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Tamil
Nadu bettered India’s national average for its Human Development Index
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Tamil
Nadu, the southernmost state in India, recently published its first Human
Development Report, and became only the sixth Indian state to do so. The report
pegs Tamil Nadu’s Human Development Index (HDI) at 0.657, an improvement on
the national average of 0.571. TN also bettered the national average in the
Gender Development Index (GDI). That, however, is the good news.
The
bad news is that the report has sounded a cautionary note on issues that affect
some of the most vulnerable sections of the population: addressing the problems
of the poor, the issue of gender inequality, care for AIDS victims who number
the highest in the country, and a sensitive policy for the elderly.
HDI
is a tool recommended for developing countries by the United Nations Development
Programme (UNDP). It seeks to define development objectives not just in terms of
an increase in the GDP, but in terms of enhancement of human well-being - how
well and how much of a population has benefited from development.
Earlier
in the year, a report of the Central Union Planning Commission had placed Tamil
Nadu third in a list of 15 major states. The state HDI is based on 8 parameters:
population, sex ratio, density of population, per capita income, Below Poverty
Line, Infant Mortality Rate, Literacy Rate and the national HDI.
The
State HDI has been constructed for all of its 29 districts. Chennai, also the
capital city, takes the top position, while the backward district of Dharmapuri,
infamous for female infanticide/ feticide, ranks last.
No
Money…No Food
65%
of the state’s population of 62 million (as per the 2001 census) live in rural
areas. But the primary sector’s (agriculture and allied activities)
contribution to the State Domestic Product declined form 24.82% in 1993-94 to
18.16% in 1999-2000. The Report
warned, “Generating employment or enhancing income levels should center around
the primary sector.” The Report also said that poverty had a significant and
adverse impact on girls’ education.
Says
Professor M. S. Swaminathan, the country’s legendary agricultural scientist
named by TIME magazine as one of the twenty most influential Asians of the 20th
century, “25-26% of our population are chronically undernourished, what we
call endemic hunger, the lack of adequate sustenance. This is not because there
isn’t enough food. You have a large variety of food available in the market,
provided you have the money to buy it. So the key question, why don’t we have
the money? Because there are no jobs. This is the job famine. The livelihood
famine.”
Public
Health Care Lacking
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Resources
are lacking in Tamil Nadu’s public health care system
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Public
health care is another weak area. The state has been hogging publicity for being
a ‘medical tourism’ destination with its impressive growth in sophisticated
private sector health care. But, although the state’s subsidies for corporate
hospitals have grown, they have not been matched by a similar dedication to
enhancing public health facilities. A
regulation in standards, particularly in terms of quality of cost and care, is
seriously lacking.
Also,
private medical institutions and super specialty hospitals are largely located
in metropolitan or bigger cities. The National Sample Survey data of 1997-98
pointed out that the poor in Tamil Nadu were more likely to use a public
facility than a private one, given the right opportunity.
Nevertheless,
mothers like Jaya, a 32-year-old wage earner in the unorganized domestic help
sector, spend large sums of money on quacks or neighborhood ‘nursing homes’
of dubious merit. She says, “I spent 3,000 rupees with different doctors in
the last two months for my two children, who were coughing all the time. The GH
(Government Hospital) will take me an hour to reach and they will make me wait
the whole day. I will have to bribe
everyone from the peon to the pharmacist there. Also, I won’t be able to go to
work so I will lose my earnings. In reality, it is cheaper to go to private
doctors, even though I know they are not good.”
Resources
are also severely in short supply. The
Government Hospital in Chennai, the state’s apex public facility, has a
waiting list of 5,000 for open-heart surgeries. For a great majority of the
parents of the 9,000 children born every year with defective hearts that require
surgery, it is simply not possible to afford the private price tag of
Rs.100,000.
Female
Infanticide/Feticide a Stark Reality
Gender
inequality is another issue requiring extra attention.
The state’s sex ratio has been improving steadily, from 977 (per one
thousand males) in 1981 to 974 in 1991, and now, a significant 986 in 2001. But
little that has changed the ground reality in the worst affected districts of
Dharmapuri, Salem, Namakkal, Madurai, Erode and Theni, where female
infanticide/infanticide continues unabated.
Says
P. Pavalam, State-level Convenor of the Campaign Against Sex Selective Abortion
(CASSA) in Madurai, “Instead of general infant mortality rates, the state and
national HDI must include the gender differential infant mortality figures (that
shows how many baby girls died as infants, as opposed to boys). Secondly, sex
ratio at birth (how many girls were born as opposed to boys) must be included as
a fundamental indicator. Only then will the HDI be more meaningful. Otherwise,
it will not reflect the true reality.”
The
sex ratio at birth continues to be below the biological average in the backward
districts of TN. Access to
technology and punitive punishment imposed on the perpetrators of female
infanticide has led to a shift from infanticide (killing healthy female infants)
to feticide (aborting female fetuses before birth).
AIDS
Victims Left Out
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Women
infected with AIDS in particular face discrimination in health care settings
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Tamil
Nadu is home to 22,826 PLWHA (People Living With HIV/AIDS), or over half of the
AIDS victims in this country. But,
at the office of the Tamil Nadu AIDS Control Society, the state’s nodal agency
set up supposedly to monitor and disseminate information related to AIDS in the
State, officials take hours to provide current information, leave alone help.
Says one bitter NGO activist who would prefer to remain unnamed, “In the time
they take, we could well die.”
AIDS
workers say that women continue to face discrimination in health care settings.
Critical areas of concern include advice on abortions, testing without consent,
refusal of health care providers to deliver the child of a positive woman,
denial of adequate medical attention and medical information, administration of
medicines without assessment of viral load, and negative attitudes of medical
professionals.
According
to Geetha Ramaseshan, a leading Chennai-based women’s rights lawyer,
“Activists need to examine public health policies that affect people living
with HIV to ensure that their rights to life are not violated.”
Says
P. Kausalya, AIDS activist and President of the South India PWN+ (Positive
Women’s Network), “Most Western funds and government support is specifically
earmarked for promoting awareness and for prevention measures. For those of us
who already have AIDS, there is virtually nowhere to go.”
Recognition
of the Elderly and Their Needs
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The
elderly are left out
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Finally,
the HDR made more than a passing reference to the need for social security for
the aged. The elderly are expected to number 11.43% of the population by 2011.
There is no specific policy in place for them. Says Annie Kurien, State Vice
Chairperson of the Dignity Foundation, one of the few NGO agencies working for
the aged, “The Government is doing practically nothing for its senior
citizens. They need medical attention, improved transportation, a range of
concessions as applicable in the Western countries and a policy that understands
their basic needs. The feeling that ‘they are useless’ is reflected in the
lack of sensitivity in the State’s policy towards them, which is virtually
nonexistent. Just because they are
helpless, you can’t put them all in the gas chamber!”
Lalitha
Sridhar is a Chennai-based freelance
journalist keenly interested in development issues. Your emails will be
forwarded to her by contacting the editor at:ScienceTech@islam-online.net.
