Monday, February 25, 2013

An Unhealthy Paradigm?

Consider this state in India: As much as 44.6 per cent of its children are malnourished. While Infant mortality rates have gone down, its decline has been slower than the national average. More than 65 per cent of its rural households and 40 per cent of its urban ones do not have access to latrines and they use open spaces for defecation. The state has 918 women for every 1,000 men, well below the national average. Poverty amongst urban Muslims is eight times (800 per cent) more than high-caste Hindus.

Clearly, this state should belong in the cluster of lesser-developed ones in India, such as Bihar or Madhya Pradesh. But it does not. In fact, it rubs shoulders with all the developed ones, such as Maharashtra and Tamil Nadu. Yet, it lags every one of them in human development. You have obviously guessed by now that the state is Gujarat, but you would have perhaps never imagined these dismal statistics, considering the state’s high-growth trajectory.

Take a walk with Neeta Hardikar, founder of NGO Anandi, which works amongst the Naiks, Bhils and Rathwas in the beautiful villages dotting the hills of Devgadh Baria and you will be impressed by both the spotlessness of the homes of these tribals as well as their open, engaging disposition. But this bucolic idyll masks a more alarming reality. Hardikar says that there have been 10 pregnancy-related deaths in these villages in just the last two months. There simply is no credible government infrastructure to provide extended healthcare. “Where are the benefits that this growth model is supposed to be giving us?” asks Hardikar.

It is not that the government does not have a health programme. If fact, the Chiranjeevi scheme, a public-private partnership (PPP) model, has made strides in addressing many of the health issues that have historically plagued Gujarat. There is just one problem with it: “The government has not done a bad job, but it has a very strong urban focus. Rural and remote tribal areas tend to be ignored,” says Leela Visaria, former professor and director of Gujarat Institute of Development Research. Handling health issues in this area is not an easy undertaking. The problems afflicting people here are complex and require innovative medical solutions. Many here have sickle cell anaemia and pregnant women often show up in delivery rooms with alarmingly low counts of haemoglobin. There is also a huge problem in convincing medical professionals to work in these areas.

Whether out of sheer neglect or unwilling candidates, the state-run Community Health Centre in the district that caters to 96 villages has had no gynaecologist or pediatrician for seven years. The maternity homes in Baria have no capabilities for blood transfusion or neo natal care and are without an anesthesiologist.

Godhra, the nearest town which is about 40 kilometres away, is the only option for anyone requiring critical care and even there, the state hospital does not have a gynaecologist. “There is a joke that there are probably only eight gynaecologists available to the public sector in Gujarat,” says Visaria.

In the education arena, the situation is equally bleak. According to NGO Pratham, school enrollment is up to 95 per cent in rural Gujarat, but learning levels remain shockingly low. Fifty five per cent of rural students in the fifth standard cannot read a second standard level text, and 65 per cent of these students cannot do simple subtraction. Many in the arena say that government school teachers come drunk or sit around playing cards. Hardikar, who runs a camp for children in Baria for 24 days a year, says that none of her fifth standard students can read alphabets.

And what of higher education? “It is a flop show,” says economist Y K Alagh. Colleges and universities are run by thugs and incompetent administrators with only the technical institutes showing some potential, according to social scientists based in Ahmedabad.

One reason for this dismal outlook is because the state has practically frozen employment and marginalized public sector workers. “Many people I know have two jobs. Go to any government office anywhere in Gujarat and I challenge you to not spot a stock-trading window opened up on someone’s computer,” says Visaria. Which brings us to another explanation: “There’s no great preference for education amongst the trading community,” says Professor Sebastian Morris at the Indian Institute of Management, Ahmedabad.

These ground realities have meant that Gujarat fares dismally in practically every human development index that has been generated recently. UNDP’s 2011 Inequality-adjusted Human Development Report 2011 has it at number seven, while dropping down even further in the sub-indices of health (10th rank) and education (9th rank). The India Human Development Report, 2011, brought out by the Institute of Applied Manpower Research says that Gujarat fares the worst in terms of overall hunger and nutrition among the industrial high per capita income states.

Economists like Aravind Panagariya has written that Gujarat is on the right track because its high growth will allow it to spend larger sums on the social sector. But Gujarat has been doing well for a long time now, yet its per capita state expenditure on health and education was Rs. 1148 and Rs.293 respectively, putting the state at 17th and 16th among the major 20 states in India, according to Professor Indira Hirway, Director and Professor of Economics at Center for Development Alternatives, Ahmedabad. With social sector expenditure consisting 37.8 percent of the total public expenditure, this fastest growing state ranked 15th among the major 20 states in India in spending on the social sector in that year.

When Narendra Modi was interviewed by the Wall Street Journal some time back about the surprisingly high rate of malnourishment in Gujarati women, his response was, “Gujarat is also a middle-class state. The middle class is more beauty conscious than health conscious – that is a challenge. If a mother tells her daughter to have milk, they’ll have a fight. She’ll tell her mother, ‘I won’t drink milk. I’ll get fat.’”

It’s difficult to tell whether the CM was partly joking or not, but the issue is no laughing matter considering the paradoxically ugly state of Gujarat’s social development when you consider its storied industrial growth.

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