To translate promises into action

Supriya Sule

The progress with respect to the Millennium Development Goals has been halting in India. The time to act is now.

In September 2008, the United Nations Secretary-General and the General Assembly President convened a high-level meeting at the U.N. headquarters in New York where a new commitment was made on the Millennium Development Goals (MDGs). As the 2015 deadline for the realisation of the MDGs draws closer, fuel and food prices have risen and a period of global economic meltdown is on us. The world thus stands at a critical juncture. Given that India is home to a fourth of the world’s poor, the efficiency of national poverty reduction programmes is under the spotlight more than ever before.

National Sample Survey data reveal that 220 million to 230 million Indians, nearly a quarter of the country’s population, survive on less than $1 a day (PPP). Half the inhabitants of five States live in severe poverty, while 15 per cent of the population cannot expect to live beyond the age of 40. According to the U.N. Children’s Fund, India has made substantial progress with respect to specific social indicators, particularly “those that respond to vertical, campaign-like approaches.” These include polio eradication and net enrolment in primary schools. However, precisely where there is a need for a more systemic change in attitudes and infrastructure (for example, the provision of good primary care services), improvements are almost negligible.

There has been virtually no change in India’s ranking in the U.N.’s Human Development Report between 2000 and 2007-08, indicating that there has been no marked gain in terms of the quality of life for the average citizen. It is now being realised that this stagnation is largely attributable to a sustained reluctance on the part of the government to move away from purely lateral interventions, for which the selective “indicators” of the MDGs have in effect provided a handy cover to avoid longer-term and sustained investment in infrastructure.

Let us take as an example the question of maternal mortality rate (MMR). This is one of the MDG goal areas with respect to which India is faring particularly badly: of the 5.36 lakh women worldwide who die during pregnancy or childbirth, 1.17 lakh are Indian. The fact is, of course, that India invests only around 1 per cent of its Gross Domestic Product (GDP) on healthcare. This works out to $6.39 per capita a year. The Commission for Macroeconomics and Health advises that the minimum spending on essential health interventions in developing countries should be between $30 and $40 per capita. Public financing of health in China (PPP) is $21.7 per capita. Government expenditure in Sri Lanka amounts to $15.57. In Malaysia the figure is $78.42, over 10 times higher. Consequently, the MMR in Malaysia, China and Sri Lanka is 41, 56, and 92 respectively per 100,000. In India the figure is 540. In all these three Asian countries, between 97 and 100 per cent of births are now attended to by skilled health personnel. But an Indian mother has less than a 50:50 chance of a skilled professional being with her when she gives birth.

The MDGs take into account improvement in the incidence of institutional deliveries as a mark of progress in reducing maternal mortality rates. The United Progressive Alliance government has initiated the Janani Suraksha Yojana, which offers monetary rewards for mothers who have their deliveries in a government institution. Never mind that she has possibly received no ante-natal care up to that point, and that when she arrives at the local health centre in all probability she will find it under-staffed, under-funded and lacking in basic infrastructure. According to the Bulletin on Rural Health Statistics in India (2006), nationally there is a shortage of 20,903 Sub-Centres, 4,803 Primary Health Centres and 2,653 Community Health Centres, as per the norms, based on the 2001 population figure. Nationally, there is only one bed per 6,000 people. One in four pregnant women has not had a single ante-natal check-up. And roughly a third of expectant mothers are not immunised against tetanus, which would help prevent infection in both mother and child at birth.

If a woman’s health has suffered from childhood, if she is malnourished, underweight and anaemic and has not been reached by the public health system until the moment she goes into labour, then she is at severe risk. Under the current system, she is patted on the back for making it to a public institution (provided, of course, she has not given birth on the way there), and given a small sum of money. But she gets no counselling on how best to spend the sum (that is, investing it in the health and welfare of the newborn), and will possibly use it to cover household expenditure. At no point does this resolve the wider problems that endanger the health of the mother or infant — problems that are largely a consequence of gender inequities, inaccessible health systems, lack of preventative and potentially life-saving interventions and limited pre- and ante-natal care. If each preventable maternal death is a violation of human rights, India’s shocking incidence of maternal mortality is, in the words of Professor Paul Hunt, the former U.N. Special Rapporteur on the Right to Health, “a human rights catastrophe.”

The time has come for immediate action to accompany the promises: no more token gestures, but sustainable, holistic and comprehensive strategies for poverty alleviation. The UPA government has unveiled a number of programmes with immense potential. Not the least among these is the National Rural Employment Guarantee Scheme. Such initiatives should help develop a multi-pronged, rights-based approach, with the focus on transparency, accountability and participation. This will mark not just a shift in how programmes are implemented but also the logic behind them. Development cannot be seen as a question of patronising and charitable handouts, but as the fulfilment of fundamental human rights, including the right to live in dignity, free from want.

This realignment must be visible in national planning, policy and implementation. After the 2009 general elections, the government of UPA-II and the political parties must deliver strategies that reconsider health, education, empowerment and employability as the route to achieving sustainable development rather than as mere outcomes of growth. Without progress with respect to these inter-linked goal areas, poverty in India will remain a self-perpetuating problem. And the world as a whole will fail to meet the MDGs.

(Supriya Sule is a Member of Parliament, Lok Sabha, and Chairperson of the Parliamentarians’ Group on Millennium Development Goals based in New Delhi.)

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