Wednesday, October 25, 2006

Miles to go to reach the MDGs in Madhya Pradesh

Madhya Pradesh’s estimated per capita expenditure per month on food is Rs 128.60 — the lowest in the country. This is a clear indication of the widespread poverty and lack of livelihood security in the state.

The Common Minimum Programme (CMP) of the current United Progressive Alliance (UPA) government and the National Development Goals articulated in the Tenth Five-Year Plan are broadly in agreement with the Millennium Development Goals (agreed upon by 189 countries in 2000) of poverty reduction, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, and ensuring environmental sustainability.

India’s share of the world’s responsibility in meeting the MDGs is phenomenal. It accounts for 25% of global maternal deaths, 34% of the world’s underweight children, 23% of under-5 children deaths, and 28% of the world’s poor living on less than $ 1 a day.

A further disaggregated analysis at the state level brings out different levels of human development and varied performances of state policy in guaranteeing protective and promotive social securities. Inter-state comparisons are important from the perspective of the MDGs, for they identify low-performing states that have to be goaded out of their slumber if the promises made in the Millennium Declaration are to be kept.

Madhya Pradesh and the Millennium Development Goal

Madhya Pradesh is an important Indian state; second largest in terms of area, with around 6% of the country’s population. In 2000, the new state of Chhattisgarh was carved out of Madhya Pradesh’s tribal-dominated regions. In its present form, Madhya Pradesh comprises 9 commissioner divisions, 48 districts, 272 tehsils and 313 community development blocks including 89 tribal development blocks. Its local self-governance structure comprises 45 zilla (district) panchayats, 313 janpad (block) and 22,029 village panchayats. The state comprises five distinct regions — Malwa, Nimar, Bundelkhand, Baghelkhand and Mahakoshal — with great differentials in human development indices.

According to the 2001 census, 20% of Madhya Pradesh’s population is classified as tribal, and 15% of its population belongs to the scheduled castes. Among its districts, Jhabua, Dindora, Barwani, Mandla, Shahdol, Umaria, Betul, Seoni, West Nimar and Sidhi have a tribal population of over 30%. The scheduled caste population is concentrated in the districts of Datia, Chhatarpur, Ujjain, Tikamgarh, Shajapur, Gwalior, Morena, Bhind, Sagar, Vidisha, Sehore, Panna and Damoh. The generic profile of these structurally poor groups is marked by deprivation of even basic services like health, education and sanitation (due to the discriminatory caste system, geographical location and culture), and the state’s denial of land, water and forest rights, resulting in an erosion of livelihood opportunities. The inequality of opportunities faced by scheduled castes and scheduled tribes prompted the third Human Development Report of Madhya Pradesh (2002) to highlight the need for an ST-SC Development Index.

With 37.4% of its population below the poverty line, Madhya Pradesh is one of the poorest states in the country. It ranks third among the traditionally BIMARU states (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) and Orissa. It has an above-all-India average percentage of poor, while the state’s per capita income falls below the national average of Rs 15,626. Madhya Pradesh’s estimated per capita expenditure per month on food is Rs 128.60 — the lowest in the country. This is a clear indication ofwidespread poverty and lack of livelihood security that affects a sizeable population of the state (State HDR, 2002). An estimated 38.2% of women in Madhya Pradesh are undernourished (39.9% of scheduled caste and 49.2% of scheduled tribe women). Around 56% of its children suffer malnutrition. The amount of foodgrain supplied to the state under the public distribution system is extremely low (it constitutes only 2.78% of total cereal consumption by levels of calorie intake), compared to states like Andhra Pradesh, Kerala and Tamil Nadu (Citizen’s Report on MDGs).

Madhya Pradesh’s performance on several human development indicators is dismal. At 85 per 1,000 live births, the state has a high Infant Mortality Rate (IMR), second only to Orissa at 87; the country average is 63 (SRS 2004). Similarly, the Maternal Mortality Rate (MMR) of undivided Madhya Pradesh, at 498, is extremely high, in league with Uttar Pradesh and Rajasthan and the all-India average of 407.
While the state has shown marked improvements in literacy, from 27.90 in 1981 to 64.11 in 2001, only 50% of females, as against 77% of males, are literate.Around 38% of rural households do not have access to safe drinking water. Given the fact that diarrhoea kills 400,000 under-5s each year in the country, and waterborne diseases afflict a sizeable number of poor people, adequate and safe drinking water is necessary to ensure healthy lives and is an important component of public health.

Madhya Pradesh’s overall ranking in the Human Development Index constituted by education (literacy and children’s enrolment in schools), health (life expectancy) and per capita income, is much below the all-India average and very low compared to most states, with the exception of Bihar, Assam and Uttar Pradesh. At the district level, the Human Development Index varies between 0.694 (highest) for Indore and 0.372 (lowest) for Jhabua. Similarly, the Gender Development Index, which disaggregates education, health and income figures in terms of male and female, shows huge variations among the districts, with Dewas leading at 0.634 and Morena, at 0.436, scoring lowest. Interestingly, the poorest performers — Jhabua and Morena — have a high percentage of scheduled tribe (85) and scheduled caste (21) populations. This indicates systemic exclusion of these social groups from access to equal development rights.

Major challenges

Madhya Pradesh is yet to devise a strategy that bails it out of its branded status as a BIMARU state. Although the state finance minister has claimed that, for the first time in 16 years, an overdraft situation did not arise in 2004-05, and that capital consumption had risen by 88%, Madhya Pradesh’s fiscal deficit has been rising for the last 11 years (1993-94 to 2003-04) and the shocks of this fiscal deficit have been primarily borne by the social sector. Expenditure on health as a proportion of total expenditure declined from 5.1% in 2000-01 to 3.4% in 2004-05. Similarly, expenditure on education as a proportion of total expenditure dropped from 16.3% in 2000-01 to 8.7% in 2004-05.

The state’s overall ranking in the Human Development Index is much below the all-India average and is very low compared to most other states, with the exception of Bihar, Assam and Uttar Pradesh. Some striking facts about the state are:

i) 37.4% of its population lives below the poverty line.ii) It has the lowest per capita expenditure per month on food — Rs 128.60.iii) 28.7% of workers eke out a living as agricultural labourers (a sizeable proportion of them belong to scheduled tribes).iv) It has the second highest infant mortality rate in the country, and an above-national-average maternal mortality rate.v) 38% of rural households do not have access to safe drinking water.

There has been a steep fall in the government’s expenditure on education and health in the period between 2000-01 and 2004-05.Together, these provide pointers that if Madhya Pradesh aims to bring itself up to the desired levels of development, as envisioned in the MDGs, the current pace of progress has to be stepped up. There must be a sense of urgency if Madhya Pradesh is to reach the desired outcome.
With respect to poverty alleviation in the state, major challenges relate to decline in employment growth; large size of workforce in the unorganised sector (94%); fragmentation of already small landholdings of small and marginal farmers, making cultivation an unviable livelihood option and causing greater casualisation of the workforce; dealing with land alienation of scheduled tribe cultivators; lessening unemployed person-days for the rural poor; and strengthening non-farm sector employment opportunities. Productive land being an important livelihood asset for the rural poor, the election commitments made to agricultural labourers need to be fulfilled at the earliest. Besides, creation of gainful employment opportunities will become a necessity with further improvements in literacy rates and the outreach of education to remote areas.

In the context of primary education, a major challenge will be to devise strategies to bring out-of-school children (constituting children who have never enrolled in schools, and dropouts) into school. According to the Seventh All India Education Survey for 2002-03, Madhya Pradesh, Andhra Pradesh, Bihar, Rajasthan, Uttar Pradesh and West Bengal accounted for most of India’s out-of-school children in the age-group 6-11 (Class I to V). The state (including Chhattisgarh) had a dropout rate of 30% at the primary level (in 2001-02), which, although better than the northeastern and other BIMARU states, still constitutes a huge challenge if the fundamental right to education for all children in the age-group 6-14 years is to be realised. Quality of education is an important issue, which has particularly arisen from the growing trend in recruiting para-teachers on lower salaries. According to Rajya Shiksha Kendra data (2004), 49% of primary teachers and 43% of upper primary teachers were untrained. The pupil-student ratio in government primary schools is 46. Other issues relate to pedagogy of teaching, attitude of teachers towards scheduled caste and scheduled tribe students or first-generation learners, teacher absenteeism, infrastructure and facilities (drinking water and toilet) available at schools, access in terms of distance, and incentives like midday meals, scholarships, etc.

The scenario in the health sector is even more daunting. Eighty-five out of 1,000 children born in the state die due to lack of health facilities. A sizeable proportion of children are malnourished. Analysis of age-specific death rates for the year 1996 revealed that 37.3% of total deaths in Madhya Pradesh occur within the age-group 0-4. Only 22.4% of children aged 12-24 months receive immunisation against all vaccine-preventable diseases. The maternal mortality rate, at 498, is above the national average. NFHS-2 revealed that only 20.1% of deliveries in the state are conducted at medical institutions. Only 41.7% of pregnant women registered for prenatal care in 1995/96, and only 27% received both required doses of tetanus toxoid; only 40% received IFA tablets. There is a need for a) greater resource allocation by the government, b) monitoring systems at various levels of public healthcare, for proper functioning, c) vacancies for specialised personnel and doctors in tribal areas to be filled up, and d) ensuring that services reaching the needy are not intimidating, and that healthcare providers are sensitive to their needs/problems.

In its election manifesto of 2003, the state Bharatiya Janata Party (BJP) made 371 promises, which have subsequently also been taken up by the present government. But of these not more than 20% are substantive development goals concerning the poorest of the poor and relating to their livelihood, health and primary education needs. As against the social development promises, those relating to infrastructure and energy and catering to the traditional vote-bank of the BJP are more concrete in intent. Of the 102 fulfilled commitments (as stated by the State Planning Board), not more than 5% belong to public health, approximately 6% to primary education, and 6% concern livelihood and food security for the poor.
Some of the achievable commitments relate to the provision of undisputed land to scheduled castes for cultivation; granting permission to forest-dwellers for the use of wood; easy access to credit to promote self-employment; improving implementation of the midday meal scheme; making drinking water and sanitation facilities available at government schools; provision of adequate resources to anganwadi centres; ensuring the availability of nutritious food for pregnant women; and deepening ponds.

The way forward

Strengthening local institutions like panchayats and self-help groups (SHGs) is essential if the health, education and poverty alleviation goals of the Millennium Declaration are to be met within the given timeframe. Nearly six decades of development planning in the country have led to the general consensus that the top-down approach to service delivery has failed, as the benefits continue to be skewed in favour of certain socio-economic groups. As local self-governance institutions such as village panchayats are physically closer to rural communities, the goals of human development in rural areas can be more efficiently realised by nurturing local institutions as vehicles of change. For example, in the area of health, panchayats could provide an institutional base to manage community-based health services (Citizens Report on Governance and Development, 2004). Likewise, in education, they along with PTA and self-help groups could monitor the quality of education, teacher absenteeism and quality of midday meals in schools. Fiscal decentralisation is critical, along with decentralisation of responsibilities, to make village panchayats effective conduits for development.

We need to build a strong public voice on issues of health, education and the livelihoods of marginalised sections of society. In several cases it is seen that when people begin claiming their entitlements the government has passed progressive laws towards protecting the livelihood rights of the rural poor. Campaigns to generate awareness and draw in informed opinion on these issues are critical to build pressure on the government to orient its policies towards performing its welfare functions and to guard against neo-liberal tendencies of leaving the essential needs of citizens to be met by individual efforts in the market.
Jan Swasthya Abhiyan (People’s Health Movement) is one such strong campaign dealing with the right to health and healthcare, and monitoring the implementation of the National Rural Health Mission. It works with public agencies to make the state accountable for ensuring the right to health of all its citizens. The Right to Food Campaign is another strong movement that monitors the implementation of food security programmes across several states of India. Similar campaigns and alliances in the domain of local civil society in Madhya Pradesh need to be nurtured; they could provide an alternative to the government monitoring system of the CMP, NDG, MDG and Madhya Pradesh government’s commitments to the people. Providing an alternative voice on the progress of development goals, civil society, the media and campaigns broadens the scope for introspection by the government on its strategies and resource allocation for human development.

(This article is based on a report prepared for Wada Na Todo Abhiyan/Keep the Promise Campaign, which urges central and state governments to fulfil their welfare duties towards citizens)

Feburary 2006

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