterm Statistical Appraisal) have been questioned by
every thinker in the country. Nobody has taken these
figures seriously. The Arjun Sen Gupta-chaired
National Commission on Enterprises in the Unorganised Sector (NCEUS) estimated that 77% of the
people in the un-organised sector live at wages below
Rs.20 a day. Incidentally, this puts paid to the
contention of the Country Report that in view of
diversity in consumption pattern and heterogeneity of
market prices across the country and non-availability of
an acceptable PPP index for different regions of the
country, compilation of the proportion of people
whose income is less than 1 dollar a day is not plausible
in the Indian context. The NCEUS estimate constitutes
836 million Indians or 77% of all our people as living in
poverty. Dr N C Saxena has estimated that the person
living below the poverty line is around 50 % of the
population. The Planning Commission figures quoted in
the Country Report are nowhere near these.
Therefore, the projections made in this Mid-term
Statistical Appraisal can not be the basis for determining
that the poverty population of India would be halved by
2015 compared to what it was in 1990. In fact with
poverty standing at 37.2 % in 2004-05, we have to
recognize that poverty actually rose and that it takes us
back to the base year figure of 37.2%. With rural
poverty estimated by the Tendulkar Committee for
2004-05 at 41.8%, the position is actually pretty
precarious.
in India for 2004-05 to 37.2 per cent from the earlier
official estimate of 27.5 per cent. For rural India it has
been revised to 41.8 from 28.3 % though the
Committee has not revised the urban poverty estimate
for that year at 25.7 per cent. We have to go by this
revised figure because the Committee of the Planning
Commission has rightly redefined the norm on which
future poverty measurement is to be based, moving
away from the limited emphasis laid so far on calories
and recognizing that poverty is more than bare food
needs. There are other goods and services the poor
need and do aspire for. The Expert Group’s intention,
says the EPW editorial, is that this “is to be the
standard of living that defines the current (officially
accepted) cut-off between being poor and non-poor in
urban India taking into account the consumption of all
goods and services”. While this has been recognized
for urban estimates of poverty even now, in regard to
rural poverty measurements the estimates had
remained too low “in terms of the normative
requirements of food, education and health”. Thus the
Tendulkar Committee is rectifying an error arising
from discriminatory standards in measuring rural and
urban poverty.
We have to recognize this and go by the revised
figures of poverty given by the Tendulkar Committee
which are much higher, in reviewing the MDGs. Any
argument to the contrary that we may be comparing
measurements based on different norms applied in
1990 and at present should be rejected because the
objective of setting up goals is not to delight the
statisticians but to look where poverty truly stands in
India. Not only that. How to understand poverty as it
should really be so that measures are initiated as
appropriate to various sectors is the substance of any
poverty statistics. I am saying various sectors because
the Millennium Development Goals speak not only of
poverty in general terms of general numbers but also
in terms of certain health goals and indicators such as
IMR, MMR and under nutrition of the child and
education. These goals and indicators are all related
and therefore if we do not correct the way we
measure Poverty Head Count Ratios, we would only
be endlessly groping in the dark as to why if poverty is
declining as we are made to believe while several
related parameters like the health indicators are
deteriorating.
As for the rate of reduction referred to by the Midterm Statistical Appraisal, we all know that millions of
people tend to go below the poverty line in years of
drought like the year 2009-10 when the monsoons
failed and agricultural production dipped. Further, the
Inflation figure for May 2010 was 10.2 % over the year.
In June 2010 inflation rates showed that food articles
as a group had risen by 16.5 % and food grains close
to 10 %. To this we should now add the fuel prices
risen by 13 %, as pointed out by an editorial in the
Hindu on the 16th June 2010. These figures were the
highest for 19 months prior to June 2010. In a
scenario like this to predict that the rate of poverty
would decline at 1.4 % just because the rate of decline
based on thin sample estimates of consumer
expenditure for the year 2005-06 was 1.4% and that
this could even improve in the run up to the year
2015, is a hazardous guess. Even at that rate there is
no way the targeted 18.6 % would be reached by 2015
Against this background, it needs to be pointed out that
in the context of the estimates being made of people
living below the poverty line for the introduction of
8
in the light of the revised estimates. In this view there
is no way that the PHR would he halved to 18.6 by
2015. The Mid-term Statistical Appraisal also makes a
reference to the need for India achieving a PHR of
22.09 by 2010-11 if this target has to be achieved by
2015.
The Tendulkar Committee revising its
estimates of poverty to 37.2% clearly shows that
instead of moving towards a reduction in PHR the
country is moving in the opposite direction. Against a
level of poverty projected by the Tendulkar
Committee of 41.8% for rural India and 25.7% for
Urban India, all the discussion in the country paper
needs to be turned on its head and new projection
paths need to be worked out. It would be in order for
us to call upon the Central Statistical Organization to
rewrite the chapter on reduction of extreme poverty
and hunger.
of the poorest of the poor nor India’s poverty
strategy reduced inequalities.
Target-2: Halve, between 1990 and 2015 the
proportion of people who suffer from hunger.
The Country Report acknowledges that “at the official
natural poverty lines at 2004-05 prices of Rs. 356 per
capita per month for rural areas and Rs. 539 for urban
areas, the calorie intake works out to be about 1820
Kcal for both rural and urban areas, which is much
below the 2100 / 2400 kcal for healthy living or food
security.” It also acknowledges that consumption
expenditure surveys reveal that the NSS results show
that calorie consumption of the bottom most quartile of
per capita expenditure in rural India has consistently
declined since 1987-88, from 1683 kcal to 1624 kcal in
2004-05. The proportion of population that has dietary
energy consumption below 2100 / 2400 kcal has tended
to rise since 1987-88 with about 64 % below the norm
in 1987-88 increasing to 76 % in 2004-05. The Mid-term
Statistical Appraisal Report refers to the NFHS data
relating to the under nourishment indicator in MDG 1
namely, the “prevalence of under weight children”, and
concludes that going at the present pace of change India
is likely to have 40.23% of children below 3 years under
weight in 2015 against the target proportion of 26.76%,
falling short by about 13% points. This short fall is huge.
As for the states, Punjab, J & K and Tamil Nadu would
achieve their targets of halving their 1990 proportion of
under weight children earlier than 2015 in that order.
“The rest of the States are mostly lagging behind in
following the desired rate of decline” to attain the target
of halving by 2015, says the Report. The Report claims,
however, that A.P, H.P., Karnataka, Maharashtra,
Manipur, Mizoram and Tripura should be considered to
be on track to achieve their targets as they may fall short
by 5 percentage points, “which is within a feasible range
of closing up.” This optimism of the Report emerges in
regard to the three major States in the category though
the trend relating to the projected proportion “tends to
move in a slightly jagged path having very little decline
during 1998 and 2005 compared to the preceding
period of 6 years.” It must be stated here that this is a
strange observation in regard to expectations for the
future. The expectation that a short fall of 5 or less
percentage points is within a feasible range of closing up
and that states which have departure from the target
level of not exceeding 5 percentage points may be
considered to be on track for achieving their 2015
targets is an optimistic expectation that is thoroughly
unjustified. This can be illustrated if we take Andhra
In the light of this newly emerging picture, the
conclusions arrived at in the Country Report, apart
from their validity, render the picture even grimmer.
These conclusions are grim because even the states
on the so-called fast track to halve their poverty
levels, are comparatively small in their geographic
size and population; the major states of Bihar, Delhi,
Haryana, MP, Maharashtra, Orissa and UP and the
newly carved out states would all miss their targets
for 2015, some by big short falls; these major states,
the most populated and in the heartland of India,
have always had uneven development in almost all
socio-economic sectors and therefore they have to
be brought on track through accelerated measures
against poverty; that the “on-track” states saw a
higher decline in urban poverty rather than in rural
poverty contributing to the over-all grim rural-urban
dichotomy of poverty. Kerala is an exception to this
but within states and, therefore, within India the
rural-urban dichotomy poses huge challenges in
strategy terms. As the Report rightly observes, rural
and urban poverty ratios run parallel to each other.
Regardless of the optimism based on the premised
data, the Report states with certitude that the most
deprived may not rise above the poverty line by
2015. That certainty is an understatement
considering that the Report finds that the Poverty
Gap Ratio is so adverse as to show that the shares
of the poorest quintile in national consumption for
rural India declined from 9.6 to 9.5 over the period
1993-94 to 2004-05 and for urban areas it declined
from 8 to 7.3. Obviously, the anti-poverty
programmes have not helped in reducing the misery
9
Pradesh as an example. Now, it would be straining
credibility if it is argued that Andhra Pradesh is a
nutrition deficit state in terms of food and nutrition
resources available to it overall, but yet it is amongst
one of the worst performing in regard to children who
are under-weight and stunted.
Pradesh. But the trend in decrease in Andhra Pradesh,
The National Family Health Survey (NFHS-3), 2005-06
shows that for all India the percentage of children under
age-3 who are under weight for their age is 46, only 1
percentage point less than the figure for NFHS-2 of the
5 percentage points, is much slower than that of all
India, 8.
In rural India, the percentage of children under-3 who
are stunted is 40.7; those wasted is 19.8; those who are
under weight is a whopping 49. The percentage is a high
36.4 in urban India for under-3 children who are under
weight.
These are strikingly unflattering truths for
the State of Andhra Pradesh that has no
dearth of nutrition resources.
year 1998-99. This alarming trend is similar in Andhra
Pradesh, although at a lower level (37%). If this trend is
to continue the Millennium Development Goals of 27
for India and 24 for Andhra Pradesh will not be
achieved in time.
Therefore, it is necessary to state that this Country Report
does not take into account the realities about performance
in regard to indicators at the sub-regional level.
It is also important to refer to the Report’s own
conclusion that “the number of States having 40–50
percentage of under weight children has increased from
8 in the year 1998-99 to 12 in 2005-06”. This is a clear
proof of a period of 7 years ill-used, which could have
been used to change the profile of the 0-3 population
twice over. This conclusion yet again reminds us of the
failure of the Indian State on a broad front in important
indicators that over-arch poverty eradication efforts of
which hunger is the first threshold.
If this is alarming, the proportion of children under-3
who are wasted (too thin for height) has increased
compared to NFHS-2 by 3 percentage points for all
Strategies
Poverty and hunger are inter-connected. While this
note is not designed to go into a socio-economic
analysis of all poverty it is inevitable that a basic and
general observation needs to be made in regard poverty
strategies in the context of Goal 1 of the MDGs. That
observation is that hunger which is the first threshold
of poverty needs to be tackled directly, that is, hunger
should be dealt with qua hunger regardless of the other
dimensions of poverty, if poverty itself has to be
comprehensively addressed. The other dimensions of
India to reach 19% and by 4 percentage points for
Andhra Pradesh (13%).
The figure for children under 3 who are stunted (too
short for age) is 38% for all India and 34 for Andhra
10
poverty in a household that make for the larger issue of
poverty can be dealt with only after hunger, the first
dimension has been tackled. Thereafter, that is in
parallel, poverty can be addressed successfully through
other strategies like micro-enterprises and other
avenues of self- employment in agriculture or off farm
avenues etc. This is because hunger-induced insecurity
leads to risk-aversion which defeats strategies like
credit-based self-employment programmes designed to
fight poverty. There are also categories of the very poor
like the old, infirm, widow and single women headed
families and the disabled, who would need to be
provided food free. Even in wage employment
programmes we need to build in a food wage
component to make the wage real and a living wage, as
mandated by our Constitution. Therefore, all poverty
strategies, especially in rural areas would need to build
in a food component that is free where required, and
appropriately subsidised elsewhere, depending on wage
levels. It is the same hunger that results in other
manifestations like under-weight children.
the sum total of the entitlement that a poor
household would access through its entitlement
in all the food and nutrition related schemes
that the Government implements or proposes
to implement. Therefore the strategy should
include all the food and nutrition-related
schemes as also schemes where the potential
exists for the use of essential commodities (like
in the MGNREGA) together and examine how
much a poor household would access through
all these programmes through organically
integrating them at the delivery level. Some of
the most important programmes relevant to food and
nutrition security are the employment ingredient in
the Mahatma Gandhi National Rural Employment
Guarantee Programme (MGNREGA 2005); the
Targeted Public Distribution System (TPDS); the
Integrated Child Development Services (ICDS)
programme; the Antyodaya Anna Yojana (AAY) and
the Annapurna scheme; and the Mid Day Meal (MDM)
programme. For guaranteeing food and nutrition
security to the poor, for a start, we can build on the
base that these programmes provide, but it must be
recognized that none of these programmes can
stand alone and be expected to deliver food or
nutrition security; that some of these
programmes need to be drastically overhauled;
and that all these programmes have to be
viewed as complementing one another so that
necessary linkages are created to make food
and nutrition security a reality in terms of
quantity and quality. It is important to add that
all these programmes need to be predicated on
adequate, decentralized production.
Importantly, the point needs to be made that food
security is not the same as nutrition security and that
when we talk of poverty reduction in the 21st century or
reduction in MMR, IMR, and under-5 mortality we should
make sure that nutrition security is also included in what
we are attempting to do by way of poverty strategies.
We need certain changes in fighting of hunger and
ensuring food security. Nutrition security is the whole
while food security is a part of that, and therefore a
food security law or poverty strategies contemplated
should really aim at food-cum-nutrition security rather
than merely food security. We are fortunate that we
already have in some of our existing laws and
programmes the ingredients addressing these
concerns at least at the conceptual level even if not in
the manner in which we have been implementing
them. It is also worth noting at the outset that
an important strategy for defending and
expanding the rights of the poor in any scheme
that seeks to guarantee a particular right is to
fine-tune it to the other related schemes in a
manner that all related schemes pull together
all the rights that govern all the participants in
such schemes. Such a synergy will guarantee all
rights essential to the poor, each right
reinforcing the other. Food and Nutrition
security is no exception to such a synergy. In
fact the most important paradigm that should
govern efforts that guarantee food-cumnutrition security is to define such security as
If such strategies are not followed neither poverty nor
hunger would get halved as proposed in the MDGs.
The emerging architecture can be represented by the
diagram below:
11
It may be mentioned that this diagram embraces all the
needs of hunger, child under-nutrition, issues that
impinge on maternal mortality, sanitation and safe
drinking water which together constitute the core of
the MDGs. By implication what this also means is the
failures of the Indian State to reform these programmes
where needed and implement them properly so that we
did not find ourselves in a position of being nonachievers of the goals relating to these. I suggest here
the reforms needed in one programme that is fully
relevant to Goal 4 of the MDGs, namely, the
Integrated Child Development Services (ICDS)
programme.
nutritive values of the foods required by the
pregnant and nursing mothers and the 6 months to
6 year children. “Coarse” cereals and millets have
an exceptionally significant role in this.
3. Ensure regular supply of Vitamin A and Iron
and Folic Acid to pregnant women and
adolescent girls as this is fundamental to the
woman’s and the child’s nutrition security.
Its absence compromises safe pregnancy and
causes irreversible birth defects. Non-supply or
short supply to the Anganwadi Centres of Vitamin
A, Iron and Folic Acid, medicines, referral slips, and
inadequate identification, check-up, and follow-up
of children with disabilities, all of which is now a
common failure in the ICDS must be addressed
afresh.
Given its objectives, it is not enough to talk of the
universalising of the ICDS as we have been doing since
1985. A Government policy resolution approved by
Parliament needs to be put in place accompanied by a
time-bound programme of action the time frame being,
say, 5 years, with another 2 extra years for bringing into
operation the last of the ICDS projects established at
the end of these 5 years so that in about 7 years we will
have covered the entire country with Integrated Child
Development Services. However, the following
minimum reforms need to be carried out in the
programme before we universalise the ICDS:
4. The issues relating to the Cold Chain in
Immunization in the ICDS, such as the entire
logistics relating to movement of vaccines over long
distances from the source of manufacture to the
Anganwadi Centres over several stages, and how
we ensure that the vaccines do remain potent till
the time of their administration to the child and the
pregnant woman require to be addressed.
5. The specific responsibilities to be discharged
as between the Health and ICDS
functionaries in regard to Immunization; NHE;
health check-ups; referrals; ORT; distribution of
Vitamin-A; distribution of Iron and Folic Acid; and
dispensing medicines for minor ailments need to be
reviewed and fresh mandates laid down.
1. What the ICDS needs today is not the
limitedly conceived Anganwadi Centres, but
crèches that provide the services for 8 to 9
hours, six days a week, with special emphasis
on delivering services to the crucial 0-3 year
cohort, a cohort that hardly benefits today
from the ICDS in any worthwhile manner.
This age is most crucial and relevant for nutritional
and stimulation purposes from the point of view of
the child’s brain development. How a crèche is also
a real help to the rural working woman labourer
has already been explained in the section on the
MGNREGA. Enhanced manpower, infrastructure
(in building which MGNREGA resources should
play a part) and levels of nutrition would be crucial
for this reform.
6. Issues relating to the mode of recruitment,
remuneration, discipline, service conditions
and motivation levels of the AWWs and
helpers need an immediate review.
Anganwadi Workers’ non-residence in the village
and absence of home visits would need to be
addressed. All aspects relating to the adequacy of
their training and how to strengthen it would need
to be addressed. These issues affect the goals and
objectives in the ICDS programme relating to
nutrition security.
2. The supplementary nutrition served must
have to be locally and culturally relevant
which means that ready-to-eat foods of any
sort transported over long distances, which
among other defects is also a source of great
corruption, must be removed from the
programme altogether. The supplementary
nutrition served must be cooked from locally
available food materials, keeping in mind the
7. The issues pertaining to the practice of
“taking home” of the supplementary
nutrition by pregnant and nursing women need to
be addressed so as to determine whether this is a
nutritionally desirable policy at all, and if yes, the
safeguards that need to be followed.
12
8. Strengthening of the Adolescent Girl
programme including her nutrition as her
health, training and involvement are
essential so as to have this programme
implemented properly and universally in
every village.
of gender equality in primary, secondary and tertiary
educational enrolment by 2015 and getting in full the
effects of such equality on women’s participation in the
labour markets of industry and services. So parity by
2015 would be out of question in numbers or wages in
the non–agricultural sector. The rate of change in
respect of share of women in wage employment in the
non-agricultural sector has been about 2 percentage
points over a period of 5 years in the recent past. At
this rate women’s share at best may reach 24 % by
2015. Market dynamics and existing socio-cultural
frame work would make greater reach difficult.
9. Growth monitoring and Nutrition and
Health Education must become dominant
themes in the ICDS and involve men folk so that
best nutrition practices get internalized by every
member in the household - man, woman, and child.
10. Use of MGNREGA resources for infrastructure
building in the ICDS.
This assessment in the Country Report is not off the
mark.
Monitoring of Hunger
Writing on this issue Nisha and Ravi Srivastava (EPW
July 10, 2010) point out that while economic factors
principally determine men’s participation in
employment, “forces that influence women’s
participation in work are diverse and include
demographic, reproductive, social, religious and
cultural factors.” Work participation rates (WPR) in
rural areas are highest for scheduled tribes and
scheduled caste women and the lowest for “other”
caste women. These categories are poor and have no
choice and no social taboos and hence work, where as
the converse is true for women from “other” castes. As
regards levels of education, for male workers education
is associated with higher WPR in both urban and rural
areas. It is the other way for women because illiterate
women have a higher WPR than women with higher
levels of school education, a trend reversed only for
women with technical or vocational education or
graduates.
To eradicate hunger, monitoring of the hunger status of
individual households village-wise in hunger prone
areas and computerising the data pertaining to
household hunger should be done as a baseline and
benchmark. Such hunger monitoring is not taking place
in India, though there is no dearth of hunger atlases.
This monitoring will help watch closely and
easily the developing hunger situation anywhere
including of migrant families so we can intervene
with relevant measures at very short notice. Such
monitoring should lead to measures discussed in this
paper for overall food security, but short-term
strategies like opening of nutrition centres at
the shortest possible notice should be part of the
policy in ushering in the Right to Food, so that
response to a sudden crisis is swift and averts mortality.
Goal – 3 : Promote Gender Equality And
Empower Women
In 2004-05, 39 % of illiterate rural women were
employed, but only 25 % of rural women who have
passed higher secondary. The reason is, as already
explained above, restrictive social norms operating for
women and also availability of fewer jobs for them. The
gender gap, in urban areas, however narrows if women
have better educational qualifications. Workforce
participation shows a consistently declining trend with
rising economic status for rural women. While for
urban women also this is true, it rises with the highest
consumption deciles, reflecting association of higher
educational attainment of women with higher incomes
and greater availability of employment in urban areas.
Target 4: Empowerment of Women – the
third Indicator
The third important indicator for target 4 under MDG
3 is “share of women in wage employment in the nonagricultural sector”, defined as the share of female
workers in the non-agricultural sector expressed as a
percentage of total employment in the sector. This
would measure the “degree to which labour markets
are open to women in industry and service sectors,
which affects not only equal employment opportunity
for women but also economic efficiency through
flexibility of the labour market, and, therefore, the
economy’s ability to adapt to change.”
In the rural areas, wages are higher for men in all
categories of employment, the disparity being highest
for regular workers in non-agriculture (ratio being 0.57
The Report points out that there will be a time lag
between achieving the over all target of universalisation
13
%). Among casual labourers only 10 % are in nonagriculture compared to 29 % of men. A very low
proportion of women are in regular work, where
employment is secure and wages are high. Thus the
significance of non-agriculture lies both in availability of
more opportunities and better wages.
held to the Lok Sabha, representation of women has
fluctuated between 8 % to 12 % of the strength of the
lower house. In the current Lok Sabha, in a house of
545 numbers, there are 59 women constituting a
percentage of 10.8. As of 27-01-2010, in the upper
house or the Rajya Sabha, of the 234 members 21 were
women, accounting for 9 % of the total membership.
Taken together, the over all percentage of lady
parliamentarians stands at 10.3 %.
We can sum up the over-all picture and the policy
action required in the words of the authors themselves:
“All types of non-agricultural work require, on
average, relatively more education and some degree of
autonomy. The more valued jobs require a greater
quantum of these……….These variables also
determine variations in women’s participation in the
more valued jobs outside agriculture. The poor status
of rural women in terms of their autonomy and control
over assets… …and low levels of education and
employable skills call for interventions of a promotional
nature from different entry points. First, a higher level
of education and employable skills for women workers
is a sine qua non for improving their levels of
productivity and enabling them to move into nonagricultural vocations. The emphasis on universalizing
elementary education has undoubtedly narrowed the
enrolment gap between men and women but given the
low levels of education and employable skills, and the
gap between men and women workers initiatives
should also focus on the existing work force (emphasis
added). A break point occurs when women and men
acquire a higher secondary level of education, enabling
them to enter higher quality jobs”. Further, “women’s
autonomy, measured in terms of access to land and
control over its operations, as well as mobility and the
willingness to join self-help groups, affects their ability
to access resources and improve productivity, and also
to move into non-agricultural avocations. Such
autonomy responds to a complex set of social factors.
But policy initiatives can move the frontiers outwards
and can improve women’s access to knowledge,
technology and resources, empowering them as
economic agents”.
We note that since the year 1991, this constitutes the
highest percentage of representation for women in the
Indian Parliament. However, at 10.3 %, this is not good
enough for a country that has had a woman Prime
Minister 4 decades ago and which currently boasts of a
woman President. In a manner of speaking this poor
representation reflects the general position of Indian
women in Indian society in regard to almost all
indicators. Any discussion on women’s representation
in the Parliament can not be complete without a
reference to the efforts at reserving seats for women in
the Lok Sabha. A reference to this issue as it has
developed over the years would show both a desire to
enhance women’s representation in Parliament on the
part of most as also the complicated nature of achieving
this objective. There have been several bones of
contention in this debate but the chief of them is the
demand on the part of a few political parties, mainly
regional ones, that such reservation mooted at 33 % of
the total number of seats, should also provide for a
reservation within this over all reservation for scheduled
castes, scheduled tribes, minorities and other backward
classes (OBC). This debate has been so contentious
and inconclusive that it has raged over a period of 14
years. Eventually, a Constitution amendment bill to
introduce 33 % reservation for women in Parliament
and the State legislatures has been introduced in the
Rajya Sabha and has also been passed but this has to be
passed by the Lok Sabha as well. The bill does not
provide for reservation within reservation. There is
considerable force in the arguments of both sides –
those who want the bill to be passed as introduced and
those who want reservations within the 33 %
reservation for women. While the proponents of the
bill argue that the 33 % general reservation for women
would help break the “patriarchal hold” on the nation’s
politics, those who advocate reservation within
reservation argue that unless such a provision is made,
upper class and upper caste women would corner
these reserved seats to the detriment of the women of
the marginalized classes. In the opinion of this writer,
the latter fear is a valid fear and therefore a valid
Women’s representation in Legislative
bodies.
The Country Report makes a reference to India’s
democratic credentials and the fact that Indian women
have always had the right to vote in elections ever since
India attained her freedom, with equal right to get
elected to the country’s national Parliament and the
State legislatures. Without a comment, the Report
states the fact that in the 15 general elections India has
14
The Report points out that IMR is also included for
tracking in the context of the U5MR target to be
achieved and finds that figure to be 53 in 2008, declining
over a period both for males and females, though more
pronounced for male than for female. For IMR,
India’s target for 2015 is 26.7, but this will come
down only to 46 given the rate of decline from
the base year to 2007. Thus the IMR target is not
going to be achieved.
argument. The counter argument of the proponents of
the bill as introduced is that this can be obviated if only
principles of social justice were honestly applied by all
political parties in the choice of the candidates fielded in
the elections. The right solution, however, appears to
be not to leave such a choice to self –serving politicians
who decide on “ticket” distribution in political parties
but to mandate it in the Constitutional amendment
itself by providing for reservations for the marginalized
castes with in the over all reservation of 33 %. In any
event, this issue needs to be sorted out by the political
parties for the urgent reason that the presence of at
least a third of the total number of parliamentarians and
members of the State legislatures as women would help
in the public and legislature focus, on women’s rights
such as those relating to land, employment, property,
education, health, declining sex ratios, female IMR,
MMR, domestic and other violence, sexual harassment
at the work place and a host of other issues that
adversely affect women’s dignity and equality and
therefore their empowerment.
The Report pinpoints the need for the usual laggard
States to pull their socks up. In addition it emphasizes
the need for comprehensive improvement with
particular respect to early neo-natal deaths, that is,
deaths occurring to newborns within 7 days of life. Early
neonatal deaths constituted 51.6% of total number of
infant deaths in 2007. The share of neo-natal deaths
(deaths within the first month of life) is 65.5% of total
number of infant deaths in 2007. Early neonatal deaths
have not declined during 2001-2007 in some of the
states like Chattisgarh, H.P., Rajasthan, U.P., and Orissa
and for some of them actually are on the rise. On the
whole infancy deaths constituted 17.2 % of total deaths
in 2007.
Goal – 4: Reduce Child Mortality
Target 5: Reduce by two thirds, between
1990 and 2015, the under-5 mortality rate.
In IMR also gaps exist between female and male infants
and this trend of infant girls of being at greater risk will
continue to 2015. Among all the bigger states, female
infants experienced higher mortality except in Madhya
Pradesh and Delhi. This the Report highlights as
contrary to the universality of higher mortality risk for
male infants compared to female infants. The IMR ruralurban gap is substantial at 22 points in 2008 (58 – 36),
despite decline since 1990. For India to achieve it’s over
all IMR targets, says the Report, rural IMR should
decline to 28.7 in 2015 and urban IMR to 16.7, which
will not happen. These would rather be 51 for rural and
30 for urban in 2015. This rural–urban divide is also
pronounced in female and male IMR.
The target to be achieved under this head is 42 per
1000 live births by 2015. The Country Report says
that the trend for projecting estimates for 2015
suggests that India is likely to fall short of the
U5MR level of 42 by 28 percentage points. This is
based on estimates from NFHS – I, II and III considered
along with the Abridged Life Table-based estimates of
the RGI. The NFHS III U5MR is 74.6 per 1000 live births
for 2005-06. Goa, Haryana, J&K, Kerala, Sikkim and
Tamil Nadu, are likely to be early achievers while Delhi,
Gujarat, Himachal and Tripura are just on-track as
these had a U5MR of less than 60 in 2005-06. All other
States tend to be on slow track, with reference to their
U5MR in 1990.
Life in rural India is thus dangerous and particularly so
for the female. The gaps are huge, as the Country
Report shows, in Rajasthan, Assam, Madhya .Pradesh,
Gujarat and Himachal Pradesh.
The Report makes the single most important point in
the entire discourse on achieving the MDG targets
which is that in the matter of national U5MR also a
faster decline as a whole will depend upon very rapid
decline in States, which are the larger ones and more
populous and comparatively lag behind in other MDG
targets as well. There is also the problem that for the
newly formed states of Chattisgarh, Jharkhand and
Uttarakhand data for 1998 – 99 is not available for
present comparison and hence data for their parent
states would have to be the proxy for them.
In the matter of the IMR, only Arunachal and Manipur
are likely to achieve their targets! Even states like Goa,
Kerala and Tamil Nadu, not to mention Maharashtra,
West Bengal and Sikkim, will fall short of the target
though by less than 10 points. The Report makes the
startling point that in Kerala, during 2005- 2007, the
average IMR, compared to average IMR during 1995-97,
showed an increase by 2.9 % due to increase in urban
IMR by 12.8%.
15
Immunization
according to NFHS-3, the percentage of children 12-23
months, who have received all recommended vaccines,
is 44 for all India while it is 39 for the rural areas. Taking
a “progressive southern state” as example, we find that
in Andhra Pradesh the combined figure for urban and
rural is 46, the figure for rural areas is 43 which is only
slightly better than the figures for rural India as a whole.
If these figures of NFHS-3 are discouraging the further
bad news, however, is that the trends in vaccination
coverage shows drastic decline compared to the results
of the NFHS-2 survey 1998-99. The NFHS-2 figures for
urban Andhra Pradesh were 73% against 51% according
to NFHS-3. Similarly the vaccination coverage was 54%
The Country Report states that the MDG target
for reducing child mortality does not envisage
explicit target towards universal coverage of
immunization, particularly against measles in
the age-group 12-23 months. It adds that the
proportion of one year old children (12-23
months) immunized against measles is the
prescribed statistical indicator for measuring
the coverage of immunization in the country;
that the national level proportion rose from 50.7% in
1998-99 to 58.8 % in 2005-06 and that this rate of
increase would find India covering 97% of children 1223 months by 2015. It
states
further
that
Table-1
according to DLHS – 3 for
Age of the Child
Name of the Vaccine
No. of Doses
2007-08 coverage had in
By Birth
Oral Polio
0 Dose
fact reached 69.6%. At least
By Birth
B.C.G.
1 Dose
17 states would achieve
1 ½ Month
D.P.T., Hepatitis-B, Oral Polio
First Dose
universal coverage before
2
½
Months
D.P.T.,
Hepatitis-B,
Oral
Polio
Second Dose
2015. Having said this, the
Report emphasizes the
3 ½ months
D.P.T., Hepatitis-B, Oral Polio
Third Dose
rural-urban gap exceeding
9 + Months
Measles
Single Dose
20 percentage points in
9 + Months
Vitamin – A
First Dose
2005-06 in some of the
18 to 24 Months
D.P.T. and Polio
Booster Dose
heartland
states
like
Pregnant Mothers
3 to 5 Months of Pregnancy
First Dose of T.T. Injection
Rajasthan, Madhya Pradesh
Pregnant Mothers
After 1 Month of First Dose
Second Dose of T.T. Injection
and Chattisgarh. This ruralurban gap existed even in
States like Kerala, J&K and Haryana where urban
according to NFHS-2 1998-99 in rural Andhra Pradesh
average exceeded 80%. Given their respective rates of
which declined drastically to 43% according to NFHS-3
coverage, the heartland states of UP, Bihar and
of 2005-06. The overall decline for all of Andhra
Rajasthan would have covered by 2015 only 57 %, 60 %
Pradesh – Urban and Rural – is from 59% from 1998-99
and 43 % respectively of their one year old children.
to 46% in 2005-06. These figures speak for themselves
Against the background of this analysis by the Country
Report, it is necessary to place a few important facts
about immunization on record to restore the true
perspective of immunization for child survival and what
is happening on the immunization front in India. First
and foremost the claim in the Country Report that
“one year old children (12-23 months) immunized
against measles is the prescribed statistical indicator for
measuring the coverage of immunization in the
country” needs to be challenged. Child mortality is
combated by providing immunization to the mother and
children preventing 7 vaccine preventable deaths which
contribute to 33% of IMR. The required Immunization
about the dangerous health security situation for the
schedule is given in Table-1.
children of India and decline in the health security of the
The status of Immunization in regard to all these leaves children of even the so-called progressive state of
much to be desired. As for vaccination coverage Andhra Pradesh.
16
Goal -5: Improve Maternal Health
The rural-urban gap in coverage is also huge in 2005-06,
39.1% and 75.2% respectively.
Target 5: Reduce by three-quarters between
1990 and 2015 the Maternal Mortality Ratio.
Institutional deliveries stood at 47% in 2007-08,
testifying to lack of attendance of skilled personnel at
delivery.
Maternal health is a function of both poverty
eradication and focused food and nutrition security of
all women in the reproductive age including in
particular the pregnant and nursing
However, the Report fails to refer to the failure of
distribution of Vitamin A and IFA tablets to pregnant
mothers in the context of safe motherhood.
Distribution of Vitamin A and IFA tablets has serious
implications for safe pregnancy and constitutes a care
that far precedes the presence of trained or skilled
personnel at delivery. The ICDS programme in India is
specifically designed for this but studies show there is
gross failure in regard to this leading to unacceptably
high levels of anaemia threatening mortality for the
mother. Distribution of Vitamin A and IFA tablets to
pregnant mothers would be an important measure in
reduction of MMR and needs to be monitored as an
indicator. The role of the NRHM in this regard also
would need appraisal.
The Report states that the estimate of MMR it has is
based on those available from SRS – based studies.
These estimates quoted in the Report are that the
national MMR level has come down from 398 in 199798 to 254 in 2004-06, a 36% decline over 6 years,
compared to a 25% decline in the preceding 8 years
from 1990-1997. Therefore, India would reach an MMR
of 135 in 2015, falling short of the target of 109 by 26
points. While leaving any debate on the SRS figures to
experts, it needs to be stated here that according to the
UNICEF’s “State of the World Children 2009” the
MMR for the year 2005 for India was 450. The issue
therefore is we need a clear comparative study
between those two figures of the SRS and UNICEF and
see where the similarities are and where the differences
are and what really is the correct MMR for India.
Goal-6: Combat HIV/AIDS, Malaria and
TB.
However, even going by the figures quoted in the India
Country Report 2009, a 26 points shortfall is a heavy
shortfall. The SRS figures for 2004-06 for Assam,
Rajasthan, UP and Uttaranchal are very high. While the
projection is that Assam, Haryana and Orissa will fall
short of their 2015 targets by heavy margins, UP
(including Uttaranchal), Rajasthan, MP (including
Chattisgarh) and Karnataka will finish 70 – 90 points
short. In Assam and Haryana MMR has actually risen in
the last one decade. Therefore achievement in regard
to MMR has to be looked at in terms of the over all
national short fall of 26 points and also the huge short
falls in a wide range of States covering not only the
North and East but even a Southern state like
Karnataka.
Target 7. Have halted by 2015 and begun to
reverse the spread of HIV/AIDS.
The Report discusses safe motherhood in this context
and refers to the proportion of births attended by
skilled health personnel, though there is no explicit
MDG target for this indicator. It rightly deplores the
fact that by 2015 this indicator will not exceed 62% and
points to this indicator as an important measure to
bring down MMR to the targeted 109. It points out that
all states other than the states of Andhra Pradesh, Goa,
Karnataka, Kerala, Punjab, Sikkim and Tamil Nadu
would experience short falls from universal coverage,
some with huge short falls like Assam, Arunachal
Pradesh, Bihar, M.P., U.P., and Uttaranchal.
(iii) Despite the total number of infected females
declining to 0.95 million in 2007, the percentage of
females living with HIV/AIDs continues to be
around 39 %.
Among the points the Country Report makes the
following are significant:
(i) The prevalence of HIV/AIDs in 2007 in the high risk
groups “continues to portray the concentrated
epidemic conditions in India.” These percentages
rose to 7.2 % for IDU; 7.4 % for MSM; and 5.1 % for
FSW in 2007, compared to 6.9 %, 6.4 % and 4.9 %
respectively the previous year.
(ii) The cumulative number of AIDS cases rose to 2,
63, 423 in October, 2008 compared to 1, 99, 453 in
December 2007.
(iv) The southern states of Andhra Pradesh, Tamil
Nadu, Karnataka and Goa continue to be the major
prevalence area, despite recent declines in
incidence.
(v) New areas have seen rise in HIV prevalence,
particularly in the northern and eastern regions.
17
(vi) A significant number of Injecting Drug Users (IDU)
live with HIV and AIDs in four of India’s biggest
cities – Chennai, Delhi, Mumbai and Chandigarh.
Under-15 category is at greater risk, accounting for
3.8 % of all HIV infections.
makers that loyalty in love is a cardinal virtue; that
sexual activity is not a teen age activity and that sex is
best practised after marriage. The Human Rights
discourse should highlight that the human rights of
women also include the right not to be infected as part
of their right to life as a priority right as it has intergenerational implications. A one-dimensional approach
that only emphasizes mechanical means of protected
sex as a panacea for all evils is bound to fail as evidenced
by the Indian experience.
(vii) Lack of knowledge of currently married women of
India of HIV/AIDs. The Report states that as per
DLHS in 2007-08 the proportion, who have heard
of HIV/AIDs, was only 58.6 %. Knowledge of HIV/
AIDs is much lower among rural women, nonliterate women, scheduled tribes women, women
with low standard of living and young women. 79.9
% of urban and only 48.8 % rural women had heard
of HIV/AIDs in 2007-08, a marginal increase from
78. 5 % and 42% respectively in 2004-06.
On the socio- economic side of this question lies
discrimination against the victims of HIV/AIDS and
studies are emerging about even right to property being
denied to women victims, not to mention their social
boycott by communities giving a new dimension to the
already existing gender discrimination against women.
Combating the disease should include the combating of
discrimination as well as an indicator in women’s
empowerment considering that often the woman
patient is the victim of male callousness.
These findings greatly dilute the “progress” claimed in
the Report in regard to decline in over all numbers; the
spread of HIV/AIDs in the country showing a
downward trend; the prevalence rate of HIV infection
seemingly stabilizing over the last few years; prevalence
specially declining in the major prevalence States of
Andhra Pradesh, Goa, Tamil Nadu and Karnataka and
prevalence falling in a major state like Maharashtra.
Target - 8
Have halted by 2015 and begun to reverse the
incidence of Malaria and other major disease.
One also experiences major statistical problems when
the Report states that the cumulative number of AIDS
cases in India till December 2007 was 1, 99, 453 which
increased to 2, 63, 423 by October 2008. This problem
is based on the doubt whether we gather the data at
such frequent intervals or there is a time lag in
reporting. If the former is the position, then the results
must be considered alarming. Either way, the data
needs to be looked in to.
The Country Report states that while the rate of
incidence of Malaria has declined between 2005 and late
2009, the percentage of deaths of Malaria patients has
not declined, the death per hundred cases being 0.07.
Incidence rate has not declined in Meghalaya, Mizoram
and Nagaland and the major malaria-affected states
include Orissa and Tripura as well. The latest figure
(2009) for Mizoram is 1.43 per hundred cases, while it
is 0.47 for Nagaland, having declined from 2.23 in the
year 2006. Actually, the death rate has gone up to 1.43
in 2009 (in Mizoram?) from 1.12 in 2006. It would also
bear mention that the Report recalls that while in 1976,
when malaria “staged a come back in India” after it had
been “eradicated” in the 1960s, the figure for Malaria
cases had touched 6.4 million for all India. In 2005, the
Malaria cases reported were nearly 1.9 million, which
makes it 30 % of the peak reached in a period of 33
years. The seriousness of this is alarming. This writer
made an investigation in August 2005 in the Paderu
scheduled area of the Vishakapatnam agency of Andhra
Pradesh at the instance of the NHRC into allegations of
Malaria deaths of tribes and found that while there was
a raging fever in the area which accounted for hundreds
of deaths in that area, the State Government kept
denying that the deaths were due to Malaria. The
deaths that occurred there in 2005 were attributed to
Two things clearly emerge from a reading between the
lines of the presentation made in this Report:
(i) The efforts at awareness generation in regard to
HIV/AIDs have significantly failed and
(ii) The law enforcement machinery failed significantly
in regard to detection and cracking down on the
sale and use of drugs.
It would bear mention that with the sexual mode of
transmission continuing to be the major mode, there is
need in addition to awareness generation methods, for
handling sex workers with care, dignity and
consideration and help with their rehabilitation on a
large scale so that these dreaded diseases are fought on
all the fronts that matter most. It would be helpful if the
message gets across to the youth from credible opinion
18
Goal-7 : Environmental Sustainability
the deadly P falciparum mosquito but the Central and
State authorities kept insisting this was not malaria.
When specifically questioned as to what then was
causing these deaths the bland reply was that they were
because of “viral” fever. Once the health authorities
take the stand that some thing is “viral” there is no way
to determine the real cause.
Target 9. Integrate the principle of
sustainable development into country
policies and programmes and reverse the loss
of environmental resources.
The eleventh Five Year Plan 2007-2012 envisages 5
percentage points increase in forest and tree cover by
2012. According to the Country Report forest cover
rose between 2005 and 2007 by a marginal 0.03 %, from
20.99 % to 21.03 %. During this period there was loss of
forest cover in Andhra Pradesh, Arunachal Pradesh,
Chattisgarh, Nagaland and Tripura. The Report refers
to the methodology in assessment of forest cover and
claims that the new technique helps assessment more
acuurately. Such statements and claims can not cover
the fact of near zero increase of forest cover to the
extent of the data we have and loss of cover in some
States that further include Assam, Karnataka and
Madhya Pradesh. As for tree cover assessment,
reference has been made to indirect method of
assessment giving way to direct method of assessment
but the tree cover rose during 2005-2007 by a
negligible 0.03 % of the country’s geographic area. The
bottom line is that the national goal for forest and tree
cover is 33 % of the Geographical area of the country
and in 2007 this cover depending on interpretation as
given by the Country Report constituted any thing
between 22.26 % and 25.25 % of the geographical area
of the country. Given the data provided in the Report
of increasing forest and tree cover in the very recent
years, efforts at sustainability of India moving towards
the norm seem dubious.
It is clear that Malaria is well and alive in these tribal
areas of our country and what is equally well and alive
also is the state of denial on the part of the central and
state authorities. The detailed report of this writer
dated the 20th August 2005 on the outbreak of Malaria
in the Paderu Agency in case No214/1/2005-06NHRC/ Law Division- IV dtd 27-7-05 of the NHRC can
be seen on the website sentinel-venugopal.in
Prevalence of Tuberculosis and mortality due
to it.
The Report mentions that India is the highest TB
burden country in the world accounting for one fifth of
the global incidence, with 1.9 million cases, ironically
the same number as cases of Malaria. The Report states
that the Revised National TB Control Programme
(RNTCP) to detect and cure cases, launched in 1997
covered the nation by 2006 and by 2008 1.51 million
patients had been placed on treatment. The Report also
states that thanks to the “internationally
recommended” Directly Observed Treatment – course
(DOTS) strategy, mortality associated with TB has
declined from a range of 42-44 in the early 1990s to 2627 (check) per 100,000 population. The figures given by
the Annual Global TB Report of the WHO quoted in
the Country Report, however, shows that since 2005
the decline is slower than that in the earlier part of the
decade. At 26 deaths per 100, 000 population in the
year 2007 the mortality rate is high. States such as
Rajasthan, Delhi, Madhya Pradesh, Gujarat, Andhra
Pradesh, Assam, Haryana, Jharkhand, Nagaland and
Uttar Pradesh are the leading TB burdened States and
have a percentage of smear positive cases above the
national average. The smear positive cases percentage
diagnosed from suspected cases examined in 2008
ranged in these States from15 to 19.
As for Carbon Dioxide emissions, the Report states
that fossil fuels contributed 95 % of the total
commercial energy consumed in India with only 5 %
derived from hydro-power, nuclear and renewable
energy. Fossil fuels combustion contributed 91 % of
total Carbon Dioxide emissions, coal accounting for
nearly 62 %. These are all very disturbing figures though
the Report, by providing figures for India’s per capita
Carbon Dioxide emission vis-à-vis other countries, by
implication tries to say that India’s position is better
than certain other countries. Though on paper this is
true the significant difference between us and the other
countries referred to is that we have the largest
number of the poor for any country in the world, who
are already burdened with a variety of environmental
problems, including environmental sanitation of the
kind that has no parallel on the planet. Therefore, it
would be truly odious to live a comparative life in
matters like these.
It would be advantageous to determine to what extent
the nutrition situation in the country, especially among
the poor, as revealed in the data available from NNMB,
NFHS and other sources relate to the incidence of TB
as also the failure to administer the BCG vaccination at
birth because of absenteeism of the health personnel in
rural areas.
19
India’s Carbon dioxide emissions and very negligible
expansion of forest and tree cover and indeed receding
forest cover in several states need to be looked at
together as also the nation’s climate change needs.
Wisdom would lie in diversifying our energy sources
particularly in expanding efforts aimed at soar energy of
which there is no dearth for us. It is to be recalled that
Prime Minister P.V.Narasimha Rao made a big effort to
promote this cause in the 1990s through energizing the
G-20 countries but since then , over 17 years , efforts in
this direction have been at best lackadaisical. There is
on the other hand an over emphasis on nuclear energy
with all the hazard inbuilt in terms of dangers to large
populations, environment and our very national
sovereignty in terms of liabilities as seen from the
dubious Nuclear Liability Act, 2010.
interest readers that this phrase “people-centred
sustainable development” was evolved at India’s
instance and included in the WSSD Declaration of
1993. India cannot betray herself now, seventeen years
after this concept was evolved through its own efforts.
Conclusion
As mentioned in the Introduction it is important that a
Country Report or an appraisal should not be a mere
statistical appraisal. The Country Report should be built
on the basis of reports and appraisal made by the
Ministries and the Departments concerned in
consultation with the States. Such reports which form
the basis for each Ministry or Department should be
critically examined by each of such Ministries and
Departments for outcomes based on verifiable
indicators previously handed down to the State
governments or central agencies. The Central
Ministries and Departments should also call for
comments from the implementers on the validity of the
strategies applied to goals so that decisions can be
taken to determine whether they were successful or
failures and what changes were called for including in
regard to policies themselves. It is obvious from a
reading of the India Country Report 2009 on the MDGs
that these principles have not been observed. The
Report is therefore good in parts.
The short point is that, in the context of this Goal, India
must act in the enlightened self-interest of its own
people, particularly its huge vulnerable masses and not
comfort itself with comparative international data on
emissions or crude GDP growth figures and domestic
and multinational business interests. Social activists
have to put these issues in perspective and in simple
terms before the people of the nation and mobilize
them in the latter’s own interest. Sustainable
development should mean “people-centred sustainable
development” as expounded in the Copenhagen World
Summit on Social Development (WSSD) in 1993. It may
20
Goal 1: Eradicate Extreme Poverty and
Hunger
-Biraj Patnaik
1. Introduction
There is contentious debate in India today, both as to
the level, direction and change in poverty as it is
currently defined, and whether the definition captures
all the dimensions of deprivations suffered by the poor
(Sheriff et al. 2002). According to Table 1 the highest
decline in poverty took place during the period 1994–
2000, by 1.7% annually, as opposed to only 0.4% during
1987–93. However, the Planning Commission’s claim of
a very fast drop in poverty during the period 1994–
2000 by ten percentage points is not supported by
other researchers. According to Deaton (2003) the fall
was by seven points, whereas a recent paper (Sen and
Himanshu 2004) estimates this drop as only three
percentage points. Movement of other social indicators
too do not confirm fast reduction in poverty in the
1990s.
Nature of poverty and deprivation in India
Despite India being one of the ten fastest growing
economies of the World, India is home to over one
third of the world’s poor people, and overflowing
government granaries have not been able to prevent
hunger, malnutrition, or even starvation deaths. This
paper assesses the reach and effectiveness of the main
poverty alleviation schemes in India, and suggests
adjustments that need to be made in the current
strategy for maximum impact.
Poverty in India is officially measured not on “dollar-aday income criteria” but in terms of the expenditure
corresponding to monthly per capita expenditure of Rs
49 in rural areas and Rs 57 in urban areas at 1973–4 allIndia prices, with people below this expenditure
considered poor. This expenditure was then
considered necessary to achieve specified levels of
calorie consumption, namely 2400 calories/day in rural
areas and 2100/day in urban. At 1999-00 prices the new
poverty line expenditure varies from state to state,
from Rs 350 to 450 per month per capita in rural, and
Rs 450 to 550 in urban, although it is quite possible that
people may have shifted their consumption to non-food
items from food items, and therefore consuming much
less than the desired calories, although classified above
the poverty line1.
Athough poverty among the Scheduled Castes has
declined from 46 to 38% during 1993-99, caste
continues to differentiate the experience of poverty,
exacerbating its effects for some groups over others.
The caste system confines those from lower castes to a
limited number of poorly paid, often socially stigmatised
occupational niches from which there is little escape,
except by migrating to other regions or to towns
where their caste identity is less well known. Acute
levels of deprivation combined with greater likelihood
of exclusion from social welfare services and povertyreduction measures mean that members of scheduled
caste groups, particularly children, are more likely than
the rest of the population to die prematurely.
The Planning Commission estimates poverty from
consumption distribution reported by the National Sample
Survey Organisation (NSSO). These results are given
below in Table 1. The number of urban and rural poor for
each state in 1999-00 is given at Table 26, annex 1.
In addition to caste, poverty has many other social
dimensions. Many states, especially in the north and
western part of the country, are characterised by longstanding and deeply entrenched social inequalities
associated with gender. Gender cuts across class,
leading to deprivations and vulnerabilities which are not
necessarily associated with household income. There
are disturbing indications that gender inequalities in
critical human development indicators like life
expectancy, health and employment have either
remained stagnant or increased. The decline in the
juvenile sex ratio over the last decade, visible in the
data from Census 2001, is an indication that the
Table 1: Poverty as assessed by the Planning
Commission
Year
1973–74
1987–88
1993–94
1999–00
Percentage
below poverty
line
56.4
39.1
36.2
26.1
Annual decline in
percentage points
during the period
1974–87
1987–94
1994–2000
1.3
0.4
1.7
21
India, the picture is quite stark and almost two thirds of
the county’s poor are present in a half a dozen states of
India viz. Uttar Pradesh, Bihar, Jharkhand, Orissa,
Chhattisgarh and Madhya Pradesh.
Constitutional assurance of freedom and equality for
women is still far from being fulfilled.
Age is also emerging as a marker of vulnerability, partly
as a result of changing patterns of family organisation.
As social norms change and families move away in
increasing numbers from joint or extended family
systems to nuclear families, the care of the aged and
infirm has begun to be viewed increasingly as a burden
among poorer households whose need for gainfully
employed labour is paramount. As the India Human
Development Report notes (p.214), ‘aged persons who
own assets are more likely to be well looked after’. The
very young tend also to be vulnerable: it is their welfare
which is often sacrificed in times of scarcity in order to
protect the welfare of earning members.
Thus poverty is an extremely complex phenomenon,
which manifests itself in a range of overlapping and
interwoven economic, political and social deprivations.
These include lack of assets, low income levels, hunger,
poor health, insecurity, physical and psychological
hardship,
social
exclusion,
degradation
and
discrimination, and political powerlessness and
disarticulation. On the basis of empirical research, it has
been established that the actual aspirations of the poor
are in fact for survival, based on stable subsistence;
security, based on assets and rights; and self-respect,
based on independence and choice (Chambers et al,
1989). Therefore, policy instruments should be
designed to address not only the low income and
consumption aspect of poverty, but also the complex
social dimensions.
Unlike developed countries where there is a high
degree of co-relation between poverty and
unemployment, in India the poor are often too poor to
afford remaining unemployed. Lacking proper safety
nets, almost all sections of the able-bodied poor engage
in some form of livelihood activity. Instead, the
problems reflect the nature of the activities that the
poor and vulnerable groups engage in. Those who lack
assets, education and social networks are most likely to
be found in the worst paid and most casualised
segments of labour and commodity markets. They also
engage in activities that tend to be intermittent and
seasonal so that they have to engage in a multiplicity of
poorly paid occupations to survive. They work at very
low wages to survive. Unemployment in the poorest
states (Madhya Pradesh, Orissa) therefore in India is far
less than in the developed states, such as Kerala and
Tamil Nadu. There is also disguised unemployment
amongst the self-employed, as work stretches to fill the
available time.
Official Response of the Government of
India on MDG 1
Target 1: Halve between 1990 and 2015, the
proportion of people whose income is less
than one dollar a day.
“The incidence of poverty in India declined from 55 percent
in 1973-74 to 36 percent in 1993-94 and further to 27.5
percent in 2004-05”. So begins Section 1 of the official
India Country Report (2009) on Goal 1 of the
Millennium Development Goals (MDGs). Poverty it
would seem from this has been halved, from 55% in
1973-74 to 27.5% in 2004-05. It would therefore be
instructive to revisit the methodology of estimating the
poor in India and what it actually means in terms of the
numbers of poor. The current Planning Commission
estimates of poverty fix the poverty line at a per capita
per day expenditure level Rs.12 per day for rural areas
and Rs.17 per capita per day for urban areas. At this
level, the percentage of poor in the country is 27.5%.
The Tendulkar Committee which has comes up with a
slightly altered methodology for estimation and an
enhanced poverty percentage of 37% pegs it at a per
capita per day level of Rs.15 for rural areas and Rs.19
for urban areas. With this marginal increase, the
Tendulkar Committee has persisted in defining the
poverty line as a “starvation line”. It is against these
parameters that the India Country Report seeks to
achieve its’ targets of reducing hunger. That the
parameter itself is extremely flawed has been brought
And lastly, poverty is intimately connected with
vulnerability and shocks. Severe and chronic
deprivation in India is compounded by general
uncertainty with respect to livelihood and life, which
threatens an even wider section of the population than
might be counted as poor. Short-term, often acute
fluctuations in living standards are often superimposed
upon longer-term, persistent deprivation associated
with generally low standards of living. As Dreze and Sen
(1991, p.10) point out, ‘the average experience of the
poorer populations understates the precarious nature
of their existence, since a certain proportion of them
undergo severe – and often sudden – dispossession, If
one looks at the regional distribution of poverty in
22
out by another Committee appointed by the
Government of India – the National Commission for
Enterprises in the Unorganised Sector (NCEUS) which
had, by using NSSO data pegged the percentage of
population living on a per capita per day expenditure of
less than Rs.20 at an astounding 77%. If this represents
closer the poverty line in the country, the India
Country Report should have pegged the achievement
of their target against this rather than the Planning
Commission estimates. In fact, the India Country
Report does not mention either the Tendulkar
Committee Report nor the NCEUS Report or even the
Saxena Committee Report (which had pegged rural
poverty at 50%). It ignores the dollar a day definition
used by the MDGs and instead forwards an argument
that it is not “plausible” to report on the number of
people whose income is less than a $ 1 a day for the
entire country.
Using these three basic indicators, India is ranked 65th
amongst 84 countries, behind Djibouti, Burkina Faso
and Togo. The situation in India is described in the GHI
as “alarming”. One wishes the claims being made in the
India Country Report reflected this shameful reality.
If we look just at the specific indicator of under weight
children, between the National Family Health Survey 2
(1999) and NFHS 3 (2006), India registered a mere 1%
decline in it’s child malnutrition rate. From 47% to 46%.
India has the highest rate if child malnutrition in the
world with a child malnutrition rate that is double that
of sub-Saharan Africa. The best performing states of
India on this count like Punjab and Kerala barely manage
to reach the malnutrition rate of the average of the
African continent (30%). A third of Indian babies are
born with a low birth weight as compared to just 15%
of all babies born in Africa.
Once again the India Country Report disappoints in it’s
analysis of child malnutrition. Like with the previous
section, every single graph in the report, for instance is
of the best performing states, even though the report
acknowledges that at the current pace, India is likely to
have 40.23% of children below 3 years underweight in
2015 as against a target proportion of 26.8%.
Further, the India Country Report chooses to lay
greater emphasis on the state level disaggregated data
on the poverty head count reduction rather than adopt
a country-wide approach. This allows it to project an
overall favorable picture with 25 states reportedly on
“track” or on “fast track” to achieve a reduction in
poverty as compared to 10 states which are on “slow
track” to achieve the desired reduction. What this
state level disaggregation really does is to mask the
reality that most of the country will not be on track to
achieve the MDG target simply because the most
populous in the country including Uttar Pradesh,
Madhya Pradesh, Maharashtra, Orissa, Bihar will be not
be able to come anywhere close to the MDG goal.
By obfuscating the issues and presenting facts that are
at best half-truths, the India Country Report amplifies
the depth of the problem, rather than underplay it, as
the Government would have desired.
The reality remains that India is unlikely to be anywhere
close to achieving the MDG targets, despite being the
second fastest growing economy in the world.
Contrast the claims with any other indicator that is
objective and the deception becomes much starker. For
instance, the Global Hunger Index drawn up by the
International Food Policy Research Institute (IFPRI)
uses three equally weighted indicators, listed below, to
list 85 developing and transitional countries in the
world:
MDG 1 and India
Debate on food security bill and poverty
estimates
The recent report of the Suresh Tendulkar committee
on the estimation of poverty in India is bound to engage
academics and activists from all sides of the ideological
divide in the days to come. Much of the debate, one
suspects, will be around the poverty figure that
Tendulkar and his colleagues have come up with. The
estimate of poverty put forth by the committee is 37.2%
for all of India (with 41.8% for rural areas and 25.7% for
urban areas).
1. Proportion of people who are calorie deficient, or
undernourished, which is a key indicator of hunger.
2. The prevalence of underweight in children under
the age of five, which is a measure of childhood
malnutrition – children being the most vulnerable
to hunger and
This figure is significantly higher than the current
estimate of poverty of 28.3% (2004-05 estimates) used
by the Planning Commission. It is also higher than the
figure of 36% that has been mandated by the Supreme
3. The under-five mortality rate, which measures the
proportion of child deaths that are mainly caused
by malnutrition and disease.
23
Court in the ongoing right to food case. An easy, albeit
erroneous, conclusion from this would be that poverty
in India has gone up in the interim years since the last
estimate.
Left-wing nutritionist friend put it to me, none of the
people who undertake these revisions has ever done a
day’s worth of manual labour.
Two, when these norms were applied across the
country, the calorie consumption in the southern states
was found to be much lower than the poverty belt
states of northern India. This is despite the fact that
states such as Tamil Nadu and Kerala have had far
better nutritional indicators. For instance, Kerala and
Tamil Nadu have child malnutrition rates of 22.9% and
29.8%, respectively. Yet, average calorie consumption
in both states is lower than, say, in Bihar, which has a
child malnutrition rate of 55.9%.
What is likely to complicate the debate even further is
the fact that this interim period comprised the years of
India’s shift to a high-growth, neo-liberal model of
development. These were also the years of the greatest
advance in inequity that has been seen since
Independence. Even if these figures are dismissed as
being an underestimation of poverty, critics of
liberalization will still seize the opportunity to see the
new poverty figures as a vindication of their stance that
the poor have become poorer in the last 15 years.
Three, calorie intake has been going down in India even
for better off households and many economists and
nutritionists feel that there seems to be little
correlation between an increase in calorie intake and
household income.
While that may well hold true, it would be wrong to
draw that conclusion from this report: The Tendulkar
committee has fundamentally changed the way poverty
has been measured so far in the country and, therefore,
the current poverty estimate is not comparable with
earlier estimates. In fact, if these estimates are applied
to the earlier data, then the all-India poverty line would
have been 45.3%. Therefore, even when the new
standards are applied, poverty—by these estimates—
has seen a marginal decline.
The reason why dropping the calorie norm for poverty
estimation is bound to be controversial is this last
point—the fact that there exists a rich debate on the
subject of declining calorie consumption among the
poorer households, especially in the post-liberalization
period. Economists who have been at the forefront of
this debate would view the Tendulkar committee’s
departure on using calorie norms to estimate poverty
as yet another attempt to window dress the stark
reality of poverty in India. Since these estimates
continue to show a decline in poverty, even if it is not as
rapid as in other emerging economies such as Brazil and
China, it is bound to be treated with scepticism by
activists working on the right to food campaign across
the country. The timing of the Tendulkar report—in
the midst of a global food crisis and spiralling food
prices in India—is also likely to ensure that it is treated
with even greater scepticism than it deserves.
So what are these fundamental changes in the way
poverty is measured that the Tendulkar committee has
made?
First, and perhaps most controversially, the Tendulkar
committee has abandoned the calorie-anchored
estimates of poverty. All previous estimates of poverty
in India had used the calorie consumption norm of
2,400 calories per day per capita for rural areas and
2,100 calories for urban areas. Data collected by the
National Sample Survey (NSS) on actual consumption
would then be used, among other things, to correlate
the monthly per capita expenditure that was required
to meet these calorie norms. However, there were
problems with this approach.
The figure of poverty that is most widely regarded as
the gospel truth by most activists and civil society
groups in India is the one put forth by the National
Commission for Enterprises in the Unorganized Sector
(NCEUS). NCEUS had argued in its final report in 2009
that social sector benefits for unorganized labour
should be extended to 77% of the population, based on
a per capita per day expenditure of Rs20 or less.
However, there was never consensus in academic
circles whether this could be used as the basis of
determining the poverty line. Moreover, this figure is
unlikely to be accepted by the government to decide
subsidies.
One, many nutritionists and economists have been
wanting to give this form of poverty estimation a decent
burial for a long time now, since there were far too
many contradictions in using this norm.
Consider that the United Nations Food and
Agricultural Organization had revised the calorie intake
to close to 1,800 calories per day per capita. The Indian
Council of Medical Research has only now set into
motion a process to revise the calorie norms for India,
which is still likely to be quite contentious since, as a
24
Second, the Tendulkar committee has rationalized the
basket of goods and services that are consumed by
households at the poverty line. This had been
unchanged in poverty calculations since 1973-74. The
poverty line basket has now been updated to reflect the
expenditures on health and education that are incurred
by the poor, rather than assume that these are largely
services that are provided free by the State, as was
done in 1973-74.
take into account significant variables such as caste,
gender and disability. In that sense, the government has
squandered away yet another opportunity to take a
multidisciplinary approach to the poverty question in
India.
The bottom line from the current poverty estimate is
that it pegs poverty at a per capita rural expenditure
level of Rs15 per day and Rs19 for urban areas. While
this is an improvement from the previous estimate of
roughly Rs12 and Rs17 in the previous estimates, it still
falls short of a minimum standard of consumption
required for a life with dignity. Many would, therefore,
argue that the Tendulkar committee poverty line still
remains a “starvation line” rather than a poverty line.
At one level, this is a much needed correction since it
factors in expenditures that focus on capabilities. But
whether this should come at the expense of completely
delinking it from calorie consumption is what is likely to
be the point of departure in most of the debates that
will follow this report.
The most immediate policy implication of this report is
likely to be on the proposed national food security Act
(NFSA); the government is most likely to use these
estimates for determining food subsidies under the Act.
Third, the methodology used for the determination of
the poverty line is now much more amenable to
updating using changing prices over time, than the
previous estimation surveys were.
If the government does so, it would be yet another
historic blunder, since NFSA is perhaps the best
opportunity for India to replicate nationwide the Tamil
Nadu model of a universal PDS that can replace the
failed targeted PDS the Centre currently employs. A
universal PDS would give every citizen access to
subsidized foodgrains—and most people who do not
need them would not take them from PDS shops. But
what it also requires is very far-reaching governance
changes to prevent leakages from the system, for which
the political will just does not exist.
The primary reason the poverty line is so contested is
that many state benefits, including subsidized rations in
the public distribution system (PDS), health insurance,
education scholarships, subsidized housing, and so on,
are available only for those people who fall below the
poverty line (BPL). Consequently, funding from the
Union government to state governments is based on
this “quota” that flows out of the poverty estimation.
Since state governments face the brunt of the exclusion
errors in BPL identification—an all-too-common
phenomenon—many of them have simply done away
with the Planning Commission numbers and have used
state budgetary support to supplement the Central
quota and extend the benefits to a larger section of the
population. These state subsidies could be as high as
Rs1,800 crore for a small state such as Chhattisgarh to
more than Rs3,000 crore for Tamil Nadu. Any increase
in the poverty numbers, therefore, increases the
Central food subsidy burden and reduces the fiscal
burden on the states.
And that brings us to whether the poverty estimates
should be used at all for targeting basic necessities such
as food. For the second fastest growing economy in the
world, India continues to have one of the worst track
records in social indicators, especially child
malnutrition and hunger. It is ranked 66th out of 88
countries in the Global Hunger Index drawn up by the
International Food Policy Research Institute, and nearly
half of the country’s children are malnourished—a
track record worse than sub-Saharan Africa.
While the jury is still out on this report, what is clear is
that even though this exercise remedies some of the
maladies with previous estimates, it does not push the
envelope far enough. The estimation of poverty by the
Tendulkar committee does not factor in the
multidimensional nature of poverty. The overdependence on money metrics, which rely only on
private household consumption expenditure, does not
capture the political dimensions of being poor in India.
This report, like all such preceding reports, does not
Yet, as the annual billionaire count in India has been
relentlessly on the rise, the growing inequity, and the
consequences that follow such high levels of inequity—
including rising Maoist influence—should serve as a
wake-up call for policymakers.
It is this reality that should drive the policy imperatives
on food security rather than the numbers proposed by
some government committee based on private
household consumption expenditure data.
25
2. Implementation of Food Schemes in India:
The main objective of the ICDS scheme is to tackle
malnutrition among children under six. The National
Family Health Surveys that are conducted at regular
intervals give an estimate of the percent of undernutrition in different states in the country. In the table
below is the percent of children under three who are
severely underweight based on the NFHS surveys in
1998-99 and 2005-06. It is seen that according to the
latest survey15.8% of children are severely
underweight in the country and this has decreased by
only 2.2% in the seven year period between the two
rounds of the NFHS survey. Further, in some states the
percent of children who are severely underweight has
actually increased in this period.
Integrated Child Development Services (ICDS)
Issues with ICDS (Children not getting SNP)
Although the coverage of children under six under the
Supplementary Nutrition Programme of the ICDS
increased from 5.8 crore in the previous year to 6.8
crore in 2007-08, this is still less than 60% of the under6 population as identified by the anganwadis in the
country. The NFHS-3 data show that 81 per cent
children under 6 years of age were living in an area
served by an AWC. About 20% children have not even
been covered by the anganwadi survey and can be
assumed to be left out of any of the anganwadi benefits.
Therefore, if we calculate for the entire population of
children under six, then only about 46% of the children
are covered by the SNP services of the ICDS.
States in which the percent of severely underweight
children increased are Madhya Pradesh and Gujarat.
Further, the states in which there was a less than 2% fall
in the percent of severely underweight children are
Andhra Pradesh, Bihar, Delhi and Assam.
Pregnant and Lactating Mothers: The number of
pregnant and lactating mothers covered under the SNP
of ICDS was 1.4 crore in 2007-08, an increase from 1.2
crore the previous year. This increase is even less than
the kind of increase seen in the coverage of children
under six. Further as estimated by the Seventh Report
of the Commissioners, there would be about 4 crore
pregnant and lactating mothers in the country so this
coverage is only about 35%.
However, the data maintained at the Anganwadi
Centres shows gross under-reporting of severely
(grade III and IV) malnourished children. According to a
report prepared by NIPPCD for the Ministry, the
percentage of Grade III and Grade IV as per state
government records is now only 1 percent in 2006. In
case of 3-5 years children the percentage of children in
Grade III & IV has reduced to 0.8 percent (2006). These
figures are totally at variance with the NFHS-III figures
of 15.8% children being severely malnourished. The
field officials are thus able to escape from any sense of
accountability for reducing malnutrition. GOI should be
asked to pull up states so that they accept the NFHS-III
figures, and take appropriate measures for correcting
district records and show actual rates for malnutrition.
ICDS – Severe Undernutrition
State
% Children Severely Underweight
(children under 3)
Weight for Age
Percentage below-3SD
India
Madhya Pradesh
Gujarat
Andhra Pradesh
Bihar
Delhi
Assam
Tamil Nadu
West Bengal
Rajasthan
Uttar Pradesh
Maharashtra
Orissa
Chhattisgarh
Jharkhand
NFHS3
(2005-6)
15.8
27.3
16.3
9.9
24.1
8.7
11.4
6.4
11.1
15.3
16.4
11.9
13.4
16.4
26.1
Uttaranchal
15.7
NFHS2
(1998-99)
18
24.3
16.2
10.3
25.5
10.1
13.3
10.6
16.3
20.8
21.9
17.6
20.7
% decrease
2.2
-3
-0.1
0.4
1.4
1.4
1.9
4.2
5.2
5.5
5.5
5.7
7.3
ICDS - Recommendations
26
•
Government of India must operationalise all the
sanctioned anganwadis at the earliest.
•
A simple procedure for setting up an “anganwadi
on demand” must be put in place so that an AWC is
sanctioned and operationalised within three
months of such a demand being made, in
accordance with the order of the Supreme Court
dated 13th December 2006.
•
Children in the 3–6 year age group should be
provided a hot cooked meal at the anganwadi
centre everyday. The SNP so provided should be
age-appropriate, culturally appropriate, nutritious
and locally procured.
•
Make adequate budget allocations for the ICDS
programme so as to be able to provide SNP to
every child under six, every pregnant and lactating
mother and every adolescent girl.
•
The Government of India must make provisions for
supplementary nutrition for all adolescent girls at
the same norms as has been set for SNP for
pregnant and lactating mothers.
•
independent monitoring must be put in place, such
that a sample of the households are routinely
checked and the data verified by that reported by
the ICDS.
MID DAY MEAL SCHEMES
Strict action must be taken at all levels against the
false reporting of data that shows inflated figures of
enrolment and deflated figures of malnutrition. To
check on this practice of false reporting a system of
•
While the coverage is high in most states, it is still
not 100% in many.
•
States with less than 70% coverage: Gujarat and
Jharkhand
•
States with less than 80% and more than 70%
coverage: Bihar, Uttar Pradesh, Madhya Pradesh
Mid Day Meal Schemes - Utilization of Budgets
S.No
State
Allocations in State /UT Budget
Central
Assistance
(Reimbursement)
State
Contribution
Total
Total
% Utilisation
Expenditure
1
Andhra Pradesh
17266.56
18000.0
35266.6
17633.3
50.0
2
Assam
6265.39
1530.0
7795.4
8326.0
106.8
3
Bihar
28318.17
19400.0
47718.2
47718.2
100.0
4
Chhattisgarh
10245.09
6844.8
17089.9
7998.3
46.8
5
Delhi
3285.04
901.0
4186. 00
2546.2
60.8
6
J and K
2742.94
1186.3
3929.2
1939.4
49.4
7
Jharkhand
17160.93
11020.0
28180.9
9089.1
32.2
8
Maharashtra
25328.3
8771.3
34099.6
45546.0
133.6
9
Madhya Pradesh
19538.22
9605.5
29143.7
20176.0
69.2
10
Nagaland
761.85
300.0
1061.9
885.9
83.43
11
Orissa
24636.14
6719.4
31355.6
30041.5
95.8
12
Rajasthan
24325.40
9500.0
33825.4
14789.9
43.7
13
Uttar Pradesh
49420
16400.0
65820.0
40585.0
61.7
14
Uttarakhand
2304.21
1536.1
3840.4
2457.6
64
15
West Bengal
30620
23726.5
54346.5
37577.9
69.1
States with less than 50% utilisation: Chhattisgarh, Jammu & Kashmir, Jharkhand and Rajasthan
States with less than 70% utilisation (but more than 50%): Delhi, Madhya Pradesh, Uttar Pradesh,
Uttarakhand and West Bengal.
Recommendations
_ Currently the mid-day meal is provided only to children who are attending schools, whereas the most
vulnerable children in the school going age are out of schools working as child labour, street children etc. The
mid-day meal should be expanded to cover all children in the school-going age, irrespective of whether they
are enrolled in school. The location of the meal served can continue to be the school, this might further
encourage those out of school to join schools.
27
_
The provision for cooking costs under the mid-day
meal should be increased to Rs. 3/- per child per
day (not including foodgrains costs) from the
current Rs. 2/- per child per day in order to be able
to provide a nutritious and filling meal to the child.
Further this norm should be inflation-linked, in the
sense that it is constantly reviewed based on the
price indices.
_
Proper infrastructure for mid-day meals should be
mandatory, including cooking sheds, storage space,
drinking water, ventilation, utensils, etc.
_
8
Jharkhand
9
Madhya Pradesh 41.25
23.94
0
62.38
-21.13
10 Maharashtra
65.34
70.23
-4.89
11 Nagaland
1.24
1.24
0
12 Orissa
32.98
50.23
-17.25
13 Rajasthan
24.31
25.85
-1.54
14 Uttar Pradesh
106.79
106.79
0
15 Uttarakhand
4.98
4.97
0.01
16 West Bengal
51.79
52.77
-0.98
652.03
1058.48
-406.45
All India
Priority should be given to disadvantaged
communities (especially Dalits and Adivasis) in the
appointment of cooks and helpers. All cooks and
helpers should be paid no less than the statutory
minimum wage.
23.94
Source: Foodgrain Bulletin, November 2008
As can be seen in the table above almost all the states
have distributed more number of BPL and AAY cards
than the number of BPL families estimated to be
present in the state. This shows the need for increasing
the quotas under BPL in the states.
Targeted Public Distribution System and
Antyodaya Anna Yojana
Distribution of AAY Cards
The Targeted Public Distribution system (TPDS), is one
of the largest food schemes that was brought under the
ambit of SC orders in the case PUCL v. UoI, CWP 196/
2001. It is also the largest scheme in terms of the
coverage with over 500 million of the population,
receiving benefits under the scheme.
At the same time it must be mentioned that in spite of
repeated requests from the Commissioners’ Office the
states have not provided any information on the
estimates of the vulnerable groups to be covered under
AAY as per the Supreme Court order of May 2003 and
whether this was indeed the criteria being used to
identify AAY beneficiaries.
At present, 35 kgs of rice or wheat are provided at
subsidised rates to families below the poverty line. The
Below Poverty Line (BPL) families are identified by the
State Governments and about 40% of these familes
receive an additional subsidy under the Antodaya Anna
Yojana (AAY) which entitles them to the same quantity
of food grains but at roughly half the price of that which
is sold to the other BPL families.
The Government of India was directed “to place on
AAY category the following groups of persons:
(1) Aged, infirm, disabled, destitute men and women,
pregnant and lactating women, destitute women;
(2) widows and other single women with no regular
support;
Distribution of BPL Cards
Figures in lakhs
S.
States
No. of BPL
Number of Shortage in
households in BPL + AAY BPL cards
2000 (in lakhs) ration cards
1
Andhra Pradesh
40.63
189.3
-148.67
2
Assam
18.36
19.06
-0.7
3
Bihar
65.23
64.23
1
4
Chhattisgarh
18.75
18.75
0
5
Delhi
4.09
4.38
-0.29
6
Gujarat
21.2
7
Jammu & Kashmir 7.36
34.71
-13.51
7.36
0
(3) old persons (aged 60 or above) with no regular
support and no assured means of subsistence;
(4) households with a disabled adult and no assured
means of subsistence;
(5) households where due to old age, lack of physical or
mental fitness, social customs, need to care for a
disabled, or other reasons, no adult member is
available to engage in gainful employment outside
the house;
28
distribution of ration cards to the urban homeless
and slum households in the country’s six
metropolises: Delhi, Mumbai, Bangalore, Kolkata,
Chennai and Hyderabad.
Figures in lakhs
S.
States
No. of AAY
cards
sanctioned
No. of AAY No. of AAY
families
cards
identified undistributed
and ration
cards issued
1
Andhra Pradesh
15.578
15.578
0
2
Assam
7.04
7.04
0
3
Bihar
25.01
24.285
0.73
4
Chhattisgarh
7.189
7.189
0
5
Delhi
1.568
1.502
0.07
6
Gujarat
1.691
1.661
0.03
7
Jammu & Kashmir
2.822
2.557
0.27
8
Jharkhand
9.179
9.179
0
9
Madhya Pradesh
15.816
15.816
0
10
Maharashtra
25.053
24.639
0.41
11
Nagaland
0.475
0.475
0
12
Orissa
12.645
12.645
0
13
Rajasthan
9.321
9.321
0
14
Uttar Pradesh
40.945
40.945
0
15
Uttarakhand
1.909
1.512
0.40
16
West Bengal
19.857
14.799
5.06
All India
249.998
242.755
7.24
_
All State/Union Territories should be directed to
ensure that at least 35 kg. of foodgrains is provided
to every family as stipulated in the BPL and
Antodaya scheme.
3. Challenges
Since 60% of agriculture in India is rain-fed, there is little
hope we will be able to divorce the agricultural
economy from the uncertainties of the monsoon. What
should be cause for greater national concern is the
policy choices over the last two decades which have
increased the vulnerabilities of our small and marginal
farmers—these farmers have landholdings of less than 2
hectares and constitute 80% of the farming population.
We still lack a comprehensive vision for water security;
precious little has been done to address the issue of
falling water tables across the country.
In fact, the over emphasis on procurement of cereals
(mainly rice and wheat) has led to a systemic neglect of
dry-land crops. Millets and other coarse cereals,
oilseeds and pulses have seen a negative rate of growth
in the last five years. The procurement of these crops—
staple in states in central and eastern India with a
predominantly rain-fed agriculture—has not been
prioritized adequately. Research on dry-land
agriculture to increase productivity has been neglected
and virtually no major technological innovations have
been introduced for bringing about yield
improvements.
States with undistributed AAY Cards: Bihar,
Delhi, Gujarat, Jammu & Kashmir, Maharashtra,
Uttarakhand and West Bengal. While the rest of the
states have less than 1 lakh undistributed cards, West
Bengal is the worst with more than 5 lakh undistributed
AAY cards.
Recommendations
_ The Government of India may be directed to
double the percentage of BPL card holders from
the existing 36% to 72%.
_ The Government of India and the States/Union
Territories should be directed to indicate the
estimated numbers of each category of vulnerable
groups that the Supreme Court has directed for
coverage under AAY, the numbers covered so far
under each category, and whether clear
instructions have been issued and are being
complied with that future distribution of AAY
cards will exclusively cover these groups until they
are fully covered in compliance with the interim
order of May 2nd, 2003.
_ The Commissioners should be authorized to
supervise the transparent, expeditious and fair
And it is not just a lack of vision that reflects this
neglect. Where there is a vision, red tape ensures that
it is not implemented. The new watershed guidelines
which provide for doubling of the allocation per hectare
have been lying in limbo because they have still not been
operationalized, two years after they were drawn up.
The non-financial aspects of the new guidelines, which
put much greater emphasis of capacity building of
farmers and creating people-centric development
programmes that were part of that integral vision, lie
buried in bureaucratese.
Moreover, any increase in productivity is likely to be
offset by the rapid diversion of agricultural land for
industry and real estate. We are unlikely to achieve the
food security targets that have been set without
rationalizing land use.
29
rural health mission, the employment guarantee act and
the loan waiver for farmers. Despite this, UPA II
floundered with a bad start and continues to falter in its
commitment. The roots of this dissonance perhaps lie
in the fact that the assessment of ground zero of Indian
poverty is perceived differently by the powers that be,
both in the government and in the Congress party.It is
this dissonance in the understanding of reality that is
responsible for the hubris of UPA II. Take health and
nutrition as a sector. Despite the high growth rates of
the past two decades, India is burdened with one of the
highest rates of child malnutrition in the world. At 46
percent this is nearly double the child malnutrition rate
for sub-Saharan Africa. Pause for a minute to
understand what this figure means. It means that the
hardest lesson that nearly half the mothers in this
country have to teach their children is the lesson of
how to live with hunger. Is there a greater indignity that
we can force a mother to endure? Mothers incidentally
aren’t doing too well either. Anemia among pregnant
women (15-49 year age group) has gone up from 49.7
percent in 1998-99 to 57.9 percent in 2005-06. And
300 mothers (for every 1,00,000 births) in the country
die at child birth. This rate of maternal mortality in India
is the amongst the highest in the world and most of our
neighbours in South Asia do better than us.
While the systemic neglect of the farm sector would
takes decades to undo, there are a number of shortterm measures that need to be urgently put in place if
the impact of the drought has to be mitigated. NREGS
has the potential to not just raise wages, but also
rejuvenate the farm sector. The programme already
allows for agricultural development in the private lands
of scheduled caste, scheduled tribe and below-povertyline farmers. If, with careful planning, this scheme was
dovetailed into public works for watershed
development, it has the potential to significantly
improve productivity. The Congress party manifesto
promise of extending NREGS to every adult and
increasing the wage rate to Rs100 should be
implemented promptly. A well-designed urban
employment guarantee will also have the potential to
address the urban poor.
Similarly, the proposed National Food Security Act
could be the site for institutionalizing transformative
social protection policies. A return to the universalized
Public Distribution System (PDS) with adequate reform
measures; deepening entitlements for the more
vulnerable by providing subsidized cooking oil and
pulses and other essential commodities from PDS
outlets; and putting on track the Integrated Child
Development Services (ICDS) programme—the only
government programme that addresses child
malnutrition—would go a long way on getting food
security back in the agenda.
Anaemia among children in the age group of 6-35
months is at an astonishing 79 percent according to the
National Family Health Survey 3. Our infant mortality
rate at 53 (for every 1,000 children) is equal to the
average infant mortality of the least developed
countries in the world and two and half times that of
China. Nearly a third of all babies born in India have low
birth weight and this is twice as many as the low birth
weight babies in Africa. The National Nutrition
Monitoring Bureau tells us that close to 40 percentof
our adult population has a body mass index (BMI) of
less than 18.5 that makes the situation in India
“alarming” as per WHO norms.
It’s official now. The aam admi is off the UPA’s radar. If
more confirmation of that was needed, finance minister
Pranab Mukherjee delivered it in parliament in his
budget speech. Sure, the platitudes were still mouthed,
but not a single budget proposal reflected the concern
for the aam admi. In fact, there seemed to be an inverse
relation between the time devoted to the aam admi in
the speech and the budget allocations. If the aam farmer
was gratified to find mention in the FM’s speech, all he
got by way of additional allocation was Rs 400 crore for
six eastern states to usher in, hold your breath, a
second green revolution. This allocation represents just
0.1 percent of the total revenues foregone by way of
tax exemptions to industry. Similarly, the rising food
prices saw a week of intense debate in both houses of
parliament before the budget was presented. The FM’s
response: cut the food subsidy by Rs 500 crore! But
then, did the aam admi ever exist beyond the rhetoric
of the election manifesto at all? To be fair, there were
signs that he did figure in the last UPA government:
enhanced allocations for social sectors, the national
India is ranked 65 out of 88 countries in the Global
Hunger Index (IFPRI), below Cameroon, Kenya, Nigeria
and believe it or not, even Sudan. We are five places
below Cambodia. If this is not bad news enough, then
we manage to fare worse in UNDP’s Human
Development Index, occupying 134th rank, just ahead
of Solomon Islands.
It is this alarming challenge that UPA II was expected to
rise to and perhaps what it was voted back to power to
deal with.
30
would be left out of government welfare programmes
including the public distribution system. A government
that claims to have as its core the interests of the poor
is struggling to get a fix on their numbers. Surely this
does not augur well for the poor.
Let’s admit it, even neoliberals must have feelings. The
feeling that these statistics, perhaps, most likely to
invoke, in our Prime Minister and his fellow growthwallahs, is that of acute embarrassment, especially in
international fora, where India seeks to occupy the high
table. It even prompted the PM to describe child
malnutrition as a “national shame”. Obviously, he hasn’t
been shamed enough or this emotion doesn’t work for
him. Manmohan Singh has not even bothered to
convene the Prime Minister’s Council on India’s
Nutritional Challenges since it was created a few years
back.
So, what does UPA II really hold for the aam admi? The
National Food Security Act (NFSA), perhaps? It was
touted to be the ‘NREGA’ for UPA II and expected to
deliver the same electoral gains that the immensely
popular rural employment guarantee scheme delivered
for UPA I. The NFSA had the backing of 10 Janpath, and
the first letter written by UPA chairperson Sonia
Gandhi to the prime minister, after UPA II was sworn
in, was for the speedy enactment of this law with a draft
legislation also attached to the letter. The NFSA
featured in the president’s address to parliament and in
two budget speeches of the finance minister besides
countless references to it by the prime minister and
Congress party apparatchiks. Surely that counts for
political commitment.
Beyond symbolism, the policy choices that continue to
be made are mired in the decades old belief of trickle
down and a senseless pursuit of growth at all costs.
Social sector expenditure in this paradigm is viewed
largely as wasteful expenditure that needs to be
assiduously avoided if the fiscal deficit has to be
controlled.
Take the government’s own measures for identifying
the poor. The current estimates of poverty stand at a
per capita per day expenditure of Rs 12 for rural areas
and Rs 17 for urban areas. This is a starvation line and
not a poverty line. But even by these low standards of
poverty, at 28 percent, the poor in India could easily
come together to form one of the largest countries in
the world. A Republic of Hunger, as Utsa Patnaik puts
it?
However, the manner in which the proposed NFSA is
unfolding it is becoming a classic case study of the
proverbial “slip ’twixt cup and the lip” of UPA II. The
draft bill produced by the Empowered Group of
Ministers for instance, begins by ringing the death knell
for food security in the country, with the premise that it
will deal only with the food grain subsidy and not
nutritional security. This is a self-defeating, self-imposed
limitation for what could potentially be a historic piece
of legislation. The bill essentially concludes that Indian
state can achieve food security for all by providing 25
kgs of food grains at Rs 3 per kg to all BPL households
identified using the Planning Commission estimates.
The 25 kgs that the bill promises is in fact less than the
35 kgs which have been made a legal entitlement by the
Supreme Court in the landmark Right to Food Case.
The poverty numbers of the Planning Commission fall
way short of what is required to deal with the
nutritional emergency that the country faces. To add
insult to injury, all the critical components that should
have been part of this bill including mid-day meals,
pensions, special programmes for very vulnerable
people and maternity entitlements, find no place in the
bill. What makes this even more unconscionable is the
fact that most of these programmes are already in place.
They are being implemented across the country with an
annual fiscal outlay of close to Rs 80,000 crores. And
since they are all sub-judice in the Right to Food case, in
the Supreme Court, the government cannot
discontinue or cut back on any of these entitlements.
In the last two years, three government committees
have come up with three sets of estimates for
identifying the poor – the Arjun Sengupta Committee,
the NC Saxena Committee and the Tendulkar
Committee. The Sengupta Committee pegged the
percentage of poor in the country at 77 percent based
on a per capita per day expenditure of Rs 20 while the
Tendulkar Committee estimated it at 37 percent and
the Saxena Committee pegged it at 50 percent. Even to
accept the abysmally low estimate of 37 percent that
has been proposed by the Tendulkar Committee, the
government continues to drag it’s feet. Remember that
if this estimate was accepted the poverty line would
stand updated at a per capita per day expenditure of a
princely sum of Rs 15 for rural areas and Rs 19 for
urban areas. The great achievement of UPA II would
have been to herald in an era of prosperity wherein all
Indian citizens who were spending more than Rs 15 per
day for all their needs – food, clothing, health,
education, shelter – would not be considered poor.
Consequently, a vast majority of the deserving poor
31
All that the government was expected to do was to
bring these programmes under the legislative fold
within a better framework of accountability.
as voters later told it, was at complete variance with
ground realities. And if the Union Budget is reflective of
the government’s “vision and signal the policies to
come”, as Mukherjee proclaimed, then the United
Progressive Alliance (UPA) is in more trouble than it
can imagine.
Bring the concerns of the aam admi into the picture and
the contours of this draft bill would have looked very
different. It would have, at the very minimum,
converted into rights all the legal entitlements that the
Supreme Court has created over the past decade. It
would have taken this opportunity to plug the gaps in
existing programmes and created new programmes for
very marginalised people who are outside the radar of
policy making today. It would have created a strong
framework of accountability along the lines of the RTI
and the NREGA with independent monitoring
mechanisms. And it would have created a set of
enabling provisions for enhancing food production in
the country and advancing rights of the poor over
productive resources.
If the vision of the Budget is indeed the vision of UPA
II, there is only one word to describe it: triumphalism.
This, as the media likes to say, is a Budget for a nation
that “has arrived”. Make no mistake: India has arrived.
Just not in the way the middle class would like to
think.
India has arrived at 134rd place in United Nations
Development Programme’s 2009 Human Development
Index, just ahead of Solomon Islands and behind Bhutan
and Laos. It has arrived at the 65th place (among 88),
five places behind Cambodia, in the Global Hunger
Index. If India has arrived in the club of economic
superpowers, it is the first one to have done so with
46% of its children malnourished— that’s twice the
child malnutrition rate of sub-Saharan Africa.
What we have instead is an “all-gong-no-dinner” draft
that disappoints on all counts. The single most
important concern before the EGoM seems to have
been a reduction in the food subsidy. So instead of a
much needed universal Public Distribution System,
what we have is the existing entitlement reduced by 10
kgs in the garb of legislating food security.
The UPA vision that brought it to power in 2004 and
back in 2009 was that of the aam aadmi. So let’s try to
spot where the aam aadmi stands in Mukherjee’s
Budget.
Forget taking on board the views of activists and
campaigners, those much-derided jholawallahs, the
EGoM goes out of its way to disregard the provisions in
the draft bill sent by Sonia Gandhi to the prime
minister. Every single suggestion in that draft has been
knocked off the EGoM draft bill signalling a clear schism
between the government and the party on this very key
piece of legislation. A schism that represents the
tension within UPA II that wants to retain the rhetoric
of the aam admi, but is reluctant to abandon the
neoliberal core of its policies. Unless this tension is
resolved, there is little hope for the aam admi and
indeed for the nation.
If the aam aadmi is the little girl, pricking your
conscience, soliciting alms at the traffic light or the
homeless woman who froze to death on the pavement
in Delhi’s cold winter, there is little to cheer for them in
the Budget. Not a single penny for the ministry of urban
poverty alleviation for shelters for the urban homeless
or for residential schools for street children. Forget the
Supreme Court activism on shelters for the homeless
or the fact that a Right to Education Act now makes
education not only free, but also compulsory. A
marginal increase in the share of expenditure on
education as a percentage of the gross domestic
product, from 3.23% to 3.88%, is all. Hardly enough if
we hope to overtake Bangladesh’s literacy figures that
have surged ahead of ours in the last 25 years.
The Union Budget of 2010-11: Pointers
towards continuing policy failure
Last month’s Budget does poorly on improving the
social sector—something that needs urgent attention
If the aam aadmi happens to be a Dalit or a tribal, there
is even less to cheer. The allocations in the scheduled
caste sub-plan and the tribal sub-plan should be
proportionate to their population—at 16% and 8%
respectively. But the Budget allocates 7.19% for the SCs
and 4.30% for the STs. The National Campaign on Dalit
Human Rights estimates a shortfall of around Rs25,000
crore in the current Budget.
Elephants are reputed for their long memory. Yet
finance minister Pranab Mukherjee, who fancies this
metaphor of an elephant (as used by a leading
newspaper), seems plagued by an inexplicable amnesia.
Not many summers ago, the Bharatiya Janata Party had
to bite the dust for its “India Shining” campaign which,
32
decades. Mukherjee actually managed to knock off
nearly Rs500 crore from the food subsidy this year and
reduce the overall level of subsidies in the food and
nutrition sector from 12.83% to 10.48% of total
expenditure.
If the aam aadmi is a woman, then, on the face of it,
there is something to cheer about. Allocations for
women, according to the gender budgeting statement,
is up from 5.5% to 6.1% of total expenditure. But lest
she celebrate too soon, the Centre for Budget and
Governance Accountability is quick to point out that
this works to exactly Rs1,200 per woman per annum—
not a substantial sum by any standard.
So who really is the aam aadmi in the Budget? The tossup is between the taxpayer who gets a break of
Rs26,000 crore and the corporate sector which gets a
break of close to Rs80,000 crore. The finance minister
was quick to point out that the social sector allocation
in the Plan expenditure in the Budget was 37% and
stood at an impressive sounding Rs375,000 crore.
What he forgot to mention was that perhaps another
way of looking at this figure is to compare it with the
Rs500,000 crore of revenue forgone. Since the
taxpayer will pay back a substantial part of the Rs26,000
crore through increased prices of goods due to the fuel
price hike and the inflationary pressures that this
Budget will certainly generate, it is the corporate sector
that emerges as the clear winner in this “Spot the aam
aadmi” contest.
If the aam aadmi is one of the 80 million malnourished
children below the age of six, the nearly Rs2,000 crore
increase in the allocation for the Integrated Child
Development Services is still way below the Plan
allocation—what has been laid out in Five Year Plans—
for the programme.
If the aam aadmi is the farmer, then despite the rhetoric
to usher in a second Green Revolution, an allocation of
Rs400 crore for six major states is not just sub-critical,
but a sovereign guarantee that this promised revolution
will never fructify.
If the aam aadmi is none of the above, then surely it
must be the majority of the population that has been
suffering the crippling impact of food inflation, which, at
18%, is the highest that the country has seen in three
1.
Biraj Patnaik is principal adviser to the Supreme
Court Commissioners on the right to food. The
views expressed here are his own.
Per capita cereal consumption per month declined between 1972-73 and 1993-94 from 15.26 kg to 13.4 kg in rural areas and from 11.24 kg to
10.63 kg in urban areas. The decline is generally interpreted in terms of a shift to more vegetables, fruits and meat products, and a shift to nonmanual occupations.
33
GOAL 2 : Achieve Universal Primary
Education
-Anjela Taneja
Goal 2 : Achieve universal primary
education
in the number of school going children. However, while
the enrollment net has undoubtedly expanded, it has
not reached the level of universalization and besides,
surely what India’s children deserve is universalization
with quality and not paper enrollment of all children in
schools. It should also be stated that the goal of any
education policy should surely be of moving towards
the fulfillment of the full EFA agenda, and not be
restricted to just narrow primary enrollment goals.
Target 2.A: Ensure that, by 2015, children
everywhere, boys and girls alike, will be able
to complete a full course of primary
schooling
The right to education is arguably one of the most
fundamental rights in as much as it is not only a right in
itself, but is also instrumental in obtaining the other
rights. The linkage of education to a whole range of
developmental
outcomes
is
extremely
well
documented. It is, however, regrettable that despite
these well documented facts, the issue fails to receive
the attention that it deserves. The lack of political and
social will to commit wholeheartedly to the educational
agenda is reflected in the fact that India remains 105th of
128 Countries in terms of literacy (EFA Global
Monitoring Report, 2010).
2.1 Net enrolment ratio in primary education
It is undeniable that the country has seen an increase in
the enrollment during the last decade. The efforts made
by the government in ensuring that children are
enrolled in some form of educational facilities are
commendable. Having said so and having acknowledged
the efforts made, it is essential to take a deeper look at
the figures and analyse the situation in greater detail.
The NER for India (based on the 7th All India Education
Survey) is 94.5. The SRRI-IMRB independent survey
(2009) has produced a figure of 6-14 year old children
out of schools places the figure at 4.28% (4.53% rural
and 3.28% urban). It estimated that 3.92% boys and 4.71
girls are out of school. A large number of alternative
and older estimates exist producing fairly widely varying
estimates of out of school children. Until the figures for
the upcoming Census are tallied, there would,
consequently, be some ambiguities about the actual
number of children out of school.
This is so much more so, when assorted international
and national policy pronouncements and even legal
provisions exist that mandate provision of quality
elementary education. Thus, in the Indian context it
would be impossible to discuss the progress towards
the MDG goals during the preceding year without
mentioning the passage of the Right of Children to Free
and Compulsory Education Act, 2009 that, with all its
faults, offers greater hope for ensuring education for all
children atleast in this age group. The fact that its
implementation has since fallen behind schedule is a
cause for regret.
However, even with this limited framework in mind,
the gaps are glaring.
This failure is further reflected in the performance of
the country against all the MDGs related to education.
There is little optimism and cause to think that any of
these goals would be met as far as India is concerned. If
a child has to complete five years of schooling in line
with the expectation of the child completing a minimum
primary education cycle of five years, every child in the
country has to be in school in 2010. With the start of
school admissions having come and gone, this is
manifestly not the case. Yes, the school net has
certainly expanded and there is an undeniable increase
1. There are furthermore serious difficulties with the
definition of what constitutes an enrolled child with
the data collected at the beginning of the academic
year, usually after the conclusion of an enrollment
drive. Furthermore, there are definitional
differences where some states consider effectively
dropout children as irregular, instead of being out
of school. Furthermore, there are differences in
the age of admission across states. Similarly, there
are major definitional problems with the question
of dropout with different government estimates
34
coming up with a figure anywhere between 1.4 and
8.1%.1 This makes it difficult to come up with a
reliable figure for retention. Lastly, there have been
widespread allegations of inflated enrollment
figures based on direct link between enrollment
figures and supply of midday meal2 and closure of
schools that fail to adhere to minimum enrollment.
Lastly, India’s high Gross Enrollment ratio conceals
a large number of over-age children due to late
enrollment or repletion. This is a reflection of a
population highly vulnerable to dropout.
world’s largest number of child labourers. The NSS
2004-5 data showed that 9.07 million persons aged
5-14 were economically active. While there has
been a decline in the number of child labourers
since, the practice is far from being over. Thus,
there are no reliable estimates of bonded child
labourers, trafficked children, child soldiers,
children employed in mines and the whole host of
other forms of child labour- worst form or
otherwise. The lack of a reliable number is likewise
an indication of absence of clear time bound
strategies to end the practice.
2. Even accepting the findings of the SSRI-IMRB
survey, there are considerable variations for the
specific marginalized groups. An estimated 7.67% of
Muslim children are out of school, 5.96% SCs,
5.60% ST children are out of school. More focused
strategies to address the issues of these
marginalized groups are needed if universal
enrollment is to be ensured. Furthermore, there
are major regional disparities. Thus, 10.61% of
children in Arunachal Pradesh were estimated to
be out of school, followed by 8.36% in Rajasthan.
An area where the government has failed
particularly, is that of the education of children with
special needs. The SSRI-IMRB (2009) survey shows
that 34.12% of all children with disability were out
of school. This is especially so for children with
multiple disability of whom 58.57% children are out
of school and for children with mental disability the
corresponding figure was 48.03%. No effort for
universalization can be completed if children with
special needs are ignored.
This discussion would be incomplete if mention is not
made of the gradual decline in enrollment in
government schools. Thus, there has been a marginal
increase in the proportion of government to private
schools (80.52 from 80.18 between 2007-8 and 2008-9,
DISE Flash Statistics, 2008-9), the 10th Joint Review of
SSA report shows a decline in the overall Government
primary school enrollment, from 101.2 million to 97.9
million (excluding the 1.5 million children in Haryana).
A tentative explanation is offered by the fact that a large
part of the recent expansion of the government school
net was achieved through setting up Education
Guarantee/Alternative Education Centres of a quality
that failing to meet the minimal expectations of quality
of parents who are left without recourse except to
send their children to fees charging private schools. A
trend of movement from free to fees charging schools is
deeply disturbing from the point of view of equity. This
also needs to be seen in the context of the State
repeatedly turning to the private sector for funding of
certain core components of education delivery in the
form of PPP in school education. While the latter trend
has proportionally been greater for secondary
education, it sends dangerous precedents for
privatization of the elementary system in the future.
3. Furthermore, there are groups for which the data
simply does not exist. There are no reliable
estimates of the overall number of- let alone the
enrollment in school of- education of children
affected by disasters (natural or man-made),
internally displaced persons and migrant families.
According to the UNICEF Report (2004)3, roughly
20% of Indian population is considered migrant, of
whom 77% are women and children. The absence
of concerted national strategies for the education
of this category of children is regrettable. The
States of Jharkhand and Chattisgarh furthermore
have seen well documented instances of school
closures and consequent dropout of children in
areas affected by Naxalite activity.
2.2 Proportion of pupils starting grade 1 who
reach last grade of primary
The DISE report for 2007-8 shows a pan Indian survival
rate till Class V of only 72 percent Similarly, more boys
(72 percent) survive up to Grade V than girls (71
percent). A look at the apparent survival rate in rural
(68 percent) and urban (87 percent) areas reveals a
significant difference, that is also separately true for
boys and girls. In rural areas 69 percent boys and 68
percent girls survived up to Grade V compared to 87
and 88 percent respectively in urban areas; thus
showing a wide gap between rural and urban areas.
Furthermore, the average figure conceals several
4. No discussion on the question of enrollment can be
complete without touching on the question of child
labour4. There is no disputing that India has the
35
mentioned previously, the quality of these newly
established schools has been questioned since many
have been set up under the EGS and AIE schemes of the
government with consistently lower standards of
infrastructure and teacher training. Interestingly, there
have also been many instances of closure of smaller
schools (often in thinly populated areas inhabited by the
tribal population) using the rationale of the need for
rationalization of schools6.
regional disparities thus only 36% of children reach
Grade V in Arunachal Pradesh and 40% in Bihar. Only 2
States- J&K and TN report 100% survival rates.
Consequently, the current situation makes it extremely
unlikely that the nearly 30% gap would be met in the
coming half a decade.
This is supported by the fact that the period 2004-5 to
2007-8 has only seen a 5% increase in the apparent
survival rate. Even a doubling of this rate would not be
sufficient to fill the gap. The situation is no different for
the states. Thus, the state with the lowest survival rateArunachal Pradesh has seen only 1% improvement in
the preceding three years. In this context, it was
interesting to note the government report’s acceptance
of the fact that the apparent survival rate seems to be in
decline between
An interesting aspect with implications for retention is
the ratio of primary to upper primary schools. The ratio
for 2007- 08 was one Upper Primary school/section for
every 2.41 Primary schools/sections at the national
level. This contrasts to the Programme of Action
(1992) ratio of 1:2. Thus, according to the 7th All India
Education Survey, only 61.4% habitations in Jharkhand
have access to upper primary schools within a distance
of 3 km. Another aspect is that 64.5% schools are not
integrated with schools upper primary or higher (DISE,
2007-8). The simultaneous low number of upper
primary schools, and the absence of smooth transition
makes for higher probability of drop out.
Furthermore, the rate of transition of children from
primary to upper primary education in 2006-7 was
81.13. In other words, 19 of every 100 children are lost
in the cracks between Grades V and VI. The transition
rate was as low as 72% for rural areas. Furthermore,
the 10th Joint Review Mission for SSA calculates the
Upper Primary Completion Rate to be just 47% for
207-8. This questionable track record is partially a
reflection of the limited number of upper primary
schools with the proportion of primary to upper
primary schools standing at 2.27
However, what lies at the heart of the question of
retention with quality is the role of teachers as the
foundation of quality. The 10th JRM took serious
concern of the consistent failure of the state to recruit
adequate number of especially trained teachers.
In terms of sheer availability, the national average of
pupil teacher ratio has by and large been under 1:407.
However, the Right to Education Act raises this
standard to 1:30 which is more in line with optimum
learning of children. The national average PTR figure is
1:32- which is above the national norm. Furthermore,
even these figures conceal major inter- and intra-state
variations. Thus, 4 of 35 States and UTs had a PTR
higher than 1:40 in primary schools. There is even
greater variation at the sub-district level. 1 in 10
schools are single teacher and 12.96% have a PTR of
more than 60. Overall, 3.72% children are enrolled in
single teacher schools, and 26.05% are in schools with a
student-classroom ratio of 60 or above(DISE Flash
Statistics 2008-9). Thus, there is still a very definite
shortage of teachers.
What these figures suggest
It would be essential to reiterate that the focus on
enrollment as an indicator in the MDGs reduces the
debate to the questions of enrollment and retention
and fails to look at the underlying factors that
determine these outcomes. Questions of quality of
infrastructure, instructional quality, teacher availability
and preparedness and learning levels would not fall
under the purview of the MDGs. The present section
seeks to look at these factors in a little more detail
since a quick overview of the status of the education
system suggests that the present infrastructure and
system fails to meet these standards.
The first prerequisite for enrollment is the sheer
availability of schools. Over 87% habitations have access
to primary and 78% to upper primary schooling facilities
within 1 km and 3 km respectively5. This may be
attributed to simultaneous increase in community
demand and the massive expansion of the education
system with the establishment of new schools under
SSA (India’s education for all programme). However, as
Furthermore, the term teacher now encompasses wide
variations in the professional qualifications and service
conditions and remuneration among teachers. Thus,
Jharkhand had 47%, UP 26% and J&K 24% parateachers
out of the total teacher strength (10th JRM). Having a
trained professional cadre of teachers committed to
36
the teaching profession and having the expertise
necessary to teach children is an essential prerequisite
for effective learning. Instead, a total of 11 States have
over 10% parateachers. Furthermore, even if training is
imparted, as the 10JRM pointed out, most states have
no mechanisms in place to assess teacher quality or to
implement stage-specific training. Lastly, as the recent
review of the Centrally sponsored scheme for teacher
education undertaken by the Government has
suggested, the mechanisms for academic support and
capacity building put in place leave a lot to be desired.
the school (infrastructure has been discussed
subsequently) and the absence of adequate transport
between the place of residence and the school.
The CRCs and BRCs were expected to act as a
mechanism of providing onsite support and mentoring
to teachers, enabling them to learn from their more
experienced peers within their own localities.
However, according to DISE 2007-8, 26.70% schools
are located at a distance greater than 5 km from their
CRC, making travel difficult. Mirroring this, only 71.64%
schools were inspected during the period of 2007-8.
In terms of the actual educational qualifications, 1 in 5
teachers (19.39%) are only educated up to the
secondary level and below. Furthermore, 22.3% lack
any professional teaching qualifications. For those that
do receive training, the quality of such is questionable.
Thus, in 1995, the National Council of Teachers
Education (NCTE) was given statutory powers,
including the power to recognize teacher’s education
colleges, and set their quality standards. However, it
has over time relaxed the minimum norms for
appointment of teachers who would be teaching future
teachers. The comprehensive evaluation of the Central
Scheme for Teacher Education furthermore points to
systemic gaps in teacher training including the
functioning of DIETs, BRCs and CRCs. There are also
instances where students pursuing BEd degrees are
being taught by teachers who themselves have BEds,
according to the latest NCTE norms. Furthermore, in
violation of UGC norms, these teachers need not have
cleared the National Eligibility Test, a mandatory
provision for teaching a graduate degree course. Lastly,
some states have waivered the requirement for preservice training when making new teacher
appointments.
This situation of low teacher qualifications (academic
and professional), poor wages, low teacher training and
lack of onsite support is compounded by the fact that
only 47.94% schools have regular Head Teachers. Only
46.54% schools in rural areas had HMs. This makes it
difficult for any real leadership to develop at the school
level. The percentage of such schools in urban areas is
high at 66.59 compared to 59.10 in rural areas.
Quality of Schooling In India: Some Insights
A related question that has an impact on teacher
motivation is the question of salaries. Parateachers are
paid anything between Rs 1,500 and Rs 2,500 per
month, which is below the minimum wage for an
untrained labourer. Indeed, regular teachers don’t fare
much better. While pay scales vary from state to state,
the central figure which serves as a benchmark is Rs
4,500 for primary school, Rs 5,500 for secondary level
(graduate teachers) and Rs 6,500 for senior secondary
level (post-graduate teachers). In many private schools,
the pay is lower. Opportunities for professional growth
and advancement are often limited to non existent. This
low wage is further compounded by a range of
problems including lack of accommodation for female
teachers in rural areas, poor working environment in
Schools without head teacher (but with
enrollment of over 100 children)
45.1%
% Single teacher primary schools
13.25
% schools with PTR >= 60
12.96
% schools without female teachers
26.4%
% Schools without drinking water
22%
% Schools without common toilet
33%
% Schools without girls’ toilet
46%
% Schools without computer
86%
% Schools without a ramp
60%
% Schools not electrified
64%
% Schools not receiving teaching learning
material grant
27%
Number of districts where PTR is over 40
(all schools)
146
% Professionally trained teachers
71%
% Teachers who received inservice training
during previous year
35%
DISE Flash Statistics 2008-9
To make a school work - physical building and child
friendly classroom, a blackboard, teaching learning
materials (available and used), toilet (especially for girls)
and water facilities are some of the basics that are
essential. A look at the data suggests that while there
has been a significant improvement in the quality of
facilities, considerable infrastructural gaps remain.
37
Despite commendable efforts at school construction,
there are shortages of classrooms in some states. Thus,
while the SCR across the country was 1:35 (DISE Flash
Statistics 2008-9), there are major variations across
states. Thus, the ratio is as high as 1: 96 in Bihar.
Schools once established have not been adequately
maintained. In 2007-8 26% classrooms required either
major or minor repairs (only 30.94% classrooms in
Meghalaya were in good repair; DISE). This becomes
especially important in disaster prone areas, where
schools are often exposed to vulnerability as the
constructions do not adhere to national safety code there is risk of casualty among children, teachers and
communities as well as loss of academic days.
Under the circumstances, it is not surprising that the
learning levels of children leave a lot to be desired.
Thus, NCERT’s Learning Achievement of Class V
Children Mid Term National Survey (2008) as well as
the ASER data suggests that the learning levels of
children have not reached the standards desired.
NCERT Achievement Survey of Elementary Education
Maths
Language
Science
Soc Sc
53(3)
35.98(2)
32.96(3)
52.45(11)
40.54(10) 45(11)
Class III
58.25*(17) 63.12(13)
Class V
46.51(17)
58.57(15)
Class VII
39.87(7)
Class VIII 38.47(10)
EVS
50.3(17)
* % average achievement on scale(States below national average)
The third major determining factor is that of the
availability of adequate learning laterials. There have
been frequent complains about delayed release of the
teaching learning material and school development
grants. It is unfortunate that only 49.51% schools had
access to a book bank in 2008-9. SSA provides for a
lumpsum of Rs 5000 (earlier 2000) for school
development and Rs 500 per teacher for development
of teaching learning materials in schools imparting
elementary education. However, only 68.98 and 61.8%
schools respectively received these grants.
A look at the examination results shows that, barring a
few states, more than 90% children passed the terminal
grades IV/V and VII/VIII. The pass percentage in class of
Grade V is as high as 95% for both boys and girls.
However, the results are not necessarily a true
indication of the achievement levels. NCERT has
undertaken a survey of achievement of children for
Classes III, V and VII/VIII during 2003-4. The
achievement rates were found to be very low. The
periodic surveys carried out by Pratham called ASER
have also brought out the inadequate abilities of
students in the primary grades to read and carry out
simple mathematical operations.
Needless to say, the ultimate purpose of education is to
transact a certain curriculum within the classroom. The
National Curriculum Framework 2005 has reiterated
the need for curriculum tailored to individual capacity
while providing an insight into systemic issues that are
vital. However, with the exception of a few states, the
same has not been truly actualized into State curricula
or influenced teaching practice to the extent that it
should have. At the same time, the need for instruction
in mother tongue in early grades, the need to respect
indigenous history within the curriculum and the need
to avoid prejudicial and stereotypes of girls and children
from specific communities have been pin pointed as
issues affecting the experience of learners in India’s
schools, but have not been adequately addressed. The
lack of the lack of instruction in mother tongue in the
first few years of schooling and non implementation of
three language formula has been cited as a reason why
over 12% children suffer from severe learning
disadvantage (NCF 2005 Position Paper). Corporal
punishment is still prevalent in schools (65% of school
going children reported facing corporal punishment)
and 62% of it was in government and municipal schools
(Ministry of Women and Child Development, 2007).
Discrimination against dalit, adivasi and muslim children
has been frequently reported.
Lastly, the quality of the education system is always to a
large extent a reflection of the nature of accountability
systems that have been set in place. With the
mechanisms for academic support somewhat shaky, the
systems for community participation assume special
significance. The framework for the accountability to
parents is laid down under the 73rd and 74th
Constitutional Amendments8 that have empowered
local self government bodies for undertaking action in
the villages for development in general and education in
specific. In addition, the Right of Children to Free and
Compulsory Education Act 2009 lays down specific
responsibilities for local governance bodies. While
most states have some systems in the form of Village
Education Committees or Parent Teacher Associations,
these have not always been able to play the roles
anticipated. One of the reasons for this has been the
failure to invest in their capacity building to enable them
to play the roles expected. At the same time, the role of
PRIs has been reduced to being implementing agencies
rather than “deciders” and there are multiple parallel
committees at the village level without involvement of
Gram Panchayats diluting the role of the elected
38
Literacy
peoples’ representatives. More specifically, their role in
planning and decision making (especially, preparation of
micro-plans) has been limited (http://www.pria.org/
panchayat/act1.php)
Any discussion on quality and performance of the
education system would be incomplete without taking a
close look at the performance of children from the
marginalized sections of society- Dalits, Adivasis,
Muslims and other groups of persons suffering from
discrimination in society. Many of the trends of social
discrimination are replicated in the education system as
well. Poverty, social discrimination and relatively
poorer quality of service reaching out to areas
inhabited by these social groups combine into a vicious
cycle pushing children out of school and often into child
labour. It is essential to remember in this context that
36.5% of SC groups in rural areas and 38.5% in urban
areas like below the poverty line. The corresponding
figures for ST groups are 45.9% and 34.8%.
Furthermore, instances of untouchability in the school
(especially in the context of the provision of the midday
meal) are regularly reported and have been referenced
to as a problem in the 10JRM as well. With India having
the world’s largest number of malnourished children
and despite the introduction of the Midday Meal
Scheme in government schools, classroom hunger
remains a reality and adversely impacts retention.
Adult
male
Adult
female
Young
male
Young
female
% change from
1991 to 2001
11.8%
14.1%
10.7%
18.4%
% change from
2001 to 2007
3.5%
6.7%
2.5%
9.4%
datasource - unesco.org definitions: Youth - 15 to 24 years,
adults - 15 years +
The single largest source of data on adult literacy is the
2001 Census Data. This is, however, a decade old. An
alternative, source of evidence is provided by the NSS
data which gives a more updated source of information
with a fairly large sample. The NSS data for 2004-5
shows an overall literacy rate for individuals in this
range of 76.4%. It is 84.2 for men and 67.7 for women.
Indeed, India’s report to the EFA pointed out that
India’s performance on female literacy in this age group
falls below the average for the developing countries,
and indeed, even below sub Saharan Africa.
Interestingly, 35% of individuals between the ages of 529 years old had never attended an educational
institution (although in the case of younger children,
there is a possibility that some of these would
subsequently enroll). The consistent failure to bring all
children under 14 into school results in older children
and youth remaining out of school.
2.3 Literacy rate of 15-24 year-olds, women
and men
Furthermore, while there was a sharp improvement in
literacy levels between 1991 and 2001, especially for
young females, there has been a noticeable slowdown in
growth of literacy rates during this decade. In Young
males, growth in literacy rates is a quarter of what it
was and adult males it has slowed down to a third of the
previous decade. Amongst females, growth in literacy
rates has halved. Consequently, the 100% projection in
the report appears extremely unlikely.
Much of the debate around education tends to be
restricted to the issue of school- especially elementary
education. However, the discussion would be
incomplete if the youth population is excluded from the
discussion. Needless to say, India enjoys a considerable
demographic dividend with a large youth population at a
time when fertility rates in the developed world is
seeing a decline. This is a potential opportunity for
India- provided it invests in the training and education
of this large population. Unfortunately, there are few
signals to suggest that this is being done in a systematic
manner.
Furthermore, even if persons are literate there are
questions about the quality of literacy. The Census
definition of literacy is based on self declaration which
has its limitations. Thus, in 1991, the NSSO
administered tests to a sub-sample of the 15+ age
group population to verify the literacy status of those
who declared themselves as literate. One of the
important outcomes of this exercise was that nearly
34% of those who claimed ‘literate’ status had failed to
qualify the test (NSSO 1995 cited in Govinda & Biswal
2005).
An inherent limitation of the present MDG indicator is
its focus on “literacy” as an indicator and the fact that it
seeks to combine the population of children under 18
(who should potentially still be in school) and young
adults (with different learning needs). The present
section, therefore, starts with a discussion on literacy,
but goes onto look at the status of secondary education
in the country.
39
Lastly, literacy alone is not enough. The break up of
literate population in terms of educational levels (based
on Census 2001) indicates that 3.6% of the total
literates were without any specified educational levels,
25.8% were below primary level and 26.2% had primary
level of education. Those with middle and
matriculation/secondary level of education formed
30.2% of the literate population. Graduates and above
qualification holders contributed 6.7% of the literate
population.
commitment for education until 18 years of age under
the Persons with Disability Act, the completion rate up
to secondary education is virtually 0%. There are also
considerable inter-state variations. States like West
Bengal, Haryana, Rajasthan, Madhya Pradesh and Bihar
have particularly low overall secondary enrollment
rates and high inequality by income group, whereas
southern states of Kerala, Maharashtra, TN and
Karnataka do much better.
A significant issue of concern is that nearly 60% of
secondary schools are with private management both
aided and unaided in almost equal proportions.
However, this figure is much higher in some states (eg
Kerala, Maharashtra, Assam, West Bengal and Gujarat)
where more than 50% of enrollment is provided
through private aided schools. This creates the
situation wherein access to higher education is limited
to those families able to afford education offered in
these (largely) fees charging institutions. Indeed, the
share of secondary enrollment served by private (aided
and unaided) schools in India is far greater than in Latin
America (25%) and East Asia (19%). In addition, India
subsidizes private secondary schooling more than Latin
America. (based on World Bank, 2009)
Secondary Education
As stated previously, the population 15-25 also includes
a large chunk of children who should be in school. The
population of the age group 14-18 is estimated to have
been 9.69 crores on 1.3.2007 (Framework for
Implementation of Rashtriya Madhyamik Shiksha
Abhiyan). Since 2000, total secondary enrollment has
expanded at an average rate of 5.4% per year. In
absolute terms, this has meant an increase of 12 million
secondary students, or a total cumulative increase of
48%. This huge increase reflects an increase of demand
resulting for the next highest level of education having
completed elementary education.
However, enrollment in secondary education is highly
constrained by the shortage of secondary schools.
Multi-level regression analysis on the NSSO 2004-5
data (World Bank, 2009) shows than over 25% of the
variance in secondary school attendance by grade 8
graduates in India can be explained by secondary school
availability, after controlling for individual and
household factors. Just 65% of villages have a secondary
school within 5 km and in several states this figure is
much lower (Arunachal Pradesh: 19%, Bihar 46%,
Jharkhand 36% etc). Even within urban areas the
distribution is not uniform with “good” neighborhoods
(as contrasted with schools) having more schools and
the schools having more teachers.
There is a 10% gap in enrollment between boys and
girls. The secondary enrollment for girls in rural areas is
particularly limited, averaging only 32% for both levels
of post elementary education (Seventh All-India
Educational Survey, cited in World Bank, 2009). There
are also considerable differences between the social
groups. Attendance rates of the general population
(55%) is nearly 80% higher than the average attendance
rate for STs, SCs and Muslims (31%) (based on NSS,
3004-5 cited in World Bank). Children with special
needs form another vulnerable group. Despite the
Indicator
Boys
Girls
Total
1
Enrollment (IX-X)
1.45 crore
1.05 crore 2.5 crore
2
Enrollment (XI-XII)
0.78 crore
0.56 crore 1.34 crore
3
Gross Enrollment
Ratio (IX-X)
57.72
46.23
52.26
4
Gross Enrollment
Ratio (XI-XII)
31.54
25.19
28.54
5
Dropout Rate
(Class I-X)
60.04
63.56
61.59
6
Pass Percentage
(Class X State
Board Exam 2006)
66.30%
70.26%
67.86%
7
Pass Percentage
Class XII State
Board Exam 2006
67.49%
77.25%
71.28%
Abstract of Selected Educational Statistics (2005-6) Provisional
In 2005 the average Grade 10 examination pass rate
was 64% (68% girls, 62% boys), while for Grade 12 it
was 609% (73% girls and 66% boys). Remembering that
the pass mark is just 33% of the maximum marks, this
suggests that the learning levels are low indeed.Of
course, the pass percentages vary widely across states,
from a high of 80% in Jharkhand in 2005, to 40% in MP
(and even lower in the north east states). This however,
40
REFERENCES
is not a reflection of higher learning levels in Jharkhand
but of differing inter-state standards. Students from SC
and STs tend to perform much lower than average.
1. SSA (2009) 10th Joint Review Mission of Sarva
Shiksha Abhiyan Aide Memoire
In Lieu of a Conclusion:
2. Govinda, R & Bandopadhyay (2008) Access to
Elementary Education in India. NUEPA
What the preceding analysis suggests is the lack of
adequate political and social will to push towards the
universalization of education. Needless to say, the
consistent failure of the State to provide education of
an adequate quality is partly a reflection of the
government to priorititize spending on this sector. The
Kothari Commission (1964) recommended 6% of GDP
should go towards Education and indeed the UPA
government promised to do so as part of their
Common Minimum Programme. Unfortunately, the
government has consistently spent in the range of 3-4%
of GDP. According to the Human Development Report
(UNDP, 2004), India ranks at number 78 in terms of
share of public expenditure on education in GNP, out
of the 137 countries on which data is available.
3. NUEPA (2008) Education for all: Mid Decade
Assessment Reaching the Unreached India. NUEPA
4. NCERT (2005) Seventh All India Educational
Survey, Provisional Statistics as on Sept 30, 2002.
New Delhi: NCERT
5. NUEPA (2010) Elementary Education in India:
Progress towards UEE. DISE Flash Statistics 20089. New Delhi: NUEPA
6. Govinda, R & Biswal, K (2005)Mapping Literacy in
India- who are the illiterates and where do we find
them? Background Paper commissioned for the EFA
Global Monitoring Report 2006 Education for Life
It is hoped that the coming years would see an increase
in the focus of education and the 2015 deadline is not
missed. However, without the allocation of adequate
resources, development of the necessary infrastructure
and building of teacher capacities, it is unlikely that the
goal of universal enrollment and retention would be
attained.
7. SSRI-IMRB (2009) Survey of out of school children.
SRRI, IMRB, EdCIL
8. GOI (2010) The Right of Children to Free and
Compulsory Education Act, 2010
9. World Bank (2009) Secondary Education in India:
Universalizing Opportunity. Human Development
Unit, The World Bank. New Delhi
1.
Sarva Shiksha Abhiyan 10th Joint Review Mission Aide Memoire. 2009.
2.
Dreze, J & Goyal, A (2003) The Future of Midday Meals in Frontline Volume 20 (16) accessed from http://www.hinduonnet.com/fline/fl2016/
stories/20030815002208500.htm
3.
UNICEF (2004) Mapping India’s Children: UNICEF in Action. New Delhi: UNICEF
4.
NCPCR () Magnitude of Child Labour in India: An analysis of official sources of data. Accessed online on www.ncpcr.gov.in/.../
Magnitude_of_Child_Labour_in_India_An_Analysis_of_Official_Sources_of_Data_Draft.pdf
5.
Education for All: Mid-Decade Assessment of EFA Reaching the Unreached India NUEPA
6.
ome instances may be ascertained from http://www.tribuneindia.com/2005/20050215/himachal.htm and www.create-rpc.org/pdf_documents/
India_CAR.pdf
7.
The Right to Children to Free and Compulsory Education Act, 2009 has subsequently revised the norm to 1:35 as part of the attached minimum
schedule.
8.
73rd and 74th Constitutional Amendments of the Indian Constitution, passed in 1993, devolved a significant amount of power over social
sector and development planning to local level governments or panchyats. The constitution mandates a one-third reservation for women in
panchayat assemblies. Panchayati Raj Institutions were to serve as instruments of planning for economic development and social justice.
41
Recommendations from the Civil Society
Dialogue on MDG 2, organized by Plan
India and Wada Na Todo Abhiyan
we have different groups of communities and their
children in different states, like migrant children,
street children, children in small establishment,
children on brick kiln sites, run away or missing
children, so we need to have this coordination
between different states on education issue, so that
wherever these children are moving they could
have access to education through various Govt,
interventions rum by the Govt. specially for them.
1. Government of India has chosen only three
indicators in Millennium Development Goals. Many
other indicators have missed out, some of the
prominent issues that have missed out and need to
be taken in to consideration are:
·
Quality Education
·
Attendance and retention of children
·
Trained teachers availability
·
Particular Attention on children from most
disadvantage groups, or children with difficult
circumstances like – children affected by
disasters, children under conflict, Children
affected with HIV –AIDS, Migrant children,
child labours, domestic workers, children from
marginalized groups etc.
·
5. Just like Inter state coordination, also there should
be Inter Department coordination among different
department like education, health, P.H.E.D, P.W.D,
W.C.D, Tribal welfare, social welfare, CWC,
Minority etc.
6. Education should come under one Department,
group suggested that all the responsibilities related
to delivering education should only be the part of
one Department/Ministry and that is MHRD (
Ministry Of Health and Rural Development)
7. Govt. should also work more with local institutions
to make them accountable to achieve MDG’s
because without their involvement we can’t
achieve these.
Issues like corporal punishment and positive
discipline were not even talked about, while
this is one of the main reasons of drop out.
2. There should be some kind of rationalization in the
legislation, convergence is required between
different laws like Right to Education, Child Labour
Law, Factory law, JJ Act and others for better
understanding and clarity on different issues among
different group of children and what and how these
laws are accountable to deal with the issues.
8. Also these goals are not directly related/connected
with the community, and they are not really aware
about the figures and findings. So there is a need to
find out strategy to build this community network.
9. The share of public spending on education, Govt
should allot more money for Education, and
tracking mechanism should be transparent and
community monitoring should be promoted
because without that we can’t achieve Right to
Education.
3. A major concern was raised that as to why we are
using Gross enrollment ratio, to measure the
enrollment figure, it’s a very poor indicator. As per
Govt. reports it is quite high as over 100%. But
there are a large number of under or over age
children and the possibility of dropping out is much
higher in these children as compare to others.
10. Finally group raised the point that there is acute
paucity of trained teachers, so Govt. should also
should focus on that and this issue could be added
as one of the major indicator to achieve universal
education as this is directly linked to the children
regular learning and retention.
4. Another important recommendation given by the
group was to work on Inter State Coordination. As
42
Goal 3: Promote Gender Equality and
Empower Women
-Wada Na Todo Abhiyan and Partners
Ministry of Women & Child Development failed to
take up this opportunity to develop various programs
that can cater to the needs of this diverse group of
women so that most excluded get an opportunity to
grow to their full potential.
Introduction
India, a signatory to the declaration of the United
Nations Millennium Development Goals (MDGs) has
been implementing MDG oriented programmes to
address the multi-dimensional developmental needs of
the country for the last 10 years. With 5 years left for
the target to be achieved, the country is geared up to
assess, reflect and review the status of MDGs in India.
With this premises, Wada Na Todo Abhiyan (WNTA)
proposed to create opportunities for women who
represent most excluded groups (caste, religion and
ethnicity as well as geographical locations) to voice
their experiences in the context of MDG – specially
reduction in disparities (social, economic and political),
access to health services (comprehensive including
maternal and infant health care services) and to quality
education (universalization of education with quality).
While figures and data available on websites of various
Ministries of Government of India looks very
promising, large number of civil society organizations
and women’s organizations are pointing out many
shortcomings in the achievements. One of the
criticisms on MDG is that it is all oriented towards
quantitative targets whilst the changes in figures and
data should get reflected on improvements in ‘quality
of life’. If these goals are to be measured for bringing
any qualitative changes in standard of living, the most
vulnerable have to be counted first. Women being
amongst the vulnerable groups have to give their
verdict on how the achievements on MDGs are getting
translated into improving quality of life.
The 3rd Women’s Tribunal against poverty was
organized by WNTA with its partners in 8 states of
India in the month of August and early September 2010
with the following diverse groups:
Despite the rhetoric, policies and programmes of the
Indian government, women continue to reflect the
dominant face of poverty, with a continuing low social
position and disproportionately lower development
indicators. While progress is visible on fronts such as
legal safeguards and local level political representation,
the gains from these have not consolidated into an
improved position for women.
The 11th Five year plan has recognized that women
are not homogenous group and Gender relations and
categories of social exclusion often intersect.
Unfortunately, after recognising this diversity and
differential needs, the Plan fails to come up with
comprehensive programs for reduction of disparities.
1.
SINGLE WOMEN- Ekal Nari Sashakti Sangathan &
Shramajivi Mahila Samity (SMS), Jharkhand
2.
MUSLIM, DALIT & ADIVASI WOMEN- Mahila
Swaraj Abhiyan (MSA), Gujarat, Vimarsh,
Uttarakhand, Katha Rakha Abhiyan (WNTA
Orissa), Orissa & Tamil Nadu Women’s Forum,
Tamil Nadu
3.
WOMEN IN URBAN SLUMS- Hunger free West
Bengal, West Bengal & Paryay and YUVA,
Maharashtra
4.
TRANSGENDER- Sangama, Karnataka
Following are the outcomes of the State women
tribunals highlighting the concerns of the diverse
categories of women that have not been addressed
and the key recommendations voiced by them.
43
Single women
India counts to 30 million single women as per the
Census data, 2001 which is a very conservative
estimate. Single women are often rejected by the
family and society and are forced to live a dejected life
with no respect and dignity. Economically they become
weak and are ignored and remain outside the ambit of
various government schemes.
The single women’s tribunal held in Jharkhand has
challenged the societal norms and attitudes towards
single women. Committed to address the exclusion
faced by single women, the single women groups have
voiced for their rights and entitlements.
Single women’s struggle for rights & justice
Key Issues:
·
Single women live a life with no dignity.
·
They are ignored of the benefits of social welfare
schemes.
·
They are subjected to social evils like separation,
violence, witch crafts, deprivation of education
rights and oppression.
·
Single women are the most vulnerable entity
treated as non-existent.
·
Enable her to enjoy fundamental right, basic
amenities like food, housing, health, livelihood,
education & security so that her marginalized
status is bettered.
·
Lay down provisions at the local level to remove
hurdles pertaining to her social and family
ostracization and enable her to come out of such
tough situations.
·
Grant special provision to enable the single
women children are enabled to acquire primary to
higher education.
·
Provision to make health card for them and their
family members so that they can acquire health
benefits for them & their dependents.
·
Special provisions should be formulated for the
treatment of critical illness and severe aliments
and the access is enabled through linkage to
primary health centers.
·
Ensure livelihood rights to single women. The
government provisions should be laid down for
single women as they are not rendered hunger
prone owning to lack of livelihood options.
·
Eradication of child labour, i.e the single women
when rendered sick are compelled to render their
children towards livelihood earning.
·
Provision should be laid down to promote the
accessibility of single women over land, resources
and property so that the landless single women are
not disowned from the property they require.
·
Uniform provision for all single women on the land
& resources entitlement.
Key Recommendations:
·
Identity of the single women should be ensured so
that they can be identified.
·
Single women lives with a dual responsibility, hence
all provisions pertaining to different issues should
be laid down for her welfare.
Single women get unified during the
Tribunal in Jharkhand
44
·
Expeditious trail of cases related to single women
in fast track court.
·
Enable social security for all single women on a
comprehensive basis right Enable social security
for all single women on a comprehensive basis
right from the local level till the national level.
·
panchayat election to be held shortly even
without documents like caste, residential &
income certificate as they not get these
certificates as they have no title deeds of land.
·
Grant of special facilities to file nomination for the
Provision of prepared meal for very aged single
women and the responsibility should be
undertaken by the Gram Sabha & local agencies
that are operational.
“We don’t need your mercy but our rights!”
-Ms. Vasavi Kiro, Member, Jharkhand Women Commission
45
information and hence are unable to do anything.
Muslim, Dalit & Adivasi women
·
Schools are far-off from villages due to which
parents don’t send their daughters thinking it
would be unsafe. It becomes difficult for Adivasi
girls as they reside in hilly terrains.
·
Muslim girls are often not encouraged to go to
schools.
Around 400 women gather at the Women’s Tribunal
at Uttarakhand
·
The tribunals concerning the above 3 constituencies
were held in 4 states- Gujarat, Uttarakhand, Orissa and
Tamil Nadu to ensure gender justice to women
belonging to these communities.
Dalit children are served food in an isolated place
in schools and they are subjected to harassments
by teachers.
·
People in villages still believe that ‘drums, idiots,
low caste persons and animals’ deserve to be
beaten.
·
Girls are treated as the wealth of others by their
parents and are often neglected.
·
Women are not allowed to work at MNREGA
(Mahatma Gandhi National Rural Employment
Guarantee Act) sites. In many cases, they are not
allowed to go out for work.
·
The NFHS -3 (National Family Health Survey)
report for India says, “More than half of the
women in India -55% have anaemia, 39 % with mild
anaemia, 15% with moderate anaemia and 2% with
severe anaemia.In Orissa there are 16.3% of
severe anaemia in women, and 61.2% are with mild
anaemia in tribal belt area of Orissa women with
anaemia is 64.9 per 1000. This is high in women
with no education, women from scheduled tribes
and women in the two lowest wealth quintals.
·
Mass scale trafficking of tribal women.
·
No tribal women agriculture cooperative is
registered in Sabarkantha district, Gujarat.
·
Tribal and Dalit women are paid less wages than
men.
·
Women workers in unorganized sector have no
social security.
·
On Bt Cotton farms in north Gujarat– 3 out 10
women face physical, sexual harassment
·
Girls from Muslim community are discriminated in
schools.
·
Religious inequality practiced in schools.
·
The textbooks used in schools use derogatory
terms for the Dalits.
The Muslim, Dalit and Adivasi women face multiple
marginalization due to being discriminated in terms of
religion, caste and ethnicity and being a woman are
oppressed within their own community as well. And
gender related oppression cannot ignore the
oppression women from minorities, dalits and adivasis.
Key Issues:
·
Reservation in electoral politics for women has
merely helped the women in getting elected but
not access the power and rights of the political
position.
·
No political training has been organized by the
government for elected women representatives.
·
Lack of knowledge and information on various
government schemes to the women Pradhans.
·
Denial of opportunities to women.
·
Inadequate participation of women in Gram
Sabhas due to patriarchal moorings.
·
Unaware of legal provisions like Domestic
Violence Act. Almost no cases have been
registered. The Protection Officers lack
Around 400 women gather at the Women’s
Tribunal at Uttarakhand
46
·
Muslim women are not given the right to vote in
many places in Gujarat.
·
No relief colonies were set up by the government
after the communal violence in Gujarat.
·
Security of Muslim women is a great concern.
·
Panchayat women members not allowed receiving
information on meetings and various schemes.
·
Dalit women still practice manual scavenging and
are always ill-treated by non-Dalits.
·
There is a decrease of women of the age group 15
to 49 years in work force.
·
Infant and child mortality rate is shown to be
decreased to an intended level but the girl to boy
ratio in the mortality rate has increased.
·
The prevalence of HIV should be halted by 2015
according to the MDG-though government states it
is possible, the NFHS data shows that prevalence of
HIV is more among women of 15-19 years than men.
·
Dalit women are affected not only by other caste
domination but by the patriarchal values within
their own community as well.
·
For woman, especially Muslim woman movement
is restricted. Women face double the challenge
when they have to break this to come out and
work.
·
Key recommendations:
·
Problems of women are social in nature, but it
needs political solutions.
·
Need for gender segregated data.
·
Massive awareness programmes on women health
programmes in rural and tribal villages.
Women from different communities
participated in the Tamil Nadu Tribunal
There are provisions mentioned in MNREG
scheme as per which women should have a shelter
at the work place where their children could rest
and proper water facility should be ensured. But
these are not followed anywhere.
A woman shares her experience at the
Gujarat Tribunal
47
·
National Maternal Benefit scheme should be
restored instead of present schemes, which is
conditional and prohibits many poor beneficiaries.
·
Strict implementation of Pre-Conception and PreNatal Diagnostic Techniques Act 1994 (PC &
PNDT Act).
·
Land entitlements in the name of women.
·
BPL cards in the name of women.
·
Cells for missing tribal women should be
established.
·
Separate registration for migrated and trafficked
women should be done.
·
There is a need to bring change in training as well
as behavior of teachers towards ensuring and
practicing non-discrimination.
·
Strengthening the collectives that are supporting
women elected representatives.
·
Women elected representatives need to be given
lot of information. Apart from important issues of
training, information, awareness and finance for
Panchayats, there is an equally great need for
sensitizing the government system.
·
Change is not possible unless there is a strong link
between the three different communities- Dalits,
Muslims and Tribals and leaders of collectives of
these three communities coming together.
Members of these three communities should be
sensitive and compassionate to the questions and
problems of each other, only than can their
struggle gain strength.
·
Reservations have enabled many women from
marginalised community to take part in politics but
more needs to be done to ensure they have the
decision making power and to ensure they’re not
forced to become the puppets of other caste
people.
“We are born in this country. The Constitution of India gives
us equal Rights as citizens of India. We should get our
rights.”
-Mehmuda Patel, working with the internally
displaced colonies (after 2002 communal violence) in Ahmedabad
“A Dalit woman councilor would have a husband who directs in all
her activities and behind him would be a dominant caste man. So,
you have a woman ward member who hasn’t attended a single
Gram Sabha meeting for 10 years.”
- Vijaylakshmi during Tamil Nadu Women’s Tribunal
48
·
Women in urban slums
There has been mass scale migration to urban areas in
search of livelihood. And the conditions in urban slums
are no better than rural areas. Women in urban slums
do not have access to basic facilities; they get under
paid while working as maids and subject to torture.
Key recommendations:
The tribunals on women in urban slums were held in
West Bengal and Maharashtra where women
presented their testimonies before the jury members.
Key Issues:
·
·
Gender discriminations exist in every sector of life
– in family, in schools and colleges, in work places,
in society and politics. Physical and Sexual
harassment is common factor, violation of
conditions of employment exists usually in case of
female workers.
Agents and mediators exploit women in urban
slums in the name of accessing government
facilities.
An elderly woman speaks out at the Tribunal
in Aurangabad, Maharashtra
·
No upgradation of slums resulting in poor
sanitation and poor quality of life especially for
women.
·
30% reservation for women is only on paper.
Actual implementation is far away, especially from
women from deprived communities.
·
The government hospitals/ dispensaries do not
cater to the health needs of women.
·
Lack of awareness amongst women in slums on
various government schemes for them.
·
No toilet facilities have been made for girls in
majority of the schools.
Women are paid less wages compared to men for
the same work.
·
Women should get organized and fight for their
rights with the government.
·
Upgradation of slums and ensuring better quality
of life especially for women.
·
Involvement of women in planning and
implementation of the development of slums.
·
A proper mechanism to ensure free education to
girls up to Class-XII, need to be in place.
·
Need to set up hospitals/ dispensaries with
adequate infrastructure. It should be women
friendly and distribution of basic medicines such as
Iron Tablets/Calcium Tablets should be given for 1
month and not for 10 days. The distribution should
happen at door step and the poor woman need
not come to hospital.
·
Government should carry awareness programme
for Antenatal Care, Post Natal Care, HIV/AIDS,
Malaria and TB and schemes like Janani Suraksha
Yojana on mass level and evaluate them.
·
Monitoring mechanisms for various schemes has
to be in place and women representatives should
be involved.
·
Equal wages for women and men.
·
Schools to have all basic facilities for girls.
·
Women helpline should be activated in every
slums to address women exploitation at work
places and at home.
Panelists responding to the testimonies of women
from urban slums in West Bengal
49
systems. The place being unfamiliar, the language
and food being different and loneliness involved
makes migration difficult even while it does offer
them a chance sometimes of being freer and more
“themselves”.
Transgender
Even while the world pursues the MDGs, the problem
is that the continued framing of the mainstream
“gender equality” discourse as equality between men
and women. This keeps transgenders out of the
picture; even though they face a range of issues at the
personal, economic, political, social, legal, and medical
levels. Transgenders are denied access to basic social
services and entitlements, employment, education,
even entry to public places. They suffer tremendously
from hate crimes, including violence perpetuated by
law enforcers.
The tribunal held at Karnataka was an attempt to
broaden the idea of gender-based discrimination to
include transgenders - people who challenge the
traditional understanding of gender that seeks to
equate it to sex. It highlighted the significance of issues
of social and political exclusion that transgender
(Jogappas, Hijras, Kothis, and F2Ms) face with special
reference to 3 (of the 8) MDGs.
·
The difficulty of legally changing one’s gender as
well as the fact that they are not regarded as
worthy citizens makes it difficult for transgender
to access entitlements like ration cards, old age
pensions etc
·
Even basic entitlements like voting rights are
denied to them because the areas where they stay
are excluded or because their gender identity is
seen as incongruent with their earlier documents.
·
Stigma and discrimination while using any public
utility or public spaces – be they hospitals, public
toilets, buses etc. There are no clearly designated
spaces for transgender.
·
Sexual Harassment and verbal abuse not only at
work places but also by the general public that
make them “objects’ of ridicule and lack of public
support for them.
·
Non acceptance – as part of society, as
contributing members. They are often not even
accorded the preliminary status of being “human
beings”
·
No equality of opportunity and very limited
freedom for gender and sexual expressions.
·
There is rampant discrimination in the public
health systems. Issues of self esteem/self respect
among HIV+ persons especially transgenders often
is not taken into account at all during treatment.
There are huge gaps in the treatment that HIV +ve
transgenders receive and in the ART centres.
·
The most basic right to an identity is denied to
them. The existence of laws such IPC 377 is used
to blackmail, extort money, be violent to and in all
ways deny them their rights.
·
Even in the courts they are often not allowed to
enter and the cases are often arbitrarily decided
against them.
·
Denied of basic citizenship rights due to their
gender identity.
Transgender groups get organized to assert their
rights at the Karnataka Tribunal
Key Issues:
·
Due to the discriminatory attitudes at home, they
are forced to leave home and are pushed into
poverty.
·
The fact that they do not adhere to the gender
normative behaviour means that there are very
few job openings to them. The only options are
sexwork, seeking alms and HIV prevention work in
NGOs.
·
Issues of the forced migration due to pressure to
marry or adhere to a gender role that is different
from their identity etc results in a loss of support
50
migration etc.). The demands must set goals in
terms of the allocating resources for transgender
(whether as affirmative action or welfare
measures)
Key Recommendations:
·
Include transgender into the discourse on gender.
·
The MDGs give us a peg, an internationally agreed
upon commitments around which demands can be
made by transgender. The experiences of
transgenders should form the basis of picking up
the issues and deciding priorities.
·
The specific demands should include issues of
enumeration, (which brings in issues of identity,
·
Important to link with other development
indicators that are used to critique the current
development model.
·
Realising that issues should not only to focus on
issues of discrimination but also dignity.
“The MDG recognises the rights of sexual minorities but the
working towards it has been rather slow.”
- Vasanthi Kumar, head of Mangalamukhi,
a group of trangenders.
51
Few Data Sheets
Maternal Mortality Rate (MMR) of 8 states in India(2007)
States
MMR
Tamil Nadu
111
Maharashtra
130
West Bengal
141
Gujarat
160
Karnataka
213
Orissa
303
Bihar/Jharkhand
312
Uttar Pradesh/Uttaranchal
440
India
254
Source: Rajya Sabha Unstarred Question No. 1577, dated on 17.07.2009.
Infant Mortality Rate by Sex and Residence in 8 states of India(2008)
States
Total
Total
Rural
Male Female Total
Urban
Male Female Total
Male Female
Gujarat
50
49
51
58
58
60
35
34
36
Jharkhand
46
45
48
49
47
50
32
31
34
Karnataka
45
44
46
50
49
52
33
33
34
Maharashtra 33
33
33
40
40
40
23
22
25
Orissa
69
68
70
71
70
73
49
45
52
Tamil Nadu
31
30
33
34
33
35
28
27
30
West Bengal 35
34
37
37
36
38
29
27
31
Uttarakhand 44
44
45
-
-
-
-
-
-
India
52
55
58
57
60
36
34
38
53
Source: Ministry of Health & Family Welfare, Govt. of India. (ON39)
52
Sex Ratio (0-6 Years)of 8 states in India(2001, 2011-2012 and 2016-2017)
States
CurrentLevel
Goal by2011-12
Goal by2016-17
Gujarat
883
891
905
Jharkhand
965
973
989
Karnataka
946
954
969
Maharashtra
913
921
936
Orissa
953
961
977
Tamil Nadu
942
950
965
Uttarakhand
908
916
931
West Bengal
960
968
984
India
927
935
950
Source: Planning Commission, Govt. of India.
Per 1000 Distribution of Persons (Female) Aged 7 Years and Above
by Level of Education in Rural Areas in 7 states of India (2006-2007)
States
Per 1000 Number of Persons Aged 7 and Above with Level of Education
Not
Literate
Literate
without
Formal
Schooling
Literate
but
Below
Primary
Primary
Middle
Secondary
Higher
Secondary
All
Estimated
Number of
Persons (00)
No. of
Sample
Persons
Gujarat
454
4
137
176
134
50
30
2
8
5
0
1000
152543
2533
Jharkhand
546
4
172
128
87
49
6
0
6
0
3
1000
88400
1238
Karnataka
468
2
98
147
170
79
24
6
5
0
0
1000
159240
3162
Maharashtra
369
6
143
166
185
87
33
1
7
3
0
1000
224958
3608
Orissa
524
11
138
121
148
38
12
1
6
1
0
1000
143740
4052
Tamil Nadu
392
1
126
198
154
73
39
3
11
3
0
1000
161630
4773
West Bengal
382
30
169
240
125
34
11
1
7
1
0
1000
280207
6713
Source: National Sample Survey Organization.
53
Diploma Graduate
Post
N.R.
Certificate
Graduate
Course
MDG 4: Reduce Child Mortality
-Save the children India
Progress
on
meeting
Millennium
Development Goal 4 to reduce child
mortality
treatment for pneumonia, diarrhoea and malaria;
support for nutrition, including exclusive breastfeeding,
complementary feeding, conditional cash transfers and
wider social protection programmes. These
interventions will need to be delivered through more
effective systems, so that the poorest and most
marginalised families can also get the healthcare,
nutrition security and other services they need. For
this change to be sustainable, it will also need to be
complemented by a concerted drive to tackle
discrimination and to strengthen the rights and social
status of the poor, especially lower caste groups, and
girls and women. With the necessary leadership and the
right policies, MDG 4 can be achieved in India.
While there is much to celebrate and admire in India’s
rising prosperity, and in its growing cultural and political
influence, the country’s level of child mortality remains
high. Nearly 9 million children die each year before
their fifth birthday. Of these, a staggering 1.83 million
are Indian. Half of these deaths occur within a month of
the child being born (the neonatal period). These levels
of child deaths persist despite twenty years of relatively
high economic growth in India, and with India now as a
significant force in the global economy (set to become
the world’s third largest economy by 2020).
What has India committed to?
In the year 2000, world leaders committed themselves
to eight Millennium Development Goals, including
MDG 4 which calls for a two-thirds reduction in underfive mortality between 1990 and 2015. While India has
made some progress, with the under-five mortality rate
falling from 116 per thousand live births in 1990 to 69
per thousand live births in 2008, this progress is
inadequate when compared to the overall target to be
met. The aggregate figures mask gross inequalities
between states and between different social, cultural,
economic and gender groups within them.
India was a signatory to the original Millennium
Declaration and has reaffirmed its support for the
Millennium Development Goals, including MDG 4.
Despite progress against the target, on the current
trajectory, India will fall short of achieving it. The
current annual percentage of reduction of Under 5
mortality is 2.25%, whereas the required annual
percentage of reduction to reach the MDG goal in this
regard during the remaining seven years has to be
6.28%.
India is also a signatory to a series of international
human rights agreements and treaties that are highly
relevant to child survival. Clear commitments to
safeguard the lives of newborn babies and young
children are contained in the UN Convention on the
Rights of the Child (UNCRC), the International
Covenant on Civil and Political Rights, and the
International Covenant on Economic, Social and
Cultural Rights. For example, Article 6 of the UNCRC
refers to children’s inherent right to life, survival and
development, while Article 24 calls on governments to
‘take appropriate measures to diminish infant and child
mortality and to ensure the provision of necessary
medical assistance and healthcare to all children.’ India’s
own constitution also sets out comparable
commitments. But India’s leaders are falling short on
fulfilling their commitments to India’s children.
There is now general agreement among programme
and policy makers about the actions needed to rapidly
reduce child mortality. At the end of September this
year, world leaders meet in New York at the United
Nations Millennium Development Goal Review Summit
to assess progress against the goals. On the table for
discussion will be a proposed Global Strategy for
maternal and child health, put forward by the UN
Secretary General. As the country with the highest
number of child deaths anywhere in the world, there
remains a particular obligation on the part of India to
demonstrate leadership on this issue.
This means implementing the right kind of policies to
expand coverage of proven interventions like skilled
personnel available to support mothers during child
birth, early postnatal care, preventive and curative
54
Where are India’s children dying?
Why are India’s children still dying in such
large numbers?
Of the 26 million children born in India in a year, nearly
2 million still die before their fifth birthday and half
within a month of being born. But these aggregate
figures conceal huge inequities in mortality rates across
the country, within states and between them, as well as
between children in urban and rural areas, from upper
caste and lower caste families and from tribal and non
tribal communities.
High levels of child mortality in India can be explained at
three levels.
1) There are a few conditions that account for more
than 90 per cent of these deaths. These are
pneumonia, measles, diarrhoea, malaria and neonatal conditions that occur during pregnancy and
during or immediately after birth. The latter
conditions are particularly significant when it
comes to India’s newborn deaths. Severe
infections, asphyxia and premature births cause
over 72 per cent of newborn deaths.
The latest figures suggest that the under-five mortality rate in
Kerala is 14 deaths per thousand live births. This contrasts
with a rate of 92 per thousand in Madhya Pradesh, 91 per
thousand in Uttar Pradesh and 89 per thousand in Orissa.
These inequalities are also marked in respect of newborn
mortality rates. While the rate for Kerala is 7 per thousand,
the comparable figures for Madhya Pradesh, Uttar Pradesh
and Orissa are 48, 45 and 47.1
In most cases, the conditions that are the direct cause
of childhood deaths are preventable and treatable with
proven interventions and services. But these
interventions remain unavailable or inaccessible to
many of India’s poorest children. At the same time, for
cultural reasons, some of India’s poorest mothers and
families are reluctant to use services at health facilities
that do exist and may pursue traditional practices in the
home or the community that are detrimental to their
own health and that of their children. The survival of
the newborns, for example, is critically dependent on
cleanliness at the time of delivery, clean cutting of the
umbilical cord, keeping the baby warm and early
initiation of breastfeeding. But some traditional views
can discourage these life-saving practices. Labour may
be considered an unclean process, to be conducted in a
dirty corner of the house, for example in a cowshed. In
some cases, the delivery space is plastered with fresh
cow dung to cool the room, although this increases the
risks of infection. Early bathing of the baby is often
practiced, which heightens the risk of hypothermia, as
does leaving the newborn baby uncovered.
Mortality rates vary considerably in relation to maternal
education, wealth, religion, caste and tribe. The table
below sets out these disparities in detail.
Early Childhood Mortality Rates by SocioEconomic Background, India, NFHS-32
Background
Characteristics
Education of Mother
No education
< 5 years complete
5-7 years complete
8-9 years complete
10-11 years complete
12 or more years complete
Wealth Index Quintiles
Lowest
Second
Middle
Fourth
Highest
Religion
Hindu
Muslim
Christian
Sikh
Buddhist
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
All
Neo-natal
Mortality
Rate
Infant
Under-five
Mortality Mortality
Rate
Rate
46
48
35
32
27
20
70
66
50
42
37
26
95
79
61
47
40
30
48
45
39
32
22
70
69
58
44
29
101
90
72
51
34
40
34
32
36
43
59
52
42
46
53
76
70
53
52
69
46
40
38
35
39
66
62
56
49
57
88
96
73
59
74
2) There are a set of factors that make some Indian
children more prone to these medical conditions, and
limit their chances of survival. These factors include: the
lack of essential healthcare or the inability or
unwillingness of many mothers and their children to
access it; high levels of maternal and child malnutrition,
poor feeding practices; lack of access to clean drinking
water, safe sanitation, poor hygiene; and limited access
to or use of family planning services.
In India, as in other parts of the world, the costs of
healthcare are often prohibitive for the poor and
discourage the use of those services that do exist. The
share of health, nutrition, water supply and sanitation in
55
government expenditure stood at 5.48 percent
between 2005-06 to 2008-09. But as a share of Gross
Domestic Product, this was only 1.58 percent in 200809, way short of the Government’s own commitment
to increase health expenditure alone to 2 to 3 per cent
of GDP. Also many states with high levels of child
mortality do not spend all the resources that have been
allocated.
suffer from deeply entrenched forms of discrimination
on the grounds of gender, caste, ethnicity and religion.
For example, the relative powerlessness of many
women and girls prevents them from accessing services
without the consent of their husbands or male relatives,
and increases their chances of death.
A call to action
In many ways, India stands at a crossroads in respect to
child mortality. Can high rates of child mortality be
consigned to India’s past, or will they remain an
indelible stain on its future? The United Nations
Millennium Development Goal Review Summit is the
right moment for India’s political leaders to affirm
decisively that it is the former course that they want to
pursue, with high level commitment and with urgency.
Maternal and child malnutrition is significant too in
explaining the continuing high rates of child mortality in
India. 48 per cent of India’s children under the age of
five are chronically malnourished, 20 per cent are
acutely malnourished and 22 per cent of India’s babies
are born with low birth weight. These rates of child
malnutrition compare with some of the poorest
countries in Africa. India’s rates of child wasting, for
example, are three times higher than Ethiopia.
If the MDG 4 target is to be met in India, Save the
Children believes that decisive action will be needed in
the following five areas:
Exclusive Breast Feeding is central to child survival,
strengthening the immune system and furthering
healthy development.
But rates of exclusive
breastfeeding across India are low, and far too little is
done through the health system to promote it, as well
as to identify malnutrition at an early stage and then to
take the necessary steps to address it.
1. Child survival must become a key metric
by which India judges its success in
development
Rates of child mortality, especially amongst the poorest
communities, are a much more telling indicator of
development progress (or the lack of it) than per capita
income. While India has been applauded for its high
rates of economic growth over two decades, it still
suffers some of the worst rates of child malnutrition in
the world and accounts for more than 20 per cent of
global child mortality.
The deaths of Indian children are not therefore random
events beyond control. To a considerable extent they
are the outcome of political and policy choices taken by
Indian governments, at the central, state and district
levels. They are also influenced heavily by traditional
cultural practices, by low levels of maternal education,
and by wider economic, environmental, political and
social factors that governments and civil society could
help to shape or mitigate. This is the third level of
explanation - the underlying or structural causes of
India’s child mortality.
The Indian national and state Governments and district
administrations should be encouraged to measure and
report progress against newborn and child mortality
and morbidity indicators (broken down by wealth
quintile, caste, religion and gender), and set targets for
reducing inequalities in the coverage of services and in
mortality and morbidity rates.
As the statistics show very clearly, it is the poorest and
most marginalised Indian children who are at greatest
risk of dying before their fifth birthday. Children from
households in the bottom wealth quintile are three
times more likely to die than those from households in
the top wealth quintile. Their poverty reflects their
parents’ lack of livelihood opportunities or assets, or
their greater vulnerability to economic and
environmental shocks. This lack of income and assets
translates into reduced access to healthcare,
inadequate nutrition, unsafe and unhygienic living
conditions and limited access to education, all of which
increases the risks of mortality. But inequality in India
is not just about income disparities. Large parts of India
2. Integrate and implement existing maternal
and child health programmes and link them
to wider development strategies
The Indian government runs a number of important
programmes that address the key issues identified in
this brief, for example the Reproductive and Child
Health Programme, the Universal Immunisation
Programme, the Integrated Child Development
Services (ICDS) programme and the more recent
National Rural Health Mission and soon to be
introduced National Urban Health Mission. While
56
specialist health facilities. Examples include antenatal
visits, skilled attendants at birth, early postnatal care in
the community and facility and support for exclusive
breastfeeding, and family planning services. This should
be based on evidence based models, such as the homebased newborn and childcare model developed in
Maharashtra by SEARCH (Society for Education, Action
and Research in Community Health).
these have brought benefits, they need better
coordination and implementation at the Central, State
and local level, and the services provided locally needs
to be of better quality.
The key task is not to create yet new strategies or
plans, but to implement and properly integrate many of
these existing ones. This integrated approach must
involve the Ministry of Health and Family Welfare, but
also the Departments of Women and Child
Development, Panchayati Raj, Rural Development,
Education Public Health Engineering (responsible for
water and sanitation) and Ministry of Housing and
Urban Poverty. This integrated approach to tackling
child mortality needs to feature prominently in India’s
12th 5-year plan in 2012. There will also need to be a
clear framework of accountability to ensure that
programmes are scaled up across the country,
especially in those states with the highest mortality
rates (Rajasthan, Orissa, Bihar, Uttar Pradesh, Madhya
Pradesh, Chhattisgarh and Jharkhand).
4. Prioritise equity and rights
Reducing mortality rates amongst India’s poorest
children requires concerted action to tackle underlying
causes – those factors that limit the ability of poor
children and their mothers to get decent healthcare,
adequate nutrition, clean water and safe sanitation, and
opportunities for education. In policy and programme
terms it will require a comprehensive approach to
break down barriers and multiple forms of
discrimination and prejudice, and to ensure that
children’s rights and the rights of women are respected.
Specifically, the National Rural Health Mission should
have a clear focus on social inclusion of Dalits, Adivasis
and Muslims in terms of access to healthcare. This
should also include improved training and support for
community health workers, including in how to tackle –
sensitively but effectively – some of the traditional
practices around birth and early childhood care that are
damaging to child health. One important way to
promote rights and empowerment for marginalised
groups, and to address harmful traditional practices, is
by supporting those Indian civil society and community
groups, as well as international agencies, that are
championing these causes and working at the local level
on these issues.
Integrated and credible strategies for reducing child
mortality need to be properly resourced. The
Government of India should commit to raise central
and State funding on health from just over 1 per cent of
GDP today, to 3 per cent by 2012 and 5 per cent by
2015. As importantly, there needs to be improved
processes for ensuring the effective and equitable
disbursal of these resources and transparency about
allocation and impact. Part of this additional investment
should be allocated to recruit, train, equip, monitor,
supervise, incentivise and deploy more frontline health
workers. Targets should be set for expanding the
number of trained health workers in the poorest parts
of the country, especially women frontline health
workers at the community level.
5. Tackle malnutrition
At every level of government, India’s political leaders
need to enhance their action to tackle malnutrition This
should involve support for initial and exclusive
breastfeeding, micronutrient supplementation and
fortification, child and maternity benefits, nutrition
education, treatment of severe acute malnutrition,
early warning systems and investments in appropriate
forms of agricultural production. We would also like
to see the Indian Central government and the state
government and district administration setting clear
targets for reducing rates of child malnutrition. This
should involve the development of protocols, guidelines
and implementation strategies focused on the needs of
the poorest and most marginalised children with the
highest levels of child malnutrition. There will also need
3. Focus on newborns
As India has made progress in reducing the deaths of
slightly older children, newborn deaths have increased
as a proportion of overall childhood mortality, so that
they now account for 55 per cent of all Indian child
deaths. Tackling newborn mortality will require
interventions that enhance the health, nutrition and
wellbeing of adolescents, mothers and children during
and immediately after birth (the most vulnerable period
for the child and the mother).
Support is best provided through a continuum of care across the lifecycle, from women of reproductive age
group through birth to early childhood; and from care
at home through to first referral units and other
57
to be enhanced training and support for community
health workers to identify and treat malnutrition and to
promote good infant and young child feeding practices.
The Leadership Agenda for Action agreed by the Coalition
for Sustainable Nutrition Security in India sets out a clear
consensus on the essential interventions needed to
reduce malnutrition.
discuss Millennium Development Goal 4 to reduce child
mortality and what needs to be done to deliver faster
progress. The meeting included 45 delegates from 22
different organisations.
The delegates agreed that based on current projections
the goal to reduce child mortality will be widely missed
in India and urgent action is needed to rectify this. As
the country with the highest number of child deaths
anywhere in the world, India has a particular obligation
to demonstrate leadership on this issue. India has
demonstrated the commitment and capability in the
form of rural health reform under the National Rural
Health Mission. But the efforts towards child health
need to be further strengthened and focused.
Conclusion
India has made enormous economic strides in recent
years. But millions of Indians are failing to share in this
rising prosperity. After 20 years of high and sustained
economic growth, nearly 2 million Indian children still
die every year of conditions like pneumonia and
diarrhoea, and of complications related to pregnancy
and child birth. We do not need a major technological
breakthrough for India to tackle this problem. Other
countries, many of them poorer than India, are well on
their way to doing so. And the performance of some of
India’s states, like Kerala and Tamil Nadu, shows what
others could accomplish by pursuing similar
approaches.
The following recommendations were put forward by
the delegates at the meeting and agreed in a summary
presentation at the end of the consultation:
1) That the Indian Government delegation endorse
and operationalise the UN Secretary General’s
Global Strategy on Maternal and Child Health. This
will give India the credibility to lead the
forthcoming Partnership for Maternal, Newborn
and Child Health conference in Delhi where there
is an expectation of India’s President, Prime
Minister, Sonia Gandhi and over 40 health ministers
and finance ministers participation along with
possibly the Secretary General of the UN. The
event is an opportunity to turn the ‘pledges into
action’.
Nor is this just a moral issue. We know from the
experience of other countries and India’s better
performing states that improved child and maternal
health and nutrition is positively correlated with
inclusive and successful economic development.
With the requisite political will and the right policies,
India can achieve MDG4 and secure drastic cuts in child
mortality. To truly shine in the global arena, India needs
to act on this most important of issues with
determination and urgency.
2) Make maternal and child survival a key metric by
which India judges its success in development at the
highest political level
For more information please contact Ben Hewitt,
Project Director, Newborn and Child Survival, Save the
Children India on [email protected] Thanks
to Dr Alex George, Sarit Rout, Dr Rajiv Tandon,
Shireen Miller, John Butler, Ananthrapiya Subramanian,
David Mepham, and Rica Garde.
3) Declare 2011 as ‘the year of child and maternal
health’ in India to motivate and rally urgent action.
The Government to lead a clear process
throughout 2011 to review child and maternal
health strategies, resources and implementation as
part of the consultation about the 12th Five Year
plan
Recommendations from the Civil Society
Organisation’s Consultation “Make a Noise
for Saving the Children”
4) Announce a package of immediate actions to
reduce newborn, child and maternal mortality and
morbidity:
On the 20-22nd September world leaders will meet in
New York at the United Nations Summit to assess
progress against the agreed Millennium Development
Goals.
Civil Society organisations, Government
officials, donors, media, academia, and technical experts
have met in Delhi on September 8th at the Deputy
Chairman Hall of the Constitution Club of India to
a)Publish and operationalise the newborn and child
health policy with appropriate resource allocation
that will turn policy in to action.
b) Establish a Parliamentary Forum or Cabinet
58
strengthening efforts: for example there is a very
large resource investment that goes into vaccine
preventable diseases like polio eradication and
measles campaigns but other areas that equal or far
greater contributors to mortality also need
investment. Malaria needs to be systematically
addressed as does management of diarrhoeal and
respiratory diseases, undernutrition, neonatal
sepsis and birth asphyxia. The investment must be
based on the causality and burden of disease for
childhood mortality and morbidity.
Committee to focus on maternal and child health
and establish an oversight body to monitor
progress on child and maternal health, with Civil
Society Organisations participation.
c) Establish a clear mechanism to track the
resources spent on newborn and child health
d) Establish an institutionalised forum for
convergence and partner harmonisation (ie
National Coordination Mechanism) for newborn,
child and maternal health. The delegates
rrecognized the need to look at the issue cross
sectorally and include malnutrition as an important
causal factor of morbidity and mortality.
Consequently, gender, accountability, livelihoods,
poverty, equity and food security have to be
recognized as important underlying issues to tackle
to make a dent in the goal. Therefore there should
be convergence between health programs and
programs such as NREGA, ICDS, the forthcoming
NUHM, Right to Food and Right to Education and
even the large scale microfinance initiative of the
country by explicitly allowing health related
expenditure for refinance. The process would also
provide leadership to break the silo ways of
working within the sector between different
models and agencies (IMNCI and HBNCC).
7) Community and facility level action is required
alongside prioritisation. Community Development
needs to focus on Skilled Birth Attendants,
referrals, risk screening, Post Natal Care especially
for the newborns and mothers, introduction of
homebased new born care, grievances redress
cells, and out–of- pocket expenditure needs to go
down. Facility development needs to focus on
strengthening quality of care and mechanisms to
track quality improvement, improved estimates of
case load, access (e.g PHC’s with 24x7 delivery),
special newborn care units, rationalised human
resources and prioritised facilities that are able to
reach households at risk. We need to ensure that
the poor do not receive cheap and poor quality
care and this mandates appropriate investment for
human resources. Accountability needs to be
ensured (including that of SHG’s, PRI’s) and we
could prioritise by improving 10-15% of facilities in
the next 2-3 years.
5) That the efforts to tackle child and maternal
mortality target the poorest and most marginalised
districts and blocks where progress has been
slowest and urgently tackles the governance deficit
impacting real change in states with the highest
levels of child mortality. Focus the delivery of
resources on the poorest and most marginalised
areas based on the most neglected 235 districts,
and even further prioritisation on Uttar Pradesh
and Bihar.
8) Public Private Partnerships – vouchers,
reimbursement and insurance experiences in the
past need to now be pro-poor, have appropriate
Monitoring and Evaluations frameworks that are
robust and capture detailed district and block data,
have regulatory bodies which are efficient.
The full record of the meeting including presentations
are available as detailed background and support for
these recommendations.
6) Evidence based prioritisation: There is a gap
between the evidence on technical interventions
and the public health strategy and health system
59
MDG 5: Improving Maternal Health
- Jan Swasthya Abhiyan
Introduction
Target 5.2 Proportion of births attended by skilled
health personnel
Critique of MDG 5 from the perspective of Sexual and
Reproductive Health and Rights (SRHR) is now well
established. Feminists and women’s health advocates,
globally as well as in India have asserted that the United
Nations and international policy makers have gone back
on the commitments of the ICPD Programme of Action
and the Beijing Platform for Action for a more
comprehensive reproductive and sexual health
approach 1,2, 3. In India, the gains of the ‘Target Free
Approach’ the first and second phases of the
Reproductive and Child Health Programme as outlined
in the Project Implementation Plans, were lost because
of the narrowed focus in the National Rural Health
Mission only on reduction of the Maternal Mortality
Ratio. The promises of increased gender sensitivity in
health systems and health services, adolescent
reproductive and health services, men’s involvement in
reproductive health, services for reproductive tract
infections and sexually transmitted diseases at the
Primary Health Centres, provision of safe abortion
services, are all forgotten in the pursuit of the goal of
increasing institutional deliveries to bring down the
MMR to 109 by 2015.
Target 5.3 Contraceptive Prevalence Rates
Target 5.4 Adolescent birth rate
Target 5.5 Ante natal coverage (at least one visit and at
least four visits)
Target 5.6 Unmet need for family planning
The Government of India, however, decided to
monitor only the MMR and births attended by SBAs. In
the overview section, the Mid Term Report of the GOI4
states ‘A revised UN framework of MDG indicators has
been introduced ……. which India has not adopted for
strategic and technical reasons.’ The question arises why
CPR, Adolescent birth rate, ANC and unmet need for
family planning are not considered ‘strategic’ or
relevant for India.
The Eleventh Five Year Plan (2007-12) in its 27 National
Targets has a target on reduction of anaemia amongst
women and girls, which has a direct bearing on
Maternal Health and Maternal mortality. But this is not
part of the Mid Term Report of the MDGs in India.
As mentioned above, the Government of India in its
Mid Term report of the MDGs (1) reports only Targets
5.1 (Maternal Mortality Ratio) and 5.2 (Skilled Birth
Attendants). The report states, ‘MDG 5 MMR has taken
a quick down turn during 2003-2006, from 301 per
100,000 live births in 2001-03 to 254 per 100,000 live
births in 2004-06 according to SRS estimates. In 2000 to
2002, the MMR declined by 26 points and in 2002-2005 by
47 points. The MDG target for India is from 447 in 1990-91
to 109 by 2015. At the historical pace of decrease, India will
reach 135 by 2015.
Against this initial critique of MDG 5 from the
perspective of SRHR, this paper analyses the gains and
gaps in the progress towards MDG 5 in India.
MDG 5: Goal, Indicators
Government of India response
and
the
Since the original MDG Indicators were found
inadequate, the revised MDG monitoring framework
developed by the Inter Agency and Expert Group in
2005 included an additional goal of Universal Access to
Reproductive Health. The Goals and Monitoring
Targets thus became:
The rate of increase in institutional deliveries is slow
from 26% in 1992-93 to 47% in 2007-08. Skilled birth
attendance at deliveries has increased from 33% to 52%
in the same period. By 2015, India can expect only 62%
deliveries to be attended by skilled personnel. The rural
urban gap in coverage by skilled birth attendants in
2005-06 was 36 % points’.
Goal 5 Improve Maternal Health, and Achieve by 2015,
Universal access to reproductive health
Target 5.1 Reduce by three quarters, between 1990
and 2015, the maternal mortality ratio
60
Analysis of the Maternal Health Situation
in India
India does not yet have an accurate system of collecting
data on maternal deaths. Although several states have
initiated maternal death audits, public declaration of
annual maternal death reports with causes of deaths,
profiles of women who died, and followup action
initiated by the state health systems, is not yet done.
The GOI report points out that Kerala and West
Bengal are set to achieve their targets of reducing MMR
by 3/4th before 2015, and that Bihar/Jharkhand starting
from high MMR of 531 have also achieved a rapid rate of
reduction of Maternal Deaths. What is of concern
however, is the increase in Maternal Deaths in Haryana
and Punjab, states which are considered to be
developed, well performing states.
Assam, UP/
Uttranchal and Rajasthan’s MMRs in 2004-06 are also
worrisome. In fact these are amongst the states in India
that account for as many as two-thirds of maternal
deaths – Bihar, Chhattisgarh, Jharkhand, Madhya
Pradesh, Orissa, Uttaranchal and Uttar Pradesh being
the others (RGI Report 2006).
Skilled Birth Attendance, Institutional
Deliveries, or Safe Deliveries?
The NFHS 3 states that 47% of births in the five years
preceding the survey were assisted by health personnel,
including 35 percent by a doctor and 10 percent by an
ANM, nurse, midwife, or LHV. More than one-third of
births (37 percent) were assisted by a traditional birth
attendant (TBA) and 16 percent were assisted by only
friends, relatives, or other persons.
According to the GOI Mid Term report, the
unsatisfactory increase in skilled attendance at birth is
due to poor progress in institutional deliveries. The
report states ‘Unless institutional delivery in the States,
particularly in those which are lagging way behind the
national coverage, is widely accessible and becomes a way of
life, the ultimate objective of reducing maternal deaths to the
level that should be reached by 2015, will continue to remain
distant.’ This equating of institutional deliveries with
safe deliveries is in fact the biggest flaw in India’s
Maternal Health policy.
While a state wise disaggregation and analysis has been
done of states with high and low MMRs, an analysis of
who are the women who die has not been done in this
report. For example, NFHS 3 data shows that the
indicators for tribal women and scheduled caste
women are worse than those of ‘Other Women’. 23.7
% tribal women and 19% Schedule Caste women are
moderate to severely anaemic compared to 14%
‘Other’ women. Similar proportions are seen in
nutritional status – 21.2% tribal women and 18.%
Schedule Caste women are moderately/severely thin
compared to 13.1% ‘Other’ women. Women not
receiving any ante natal care tend disproportionately to
be women with no education, women in households
with low wealth index and Schedule Tribe women.
NFHS 3 reports that a large majority of women who did
not deliver their last birth in a health facility (72
percent) said they did not feel it necessary to deliver in
a health facility. In addition, 26 percent reported that it
costs too much to deliver in a health facility. Eleven
percent said that the health facility is located too far
away or that transport was not available to reach the
facility. Despite these statistics and the fact that many
places in India are extremely difficult to reach, the
Government continues to pursue the strategy
exclusively of institutional deliveries. There is a denial
of the fact that trained traditional birth attendants may
be able to play a positive role in difficult to reach areas.
The GOI Mid Term Review of the MDGs also does not
look at how these women die. According to the RGI
report (2006) main causes of maternal deaths are as
follows: Haemorrhage (38%), Sepsis (11%) and Abortions
(8%), Obstructed Labour (5%), Hypertensive Disorder
(5%) and other conditions (34%) (See Graph 1).
Graph 1 Causes of Maternal Death in India
In an effort to promote institutional deliveries, the
Government of India launched a conditional cash
transfer scheme called the Janani Suraksha Yojana. The
scheme gives a cash benefit – different across different
states – to Below Poverty Line women who deliver in
institutions. There is overwhelming evidence that JSY
has resulted in increasing antenatal care and the
number of institutional deliveries and probably
contributed to reducing neonatal deaths1. However,
there are problems with the JSY. The study also points
61
Universal Access to Reproductive Health
out that the poorest and the least educated women do
not consistently have the highest odds of being JSY
recipients. This indicates that an improvement of the
targeting of this programme is required. There are
other problems too – the poor quality of maternal and
neonatal care in the facilities due to lack of adequate
and competent staff2. In addition, firstly, it is a scheme
that is riddled with a conditionality that affects the most
vulnerable – women below 19 years and with more
than two children are excluded. Secondly, the
requirement of possessing Below Poverty Line identity
cards is problematic – several genuinely needy families
are excluded, while those not eligible have the cards.
This leads to corruption and bribery and it is the
poorest that are the most affected. Third and most
important is that although the JSY has resulted in
increasing the demand for services, the health system
has not been able to supply the quality institutional
deliveries uniformly and consistently. As a recent
report of the UN Rapporteur on Health3 points out, ‘ ..
the focus in India is on increasing institutional delivery,
but institutional delivery is not a proxy for access to
skilled birth attendance or life saving care’.
As mentioned above the GOI is not reporting on the
revised indicators for the goal of Universal Access to
reproductive Health.
Contraceptive Prevalence Rates
The relevance of CPR as an MDG indicator for
Universal Access to Reproductive Health is not
absolutely clear to us. As researchers4 point out
contraceptive use in India is characterized by:
•
the predominance of non-reversible methods,
particularly female sterilization;
•
limited use of male-/couple-dependent methods;
•
high discontinuation rates; and
•
negligible use of contraceptives among both
married and unmarried adolescents.
Adolescent Birth Rate
Adolescent birth rate (married women aged 15-49
years) as per SRS has declined from 76 in 1991 45.9 in
2005. The NFHS 3 reports that 58% of all married
women age 15-19 have experienced motherhood or a
current pregnancy. The proportion of women age 1519 who have begun childbearing is more than twice as
high in rural areas (19 %) as in urban areas (9 %). The
level of teenage pregnancy and motherhood is 9 times
higher among women with no education than among
women with 12 or more years of education. More than
one-quarter of women age 15-19 with no education
have become mothers and almost one-third of them
have begun childbearing. The level of teenage pregnancy
and motherhood is five times as high for women in
households with the lowest wealth index than for
women in households with the highest wealth index.
These young women are at higher risk of maternal
deaths and disability but no special effort is being made
through the JSY to reach out to the most marginalized.
According to the UN Rapporteur’s report, ‘health
work force is a major bottleneck in India achieving the
MDG 5 on maternal health. Skilled birth attendants
are not available in sufficient numbers. The Auxiliary
Nurse Midwives who are supposed to be resident at
the village sub centre and facilitate child births, are
often absent from the communities that they are
supposed to serve. Additionally, they do not have the
competencies of a skilled birth attendant – the
midwifery part of their basic training has been reduced
with the reduction in their pre-service training period
from 24 to 18 months.’
The report highlights that there is a ‘massive crippling
crisis’ in the health work force in India. Life saving care
is unavailable in rural, and disadvantaged areas. There is
an acute shortage of Obstetricians and Anaesthetists in
the public sector while 20,000 Obstetricians are
available in the private sector. Public Private
Partnerships modeled on Gujarat’s Chiranjeevi Scheme
while increasing access are not without problems of
patients being charged, quality of care which is suspect
and so on. Privatization efforts in the most backwards
states: e.g. UP and Uttarakhand, Jharkhand etc, the
setting up of franchised private hospitals for health
care-including delivery care and with a special focus on
Family Planning (e.g. Merrygold hospitals, Sky hospitals )
are similarly problematic.
The above points to the need for policies and
programmes that will ensure education for girls, as well
as delay marriage and childbearing. Sexuality education
in schools which has been banned by right wing
conservative forces denies young men and women from
making informed choices and reproductive decisions.
Antenatal Care
The NFHS 3 points out the gross inequities in ante natal
care. Almost one out of every five women in India did
not receive any antenatal care for their last birth in the
62
five years preceding the survey. Women not receiving
antenatal care tend disproportionately to be older
women, women having children of higher birth orders,
scheduled tribe women, women with no education, and
women in households with a low wealth index. In Bihar,
two thirds of the women who had a live birth in the five
years preceding the survey, were not seen by any health
care provider during their pregnancy. These
differentials suggest that improving the coverage of
antenatal programmes requires special efforts to reach
older and higher-parity women and women who are
socioeconomically disadvantaged.
Adolescents’ unmet need for contraceptives is not
taken into account while calculating Unmet Need for
Family Planning – the unit of calculation continues to be
currently married women. Researchers6 suggest that
the concept of unmet needs should be broadened to
measure the extent to which women’s reproductive
intentions are met. Studies show that health services
fail to meet the reproductive health needs of women.
Sterilisation is often the first and only method of
contraception. Women go through a series of wanted
and unwanted pregnancies, induced abortions, and
miscarriages and then opt for sterilization.
Quality of antenatal care is doubtful. During their
contacts with health workers, pregnant women are
expected to be told about the signs of pregnancy
complications and where they should go if they have
pregnancy complications. In NFHS-3, women who
received antenatal care for a birth in the five years
preceding the survey were asked (for their most recent
birth) whether they were told about the signs of
pregnancy complications and where to go if they
experienced any of these signs. Only 20 % were told
about prolonged labour as a sign of a pregnancy
complication, and even fewer (15-17 percent) were
told about convulsions and vaginal bleeding as signs of
pregnancy complications.
Other Important Indicators for Universal
Access to Reproductive Health
Postnatal Care. Considering that 60% of deaths occur
after delivery, only 1 in 6 women receives postnatal
care.
Access to safe abortions. As mentioned above, abortion
accounts for 8 % of maternal deaths. Yet access to safe
abortion services is not an indicator for Universal
Access to Reproductive Health.
Despite being
mentioned as a part of the RCH Programme in the
Project Implementation Plan and every Joint Review
Mission, state reports on MTPs are difficult to access.
Morbidities like Vesicovaginal fistulas. Considering the high
rate of adolescent pregnancies and child bearing, as well
as high levels of malnutrition amongst adolescent girls,
we need to track the extent of vesicovaginal fistulas the
consequences of which are drastic for young women.
Morbidities like uterine prolapse also need to be
tracked and treated. Infertility is a growing problem
with serious consequences for women – this too needs
to be tracked.
Unmet Need for Family Planning
Unmet need for family planning is an important
indicator for assessing the potential demand for
contraceptive services. According to NFHS 3, 13% of
currently married women in India have an unmet need
for FP. Unmet need for spacing is highest between 15
and 19 years (25.1%) and 20 – 24 years (14.9%). Unmet
need for limiting is highest between 25 and 34 years
(almost 20%).
Cancer screening. Data from World Health Statistics,
2008 indicate that only 3% had access to pap smear and
2% had access to mammogram7, pointing that it is still
distant from universal access to preventive cancer
screening services. National data on access to
preventive cancer screening is not available.
According to a SEARO WHO Family Planning Fact
Sheet5, despite improved availability and access to
contraceptive services, a substantial proportion of
pregnancies (21% of all pregnancies that result in live
births) are mistimed or unplanned. While the family
planning needs of the majority (86%) of women who
wish to stop childbearing are supposedly being satisfied,
(we would hesitate to call this ‘met need’: many of these
women may also be terminating an unwanted
pregnancy and simultaneously having sterilization in the
absence of being given any other contraception option)
the needs of women who wish to delay or space
childbearing remain largely unsatisfied (only 30% of
these women have their needs met).
Nutritional status of women and girls. Anaemia and
Malnutrition is not tracked as part of MDG monitoring.
Determinants of Maternal Health
As seen from the above data, poverty, literacy and
education, place of residence are all very important of
maternal health status. Maternal health cannot be
analysed in its compartment of MDG 5.
63
Recommendations
MDG 1 on Poverty and Hunger, has very important
bearing on MDG 5. Poverty is feminized in the country,
not so much in terms of number of females in poor
households (which is marginally higher than males in
rural, but not urban areas8) but in terms of the intensity
of the poverty that females face. Girls (6-35 months)
and Ever married) women 15-45 years are much more
anemic than boys and men as per National Family
Health Survey 3 (2005-2006). The proportion of
women 15-45 years who are anemic has increased
between 1998-99 to 2005-6 as per NFHS 2 and 3.
Further, data from NFHS suggests that women in the
20-39 years age group have a lower body mass index
than men, and there has been little decline in women’s
body mass index between 1998-99 and 2005-6. Micro
level studies suggest that intra-household food and
nutrition distribution is skewed in favor of males in
several parts of India. The feminization of poverty is
also reflected in higher rates of infant mortality rates of
females than males in India (against the fact of greater
resilience of females at birth), pointing to not only
lesser nutrition (anemic and underweight), but also
lesser investment in health care of females.
In a recent meeting to discuss recommendations
emerging from the UN Rapporteur’s report on
maternal health in India, around 75 persons coming
together as the National Alliance for Maternal Health
and Human Rights, urged the Government of India to
institute the following measures at different levels10:
Policy and budget level
MDG 3 on Gender equity is also intrinsically linked
with Maternal Health. NFHS 3 shows that while a
significant proportion of currently married women are
employed, almost one in three are unable to convert
such employment into financial autonomy because
they do not earn cash for the work they do. Further,
when married women do earn cash, they do not
necessarily have a say in how their earnings are used.
In addition, almost one in three women does not have
a say in how their husband’s earnings are used. Finally,
more than a fifth of currently married women who
earn cash earn about the same or more than their
husbands or have husbands who have no earnings.
Women’s mobility is restricted. Overall, only about
half of all women are allowed to go to the market or
to the health facility alone. Only 38 percent are
allowed to travel alone to places outside the village or
community. Gender values and norms are deeply
internalised. About half of all women and men agree
with at least one or more reasons for wife beating,
and even among the most educated, about one-third
of women and men agree. All these have a bearing on
maternal health status.
•
Massive increase of resources, with clear indicators for
accountability and monitoring (including communitybased monitoring, grievance redress)
•
Build capacity for decentralized planning and
management at district level, remove financial
bottlenecks and correct skewed budgetary allocations.
•
Planning commission should monitor the MMR and
Maternal Death Audits as they have set up the 11th
FYP goals of reducing MMR. They must hold
accountable health department and RGI to produce on
annual (and not 3 yearly) reports which contain correct
data and rates, with in 3 months of the year being over.
(The last MMR estimate is of 2004-6, even now in
2010). Similar reports should be produced for Still birth
rate, Neonatal mortality and IMR.
•
States should make public annual Maternal Death
Reports, with analysis of causes and followup action
proposed.
•
Re-examine the role of “incentive” namely JSY.
Emphasise quality orientation. Safety and maternal and
fetal and neonatal survival is not monitored. Even the
process of delivery is not monitored and cleanliness,
infection prevention, and basic medical care is not
assured under JSY
•
Enacting National Health Act guaranteeing
comprehensive, universal free access to services,
ensuring right to health care in public and
(regulated) private sectors
Programme implementation
Violence against women can also have serious
consequences on maternal mortality. Studies show that
violence increases during pregnancy and that pregnant
women who face violence9.
64
•
Urgently reconsider how safe motherhood may be
ensured for the still not reaching hospitals- not just
Institutional Delivery but safe delivery. Make first and
second ANMs accountable for delivery and PP care at
home. MO PHC should visit some critical mothers at
home.
•
Contact with any provider during pregnancy should lead
to a Tracking System by which all complications and
treatment are recorded along with outcomes
•
Need for wide mass publicity to ‘Guaranteed free
maternal and neonatal health services’ and responsible
centre to be communicated during ANC to all pregnant
women who are registered. These should be monitored
by community and an independent body.
•
The JSY focus needs to expand from institutional care to
continuum of care; all treatment for complications
must be free with adequate follow at home up based on
a protocol.
•
Transportation of mothers and newborns must be state
responsibility (2 hours window), as well as for treatment
during complications and all referrals. There should be
no cost recovery for MCH at any level.
•
•
(CBM) of health services, especially CBM of maternal
health services. Progressive generalisation of CBM
across the country based on civil society facilitation.
Adequate resource provision for capacity building of
VHSCs/ community groups to undertake CBM.
•
There has to be transparent and accountable transfer
and posting policy and an annual report on Transfer
and Posting must be produced by each health
department. Staff posting has to be rational and
equitable; staff orientation must include orientation to
the realities of poor rural women
Private sector
Monitoring of process and outcomes – there should be
regular audits of morbidities and complications that
result from deliveries. (DLHS -3: 39% of home deliveries
and 31% of institutional deliveries reported postpartum
complications)
Maternal death audit should have component of
participatory, community audit with inputs from
involved person and community; adapting joint enquiry
method. Reasonable amount of financial compensation
should be paid for each maternal death
•
private sector should follow same minimum norms as
the public sector, report out comes and be under the
purview of a common grievance redressal system as the
public sector.
•
All women delivering in private or Public or NGO
hospitals must be legally entitled to their rights to
adequate information, dignity, privacy, informed
consent, access to medical records, non-discrimination,
free beds in trust hospitals etc. enabling them to receive
better quality and access to maternal health care.
•
To ensure this, the rules for the recently passed National
Clinical Establishments (Registration and Regulation)
Act should explicitly include protection of Patients Rights
as mandatory process standards.
•
Greater accountability for each case - Redressal
mechanism required for cases of denial of maternal
health services
•
Need for stronger commitment and support at National
level and in all States to Community based monitoring
1
2
3
4
Barton, C., (2005). Where to for Women’s Movement and MDGs, Gender and Development, Vol. 13, No. 1, March 2005. pp25-35, Oxfam GB.
AWID (2003) Women and Millennium Development Goals
Sweetman, Caroline, (2005). Editorial. Gender and Development Vol. 13, No. 1, March 2005
Government of India, (2009) MILLENNIUM DEVELOPMENT GOALS - INDIA, COUNTRY REPORT: Mid-Term Statistical Appraisal Central
Statistical Organization, Ministry of Statistics and Programme Implementation.
Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to
increase births in health facilities: an impact evaluation. Lancet Volume 375 2010; 375: 2009-2023.
Paul, Vinod K., India: conditional cash transfers for in facility deliveries. Lancet Volume 375 2010
United Nations, 2010, A/HRC/14/20/Add.2, General Assembly Distr.: General, Original: English, Human Rights Council, Fourteenth session,
Agenda item 3, Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to
development Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health, Paul
Hunt*, ** Addendum Mission to India***, April 15, 2010
5
6
7
8
9
10
11
12
http://www.searo.who.int/LinkFiles/Reporductive_Health_Profile_contraceptive.pdf
http://www.searo.who.int/linkfiles/family_planning_fact_sheets_india.pdf
World Health Organization, 2008
The Planning Commission notes that the incidence of income poverty amongst females tended to be marginally higher in both urban and rural
areas. It also notes that the percentage of females in poor households in 2004-2005 is 29% and 23% in rural and urban areas, when compared
to 27% and 26% in rural and urban areas in 1993-1994 (Planning Commission, 2008b).
65
To conclude, MDGs are extremely problematic. They
lack a health systems perspective, an equity perspective
and ignore social determinants of health. MDG 5
cannot look at Institutional Deliveries as a substitute
for comprehensive maternal health and as the main
measure to decrease Maternal Mortality. Maternal
Health has to be considered in its widest sense, as a
continuum, ranging from nutritional and reproductive
and sexual literacy needs of adolescents and women
13
14
and men to post partum care. Safe and effective
contraception, access to safe abortions, freedom from
violence are as much a part of maternal health as safe
deliveries whether in institutions or within homes.
There are intrinsic relationships between MDGs 1, 3
and 5 and compartmentalization of MDGs into narrow
silos is counterproductive to their achievement.
(Drafted by Renu Khanna, with inputs from Dr. Abhay
Shukla and Dr. TK Sundari Ravindran)
Campbell Jacquelyn C, Health consequences of intimate partner violence, THE LANCET • Vol 359 • April 13, 2002
A summary of civil society suggestions for the implementation of the recommendations of the Report on Maternal Mortality in India by the UN
Special Rapporteur on the Right to Health, 2007-2010, Developed during the Public Dialogue15, 13 August, New Delhi, Organized by the
National Alliance on Maternal Health and Human Rights
66
Goal 6: Combat HIV/AIDS, Malaria and
other Diseases
-Jan Swasthya Abhiyan
Healthy living conditions and access to good health care
for all citizens are not only basic human rights issue, but
also essential accompaniments of social and economic
development. Several indicators have captured the
dismal picture of health status in India as reflected in
several health related indicators of the country.
Even though there were early successes in the
immediate post independence period, and India has
contributed very significantly to the global knowledge
base of malaria control, we seem to be losing out in
tackling the disease, and one perceives a sense of defeat
in the way malaria is seen as a public health problem.
India has the dubious distinction of being one of the
worst performers in its ability to secure access to
health. Allocation for health has been extremely low by
global standards, resulting in a large majority of people
having to access to the private sector. The existing level
of government expenditure in India is about 1% of GDP
which is unacceptably low. Even the meagre allocation
for health has not been optimally utilised, resulting in
poor quality of services provided by the public sector.
To a very large extent, health services and health care
in India tends to respond to the existing ‘market
demand’. This rotten state of affairs get manifested in
several ways; a million children die in India within the
first 28 days of life; more than 120,000 women die
every year during child birth; more than half of our
women and children undernourished; 63.22 million
individuals are pushed BPL due to healthcare
expenditure1 etc.
•
The current situation is characterised by:
•
An increasing proportion of P. falciparum all over
the country accounting for almost all the deaths
and severe morbidity
•
An increasing incidence of drug resistance to the
routinely used chloroquine, which also is leading to
increasing morbidity and deaths
•
Highly centralised mosquito control program
centered almost entirely on insecticidal effect of
DDT has been rendered largely ineffectual by
widespread resistance among mosquitoes to DDT
•
Highly ineffective vertical control programme of
the government with limited societal involvement
and its ownership.
This has resulted in recurrent focal out-breaks that reflect
the deteriorating environmental situation as well as the
lack of surveillance and the absence of strong general
health services. These outbreaks are linked to specific
eco-types of malaria. Both of these aspects of the current
malaria situation are briefly analysed below.
Resurgence of communicable diseases
The resurgence of communicable disease in India is a
reflection of the weakness in the health system.
Tuberculosis,
Malaria,
Chikungunya,
Dengue,
Encephalitis, Kala Azar, Dengue and Leptospirosis are
some of the serious infectious disease conditions in
India. However in terms morbidity and mortality
Tuberculosis, Malaria and HIV/AIDS are among the
major public health challenges of the county.
It is also well recognised that the number of malaria
cases in India is grossly underestimated by official
studies and according to the WHO the true malaria
incidence is thought to be 11 to 15 million cases in India
which represents 74% of the malaria cases in this
(South-east Asia) region2. Now scientists from the
‘Malaria Atlas Project’ have used a map-based approach
to estimate the global burden of P. falciparum malaria.
Their paper, which has just been published in the openaccess journal PLoS Medicine, puts the extent of
disease caused by P. falciparum in India at about 102
million cases in 2007. But with the uncertainty
associated with the estimate, the figure could range
from 31 million cases up to 187 million cases3.
Malaria
In India we have had nearly 60 years of malaria control
programs under different names - from a ‘Control’
program to an ‘Eradication’ program, to an ‘AntiMalaria’ program and now a combined control program
for vector-borne diseases. However these programs
have all been characterised by a limited bio-medicaltechnological understanding and approach to malaria.
67
facet of agricultural development that is taking its death
toll in terms of outbreaks of malaria even in areas like
Rajasthan where the disease was previously virtually
unknown.
Death due to malaria is also showing uncontrolled
situation which is evident form following table
Table 1 – Deaths due to Malaria
S No
Year
Deaths reported
due to Malaria
1
2003
1006
2
2004
949
3
2005
963
4
2006
1704
5
2007
1311
6
2008
1061
Apart of Malaria increasing number of Dengue
morbidity and mortality is also worrying and shows
ineffectiveness of vector control program targeted to
control Malaria and other diseases. The problems due
to inability to tackle the germ and the mosquito are all
compounded by an ineffective primary healthcare
system. This weakness gets reflected in every aspect of
the programme starting from its inability to estimate
and predict true extend of malaria burden in India.
Prevention of malaria related morbidity and mortality
critically depends upon a system of early diagnosis and
prompt rational treatment, and community based
control efforts, which should employ a combination of
measures that are feasible and acceptable. The present
control efforts are only nominal in a situation where
half-hearted DDT spray is all there is to speak of. The
overdependence on DDT as the control strategy leads
to its indiscriminate use which has already proved
disastrous and counterproductive6. Early diagnosis is a
distant dream in a system where the malaria slides are
reported weeks later, early rational treatment is out of
bounds for people living in rural and tribal areas who
are forced to access irrational care delivered by
informal practitioners.
Source: World Malaria Report 2009
The emergence of falciparum malaria in large epidemic
form has complicated malaria treatment, and in
endemic areas conventional treatment with drugs such
as chloroquine is proving to be virtually useless. Newer
drugs, such as mefloquine and the artemisinin based
combinations have been introduced. These are more
expensive (Artemesinin is 20-30 times more expensive
than chloroquine) and toxic and have made the
treatment of malaria more complicated. After the
introduction of Artemesinin, there are no new drugs on
the horizon. There is a real threat that the widespread
(and often unnecessary use of this last line drug) will
lead to resistance, and the emergence of malarial superparasites that would be immune to all available drugs4.
What is less commonly recognised is that the burden of
malarial morbidity and mortality in these ecotypes is
heavily skewed towards those populations, which are
already marginalised: Adivasis (tribal) communities,
seasonal migrant workers, agricultural labourers and
peasants directly engaged in agricultural work. Even
though the linkage between mortality due to malaria
and poverty / acute hunger was demonstrated almost
75 years ago through some very elegant epidemiological
analyses, it has not entered our consciousness nor has
it informed our control strategies. This is despite
definite evidence that the prevalence of malaria is
higher in states and communities with a higher level of
poverty.
The other feature has been the emergence of specific
‘ecotypes’ of malaria, esp. in the 1990s. An increasing
number of focal outbreaks accompanying the
emergence of specific ecotypes characterise the
present situation of malaria in India. These ecotypes
essentially represent disturbed ecosystems presenting
as high malarial incidence foci: these include ‘Urban and
peri-urban malaria’, ‘Irrigation malaria’, ‘Forest malaria’,
‘Migration malaria’ and ‘Tribal malaria’. It is not difficult
to understand that a model of development based on
increasing volumes of massive seasonal migration,
especially from tribal and forested areas, with migrant
workers living and working in extremely rudimentary
conditions in urban and peri-urban areas is directly
responsible for the epidemiological features of many of
these interrelated ecotypes5. Similarly, displacement
due to big dams, slum eviction crate new water bodies
and further increase in threat of Malaria in many
regions. Unplanned expansion of irrigation, without
health impact assessments or measures to prevent
water logging and vector breeding, present another
Tuberculosis
India is the country with the largest number of
Tuberculosis (TB) cases in the world accounting for
nearly one-third (30%) of the global TB burden. It is one
of the leading causes of mortality in India- killing -2
persons every three minute, nearly 1,000 every day. In
India itself there are an estimated 2 million people
68
without permanent addresses and migrants may not be
enrolled under DOTS despite their definitely needing
care. Then the somewhat better cure rates under
DOTS could be related mainly to the regular, adequate
availability of the required drugs (often not available in
the general programme) and selection of ‘better
patients’, rather than justifying the strategy of treating
patients like irresponsible children who need to be
‘observed’ each time they swallow a tablet.
detected with tuberculosis every year, and around 4
lakh deaths occur yearly due to the disease, this
number having remained more or less unchanged since
Independence! The total number of patients with
pulmonary tuberculosis has been calculated at a
staggering 17 million patients7.
The National Tuberculosis Program that was
introduced in 1962 was based on a broad socioepidemiological and people cantered approach to the
problem of tuberculosis. Consideration of tuberculosis
as a problem of suffering (Felt Need Approach) and
patients’ recourse to general health services provided
the basis for integration of NTP with the general health
services. Thus NTP was designed to “sail or sink” with
general health services. The experience of the TB
programs teaches us that in spite of there being a multisectoral inputs in the development of the NTP and
integration with the general health system, it has failed
in achieving its objectives, since the general public
health system itself was systematically neglected in the
continuous adoption and prioritisation of vertical
programs, especially the family planning and the
immunisation programs. The sinking state of the
general public health system has taken the Tuberculosis
Control Programme along with it.
Further, the increasing proportion of strains showing
resistance to single and multiple drugs does not
portend well for the overall situation in India. The lack
of standardisation of treatment regimes for TB in the
private sector is a major cause for this situation; this is
related to the larger problem of lack of regulation of
private providers. Along with this, the link with HIV/
AIDS means that there will be an ever-increasing
number of patients in need of care. It is thus quite clear
that the RNTCP, like every other such programme,
depends for its success on a well functioning, sensitive
and properly outreaching public health system.
Further, a new threat looms large. With widespread
use of the new anti-TB drugs, we are witnessing the
emergence of multi drug resistance TB (MDR TB).
MDRTB is a result and symptom of poor management
of TB patients. The present short course therapy is
ineffective in MDR-TB and cure rates have generally
been less than 60%. Treating such cases can be
extremely expensive – up to 10 times as expensive as
with the short course therapy. A recent paper
published in the Indian Journal of Tuberculosis
estimates about half a million MDR-TB cases emerge
every year amongst new and previously treated cases,
with half being in China and India. Estimates for 2007
suggest that India has the highest burden of MDR-TB in
the world, with 131,000 cases of MDR-TB10. As long as
the RNTCP does not offer easy and heavily subsidized
(or free!) access to quality assured diagnostic and
treatment services for MDR-TB, patients will seek
unaffordable and inappropriate care in the private
sector, which will result in further emergence and
spread of highly resistant M/XDR-TB strains. There are
thus indications that we are poised on the brink of a
resurgence of a new TB epidemic unless steps are taken
to remedy the situation.
While there has been great fanfare in the adoption of
the Revised National Tuberculosis Control Program.
The claims of great success, experience over the last
few years has raised some serious questions.
Considering the current incidence i.e. 1.9 million per
year, an average of 23 million new cases of TB have
occurred in last 12 years since the country-wide
implementation of RNTCP in India. RNTCP has
initiated nearly 10 million cases on treatment. [1] Hence,
more than half of the total TB patients by pass the local
RNTCP services and are either treated in private
sectors or are untreated8. Even after a decade of its
implementation, still there is lack of awareness among
the patients about the availability and quality of free
diagnostic and treatment facilities locally under
RNTCP. Still most of the private physicians have
practically no access to information or training
programs, which accounts for surprising disparity in
their management strategies. 8
The exclusive focus on the ‘Directly Observed’ part of
the strategy (commonly known as DOTS) is being
increasingly questioned. Recent studies have shown a
very high incidence of inappropriate care and rejection
of patients on the basis of their being ‘non-ideal’
candidates, who will spoil the statistics9. Hence people
HIV / AIDS
Starting with the first case, detected in 1986, today, HIV
has been detected in 29 of India’s 32 states and
territories. The epidemic is considered generalised in
69
six states – Andhra Pradesh, Karnataka, Maharashtra,
Manipur, Nagaland, and Tamil Nadu. The present
estimation of number of people with HIV in India is less
than three million. It may be recollected that the
present estimation was a drastic reduction from a figure
of 5.7 million cases in 2006 estimated through sentinel
surveillance method.
determinants that lead to the spread of HIV:
socioeconomic factors such as poverty, lack of
education, unemployment, marginalisation of women,
development concentrated in urban areas, migration
patterns, national debt and similar factors.
HIV / AIDS is deeply symbolic of the collective malaise
our society faces in the era of globalisation and
liberalisation. It has been said with justification that HIV
/ AIDS is a development issue, that HIV / AIDS is a
resurgent infectious disease, that HIV / AIDS is a public
health crisis, and that HIV / AIDS is a major rights issue
for a range of people whom this problem impinges
upon. Keeping these and other dimensions in mind, no
sweeping generalisations or vertical solutions are likely
to be able to address this problem in its entirety.
In response to indebtedness and as part of the
globalisation process, governments in developing
countries have been forced to increase exportoriented industrialisation and to reduce government
expenditure. The model adopted for economic growth
has led to the growth of employment in urban areas.
On the other hand, public investment in the agricultural
sector
has
been
neglected
with
growing
impoverishment of the rural toilers. This combination
has brought about increased migration from rural
communities into the cities. Long periods of separation
from families, loneliness, alienation and work related
pressures often drive people into high-risk behaviors,
including use of drugs and alcohol and multiple sex
partners.
Neither exaggeration nor denial is likely to serve the
cause of tackling the problem effectively. The complex
and multidimensional nature of the problem requires
among other things, an approach that can grasp the
myriad socio-economic processes fuelled by the
process of globalisation-liberalisation responsible for
the emergence and spread of the epidemic, the health
system crisis that needs to be urgently addressed in
order to present an integrated response to it, the range
of socio-behavioural factors that need to be addressed
for prevention, and the rights of affected persons to
comprehensive care and social acceptance as part of a
larger vision of health related human rights.
Mobile populations like migrant labourers also become
intermediaries for infection to spread to other
geographic locations as well as back to their spouses.
Poverty and unemployment also drive women into
transactional sex, again involving multiple partners and
usually reduced negotiation power for safe sex
practices.
A completely biomedical approach to tackling AIDS
therefore can only hope to deal with the ‘iceberg’ of
infected people or so called ‘high risk groups’. Even
though awareness drives and condom distribution are
seen as preventive measures, these initiatives fail to
address what drives people into vulnerable situations
exposing them to unsafe sex in the first place. Unless
there is a questioning of the developmental processes
and attention is given to access to healthcare, education
and food security for socio economically vulnerable
sections of the population, there is little hope that the
roots of the epidemic can be attacked. It is worrisome
that while all other communicable disease control
disease programmes are being integrated under
NRHM, HIV-AIDS remains a stand alone vertical
programme, perhaps due to the insistence of its
influential donors.
Of the major modes of spread of HIV - sexual contact,
mother to child transmission, and through infected
blood (transfusions and intravenous drug use), in India,
the predominant mode of spread is assessed to be
through sexual contact (80-85%), while the other 15%
is accounted for by the other modes. One specific point
that needs to be considered here is that HIV spread
through unsafe injections (a widespread and common
practice, especially in the private sector in rural areas
and urban slums) has hardly been studied
systematically, and remains neglected. Interventions to
control the spread have therefore, concentrated on
these three modes and have been linked with a
verticalisation of the program. Efforts are concentrated
on creating awareness of the disease, safe sexual
practices and distribution of condoms. Measures have
also been taken to provide Anti Retroviral Therapy
(ART) to people suffering from HIV from a few specific
centres. At a broader level, most of the existing
approaches fail to take into consideration the other key
A vertical emphasis on HIV / AIDS care as an additional
measure might be justifiable where well-functioning
healthcare systems already exist. But in countries
where basic healthcare is not ensured, prioritising HIV/
70
expenses on poor patients. Care and support should
also include the right to employment (important
judgments exist protecting people from losing a job due
to HIV status), right to education for HIV positive
children, and property inheritance laws, which are of
vital importance to women whose husbands, have died
of AIDS and who have been thrown out by their
families. The latter mentioned, law is of great
importance in the Indian context where women are
often married to infected men with the intention of
care giving during the period of illness, and are deserted
by the family upon the death of the man. The woman is
often left without any property and by then is herself
infected, left with no support in the face of a fatal and
stigmatizing illness.
AIDS care in isolation will not only be met with lack of
success in the public health sense; it may also jeopardise
the struggle for basic healthcare by sidelining it and
making it appear less relevant. Ensuring a well
functioning public health system at all levels – including
functioning laboratories for detection, peripheral
hospitals capable of treating patients with common
opportunistic infections, well functioning larger
hospitals capable of treating all aspects of AIDS, and a
well functioning system for health education - is an
essential prerequisite for HIV-AIDS control. These
cannot be achieved just by pouring more and more
funds into an isolated programme.
If we look at the need for availability of anti-retroviral
treatment, there have been significant scaling up in
availability. However it is still lags significantly behind
requirement. The following table from NACO’s Annual
Report for 201011 gives details of ART treatment
access; less than 50% of those registered actually have
been started on ART. More importantly about 33% of
those who started treatment have either died or not
continued treatment (meaning that they are at risk of
succumbing to the disease). If we take the estimate of
23 million HIV positive cases as the baseline, we would
expect that in excess of 7,00,000 patients would
require to be on ART. In contrast, only about 40% are
receiving ART12. Another major concern expressed by
experts is the underreporting of the requirement and
denial of treatment to second line ART, ie treatment
with newer (and more expensive rugs) for those who
become resistant to the first line drugs 2. The
government has set eligibility through exclusion criteria
that make it very hard to get enrolled onto a
government-funded programme.
What is responsible for these worrisome
disease trends?
The causation and spread of various communicable
diseases shows several pattern and analysis of which is
crucial before the responses are designed.
1.
There is a direct connection between the
conditions of poverty and people suffering from
common diseases. Significantly disproportionate
number of poor suffer form all the above discussed
disease conditions as shown by the evidence from
India which is undisputable, even with all the
limitations caused by the non-availability of reliable
data.
2.
Forces of neo- liberal globalisation aggregates the
situation by creating conditions conducive for
disease spread. The introduction of neo-liberal
policies in India created a crisis by constraining the
services to limited ‘cost effective’ interventions. It
has increased cost of treatment through
privatisation of health services and imposition of
user fees in government health facilities. Health
personnel requirement is also ignored which has
caused severe shortage of person power in public
health system. Brain drain, promotion of medical
tourism caused further reduction of trained men
power in health sector. Neo Liberal policies also
affected agriculture adversely, reduced job
opportunities, increased social insecurity. Fixing
MDG without discussing these ground realities and
conditions will not help poor of third world to
improve their health condition.
3.
Vertically designed disease control programs that
fail to acknowledge the complexity involved in the
causation of disease, and that are designed in
Table 2: People on ART in India
Persons registered for ART
8,93,567
Persons ever started ART
4,37,435
Persons alive and on ART
2,94,900
Source: NACO report, 2010 (Data till January 2010)
In addition to ensuring access to treatment, diagnosis
and right to treatment of opportunistic infections and
HIV infection, special attention needs to be given to the
protection of rights of people living with HIV-AIDS in
the context of the social impact of HIV infection.
Although ART is given to nearly half of the patients but
treatment of opportunistic infection is not covered and
free treatment is not provided which put major
71
MDGs and approach to Communicable
Disease Control
isolation from the reality within which people live may have short term gains but cannot be sustained
nor do they provide long term benefits. Vertical
organised disease control programmes are
bureaucratically organised interventions focusing
on two or three major risk-factors often identified
through reductionist scientific enquires and costeffectiveness criteria. Community involvement and
responsibilities are not planned as part of the
programmes. To really control disease / prevent
unnecessary burden one has to evolve programs
that tackle the determinants of health and socioecological factors, in addition to providing cures
and interventions that affect the immediate causes.
4.
Millennium Development Goals announced at the dawn
of the current millennium introduced a set of eight
goals as the development agenda for the world. These
goals are offered along with measurable indicators
pertaining to these developmental goals. Prominent
among them are MDG 4, 5 & 6 which are directly
dealing with specific issues concerning health.
An important aspect to be considered here is that
MDGs replace various previous internationally
acknowledged and obligated (UN organisations
initiated) developmental paradigms. A notable one
among them is Primary Health Care (PHC) approach
offered at Alma Ata declaration. It indicated a radical
road-map which had the potential to make health for all
a reality. PHC concept, as unfolded in the Alma Ata
declaration had taken an unambiguous positions when it
called for economic and social development based on a
new economic world order. This was upheld as the
essential criteria for the fullest attainment of health for
all and to the reduction of the gap between the health
status of the developing and developed countries.
Positions offered by MDGs however keep away from
taking such a stance on the circumstances which makes
people vulnerable to diseases or continue to live in
diseased conditions. It neither mandates any action
against the present global developmental paradigm.
The absence of well performing health system
characterised by low investment in public health,
accompanied by increased privatisation of
healthcare take out most important foundation for
initiating action against diseases. Failure to develop
general health services, which need to be the basis
for any interventions tackling particular diseases,
will only lead to the failure of vertical, bio-medical
interventions.
MDGs, avoids taking a ‘health systems approach’ and
ignores the current deepening of health system crisis as
the result of underfunding of public health,
commercialisation of health care, malign role of drug
industry etc. The MDG approach just talks of attaining
lower IMR, MMR and reduction in TB, Malaria and AIDS
as if these can be achieved in isolation, or with
ignorance of the larger systemic issues. This is a typical
highly ‘verticalised’ approach to complex and systemic
problems, which let alone linking with the social
determinants, does not even look at the immediate
health system determinants.
MDGs themselves are contradictory in nature. The
eighth and the final goal calls for increased global
partnerships for development. This position has an
overarching support for the present developmental
paradigm which forms the root cause for many of the
development issues the other goals try to address. A
good example being access to medicines which is an
important step in the fight against major diseases.
However achieving this would mean countering the
Source: JSA Campaign booklet on ‘Health systems
in India- crisis and alternates
72
present trade regimes which unfortunately the MDG
process is rather silent about.
addition to providing cures and interventions that affect
the immediate causes. The following are a few
suggestions towards a more integrated approach:
Limitation of present response
Communicable diseases are related to a complex set of
factors, and cannot be explained adequately by
simplistic linear models. The health of a given
community is not determined merely by the presence
of genes, germs, toxins or influence of healthcare
services. Rather it is also influenced by larger social,
economic, political, cultural contexts. In other words,
the health of a given society is closely linked to the
model of development that is followed. But health
planners and professionals sitting in capital cities
continue to largely ignore the social, economic and
cultural contexts of people’s lives. There has been a
consistent choice of vertical programs over more
‘horizontal’ and people centered approaches in an
attempt to tackle what are essentially social problems
by means of a focus on technical fixes. This approach
has not only ignored local contexts but also led to a
consistent neglect of the general health system, which is
crucial to addressing the felt needs of the people, as
well as to provide a basis for implementing any other
health program.
•
Cure and control of communicable diseases, like
any other disease should be seen as a fundamental
human right of communities and individuals rather
than as a favour by the government on
‘beneficiaries’.
•
The strengthening of the general health services
needs to be seen as a priority as it both fills an
urgent need of the people as well as being a
foundation for the introduction of any further
interventions.
•
Any disease control program needs to tackle the
determinants of health, while addressing the
curative aspects as well.
•
Given a human rights approach and the importance
of the context and the complexity of the issue,
people and communities have to be actively
involved in all stages of planning, implementing and
monitoring and evaluating.
As the ICSSR / ICMR report says, there are no
shortcuts, mere expansion of the present services is
not going to solve the problem, what is needed is a
radical restructuring of the services, placing the people
in the centre.
To really control disease / prevent unnecessary burden
one has to evolve programs that tackle the
determinants of health and socio-ecological factors, in
73
Goal 7: Ensure Environment Sustainability
- Indira Khurana, WaterAid, India
MDG 7 is about ensuring environment sustainability.
One of the targets under Goal 7 is Target 7c: Reducing
by half, the number of people without access to safe
water and sanitation. This chapter focuses on this
target and on the potential effects of climate change on
it (see Box: About MDG 7).
The ‘right language’
Target 7a: Integrate the principles of sustainable
development into country policies and programmes
and reverse the loss of environmental resources
The South Asian Conference on Sanitation
(SACOSAN), a government led biennial convention
held on a rotational basis in each country, is a platform
for dialogue and influence created by the governments
of South Asian Countries to review the progress on
sanitation. It is linked also to the attainment of the
MDGs.
“Every citizen of India should have access to safe
water and sanitation as a right”
-
Target 7b: Reduce biodiversity loss, achieving, by
2010, a significant reduction in the rate of loss
Indicators
-
Proportion of land area covered by forest
-
CO2 emissions, total, per capita and per $1 GDP
(PPP)
-
Consumption of ozone-depleting substances
-
Proportion of fish stocks within safe biological limits
-
Proportion of total water resources used
-
Proportion of terrestrial and marine areas
protected
-
Proportion of species threatened with extinction
On July 28, 2010, the Right to water and sanitation was
tabled and accepted at the UN General Assembly. This
Resolution was presented by the Bolivian Prime
Minister, 122 countries voted ‘Yes’, 41 abstained and
no country voted against it. India was one country that
voted ‘yes’.
What are the implications of this resolution for India?
Will it help assure safe water and sanitation for all? In
the short run, will it help us achieve Goal number 7,
target no 10 of the Millennium Development Goals,
which boldly states: Halve by 2015 the proportion of
people without sustainable access to safe drinking water and
basic sanitation? More importantly, will it help attain
universal coverage and usage?
Target 7 c:
Drinking
water
and
sanitation:
Underpinning social development
Halve, by 2015, the proportion of people without
sustainable access to safe drinking water and basic
sanitation
Globally, diarrhoeal disease caused by poor sanitation
and unsafe water kill around 1.4 million children every
year, more than AIDS, malaria and measles combined.
Indicators
-
Proportion of population using an improved
drinking water source
-
Proportion of population using an improves
sanitation facility
At present there are globally 2.6 billion people living
without safe sanitation, which means countless
communities where people are exposed to their own
and others’ faeces. Excreta are then transmitted
between people and also find its way into water
sources, resulting in a public health crisis.
Target 7d:
-
PM Manmohan Singh, November 2009, inaugural
address, SACOSAN III, Delhi.
Achieve significant improvement in lives of at least
100 million slum dwellers, by 2020
In terms of child health, repeated diarrhea and
nematode infections are associated with 50 percent of
74
childhood malnutrition. Recent evidence indicates that
a greater impact on child malnutrition is caused by a
lack of sanitation leading to the repeated ingestion of
faecal bacteria.
the first two – access and affordability – are assured, of
what use will this be if the digestion system is infected
by waterborne disease and nutrition is draining away
due to copious diarrhea? Of what use will be nutrition
or anemia mitigation programmes? One study indicates
that annually the rural population spends Rs 6,700
crore on treatment of waterborne disease. The
Planning Commission has informed that health
expenditure has been one significant factor for pushing
people back into poverty.
Lack of progress on sanitation and hygiene has broader
impact on healthcare. Without safe water, sanitation
and hygienic practices, patients with already lowered
immune systems have their recovery and survival
chances drastically reduced, particularly those living
with HIV/AIDs.
In case of education, girl child drop outs are also
because of the support needed to collect water for the
house and due to absence of functional toilets for her n
school, especially during adolescence.
Beyond the direct impact on health, lack of sanitation
damages other areas of human development. It affects
education access and attainment, both in physiological
terms by repeated illnesses stunting intellectual
development and in practical terms by causing may
teenage girls to drop out of school, further entrenching
the barriers caused by gender inequality. It also
frustrates global and national efforts to eradicate
poverty simply because sick people are unable to work
or study. In addition, large investments have to be made
to treat avoidable disease affecting economic
prosperity.
Access to safe water and sanitation is thus directly
linked to several other goals as indicated in the Table 1
below:
Table 1: Linking Goal 7
In 2009, the expert group on poverty headed by Dr S
Tendulkar, former chairman of the Prime Minister’s
Economic Advisory Council estimated that 41.8 per
cent of India’ population is below the poverty line, 10
per cent higher than the Planning Commission’s
estimates.
A new Multidimensional Poverty Index (MPI) worked
out by the UNDP and Oxford University this year
indicates that India is actually poorer than estimated
and reveals that the persistence of acute poverty is
more than an economic phenomenon based on income
levels. The ten indicators that form part of a composite
indicator include child enrolment and years of
schooling, child mortality and nutrition, electricity,
flooring, drinking water, sanitation, cooking fuel and
assets.
Recently, several public welfare schemes targeting the
poor areas have been announced, some even
implemented. But in absence of access to safe water
and sanitation, essential for survival and survival with
dignity, questions arise about the accruing of optimal
benefits from these.
Goal
Target Description
1
Halve, between 1990 and 2015,
proportion of population below
national poverty line
2
Ensure that by 2015 children
everywhere, boys and girls alike, will
be able to complete a full course of
primary education
3
Eliminate gender disparity in primary
and secondary education, preferably
by 2005, and in all levels of education
no later than 2015
4
Reduce by two-thirds, between 1990
and 2015, the under-five mortality
rate
5
Reduce by three quarters, between
1990 and 2015, the maternal
mortality ratio
6
By 2020, to have achieved, a
significant improvement in the lives of
at least 100 million slum dwellers
Drinking
water
programmes in India
The criticalness of safe drinking water and sanitation
can be explained by citing the example of food security
or the right to education. For attaining food security,
availability, access and absorption are essential. Even if
and
sanitation
Water supply and sanitation were added to the national
agenda from the First Five-Year plan, when in 1954, the
75
first national water supply programme was launched
but as part of the government’s health plan. At that
time, sanitation formed a section on water supply. The
central and state governments provided equal share of
funding for water supply schemes.
-
Access to improved drinking water sources:
In the initial years, the states faced problems in
implementation due to lack of qualified work forces for
implementing the projects. In 1968, financial authority
was granted to the states to sanction rural water supply
projects. This was followed by the launch of the
Accelerated Rural Water Supply Programme (ARWSP)
in 1972. Subsequent years saw the formation of the
National Drinking Water Mission in1986, setting up of
the Department of Drinking Water Supply in 1999 and
launch of the Sector Reform Project in 1999 and
consequently the Swajaldhara Programme was launched
in 2002. In 2007, the funding guidelines for Swajaldhara
changed from the previous 90:10 central-community
share to 50:50 centre-state shares, with optional
community contribution.
-
The situation particularly inadequate in case of
sanitation, since only 1 in 3 Indians has access to
improved toilets.
-
Overall households having access to improved
water sources showed increasing and clear trend:
Halving the proportion of households without
access to safe drinking water sources from its 1990
level of 34 per cent to 17 per cent was already
attained by 2007-08.
-
Sustainability of the above a challenge and depends
on creation of safe drinking water supply facilities
for the increasing population.
-
At the current rate of decline in proportion of
households having access to safe sanitation, India is
likely to have the proportion of households
without any sanitation reduced to about 46 per
cent by 2015 as against the target of 38 per cent.
India is likely to reduce the rural population of no
sanitation to 63 per cent (as against 47 per cent)
and urban population with no sanitation to 15 per
cent (as against 12 per cent).
Definitions
Improved water sources as defined for the MDG target
include (a) piped water into dwelling, plot/ land 9b)
public tap/ standpipe (c) tubewell borewell (d)
protected dugwell (e) Protected spring (f) Rainwater
collection harvested rainwater (g) Shared sources of
the above
Improved sanitation facilities as identified for MDG
target include (a) flush/ pour flush into septic tank,
piped sewer system(b) Ventilated improved pit latrine
(c) Pit latrine with slab (d) Composing toilet. Shared
facilities of the above are not regarded as improved.
What the government report states:
Water supply and sanitation continue to be
inadequate, despite longstanding efforts of the
government at various levels and communities at
improving coverage.
-
Access to improved sanitation facilities:
The new rural drinking water supply guidelines are the
latest changes in the rural drinking water supply
schemes of the government which have come into
effect from April 1, 2009 when the name of the
programme was changed to the National Rural
Drinking Water Programme. The new guidelines
mention that by March 2012 all rural habitations will be
covered with an assured supply of water and that
Panchayats will manage water supply schemes in their
villages. This implies that as far as rural drinking water is
concerned, target 7 c which relates partly to drinking
water will have been attained. Challenges remain as has
been documented in the Government’s report on the
MDGs (see Box: What the government report states). The
investments made in rural drinking water supply are
given in Table 2.
-
The absence of common standard definitions
makes temporal comparison using existing survey
and census estimate almost impossible.
Table 2: Investments in rural drinking water
(1951-2012)
In case of drinking water, quality of service is poor.
Most users that are counted as having access
receive water of dubious quality and on
intermittent basis.
76
Plan period
Investment made proposed in Rs crore
Centre
State
Ist (1951-56)
0
3
IInd (1956-61) 0
30
IIIrd (1961-66) 0
48
IVth (1969-74) 34
208
Vth (1974-79) 157
348
VIth (1980-85)
895
1,530
VIIth (1985-90)
1,906
2,471
VIIIth (1992-97)
4,140
5,084
IXth (1997-2002)
8,455
10,773
Xth (2002-07)
16,254
15,102
XIth (2007-12)
39,490
49,000
Coverage conundrums
attaining numbers
and
beyond
The MDG 7c target has value and there is merit in
achieving progress towards attaining this. Over the last
few years, however, the numbers though important,
sometimes fails to reveal hidden challenges, existing
inequities, and sustainability of achievement and
realization of impact. Some of these challenges are
indicated below.
Source: Mid-term appraisal of the XIth Five Year Plan, Planning Commission, India
As on April 2005, 91 per cent of urban areas had access
to water supply albeit inadequate and non-equitable.
The Class 1 towns had highest average access to water
(73 per cent) followed by the Class 2 and 3 towns.
Within a city, poor people living in slums and untenured
settlements have largely been deprived of water
services.
a) Getting the numbers right: Does coverage always
imply access?
Often release of allocations or their expenditure is
taken as a measure of coverage. This is not necessarily
true. For example, in case of sanitation, release of funds
implies that a toilet has been constructed. In case of
drinking water there have been examples, where
expenditure has been made but not a drop of water has
emerged from the created infrastructure. The table 3
below cites examples from the Bundelkhand region
wherein expenditure has been made, the habitation has
been declared to be fully covered, and yet drinking
water eludes the residents of these habitations.
As per the 2001 census, 36.4 per cent of the country’s
population had an access to latrine. In the subsequent
years though the coverage of rural and urban sanitation
has increased, there are concern over usage and with
665 million Indians still defecating in open, sanitation
remains a big challenge.
The Total Sanitation Campaign (TSC) was launched in
1999 with the aim of providing Individual Household
Latrines (IHHL) to all rural households. The urban
sanitation coverage as on April 1, 2005 stood at 63 per
cent which rose to 83 per cent as per the National
Family Health Survey (NFHS)-III (2005-06). Similarly,
rural sanitation coverage rose from 21.9 per cent in
2001 to 45 per cent in 2007 to the current 50 per cent
in 2009.
Table 3: Differences between reportage and
reality in habitations in Bundelkhand
b) Data reliability and reconciliation:
There are several reports – many of them by the
government itself – that questions the veracity of data
and the sustainability of such coverage. Variation has
been found in surveys that have been undertaken by
different institutions.
An important challenge which remains is that coverage
need not necessarily mean usage of sanitation facilities.
There are various studies which indicate that mere
coverage of sanitation have not resulted in usage and
resulted behavior change of not defecating in the open.
Quality of construction, materials used and availability
of water are some of the factors which influence the
usage of toilets. Only 3.9 per cent of the total
households in rural India have closed drainage systems
while in urban India, 34.5 per cent of the total
households have closed drainage facility. Approximately
22.1 per cent of urban households do not have any
drainage system at all.
This makes it difficult to compare and reconcile to
gauge and monitor actual progress. While JMP 2010
figures based on 2008 data states that rural India has
achieved sanitation coverage of 31%, the Online
Reporting Data from Department of Drinking Water
Supply states that India has achieved 65% sanitation
coverage as on date. Comparative statement of State
wise figures with respect to Rural Sanitation coverage
as per DLHFS-3 Survey and TSC online monitoring
system is given in the table 4 in page No. 78.
77
Table 3: Tikamgarh district, Madhya Pradesh
Name of
village
Type of
Scheme
Present status
Bandha
Under one
village scheme
Half of village linked with Organizational
pipeline but half of
survey & from
village not linked,Motor community
is not working
Source of
Information
Hateri
Under one
village scheme
Boring done, pumping
system installed, but
pipeline not laid, nor
stand posts created
Nadanwara
Under one
village scheme
Motor is not functioning Organizational
since many years and the survey & from
community
pipeline is jammed
Organizational
survey & from
community
Coverage Details
Name of
habitation
Coverage status
Banyat
FC
Bandha
FC
Harizhanbasti
Hateri
Khirakmundi
Mundi
FC
FC
FC
FC
Badli
FC
Nandanwara Bhata
FC
Nandwara
FC
Sankargarh
FC
Jalaun district, Uttar Pradesh
Asahna ( BlockMadhougarh)
Parasan (
Kadoura)
Under one
village scheme
Under Multi
village scheme
Four years’ old project is
not working from very
beginning; pump house
constructed, tube well
around 600 m from river
installed but not drawing
water
Through the
use of RTI (
right to
information)
Asahna
FC
Geedan ki Khod
FC
Five years’ old multivillage scheme is not in
functional condition.
Around Rs 36 lakh of
Rs 76 lakh allocation
released.
From
community
Almori
FC
Bhadara dera
FC
Kunehta
FC
Mohan Devi
FC
Parsan
FC
Sarsai Dera
FC
FC
Hansa
Kadoura
Under one
village scheme
Five years’ old scheme is
not working from very
beginning
Through the
use of RTI
Hansa
Sirsha Dogdi
Under one
village scheme
Source available, pump
house and overhead
tank constructed, But
there is no main pipe
line in the village and no
tap stand. Electricity
supply to the village is
irregular
From
community
Sirsadogarhi
FC
Multi village
scheme
At present the schemes
is not working and
community badly
suffering for getting
potable water
Through the
use of RTI, still
awaiting
information
Suravali madhogarh
FC
Suravali
Source: Sanjay Singh, Parmarth and DDWS website, research compiled by WaterAid
78
Table 4: Comparison of rural sanitation
coverage as per District Household Level Survey
and TSC online data (2007-08)
No State
Sanitation
Sanitation
Coverage
as per TSC DLHFS-3
online 07-08 (07-08)
the rural population spends Rs 6,700 crore on
treatment of waterborne disease.
d) Reaching out to excluded:
Access continues to elude the people who need this the
most: The SCs and the STs, in spite of Constitutional
provisions and allocations for rural drinking water
supply. Lack of awareness about government
programmes and service provisions, coupled with no/
little voice on one side and an apathetic governance
structure on the other has resulted in their continued
deprivation. In absence of a well defined accountability
mechanism and legal provisions, status quo remains.
Difference
Coverage
1
Andhra Pradesh
60.56
22.60
37.96
2
Assam
64.59
66.10
-1.51
3
Bihar
20.46
12.30
8.16
4
Chhattisgarh
30.30
9.80
20.50
5
Goa
58.87
66.70
-7.83
6
Gujarat
55.59
28.20
27.39
7
Haryana
78.58
45.20
33.38
8
Himachal Pradesh
54.26
52.70
1.56
9
Jharkhand
21.25
4.80
16.45
10
Karnataka
38.64
23.00
15.64
11
Kerala
100.00
95.90
4.10
12
Madhya Pradesh
34.55
10.10
24.45
13
Maharashtra
56.42
31.00
25.42
14
Meghalaya
47.37
61.50
-14.13
15
Mizoram
100.00
97.10
2.90
16
Orissa
33.61
10.50©
23.11
17
Puducherry
23.85
28.80
-4.95
18
Punjab
55.33
69.80
-14.47
19
Rajasthan
31.40
12.90
18.50
20
Sikkim
100.00
90.80
9.20
21
Tamil Nadu
76.00
19.50
56.50
22
Tripura
100.00
92.40
7.60
23
Uttar Pradesh
56.66
15.40
41.26
24
Uttarakhand
51.20
43.70
7.50
25
West Bengal
80.90
45.40
35.50
India
53.20
30.90
22.30
In terms of MDGs, SCs and STs lag behind as was
indicated by Census 2001. There are significant
differences when it comes to the availability of drinking
water and sanitation. Access by these communities is
often hindered by lack of allocation and expenditure on
one hand and social processes that are in play on the
other (see Box: Social exclusion and access to drinking
water). According to the Census of 2001, SCs and STs
together constitute 24.4 per cent of the population or
251 million.
Social exclusion and access to drinking
water
The prevailing caste system hinders water access: In
fact, water is used as a weapon to perpetuate
dominance. A survey of 565 villages across 11 states
shows denial of access to water facilities in 45-50% of
the villages. Exclusion is also prevalent in schools
where SC children are not allowed to drink water from
common water sources. Teachers and non-SC students
do not take water from SC students. Discrimination
gets enhanced in times of disaster and scarcity e.g.
Floods and drought; when safe water is at a premium.
Water tankers are directed towards upper castes
hamlets because of the power they wield. There have
been examples of the same during the drought in
Bundelkhand and the tsunami is South India. In areas
where water pollution is high, impact is much worse for
excluded communities.
Source: DDWS presentation, May 2010
c) Poor performance in poor states:
16 of the 28 states have coverage less than 50 per cent,
some of which are these states are densely populated
and home to a large number of poor. This means that
the population who is not covered will probably be
poor and excluded when the need here is the most.
States are unable to pick up or absorb funds.
Investment has not always translated into service.
Community engagement is unsatisfactory. The human
translation of all this: disease, debt and death. Annually
Common water sources are rarely ‘common’: They are
instead branded by a divisive line of caste as for the
prerogative use of the dominant castes. This exclusion
is maintained by the creation of a meticulous system of
checks to circumscribe the SCs rights to water through
varying untouchability practices or outright denial of
water, and any steps taken by them to cross this
invisible line is swiftly crushed.
79
Where segregated water supplies are not found, SCs
often endure the following practices of untouchability:
to diversify our sources for drinking water” (Ref: Press
information bureau release on April 10, 2010).
-
SCs and non-SCs do not stand in the same line to
fill water and do not use the same pulley to draw
water from the well.
-
SCs cannot dip their pots in a well or pond when a
non-SC is drawing water
Reaching drinking water to all rural habitations has
proved to be a tough job for the government. In the last
55 years the government has missed the target of 100
percent coverage thrice. In fact the coverage as on
December 2009 was 70 per cent, a drop of around 26
percent from 2005 level.
-
Non-SCs can draw water from water sources
‘allotted’ to SCs when their own water sources
have dried up, but the reverse is not possible
-
SCs cannot take water from a common water
source on their own, and have to request a non-SC
to pour water into their pots.
India is turning into a one source entity, almost addicted
to groundwater: Around 85 per cent rural areas
depend on this for drinking; more than 50 per cent for
irrigation; around 50 per cent for industry. On March
12, 2010 the Parliament was informed: “Groundwater
in 33 per cent of India undrinkable”.
Both the rural and urban areas are facing a similar set of
problems: sustainability of sources, sustaining gains
achieved over the years and making services accessible
to the poor and those who have been historically
excluded due to a host of factors. New challenges are
emerging due the current development paradigm that is
water extractive and inequitable in nature, and climate
change. While water is emerging as a contentious and
intensely sought after resource, the mechanism for
equitable and justiciable access is yet to be in place.
Similarly, in rural sanitation India has to construct a
mind boggling number of toilets and also to ensure its
use. In urban areas sanitation has to reach to a large
number of slum dwellers. The sheer numbers for
service provision is daunting.
When SCs complain about lack of drinking water, the
response ranges from threats to violence and
sometimes death.
The habitations where STs live are usually remote and
scattered, often inaccessible in forested, hilly and
undulating terrain. Reaching with safe drinking water
often requires greater investment for reaching out to a
small population. Often appropriate technology is not
available. While these are cited as reasons behind
failure to provide drinking water infrastructure, this
rarely comes in the way of large projects such as mining.
What is ironical is that most tribal dominated areas are
good rainfall areas that serve as catchment for
watersheds and water projects that supply water to the
plains. Yet the tribals do not get water, even for
drinking. In places where investments have been made,
the emphasis is more on spending than spending
sensibly and sustainability. Inadequate attention given to
local drinking water sources, water supply systems and
management.
The challenge before the officials of the department of
drinking water supply and sanitation (DDWS) of Union
Rural Development Ministry (the largest funder for
rural water supply programmes in the country) is: Can
India ever attain 100 percent coverage? For this
another question needs to be asked: can India contain
slippage completely? And this raises the million dollar
question: why does slippage take place?
e) Sustainability of attainment:
Drinking water is the least use of water among various
uses: yet access continues to be a challenge, pointing
perhaps to larger water problem: that of inappropriate
and inequitable management.
The Approach Paper to the 11th Five-Year Plan has
treated coverage as a ‘dynamic concept’ and reasoned
out slippage as being due to: sources going dry or
lowering of the groundwater table due to withdrawal
exceeding replenishment, sources becoming quality
affected; sources outliving their lives; systems working
below rated capacity due to poor operation and
maintenance; increase in population resulting in lower
per capita availability; emergence of new habitations
and slippage due to seasonal shortage of water (low
rainfall, etc).
In mid-April 2010, CP Joshi, the Union minister for
rural development declared: “India has achieved the
Millennium Development Goal for drinking water by
providing 84 per cent of its rural population with access
to improved sources of water.” But he also put a rider:
“Sustaining water security in rural areas is the biggest
challenge. Our groundwater is depleting, being used
much more for agriculture and industries and we need
80
Indian cities and towns are increasingly facing potable
water crisis due to mounting demand and inadequate
measures to meet the same. As per 2001 census,
285.35 million of the total 1.02 billion population in
India, live in 5,161 towns, constituting 27.85 per cent of
the total population. Of the 5,161 urban agglomerations
and other towns, 35 metropolitan cities account for
about 110 million or 37 per cent of the total urban
population. Assuming that the urban population would
continue to grow at a rate of 3.1 per cent per year, it is
expected to reach to an estimated 790 million (nearly
55 per cent of the total population) by 2025.
to only a few, perpetuating inequitable access. The
burden on public utilities continues to mount.
The lack of availability of municipal water had resulted
in over exploitation of groundwater through the private
tube well. There is no account of household level
groundwater extracting structures in India. This leads
to problem in planning. After extraction, groundwater
contributes to sewage flow. In absence of groundwater
extraction estimates, the city planner is unable to plan
sewage management effectively.
Rural sanitation faces challenges that include: (a) sheer
numbers to be covered (b) dealing with a bureaucracy
that often is insensitive to the benefits of sanitation, (c)
generation of genuine demand, (d) sustainability of
behavior change and (e) operation and maintenance.
Though the government generates the impressive
figure of 93 per cent (233 million) coverage of the
country’s urban population by piped service, there are
large variations between states, between the classes of
cities and between different sections of society. Water
supply in most cities is not available to all, at required
pressure and for adequate number of hours every day.
This is irrespective of the quantity of water available for
distribution. Those who can afford, cope with this
erratic supply using backyard bore wells, booster
pumps, storage tanks, etc, while the poor suffer by
investing most of their time in waiting for the water to
come or in travelling to fetch the same from a distant
source.
The biggest problems facing the urban poor are access
to basic services. A major factor contributing of this is
the issue of land tenure, given that a majority of the
urban poor live in tenements not notified by the urban
local bodies. The fear of eviction is a constant source of
insecurity. These places often lack basic civic amenities
like clean drinking water, solid waste collection,
hygienic sanitation systems and adequate health
facilities. There is a significant impact on the burden
faced by women in collecting water and maintaining
household hygiene. Many times civic services in these
areas are controlled by local patrons and people living
here become victim to their assault.
The deterioration in the water services in the cities has
been compounded by “unaccounted for” losses due to
bad maintenance and operation. Distribution losses are
estimated to be in the order of 30-50 per cent in almost
all cities. Capacity to plug or detect leakages is weak. In
addition to system losses, metering inaccuracies,
unbilled consumption, illegal tapping and unauthorised
consumption results in a voluminous amount being
labeled as “non-revenue water” (NRW). In India, the
average NRW is estimated at 45 per cent.
The Jawaharlal Nehru Urban Revival Mission (JnNURM)
has a sub mission named Basic Services to the Urban
Poor (BSUP) which focuses on the integrated
development of slums including components of water
supply, sewerage, drainage community toilets and solid
waste management. This component is being managed
by the Ministry of Housing and Urban Poverty
Alleviation. The sharing of the programme under two
ministries leads to procedural delays and problems in
implementation.
Urban centers depend on both surface and
groundwater sources for supplying water, subject to
availability and the cost factors. While some urban
centers depend entirely on surface sources, such as
rivers, lakes and reservoirs, others use a combination
of surface and groundwater sources.
The National Urban Sanitation Policy released in 2008
aims for totally sanitized, healthy and livable cities and
seeks to ensure and sustain good public health and
environmental outcomes for all their citizens with a
special focus on hygienic and affordable sanitation
facilities for the urban poor and women. Awareness
generation and behavioral change; open defecation free
cities; Integrated city wide sanitation; sanitary and safe
disposal; and proper operation and maintenance of all
sanitary installations are main goals of the policy. A
The current paradigm requires cities to source water
from further and further away. Delhi for instance, is
presently sourcing part of its water supply from a
distance of 500 km, from Tehri dam. This adds up to the
cost of treatment and delivery of water. It also leads to
increased inefficiencies in supply. As the cost of supply
and delivery is high, the state can afford to supply water
81
national advisory group on urban sanitation (NAGUS)
has been set up by the ministry of Urban Development
which will assist the ministry of urban development in
implementing the National Policy. As part of the
National Sanitation Policy, each state is to formulate its
own State Urban Sanitation Strategy with a state level
apex body monitoring the implementation of the state
strategy. As per the provisions of the Urban Sanitation
Policy, cities have to develop City Sanitation Plans
(CSP). While preparation of CSP for over 5,000 towns
is a challenge, its implementation will be even more so.
-
The impact of climate change is not new in nature, but
the same old problems manifesting in greater severity
and frequency: Climate change will intensify current
problems related to water and sanitation. Climate
change may render the current
Climate change and effect on MDG Target
7c
Investment on drinking water and sanitation void unless
precautionary steps are taken, which include:
By 2080, an additional 1.8 billion people are likely to be
living in water scarce environments as a result of
climate change
-
Increase populations of microbial organisms due to
rising temperatures which will affect water quality.
As temperatures soar, humidity increases, water
becomes scarce and disasters such as floods
increase, so will diarrhoea, cholera, malaria and
other vector borne disease
Human Development Report, 2007, UNDP
The changing climate poses additional challenges on
sustained access to drinking water and sanitation. Some
key facts and concerns include:
•
Taking climate change into account in water and
sanitation sector investments and planning
•
Understanding how climate change will affect
groundwater aquifers
•
Adaptation measures which include water
conservation rain water harvesting and waste
water reuse
•
Surface air temperature in India is going up at the
rate of 0.4 degrees Centigrade
•
•
Rainfall patterns are changing: more extreme rainy
days; less number of rainy days; decline in summer
rainfall, excess rainfall in ‘low rainfall’ areas
Communities having the wherewithal to fight local
climate change impacts,
•
Mainstreaming potential climate change into
current development programmes,
•
Total runoff in most rivers will increase, cause
more flooding; runoff will be less in lean season
•
•
Glaciers are melting at an accelerated rate may
cause increased flooding in Himalayan rivers and
subsequent increase in flash floods. Glacier-fed
rivers will eventually run dry
A strong national programme on climate change
that factors in drinking water and sanitation needs
•
Conclusions
The drinking water and sanitation sector has entered
into a critical phase in the country: The government has
deadlines for universal access to water and sanitation
that are just round the corner – 2012. International
commitments under the MDG goals are just five years
away, in 2015. In both cases, meeting commitments
appears a rather daunting task.
Rising sea levels and coastal erosion will gobble up
land and turn coastal freshwater aquifers saline
Effect of climate change on drinking water and
sanitation:
The changing climate which pose additional challenges
to a country where the water resources are already
under considerable stress. For example, climate change
will:
It is not that government is not putting in efforts to
achieve these goals. The challenges lie elsewhere. Both
the rural and urban areas are facing a similar set of
problems: sustainability of sources, sustaining gains
achieved over the years and making services accessible
to the poor and marginalised. Superimposed on these
are the new challenges emerging due to changeover in
India’s economy – the current development paradigm
that is water extractive and inequitable in nature – and
global warming induced climate change. While water is
- Deepen the existing drinking water crisis. The
quantity of water available under the changing
monsoon regime will lead to disaster-like
situations: enhanced scarcity in drought prone
areas, excess water in drought areas and drought in
flood prone areas.
82
emerging as a contentious and intensely sought after
resource, the mechanism for equitable and justiciable
access is yet to be in place. Similarly, in rural sanitation
India has to construct a mind boggling number of toilets
and also to ensure its use. In urban areas sanitation has
yet to reach to its large number of slum dwellers. The
sheer numbers for service provision is daunting.
Recommendations
Caste and class play a role in accessing water, sanitation
and hygiene. The age-old social hierarchy still defines
access to and control of drinking water. Their
discrimination gets sharper in times of disasters and
stress. Inclusive access thus continues to elude the
people who need this the most: the SCs, STs, the poor,
aged and the differently abled.
2. Ensuring that the MDG plan recognizes drinking
water and sanitation as a critical sector in human
development efforts
Some of the recommendations for attaining and
sustaining MDGs targets and thinking beyond for
universal coverage and access in India include:
1. Ensuring drinking
enforceable rights
water
and
sanitation
as
3. Prioritising access to the excluded groups,
marginalized due to social, ethnic, age, sex,
economic and health factors through allocations
and monitoring
Globally, poverty eradication strategy integrates access
to water and sanitation. Most of the people without
access to water and sanitation are also world’s poorest.
Most MDGs will fail unless there is access to these basic
needs. The MDGs plus 10 is a wake-up call and offers an
opportunity to reinforce our commitment to engage so
that every resident of this country can drink safe water
and deal with normal physiological processes in privacy
and in dignity and at own convenience.
4. Ensuring alignment and reconciliation of data from
different sources to get accurate numbers of
population covered; capturing community voices in
assessment
5. Thinking beyond numbers into actual service
availability
6. Ensuring sustainability of coverage
Clearly more needs to be done and done better. The
challenges are within and beyond government
departments whose mandate this is.
7. Empowering local governance systems
8. Develop a strategy for coverage for all and always
83
84