PHM-Exch> MDGs in India

[Claudio Schuftan]

*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 wor ld’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.)
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20090712/d09e7225/attachment-0001.html>