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Human
Development in India
Halting
Progress on Health
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India
spends 1.3% of its GDP on health.
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It may be difficult to dismiss the claim by the
Resident Representative of the United Nations Development Programme (UNDP) in
Delhi that the developing world was on track on at least the first of the UN’s
Millennium goals – to halve the number in the world living on less than a
dollar a day by 2015. This is largely because of two countries – China and
India -- which, between them, comprise every third person on the planet. Both
had registered sustained economic growth in the last few years.
Recently,
at the launch in Delhi of this year’s UNDP Human Development Report, the theme
of which are the Millennium Development Goals, speakers lauded India’s
contribution to this process. Throughout the 1990s, India has averaged a 4%
growth every year, which is greater than most other developing or developed
countries. The number of people living below the poverty line, using the same
Bank yardstick of a dollar a day, declined from a third in China in 1990 to 16%
in 2000. In India, the proportion was 42% in 1993-94 but dropped to 35% in 2001.
Significantly, this Bank figure is higher than the official figures put out by
the Planning Commission and others here.
The
report commends India for maintaining food stocks since the 1970s – as a
matter of fact, this plenitude is now actually seen as a problem, since the
country is paying a staggering bill for the procurement of food grains and
storage, even while stocks are deteriorating and being devoured by pests. This
prompted one parliamentary committee to recommend that stocks should be dumped
in the sea to reduce the costs. The report attributes the productivity gains to
the green revolution, with grains and essential commodities like sugar and
cooking oils being made available through the public distribution system. It is
another matter altogether that the green revolution has now run its course, with
declining yields as the soil has been depleted of nutrients through overuse,
prompting some experts to advocate biotechnology as the next panacea. Food for
work programmes have been extolled too, but these have also reduced sharply in
recent years, despite the groaning go-downs.
Even
with the change in per capita income, the bulk of Indians continue to
live in penury. |
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It
will hardly do, therefore, for India to congratulate itself on its human
development. It may be true, as the report emphasizes, that the country has done
well in devolving powers to local bodies, especially in states like Kerala,
Madhya Pradesh and West Bengal. The fact remains that India’s ranking in human
development has come down from 124 to 127, among the 175 countries measured in
the world. Indeed, it figures lower than humble Botswana on this front – the
kind of country which India may well consider extending aid to.
The
Indian government has been quick to draw attention to the new listing which UNDP
has adopted: the addition of two new countries -- Bosnia-Herzegovina and the
Palestinian territories. But no amount of quibbling over statistics or sleight
of hand can camouflage the abysmal fact that even while per capita incomes have
risen, the bulk of Indians continue to live in dire penury. What is more, the
regional variation is very marked. Between 1992 and 1997, per capita incomes in
Gujarat grew at a whopping 7.8% per year, while in Bihar, these actually declined
by 0.2%.
There
are 68 deaths of infants for every 1000, and 96 per thousand for
children under the age of five. |
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The
score card is truly bad when it comes to health, which is surely a more telling
index of a people’s progress than rupees earned. India spends a paltry 1.3% of
its GDP on health, when one combines both the expenditure of the central and
state governments. Experts often point out that one of the most accurate
measures of a nation’s well being is the infant mortality rate: not only does
it speak of the health standards available to toddlers but it encompasses a
mother’s nutritional status before and after birth. India still registers 68
deaths of infants for every thousand born alive, while the figure for children
under five is as high as 96 per thousand live births. This actually reveals why
the county continues to record high population growth rates: no family can be
sure that its young will survive till adulthood.
When
it comes to education – which is umbilically linked to health -- the story is
brighter. India has stepped up its spending on education from 0.8% of its GDP in
1950 to 3.2% at present, which still falls far short of the 6% set as an
official target. There are as many as 40 million children out of school, which
is more than a third of the world’s total. The report does well to highlight a
little-known fact why parents hesitate to send their children to school, quite
apart from the need to put them to work at home or elsewhere. It is simply that
the cost of uniforms is prohibitive. In eight states assessed, this is one of
the major expenses incurred in schooling, a powerful deterrent. The solution
lies in making this optional or, better still probably, to do away with such
conformism altogether.
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Classrooms
are in a state of neglect. |
India
is also notorious for not having school buildings or, where there are, for
letting them fall into a pitiful state of neglect. Again, schools lack
blackboards, if not the chalk to write on them. The widespread use of discarded
letters and other paper, which have only been written on one side, as makeshift
exercise books could help to a small extent at least. And as for school
buildings, the government has already been using local materials and contractors
and construction techniques in its District Primary Education Programme since
1994.
The
good news is that some of the poorest states – Madhya Pradesh and Rajasthan
– have advanced on education due to the handing over of powers to panchayati
raj institutions. These grassroots bodies, backed by the state government, have
made primary education a priority. In the decade from 1991, Madhya Pradesh has
increased its proportion of literacy by 20 points; Rajasthan was two points
better. Madhya Pradesh has even introduced an Education Guarantee Scheme so that
all children in the remotest rural hamlets have access to the three Rs.
Following
the success of the free lunch scheme in Tamil Nadu and Andhra Pradesh, not only
has the nutritional status of poor children risen in these states but attendance
has gone up too, which is surely a win-win situation. Why every government –
particularly in what used to be called the sickly BIMARU states of Bihar, Madhya
Pradesh, Rajasthan and UP (though Rajasthan may now have graduated out of this
group) – can’t use the burgeoning food stocks to feed children in schools is
a question which only they can answer, just as food-for-work schemes are the
obvious solution in times of distress.
There
is another, much less perceived connection between health, sanitation and
education. Many children – particularly girls – avoid school because there
are either no toilets or they are in a disgusting condition. Where these have
been provided, attendance has risen sharply and in some cases, children actually
clamor to go to school even over the weekends purely because they can use such
facilities, which are missing at home. There is also a crying need for
child-sized toilet pans in schools, because tots fear using the conventional
sizes.
If
there is one overwhelming message that emerges from this latest Human
Development Report, it is that the poorest countries – and, what is more, the
poorest regions within those countries – can overcome some of their problems
through spending on health, sanitation and education. Years ago, the American
sociologist Myron Weiner showed that the returns purely in economic terms on
spending on primary education, even for farm families, is higher than any
investment in any other sector. If any proof is required, it is surely the fact
that Kerala has health indicators which resemble those in the US, although its
per capita income is a fraction of an American’s and the annual spending on
health is just $28.
Darryl
D’Monte is the founder President of the International Federation of
Environmental Journalists. He is also the Chairperson of the Forum of
Environmental Journalists of India (FEJI) and a syndicated columnist and writer.
He was previously the Resident Editor of the Indian Express (1979-1981) and of
the Times of India (1988-1994) in Mumbai.
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