Editorial: Is Arvind Kejriwal Dangerous For Indian Politics?

By M H Ahssan | INNLIVE

Who is more dangerous for India – Arvind Kejriwal or Narendra Modi? This is a question that India needs to answer. But a recent article titled ‘Arvind Kejriwal: The Most Dangerous Man In Indian Politics’ has ventured to supply a one-sided answer to this question. The title is as catchy as it is misleading if not subversive. 

The ensuing ‘analysis’ is sadly not borne out by facts but relies on obfuscation and rhetoric. The tragic outcome is that many pertinent facts have been buried beneath the rubble of unsubstantiated allegations and sinister accusations. On the whole the article is an anti-Kejriwal diatribe disguised as an intellectual treatise.

While conferring on Modi the respectable halo of a “firebrand Hindu nationalist”, the writer goes on to indulge in pure speculation and sweeping generalizations about Kejriwal and other AAP leaders.

FOOD BANK POLITICS, A GRAND 'STEAMING SUCCESS'

By M H Ahssan / Chennai

Tamilnadu has a history of mixing politics and food. With Jayalalita’s Re 1-idli scheme becoming a hit with even the middle class, has she perfected the art of food bank politics?

At 8am, the sun shines bright over Sant home High Road which leads to the panoramic Marina beach in Chennai. A newly painted small stucco building on this road is making waves. A long queue is weaving out of the verandah of the two roomed building and if you walk past it and step into the kitchen, the smell of freshly cooked idlis and sambar, the staple Tamil breakfast, assails you.

'They Still Die in Labor Room'

By Samiya Anwar & M H Ahssan

Taj Mahal- One of the seven wonders of the world, One of the Greatest monuments, dedicated to the memory of the Queen Mumtaz , by her husband Emperor Sahajahan, is a testimony and a grim reminder of the tragedy of maternal mortality, that can befall any women in childbirth. The probability of an Indian mother dying during childbirth is roughly 10 times that of her Chinese counterpart. Reducing the Maternal Mortality Ratio (MMR) by three-quarters in 10 years is now a Millennium Development Goal. Why is MMR in India so high and how far are we from the goal? HNN unravels the many challenges to saving mothers' lives.

Maternal Death - A Tragic Reality
Women, undoubtedly is the most beautiful piece of creation. She is not just a female, she is more than it. She is definitely a special handiwork of God. That is why she is wanted, she is loved. Men love women. Isn’t so and why not they are always surrounded by women. First it is a woman, to whom they are born. Then they grow with women as sisters. They are married to women. And also women are the one who reproduces the generations. Yes, because women are the reason for the offspring and growth of society.

But the same women are put to menace for procreation of mankind. They are often treated as reproducing machines. Not cared, left as scraps or doormats at homes women die anonymously especially the poor. For women it is a joyful start to a life as the mother and for a child a whole new life. It is really indecent that there is no man or women who take care of them or good medical facilities when the women are in need of special care and attention during and after pregnancy. Hence they either develop complications in the womb or die soon after child birth. Lack of education and short of medical facilities would be the cause. Many stories of women dying with maternal deaths are largely untold and unheard.

This is a social issue and heeds attention. Thanks to the television channels for wonderfully presenting the shows on social problems. Balika Vadhu, is such a social serial on Colors, which had so far portrayed the maternal deaths of young women. It is a mirror of Indian Society. The Indian Government estimates that 301 women die annually for every 100,000 live births. In some states the maternal mortality ratio is even higher -- 358 in Orissa, 371 in Bihar, and 379 in Madhya Pradesh. It is also estimated that few rural women chooses to remain passive. Laajwanti (name changed) a rural girl barely 16 has no complaints; however, she says “It’s a woman’s duty to produce as many children she can. They are God’s gift.” It is been observed that the maternal mortality rate has risen faster as there is pressure on girls to produce as soon they reach puberty. It is a shame to our country which is developing but not the people. We’re still backward. Right!

As the new data analysis tool reveals an estimated 80,000 pregnant women or new mothers die each year in India often from preventable causes including hemorrhage, eclampsia, sepsis and anemia. Since many deaths happen in the anonymity of women's homes or on the way to seek help at a medical facility, they often go unrecorded. It is absurd because we know about such practices, we have heard it, we have also listen to the news channels and read in several newspapers but still there is no official complaint.

Over 67% of maternal deaths in eight districts in Orissa were among SC/ST groups. Illiteracy is as much a factor as lack of primary health care. After achieving so many laurels in academics, still we’re not fully educated. Though the enrolment in schools has risen from past, our country yet suffers from problems due to lack of information and knowledge. Also in Purulia, West Bengal, 48% of the women who had died had no formal schooling. That’s a real embarrassment. In Bihar’s Vaishali, we can see 42% of the deaths occurred due to Haemorrhage, the most common cause of delivery-related deaths, with almost all hemorrhages occurring after delivery. Many women who delivered at home also died from postpartum hemorrhage. Eclampsia, a serious complication during pregnancy that is attributed to under-developed arteries in the placenta, was the second most common cause of death (17% in Dholpur, 19% in Purulia, and 27% in Guna/Shivpuri). However, the standard treatment for eclampsia, magnesium sulfate, was often not available in these places. These are the shocking findings of an ongoing survey across six states being conducted in co-ordination with the United Nations Childrens’ Fund (Unicef). India is still quite far from achieving the Millennium Development Goal of reducing maternal mortality rate (MMR) by three quarters by 2015. On an average, there are at least 301 women dying annually for every 100,000 live births. In some states the MMR is even higher—358 in Orissa, 371 in Bihar and 379 in Madhya Pradesh.

Causes may be:
- Early marriage,Hidden pregnancy, history of abortion, etc
- Financial disasters, No medical facilities
- Smoking, drinking and drugs (urban women)
- Lack of knowledge (like the example I gave about Laajwanti above)

Maternal death is a sensitive issue of human race. We need to curb the social ailments from the society. It is like terrorism killing the number of innocent lives in the dark of ignorance. Though it is hard to eliminate fully from the society we can generate proper awareness about the loss of humanity with every mother dying during and post pregnancy.

Maternal mortality: This India story is a shame!
Over 67% of maternal deaths in eight districts in Orissa were among SC/ST groups. Illiteracy is as much a factor as lack of primary health care. In Purulia, West Bengal , 48% of the women who had died had no formal schooling.

Haemorrhage is the most common cause of delivery-related deaths, with almost all haemorrhages occurring after delivery. In Bihar’s Vaishali, 42% of the deaths occurred due to this. Many women who delivered at home also died from postpartum haemorrhage.

Eclampsia, a serious complication during pregnancy that is attributed to under-developed arteries in the placenta, was the second most common cause of death (17% in Dholpur, 19% in Purulia, and 27% in Guna/Shivpuri). However, the standard treatment for eclampsia, magnesium sulfate, was often not available in these places.

These are the shocking findings of an ongoing survey across six states being conducted in co-ordination with the United Nations Childrens’ Fund (Unicef). India is still quite far from achieving the Millennium Development Goal of reducing maternal mortality rate (MMR) by three quarters by 2015. On an average, there are at least 301 women dying annually for every 100,000 live births. In some states the MMR is even higher—358 in Orissa, 371 in Bihar and 379 in Madhya Pradesh.

A new tool, Maternal and Perinatal Death Inquiry and Response (MAPEDIR), has been developed to analyse the underlying medical and social reasons behind maternal death and is being used across 16 districts in Rajasthan, Madhya Pradesh, West Bengal, Jharkhand, Orissa and Bihar providing an ongoing, systematic collection of data to reconstruct and analyse the cases of 1,600 women—the highest number of audited maternal deaths in the world. MAPEDIR also informs health officials about the challenges local women face in accessing reproductive health care.

“The tragic reality is that too often maternal deaths are not visible. They don’t leave any trace behind, and their deaths are not accounted for. Unicef is committed to continue working with the National Rural Health Mission to promote surveillance as a key strategy to lower maternal and child mortality,” Chris Hirabayashi, Unicef India deputy director of programmes, said at a meeting with health officials from the six states who are using MAPEDIR.

“Unless we know the main reasons for maternal deaths we cannot take effective measures to tackle them. The traditional system did not deal with the issues adequately. Now using MAPEDIR, we can know if the death are due to delays in decision making at household level or lack of transport or delay at the facility or a cumulative of all three,” S P Yadav, director of medical and health services in Rajasthan said.

A team made up of state government health and nutriti on officials and NGO members, headed by a member of the local village council or Panchayati Raj Institution, conducts interviews with surviving family members at community-level with technical support from Unicef and funds from the United Kingdom’s department of international development (DFID) work under MAPEDIR.

Social and economic factors like the low status of women in communities, the poor understanding of families on when to seek care, lack of transport, poor roads, the cost of seeking care, multiple referrals to different health facilities and a delay in life-saving measures in rural areas have been listed out by Unicef as the reasons behind the high MMR.

Many of these deaths happen in the anonymity of women’s homes or on the way to a medical facility and so they often go unrecorded. An estimated 80,000 pregnant women or new mothers die each year in India often from preventable causes including hemorrhage, eclampsia, sepsis and anemia.

Who cries when mothers die?
Munna was nine months pregnant. She did experience pains few days back, when her husband and mother-in-law rushed her to the nearest primary health centre in Kushwai of the District Shahdol in the State of Madhya Pradesh in India. They had to make her travel by bus from their village, and then in pain Munna had to walk, which she could barely to reach the health centre.

But unfortunately the kushwai health centre, where they had come with lot of hopes, did not had a medical doctor for last one and half years. One male health worker mans the centre. Though, he puts in his best but that may not be enough for women like Munna and others who need medical support.

Inspite of reaching the primary health centre, she did not get any help. She has to travel another eight kilometers to Burhar, the place where there is a community health centre. The centre is fortunately newly built and has facilities for delivery. Munna did develop some complications during the delivery but fortunately survived to see her new born.

She was lucky but thousands of women which die in the state are not. App 10,000 women die every year in Madhya Pradesh during pregnancy or within 42 days after pregnancy. Majority of these could be prevented. Medically these deaths may be due to hemorrhage, infection, eclampsia or unsafe abortion or any of three delays. But fact is there exists a yawning gap in our health system which stands in between life and death of women in the state. This gap has linkage to availability and access to health services, infrastructure, awareness among communities of not only the services but even recognizing danger signs, issue of how where they can access the services etc. Studies also tells us that for every maternal death in India, 20 more women suffer from the impaired health.

But if the situation at ground is like this, and has been there. What is the state’s response to an issue like this? Does it impact the political leaders, their discourse? Does issue of women dying in the state is debated in discussions where funds are allocated or decisions are made? Does state’s machinery care for it? Does civil society raise its concern?

To answer some of these questions a dip stick assessment was done in year 2004 at various levels within civil society, debates in the state assembly, media analysis. Outcomes were revealing. First of all the issue concerned only few in health department. There were only handful of civil society partners, and their major role was to support service delivery system. As such there was no push or urgency to bring change. Interestingly, the issue had never being debated on the floor of the state assembly, a place where elected representatives ‘of the people, for the people and by the people’ decide. It did not impact them, many of them were not even aware of the fact that state has this high number of maternal deaths? An issue like this was never raised by the political leaders in the debates which happen there – an issue of total neglect at the highest political body. Media covered ‘event news’ around the safe motherhood day, probably they never got the right information too.

That was a starting point, but nevertheless situation has changed today. Today state recognizes it as a major issue when it comes to women and children. State calls for an action. It is on high priority list of the political head of the state, state party is being questioned on the number of deaths, gaps on the infrastructure and many related points. Today more than 150 civil society organizations are raising concern on the issue and demanding urgency and urgency of action in the state.

How it happened and what does it impact and what strengths does it generate? Movements don't just happen; the energy that underlies them must be marshaled, channeled, and focused. The principal means by which this is achieved in our society, and within our political tradition, is through advocacy networks and coalitions.

Networks like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Jan Adhikar Manch and Collective for advocacy, resource and training, Madhya Pradesh Samaj Sewa Sanstha, Mahila Chetna Manch, and many others have not only contributed to help bring the issue at an individual level but as a part of informal collation added to that force which helped bringing the agenda on political normative framework. Some of the strengths which this informal network helped bring were the numbers of civil society partners raising concern on the issue spread across different regions of the state. From a handful few now it is more than 150 civil society partners in the state working in all divisions to bring the issue to forefront. The turn around is also in their way of working from being a service delivery partners or a social mobilization partners in supportive and submissive role in a new avatar of advocacy partner. In this new role civil society speaks on the issue of right to health, its violation, demands state’s accountability to provide for safemotherhood. In this new business influencing people who make decisions which impact human lives is the key.

The primary target of the civil society was to bring the issues which impact lives of women at the villages, blocks and districts to the agenda of the people who make or influence decisions, i.e. state assembly debates, political leaders, members of legislative assembly, ministers, media, rights commission etc. They had been to some part successful. ex-pression of this concern was undertaken by directly meeting and sensitizing political leaders. The evidences highlighting gap were shared with political leaders, urging them to rise above politics and give a strong call for action. These non governmental organizations wrote memorandums, shared information and collected evidences for the same purpose. Media engagement also supported by providing an enabling environment for change. Strong evidences i.e. case of maternal deaths which can be presented, health system gaps were highlighted which added pressure on the state and the leaders to react. Resultant of this solid gains achieved. Today questions on maternal mortality are being raised in the state assembly, the highest policy making body of the state. It is not just few many voices are being publicly heard on the issue. There is a increased concern within media.

From nowhere it came to a point where state publicly acknowledge the problem, and its commitment to act. Many new polices and schemes have been announced and that too in the rapid succession. This amount of concern and even expressed publicly by leaders had never been seen earlier in the state on the issue of maternal mortality. But that is not enough today empowered civil society and media is always looking with eagle’s eye on the new measures of the state and vocally points out the gaps This is a positive sign, where people are voicing their opinion. But it is not easy as said. Political leaders have started picking up real cases of deaths, gaps in infrastructure in the state, violation of rights, gaps in policies and seeking answers to what is being done by the state to response to the situation.

Advocacy experts tell us that ‘people centered advocacy’ is the best, i.e. position when people who suffer can speak for themselves. A step has been taken in the same direction by the engaged networks. Madhya Pradesh Jan Adhikar Manch in their work with communities helped to bring the issue to debate in various gram sabhas which were held by panchayats in Gwalior – Chambal division. Similarly women who had participated in various women conventions hosted by Madhya Pradesh Samaj Sewa Sanstha came forward and wrote about the problems women face in rural areas when it comes to issue of safemotherhood and why do women die in their villages while giving birth. As per sources of Madhya Pradesh Samaj Sewa Sanstha more than 200 women have written to the Chief Minister. On a simple fifty paise post card, they wrote by theselves and it was send to the Chief Minister. It looks simple but powerful, if it gets to his eyes. Recently a large number of women from villages across Madhya Pradesh have joined a signature (or thumb-impression) campaign to press for their right to health and to call upon the Government to ensure that the dream of safe motherhood becomes a reality. As a part of a special drive to raise concern on this crucial issue, more than 20,000 women from different villages of the State are now in the process of signing (or placing their thumb impression) on a various banners demanding the right to health and calling upon the State to ensure that the dream of safe motherhood becomes a reality. Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha are the civil society partners who are collecting these signatures/thumb impressions of women. They say that they do so after they are adequately sensitizing them on the issue of maternal mortality. Then if they feel that some concrete action is needed to improve the situation, they come and sign. Plan is to present the banners with their signatures to policy makers.

One might say that this is good effort, which indeed it is to bring the agenda of maternal mortality on to the political and action framework but it is still a long way to go. This is true. But if one looks back one and half years where there was hardly any concern, hardly anyone called for action, except few that too ‘within the box’. The focus was limited. From nowhere it has come somewhere, which is an important achievement by any means. Need of the day is to provide possible answers to the state, which is willing to listen. Answers which can help deliver results, within the context of the field realties and socio – cultural aspects – a new call to many!


Lhamu, a mother of twelve, lives in a remote village in Western Tibet. Three of her children died within a month of birth and the four year old strapped to her back looked as small as a one year old. She gave birth all alone, at home, all twelve times. But Lhamu was lucky. She didn't die. One in 33 women dies during childbirth in Tibet. Malnutrition, abject poverty and lack of any health care – however basic—plagues Lhamu's family, as it does much of Tibet. Tibet – vast lonely stretches of dead habit with nary a creature on its harsh plains and no economy to speak of. It can't be as bad here in new economy India, right?

Think again.

One in 48 women in India is at risk of dying during childbirth. The Maternal Mortality Ratio (MMR) in India is a high 407 per 100,000 live births, according to the National Health Policy 2002. Other sources put the MMR at a higher 540 (NHFS and UNICEF data, 2000). Reducing the Maternal Mortality Ratio (MMR) by three-quarters by 2015 is a Millennium Development Goal (MDG) for all countries including India. Achieving this means reducing the MMR to 100 by 2015. Part of the problem is this measurement – MMR data is just not there and if it is, it varies widely depending on what method was used to get it.

Studies show MMR among scheduled tribes (652) and scheduled castes (584) is higher than in women of other castes (516, according to one study). It is higher among illiterate women (574) than those having completed middle school (484). The key determinant seems to be access to healthcare. Less-developed villages had a significantly higher MMR (646) than moderately or well-developed villages (501 and 488 deaths, respectively).

"It is very sad that the numbers are so high even 57 years after independence," avers Dr H Sudarshan who is Vigilance Director (Health) of the anti-corruption body Karnataka Lokayukta. "Not only are the numbers from the Sample Registration System (SRS) high, they are also incomplete. We do not know how many mothers actually died during childbirth and why. Underreporting is rampant and people hide MMR numbers in fear of repercussions. We need state-wise and within states, district-wise data," says Sudarshan who was also Chairman of the Karnataka Health Task Force which made wide-ranging recommendations based on a 2-3 year detailed study conducted in the state. Regardless, the UN MMR numbers for India (540) are several times higher than those for other developing countries like China (56), Brazil (260), Thailand (44), Mexico (83) or even Sri Lanka (92).

Medical reasons
So what exactly leads to such a high MMR? The main reasons for maternal deaths related to pregnancy are anaemia, post-partum bleeding and septic abortions with anaemia being the most rampant. "Antenatal care is most important," declares Sudarshan, "and that is just not being done. This kind of care checks for high risk pregnancies."

Public health advocate Dr Mira Shiva agrees, "Hypertension and the toxemias of pregnancy can only be detected with antenatal care. There is a total neglect of a mother's health in India. [The situation] is disgusting because a big chunk of all this is preventable. The medical establishment is busy with micronutrients but that is not the answer. Giving one iron tablet to a woman during her pregnancy is too late." Shiva is coordinator of the All India Drug Action Network (AIDAN) and one of the founding members of the People’s Health Movement (PHM). Striking out at a more endemic problem, she says, "The real problem is food. It is all about food, the cost of food and the nutrition content therein. These pregnant women have to fetch the water, make fuel, work the buffaloes, etc., all on the measly amount of food they can afford. How can the nutritive intake be enough? It becomes a negative calorie balance. In short, what is needed goes beyond a medical solution."

Sudarshan echoes Shiva's sentiment, "We need to move from a medical model to a social model. Nutrition for pregnant mothers is very important and the ICDS Anganwadi scheme has clearly not achieved the hoped results." Where antenatal care is good, the results are good as well. Kerala and Tamilnadu have good antenatal care and correspondingly have two of the lowest MMRs in India. In Assam and Bihar where antenatal care is almost zero, the MMRs are among the highest. India has the lowest percentage of antenatal coverage (60%) among countries like China, Brazil, Mexico, Thailand and Sri Lanka which are all in the high 86-95% range.

While antenatal care is paramount in the prevention of pregnancy-related deaths, septic abortions are more insidious. What is worse, the latter tends to go unreported due to the nature and circumstances surrounding it. In many rural areas couples do not use any spacing methods and women conceive within 7 months of having given birth. Dr Leena Joshi of Family Planning Association of India (FPAI) is familiar with this scenario. Her voice drops with concern when she mentions abortion rates in the remote reaches of Maharashtra. "The abortion rate in these areas is just so high. With it comes hidden mortality from septic abortion deaths. Since the PHCs do not have MTP methods, the abortions are performed by quacks. And even if the PHCs or district hospitals have MTP methods, the people opt for local help." Why? "It saves them money. These are very poor people and transport costs and medical costs can be saved by walking to a local quack." As a result there are a high number of abortion-related deaths which do not get reported under maternal mortality. Dr. Joshi laments that everybody only talks about deaths during the childbirth process. "But since there are so many septic abortion cases it all goes unreported."

The problem of unsafe abortion is something that Shiva worries about as well. "Abortion (MTP) being legal in India, no one is turned away. Second trimester abortion is a big reason for rising MMRs." People come late for the abortions and complications ensue. And apparently these are not only driven by spacing problems. "Contraceptives are used only by women and failure of these is common," says Joshi. Of course, abortion of female fetuses is routine and it goes on until the woman conceives a male child. The whole scenario makes one shudder.

But all this seems to be not even half the story.

Take malaria, for example. Orissa has a high incidence and accounted for 28.6% of detected cases of malaria -- 41% of falciparum -- and 62.8% of all material deaths in India (1998). Malaria and pregnancy form a sinister synergistic pair. Falciparum malaria leads to abortion and still births in the gravid woman and can severely compound anaemia. Coincidentally, Orissa has a high incidence of sickle cell anaemia. The combination is lethal. The haemoglobin in pregnant women could drop to 1gm/dL (healthy levels are between 12-16gms/dL). While drugs are available to treat the malaria, the treatment requires a high degree of awareness and care in administration. For example, the common primaquine and tetracycline are absolute no-nos during any stage of pregnancy. But chloroquine and quinine are allowed. "But mistakes occur and are lethal," says Shiva. Acting fast and carefully is paramount and any deaths due to these infections are primarily due to gross neglect or ignorance. Orissa has one of the highest rates of MMR in India at 738.

Another key reason for deaths during pregnancy is post-partum bleeding or haemorrhage. The need for blood in such cases is imperative and access is less than ideal. Both Sudarshan and Shiva worry about the blood bank policy in India. Heavily driven by the HIV/AIDS lobby, they feel that somewhere the important issue of access to blood has been sacrificed for quality and safety since the policy makers are looking at it all from the AIDS perspective. Says Sudarshan,"The policy says you have to keep the blood in an air-conditioned room. But in Coorg, for example, you don't need it. HIV awareness is good, but blood banks need to be demystified and access and availability improved." Shiva adds, "It is imperative in case of complications during pregnancy to have blood available. But no. NACO only sees blood banks from their perspective and only in an emergency are you allowed to take blood from the banks. It is a major concern." When it comes to donation, Shiva points to an endemic problem. The strange connection between men, caring for women, and giving blood. "If the men have to pay a lot of money and go far to get blood for their wives, they just won't. And men will never give blood. They think a 100 drops of blood equals one drop of semen and thus, giving blood is related to potency. And so many times, when women need blood, it is not available."

Organisational reasons
Early diagnosis of high-risk pregnancies and complications and quick referrals are of paramount importance. But is institutionalising deliveries the answer? By requiring 100% institutional deliveries, the World Bank supported vertical program Reproductive Child Health 1 (RCH1) resulted in the abolishing of the dais (Traditional Birth Attendants), and Sudarshan believes, probably increased MMR. Subsequently, following a public uproar, the program was amended to advocate "training" TBAs into Skilled Birth Attendants. "Institutional support will bring down MMR, yes, but what type of institution is important," says Sudarshan. "The so called Primary Health Care units are so dirty that infection will probably increase because of them." "In Bihar, for example," explains Sudarshan, "80% of the deliveries happen at home. In Karnataka it is 70%." Joshi concurs with this high degree of preference. "In the Bhandara area almost 100% prefer home deliveries. And if there are complications, it means there are inevitable delays in getting more sophisticated care."

Now, if there were a skilled birth attendant (SBA) at the time of each delivery or for antenatal checkups for each pregnancy, he or she can recognize a high-risk pregnancy or a potential complication and refer the mother to a district hospital or closest emergency care unit. The incidence of death from complications would be reduced. Countries like Malaysia have employed this strategy to bring down MMR to less than 100. In India only 43% of deliveries are attended by an SBA compared to between 86% and 99% in Mexico, China, Sri Lanka, Brazil and Thailand.

Sudarshan himself is involved in training tribal girls in the Soliga communities of Karnataka to be auxiliary nurse midwives (ANMs). For a population of 3000, there is a sub-centre and for every 5 or 6 sub-centres, there is a primary health care unit. Sudarshan's team trains the tribal girls in each village so that the few ANMs posted do not have to walk the 20 kms between the 4-5 villages this program covers. Joshi's team in Bhandara also trained 25 local dais or Traditional Birth Attendants (TBAs) to recognize complications and give basic medicines and obstetric care in the villages, one to each village. They also conduct antenatal checkups every month in about 10 villages. But funds for such programs are scant primarily because maternal health is not recognized as a priority issue in India. "The awareness that a pregnant woman should be taken care of is just not there," says Joshi. "If a woman is not delivering, the attitude used to be, let's wait and see, maybe tomorrow morning she will deliver. Now with our training, the dais can recognize complications but the money to shift the patient to a hospital is still not there."

This brings us to the next obstacle. So say the SBA refers to patient to an emergency obstetric care unit (EOC) and let's assume that we have one of those for every few villages. How would the patient reach the EOC? "Transport is a big issue. It is appalling that we do not have EMS (emergency medical services) that is efficient and well staffed," Sudarshan states categorically. He is working on building one for Karnataka with a coordinating body at district level which has jeeps, ambulances, even tractors available for responding to emergency calls. "We have to strengthen the PHC and an EMS is an integral part of that," he says. Bhandara is not so lucky. "Vehicles are available in 50% of the cases. But they are expensive. In the day, people can use buses, but not at nights. There are several rivers in this area and the buses are not allowed to travel over these at night," says Joshi.

Suppose the patient does reach the first referral unit (FRU) with complications that say, require a C-section. Is that a guarantee for a safe delivery? Sadly, no. Few FRUs run 24 hours. Joshi's hospital has 2-3 gynaecologists where the recommended number for the population of that area is 5-6. "All the C-sections and hysterectomies are carried out by these 2-3 gynaecologists. In the PHC in the villages, there is one doctor and 2-3 sisters (nurses), but they are only graduates, not post graduates or MBBS. So they cannot even do a complicated normal delivery, let alone C-sections."

Even in Karnataka, the FRUs are woefully understaffed and in some cases dangerously mismatched. "In one case," says Sudarshan with an ironic smile, "an orthopedist was posted where an obstetrician was required. With bribes, these so-called doctors can get posted to any area they want regardless of what is actually required there." And then there is the big problem of anaesthetists. At the Taluka level there is an acute shortage of them. Anaesthetists are required during complications and surgeries. When Sudarshan's team proposed that nurse obstetricians and other doctors also get trained in anaesthetics, the proposal was shot down by the medical lobby. Human resource management in the health sector seems to be a big issue. Shiva echoed the sentiment saying, "We need trained people in PHCs. And people with the right training. There is no point sending patients who require C-sections to where there is no anaesthetist or ob-gyn."

Government
Now, if we had fully staffed and functioning FRUs, would that bring down the mortality rate? Unfortunately, there is still one more layer that mothers have to contend with.

Shanta lives in a slum in Bangalore. When she was expecting her second child, she had the good fortune of being close to a government hospital where care would be free. Or so she thought. When she reached there, she realized that she had to 'buy' a bed or sleep on the floor. She also had to 'buy' food. So much so that she even had to 'buy' washing services or wear soiled clothes. And when it was time to "push" during delivery, she was just too weak, and the nurses slapped her. Left and right, again and again. They abused and cursed. "Is that the way to treat a patient?" Shanta queries in puzzlement. "My mother's house where I had my first born was better," she declared. Her sister-in-law Prema now laughs as she describes her own run-in with a local PHC outside Mysore. "They wouldn't give me my child until I paid up. Luckily I had saved all year, knowing this would be the case. The nurse was actually someone I grew up with. I thought she would be fair, but no. Everyone wants money." As soon as they got their money, she was sent home -– the same day -- with no medicines or follow-up monitoring either for her or her baby.

Corruption is not a new problem. "Even if the most sophisticated PHC is right across the road the ward boy needs to be bribed with Rs 150 to wheel the mother into the operation theatre and another Rs 300 to wheel her to the ward and most cannot afford that," declares a grave Sudarshan. In his opinion this final layer is the most important and toughest one to correct. "Bad governance. The real problem is not technological care but simply what I call the epidemic of corruption in the health services. And this is not just in the public healthcare sector, the private is just as bad," he says. "Doctors in Arunachal Pradesh take their pay checks but never show up. There is rampant corruption in procurement where, in one case, 123 spurious drugs were identified but bribes were taken and they were not reported. Dialysis machines which cost 5 lakhs are bought at 12.5 lakhs. Poor people end up spending huge amounts due to over-prescription of medicines that should be free to them. This is the real problem and no amount of infrastructure improvement will bring down MMR if governance is not improved," warns Sudarshan.

Shiva adds, "The private hospitals are mercenaries too. They perform unwanted C-sections and hysterectomies where none is required simply because there is big money in these procedures." Sudarshan, who sits in the anti-corruption cell of the Karnataka Government has presented strong recommendations to the Karnataka government regarding this issue. He stresses that good accreditation, accountability, good monitoring, and honest reporting are the only things that will actually bring down MMR, given the other necessities are taken care of.

And where will the money for the necessary infrastructure come from? Prime Minister Manmohan Singh has promised that the government spending on public healthcare -- which currently stands at an abysmal 0.9% of GDP (one of the five lowest in the world) -- will be increased to 2-3% of GDP which Sudarshan finds heartening, but tempers his optimism with caution. "It is great that there will be three times the amount available today for a sector that needs it badly, but one must plug the holes first. No point pouring all that money into a leaky vessel," he quips.

So, can it be done? Can MMR be brought down under 100 by 2015?

Sudarshan thinks so, but he will give it not 10, but 15 years. "It all comes down to political will. Sri Lanka, in spite of the civil war showed tremendous political will in tackling IMR and MMR and setting goals for themselves. Tamilnadu has a Deputy Commissioner (DC) monitor maternal mortality himself." This has increased the accountability and responsibility of the people in charge and has achieved good results. In Kerala, awareness about maternal health issues is high and the citizens demand more. Literacy plays a key role in keeping the MMR low. Kerala leads the way in successfully reducing MMR and Tamilnadu is close behind. While people like Sudarshan are doing everything to make sure it happens in Karnataka, the awareness and more importantly, recognition of this as an issue is lacking in other parts of India. In Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Assam and Orissa where the MMRs are well above the national average, it will require serious political will and accountability to change status quo.

The Ministry of Health and Family Welfare puts plans in place with the best of intentions (see here), but until governance and administration is addressed, people like Prema will still have no guarantees of care without paying beyond their means to like other pockets. But whether we will make progress will also be determined by when the Ministry recognizes MMR itself one of the key "Health and Population Indicators." Today, they do not. (See here.)

Both Shiva and Sudarshan agree that what India does not require is yet another vertical program to tackle maternal mortality. Verticals tend to be donor driven and cost intensive. MMR is not a disease unto itself. Clearly, high MMR is a symptom of a larger and wider problem in healthcare, namely the overall health of the woman, and should be treated as such and across verticals. Tackling a lot of the broader issues of governance and infrastructure should bring down the MMR. The National Rural Health Mission aims to reach across verticals to integrate services and by appointing an Accredited Social Health Activist (ASHA) at the community level provides decentralized first contact care. Shiva was part of one of the Task Forces of the NRHM and lauds its efforts as broadening the RCH program. But in order that the NRHM succeed, we come back to the need for evaluation methods and strong accountability.

The health of mothers is directly related to a child's health and without due attention to the causes behind high maternal mortality ratios, we are ignoring an important determinant of the health of our nation. In doing so, we may be running the risk of damaging our chances for all-encompassing prosperity.

Ways to tackle maternal mortality
To check the maternal mortality rate in India, health experts have stressed on changing the traditional treatment and delivery system being practised in most villages.

At the 52th All-India Congress of Obstetrics & Gynaecology, the annual meeting of The Federation of Obstetric & Gynaecological Societies of India (FOGSI), gynaecologists from across the globe advocated the need to adopt advanced strategies practised in some of the countries in Africa.

“Lack of access and inadequate utilisation of healthcare facilities are responsible for maternal deaths in India. Countries like Mozambique have made good progress in reducing maternal mortality ratio (MMR),” explained Staffan Bergstrom, from Sweden.

Bergstrom added that the healthcare facilities in remote areas of countries like India are virtually absent, with no specialist doctors and advanced treatment facilities.

“In a number of countries with low per capita income, there is a scarcity of specialist doctors. Non-specialist doctors do major surgeries and fail to diagnose complications. Besides, many medical and clinical officers are being trained to perform surgeries in remote places, where specialists are not available. This is very risky,” Bergstrom explained.

“We should remember that children’s health is directly related to mother’s health. The MMR reflect the health of our nation. So, we should introduce advanced facilities in our villages,” said Gita Ganguly Mukherjee, former head of obstetrics and gynaecology, RG Kar Medical College and Hospital.

In India, one of 48 expecting mothers is at risk of dying during childbirth. According to the data of National Health Policy 2002, the MMR in India is as high as 407 per 100,000 live births. Other sources have put the MMR as high as 540 (NHFS and Unicef data, 2000).

“The chances of death of an Indian mother during childbirth is roughly 10 times more than that of her Chinese counterpart,” said Bergstrom.

India and other Third World countries have set a goal to reduce the MMR by three-quarters by 2015.

Also Read:

Motherhood Cursed Bliss in India

Obstetrical Interventions and Maternal Mortality

Death in Birth

The Heartbrake

Information & Communications Technologies (ICT): Telecentres Boon or Bane?

By M H Ahssan

Although telecentres have caught the imagination of government, their adoption is caught in a false pedagogy that treats entitlements as services and citizens as customers who pay service charges. The focus on putting a price on governance must be stemmed.

Over the past few years, there has been a lot of talk about Information and Communication Technologies (ICTs) as the next big thing for socio-economic development. This hope is based on the fact that ICTs can accelerate decentralisation, transparency and citizen-centric participation, and through these revitalise and rejuvenate democracy. Certainly ICTs possess a transformatory power, but to understand the potential vis a vis development needs, a closer examination is needed.

In this article, I examine the 'telecentre', which - as an amalgam of many different technologies - appears to have caught the imagination of government, development practitioners, funding agencies and corporates alike. A telecentre is a public place where people can access computers, the Internet, and other digital technologies that enable people to gather information, create, learn, and communicate with others while they develop essential 21st-century digital skills. While each telecentre is different, their common focus is on the use of digital technologies to support community, economic, educational, and social development-reducing isolation, bridging the digital divide, promoting health issues, creating economic opportunities, and reaching out to youth for example. The above definition of a telecentre by Wikipedia quite aptly captures its essence.

There are literally thousands of telecentre initiatives that dot the country, most of which are a mix of government pilot projects, NGO-driven initiatives and private for-profit projects. Now the Government of India is getting into the picture in a much more structured manner and is rolling out 100,000 'Common Service Centres' (CSCs) for 600,000 villages as part of its National E-Governance Programme (NeGP).

The potential of telecentres
A telecentre has the ability to forge together initiatives that weave disadvantaged communities into the mainstream, initiatives which bring together divergent needs of a community and create opportunities which lead to overall social and economic development. Typically, a telecentre would start out by providing a pool of development services, providing information related to best practices related to agriculture, health, education, livelihood opportunities & computer education. In addition to this, it would provide utility bill payment services.

By doing this the telecentre lays the groundwork for different sections of the community to come together and take part in government activities. While one might be inclined to dismiss these activities described above as trivial, it must be kept in mind that this is but the first step towards connecting citizens with government.

The next step involves the telecentre providing information regarding development schemes, social entitlements, and lists of project beneficiaries. In most cases, this information is available online i.e. most state governments digitise development information and put out the information on the Internet, which can be accessed in real time. This is an important change in India, where procuring any kind of information is almost always shrouded in secrecy and riddled with corruption, especially in rural areas. In this scenario, the telecentre then becomes that 'safe -haven' where citizens come to access all this information.

There are also initiatives by the government to make e-governance a two-way process. For instance, the government has started putting together draft policy papers on the Internet and invites inputs as part of various consultation processes. Communities which are directly affected by government plans and policies have a real chance to provide input, when such solicitations are brought to their attention. Also, in many cases, individual telecentre initiatives run by government at the district level have well established online grievance redressal systems which allow citizens to make complaints against erring government officials/public servants; complaints which are directly looked into by authorities at the highest level.

Not to sit and admire these accomplishments at the risk of losing sight of the larger picture, but the possibilities described above would have been very difficult to imagine and enforce even a few years ago. The ability of ICTs (in this case, telecentres) to bypass traditional encumbrances thus goes a long way toward bringing about citizen participation in governance.

Making the offline connection
Of course, participating in governance is quite different from shaping governance (being involved in the policy planning process from scratch). So far we've looked at citizens being able to access information on development services and the ability to talk back to government. This is only the beginning; going further, the ability for citizens to create and shape policy and the role played by telecentres in this regard is an area whose potential is only now unfolding.

A major development in this regard is the concept of 'community informatics'. While plenty of information can be made available at a telecentre, the validity of such information can vary greatly. How can this be tackled? Could citizens themselves validate - or even create - data using their local knowledge, so that its veracity is improved? The most likely answer to this question lies in community informatics (CI), which is a simple yet effective and participatory mechanism. CI refers to the process of information gathering being undertaken by communities in a bottom-up, participatory and collaborative manner so that this information directly complements and or authenticates institutional data, which then feeds into policy in that relevant domain.

CI also allows direct monitoring of government schemes by local communities. For instance, it is well known that the number of Below Poverty Line (BPL) families is often under-reported in government estimates, simply because governments are loath to be seen as presiding over great poverty. But under-counting doesn't eradicate poverty, and the sufferings of the uncounted are very real. CI can help them overcome such neglect; an enumeration process undertaken by the community itself would be more definitive in identifying BPL families, allowing it to challenge the empiricism of institutional data.

What role does the telecentre play in this process? While the actual data gathering and collation takes place offline, the telecentre is the space where the community (through volunteers) gathers and uploads the information on to computers. Where there is Internet connectivity and linkages to the government backbone network (State Wide Area Network), such data can directly feed into that system too, and be more representative than institutional data. Even if there is only intermittent connectivity, a printout of the data can be physically delivered to the government office where it gets processed and feeds into policy (Such work-arounds are being resorted to by quite a few pilot projects initiated by governments).

As governments move to a culture of e-governance, more and more data gets digitised and the opportunities for communities to participate in the overall development process increase exponentially. Once there is a certain regularity and comfort with this process, the telecentre becomes this space where people come to acquire information, hold community meetings, to an extent where government officials recognise this as an important platform and use it to interact with the community.

Thus, the telecentre acquires a certain credibility and legitimacy, by which it has the power to shape and change power equations within the community itself. In the Indian context, one gets to see pilot projects that have worked exactly this. There are specific projects which work exclusively with women's collectives, Dalits and other marginalised groups. By firmly keeping the ownership of telecentres with the constituencies they work with, many of the sponsor and volunteer organisations have managed to initiate a change in the power equations. And although there has been opposition from those sections of the community who are most likely to lose out, the changes are evident and sustainable.

A false pedagogy
At a very practical level, more development-domain departments (health, education) must be linked to telecentres in a way that citizens are in a position to benefit from entitlements that are met by these departments. This will go a long way in realising the potential of telecentres.

But there are shortcomings too. There is also an urgent need to challenge - and change - the 'efficiency' based pedagogy which is at play while describing the working of a telecentre. In the Indian context, telecentres (specifically those run by the government) have mainly been perceived as tools of e-governance. Some of the more famous initiatives are Akshaya (Kerala), Rural E-Seva (West Godavari- Andhra Pradesh) & Bangalore One (Bangalore). Telecentre functionaries describe these as 'one stop shops' where one accesses services like utility bill payment, procurement of digitized land ownership records and obtaining birth and death certificates (customers typically pay a service charge which is shared between the entrepreneur and the government department providing the service). Apart from the government functions, a telecentre may also run commercial functions like printing, photocopying etc.

The description of 'entitlements' as 'services', of 'citizens' as 'customers', and the notion of a 'service charge' are pointers towards this pedagogy. The focus of putting a price on governance is rather unfortunate and must be stemmed at the earliest. Telecentres should be thought of the same way as health centres, education facilities and roads - as public infrastructure.

What is most appalling is that nearly universally, the only kind of sustainability that ever gets talked about is that of financial sustainability - that the telecentre has to be in a position to fund itself in a matter of a year or two, and in this melee, concepts of community ownership, participation and social sustainability are thrown out the window. The 100,000 Common Service Centres the government is promoting through 'Public Private Partnership' model also suffer from this. The telecentres will be auctioned out to highest bidders, who in addition to providing government services can offer commercial services and in this way recover their investments. Clearly, that is an invitation to focus on the latter, although the purported purpose of the government in establishing the CSCs is the former.

Lessons from good telecentres
While successful efforts are sadly rare, a few telecentre initiatives have done good work in bridging the digital divide and have positively impacted disadvantaged communities.

In an earlier paragraphs I wrote about the potential of Information and Communication Technologies (ICTs) in development domains. I had specifically looked at the role that telecentres play in this regard. This article looks at existing telecentre initiatives that have done good work in bridging the digital divide and have positively impacted disadvantaged communities.

The good news regarding these initiatives is that they have clearly demonstrated extensive links between development sectors and technology. These initiatives have ensured that there is a sustained focus on development without being overawed by the technology. These initiatives refuse to see access to development services as a revenue generation activity. A key factor in these projects is that they are either run by the state administration or by NGOs (Non Governmental Organizations). The telecentres have extensive links with the community and hence address the all important question of decentralisation and accountability.

Sadly, such initiatives are few and far between and are not often highlighted. The good work done by three of these initiatives is described below.

The M S Swaminathan Research Foundation (MSSRF)
This project is amongst the oldest ICTD (ICT for Development) interventions in India. The MSSRF telecentre initiative was started in 1992 to provide technology impetus in development domains. Over the past decade or so, this initiative has extended beyond Pondicherry and Tamilnadu to other states such as Orissa and Maharashtra.

The foundation follows a 'hub and spoke' model for its telecentre initiative with a designated number of telecentres christened as Village Resource Centres - VRC (spokes). These spokes are linked to a centrally located Village Knowledge Centre - VKC (hub). A typical telecentre is run by knowledge workers who are usually drawn from the village itself. A knowledge centre provides information on government schemes, and broadcasts regular news bulletins.

Information about government schemes is available in the local language and in electronic form so people can get information for themselves. In case some piece of information is not available, the village knowledge workers try to procure that information from the village knowledge centre, where staff search for the information and relay it back to the resource centres. The centre also conducts computer training for villagers.

There is no formal setup between the information workers and the government regarding procurement of information regarding government schemes and services. Instead, an informal understanding between them allows the workers to get this information. Because the centre is a storehouse of information, it attracts people of the community, thus giving it legitimacy. The government also realises the importance of the centres and whenever the villagers need to be mobilised for any particular cause, the VRC becomes the space for doing so.

MSSRF is guided by several major principles, including:

Inclusion: Traditionally MSSRF sets up its telecentres in rural areas. They do this after consultations with different constituents of the community. One of the MSSRF's key focus areas is inclusion; they do not open telecentres in spaces that are seen to be exclusionary. In many cases, the telecentre is intentionally opened in areas inhabited by disadvantaged sections, forcing residents from the 'upper strata' of society to come to these places. This does help change the power equations, albeit slowly.

There have been cases in the past where the opening up of telecentres in areas dominated by uppers castes have resulted in restricted or no access to Dalits. Those telecentres have hence had to be discontinued. However, this was the case when the MSSRF initiative first started. Things have now changed such that inclusion of disadvantaged communities is a pre-requisite for the opening of a telecentre in any area.

Social Sustainability v/s financial sustainability: The real contribution of MSSRF in the entire telecentre debate has been in the aspect of financing. It is perhaps the first institution to explicitly state that financial sustainability is not the underlying or over-riding principle of telecentre initiatives. MSSRF clearly believes that a telecentre exists to serve the citizens and a price cannot be put on access to knowledge. This key principle has guided and continues to guide the working of MSSRF.

People do recognise that a dole-out approach won't work for long. When we ask people how the telecentres will survive if and when MSSRF withdraws, they chuckle and reply that they will get funding through the Panchayat, other village institutions or voluntary contributions if necessary. This will ensure funding for the knowledge workers and activities associated with the centre.

Community monitoring and ownership: The MSSRF initiative also addresses the all-important question of community monitoring and ownership. The monitoring and evaluation of the centre is undertaken by a joint committee comprising of MSSRF staff and people drawn from the village itself. This committee comes together every few months to discuss the current activities of the telecentre, areas that need to be strengthened and ways to strengthen them, and future activities.

With regard to ownership, MSSRF has been constantly training the information workers on the managerial aspects of running the telecentres. This gives them confidence so if and when MSSRF does withdraw, the trained workers can run the centres smoothly.

This initiative is one of those rare examples that successfully combines the issues of financing, community monitoring and ownership. This initiative thrives and will continue to do so because it caters to the information needs of the local people, gives them a sense of ownership of the initiative, and the chance to shape its running. This makes the centre indispensable to the lives of the community.

E-Gram - Gujarat
The E-Gram telecentre initiative is a relatively new one, having started in 2001 and piloted in one district of Gujarat. It has since then been extended to all districts of Gujarat. The project aims to digitise all the Panchayats in the state. An E-Gram centre is typically located in a public space, usually a Panchayat office. The centre has a computer with or without an internet connection, and a printer.

The centre is operated by a Village Computer Entrepreneur (VCE), typically a youth from the village who has technical knowledge. The centre offers services like printouts of land records, payment of electricity bills, issue of caste certificates, and information on government schemes. A certain amount is charged as user fees for availing these services, except for the provision of information on government schemes. The user fee is shared between the Panchayat and the VCE

While the aim of E-Gram was to digitise panchayats, it has achieved that and much more (which is why this initiative stands out and must be replicated):

Gram Mitras and E-Gram: As part of its mandate to bring in more decentralisation, the Gujarat government has also initiated a scheme which involves the appointment of 'Gram Mitras' (Friends of the village) in the areas of heath, education, agriculture, development & social justice. This scheme has close links with the E-Gram initiative. These Gram Mitras are not employees but are contracted, and their job is to go from house to house collecting details of a family's health, finances and so on. This information is compiled in the form of a family data sheet called a 'Kutumbh Patrak'.

Once this information is compiled, the Gram Mitras return to the E-Gram and in conjunction with the VCE, digitise this information. A printout is then taken and submitted to the taluk level office, which has a complete record of village level information. Through this data, families eligible for government entitlements are identified, and information regarding these entitlements is relayed back to them through the Gram Mitras.

While the current arrangement involves mostly offline links, there are plans to provide connectivity with the state wide area network. This will enable the VCE to enter the data on local computers, enabling the data to be automatically available to the administration at the taluk and the secretariat. Citizens on their part will be able to track their records and the entitlements available to them. Clearly, this aspect of the initiative is something that needs to be highlighted and replicated in other initiatives as well.

Outsourcing and E-Gram: Civil society groups contend that government must be held responsible for its actions and that outsourcing of any government work amounts to dereliction of duty. While this may be true, the E-gram case study presents a different side to this view, one which must be considered.

E-Gram operations are outsourced. A private technology company is responsible for the upkeep of the equipment and the supervision of the VLE. However, unlike the Common Service Centre Scheme (CSCs) where private companies own the telecentre and look upon it as a commercial venture, the example of E-Gram is refreshingly different.

The private company in charge of running the E-Gram only has the mandate of ensuring that the specified functions of the telecentre are being executed. The company has a representative at the taluk, district and secretariat level, and their performance is monitored by the district and state administration. The company is contracted for a certain time period and is paid accordingly; it is not expected to make money from citizens.

When we talk about PPP (Private Public Partnerships), this is the kind of partnerships that I would like to see, where the rein of control still lies in the hands of the government, and governance is not seen as a commercial venture. E-gram stands out in this respect. However, with the coming of CSCs with their accent on revenue generation, and the eventual merging of E-Gram into CSCs, one can only hope that the gains made by this initiative hold out against CSCs.

Akshaya - Kerala
The Akshaya telecentre project initiated by the Kerala administration has been much studied, and findings regarding this initiative have been varied. But two things regarding this project stand out:

This was probably the first project that brought together different government departments to provide a range of schemes/entitlements across a single counter.

The second and important point being that when the project was initially launched, there was a concerted effort to recruit those disadvantaged as telecentre entrepreneurs, including women and the youth.

A few years down the line, the results have been mixed with a few centres closing down, and some doing reasonably well. This result has not deterred the administration, which has reserved 33% of the centres for women during the expansion phase in the remaining districts.

Going forward ...
These are the stories of the few ICTD telecentre initiatives that continue to inspire hope. They demonstrate that development projects when implemented in the right way with the right technologies can bring about a tremendous difference in the lives of communities. They also demonstrate that ultimately, it is only political will that decides which way a project will turn out.

The Politics Behind Kamal Haasan’s Film

The U/A certificate was issued to Vishwaroopam without any application of mind,” claimed the Tamil Nadu government in the Madras High Court, defending the ban on the film. What’s more, it alleged that the certification of films itself was a “very big scam that required a full-fledged probe”.

The judge did not find merit in the ­argument and allowed an interim release late on the night of 29 January. In less than 24 hours, the release was stayed again after the Tamil Nadu government appealed against it. Kamal Haasan, who has written, produced and directed Vishwaroopam, ­besides playing the lead role in it, could now approach the Supreme Court.

The strong words used by the government’s counsel, however, point to a larger motive behind the J Jayalalithaa government preventing Kamal Haasan from ­entertaining his fans on the big screen in Tamil Nadu.

Kamal, who pledged all his property to fund Vishwaroopam, says he along with his “Muslim brothers” have been “trashed in a political game”. Even though he says he does not know who is behind it, it’s not difficult to guess who Kamal is hinting at.

Political analyst Gnani Sankaran says, “Jayalalithaa is trying to corner the Muslim votes with the 2014 General Elections a year away. By attacking the censor board, a statutory body, she is actually belittling the Centre, taking her antagonistic stand against the UPA a step further. She is using this ­opportunity to show that the Central ­government is insensitive to Muslim ­concerns. But I doubt if such steps will ­actually help anyone politically because the average movie buff knows it is just a film.”

The others have been no better. The same desire to pander to the Muslim ­constituency made even the DMK suggest to Kamal that he should work out a compromise with the Muslim outfits. The Central Board of Film Certification (CBFC) Chairperson Leela Samson has said the film was “certified with due diligence”, and described the government’s arguments as “misinformed” and the expressions used in court “deplorable”.

Those who have watched the film (including this writer) in states other than Tamil Nadu, have found nothing in the film that should offend the sensibilities of Indian Muslims. Vishwaroopam has been running to packed houses in Andhra Pradesh and Kerala, both states with a significant Muslim population, and there has been no breakdown of law and order.

In contrast, by taking the interim stay as an affront and going in appeal against the order, the Tamil Nadu government makes one wonder if there is more to it than meets the eye. And the Muslim outfits’ claim that the entire movie, save one song, is offensive, seems to be an attempt to ­target Kamal deliberately.

“Are we living in China or North Korea?” asks lawyer and film critic L Ravichander. “Yes, someone’s sentiment is hurt, but that is a woefully inadequate reason to ban someone else’s work. In our films, the villain could be called Ram or Rahman, what is the big deal? This way, no creative pursuit — be it cinema or ­literature — can flourish. Anarchy and protests also have their limits in a democracy.”

Vishwaroopam is the story of a Muslim RAW agent, who was once a covert operative in the al Qaeda and later saves New York City from a possible terror attack. The story is quite clear that the villainous Muslims are those who are in the al Qaeda, while the Indian Muslim (played by Kamal) is the hero of the film. The ­entire film is set in Afghanistan and New York.

Muslim groups, however, feel that the al Qaeda terrorists shown reading the Holy Quran would make people at large believe that all Muslims are terrorists. Another objection is to the name ‘Umar’, which the top terrorist (played by actor Rahul Bose) goes by. Muslim organisations say Umar bin-al-Khattab is the name of the second Khalifa in Islam, a revered figure, and the terrorist’s name should be changed. But then the Taliban head is Mullah Omar and no one asked him to change his name. ­Kamal has, however, agreed to make a few changes to find a way out of the mess.

A PIL has also been admitted in the Andhra Pradesh High Court against Vishwaroopam and one of the petitioners, Amjedullah Khan of a political party called Majlis Bachao Tehreek in Hyderabad, says, “It is a calculated move by the fascist ­Hindutva forces through their agents like Kamal Haasan to influence innocent non-Muslims and mislead them about Islam. It is an age-old strategy of anti-Muslim forces to portray Islam in a bad light by ­indulging in blasphemy.”

Preposterous as it sounds to accuse Kamal — given his track record as a brilliant filmmaker and a shrewd businessmen — of using his 95 crore venture as a vehicle to propagate anti-Muslim propaganda, the fact remains that either the Tamil Nadu government fell for such extreme ­arguments hook, line and sinker, or used them to get at Kamal for reasons no one is publicly willing to talk about.

Film stars and politicians have always had an uneasy relationship in Tamil Nadu, despite top politicians, including Jayalalithaa, DMK supremo M Karunanidhi, and Vijayakanth, having their roots in ­Kollywood. During the DMK regime, even top actors complained of being arm-twisted by the production and distribution network controlled by the Karunanidhi family. Actor Vijay, who owed allegiance to the AIADMK, had a tough time getting his films released during the DMK years. Things have not changed after the regime change with top comedian Vadivelu, who campaigned for the DMK, finding his career screeching to a halt since May 2011.

Little surprise then that conspiracy ­theories abound in Tamil Nadu. One of the theories links the government’s decision to Kamal expressing a desire at a public function in December last year to see a “dhoti-clad Tamilian” (an apparent reference to P Chidambaram) as prime minister. Given the frosty relationship between ­Jayalalithaa and Chidambaram, there is speculation if this would have angered Amma. Karunanidhi did not mince words when he told the media on 30 December that “Kamal Haasan’s dhoti-clad PM remark may have caused Vishwaroopam to be banned”.

Another unsubstantiated theory relates to Kamal selling the TV rights to ­Vishwaroopam to Vijay TV, when Jaya TV was also reportedly in the fray.

What is surprising is that barring Rajinikanth, Ajith, Prakash Raj and Bharathiraja, no one from the Tamil film industry has come out in Kamal’s support. Others like actors Khushboo, Jiiva and Jayam Ravi have been tweeting their support, but for a legend of Kamal’s stature, Kollywood has failed him. Clearly, very few want to get caught in this battle between Kamal and the State.

Kamal, who upset the exhibitors with his plans to release Vishwaroopam first on DTH, had to back off in the face of threats from cinema theatres not to screen his film. But the ban and the charge that the “unity of the country could be affected” by Vishwaroopam has been the last straw. “MF Hussain had to leave, now Haasan will have to,” the actor told the media, adding, “Tamil Nadu does not want me.”

One of Tamil Nadu’s most celebrated sons now wants to move out of the state to a more “secular state” or even leave ­India, if it cannot accommodate an artist like him. It’s shameful for Tamil Nadu as well as India.

What Exactly is Vishawaroopam?
Wish someone had gifted Kamal Haasan’s editor on ‘Vishwaroopam’, Mahesh Narayanan a pair of scissors. Narayanan would have found it handy to re-edit the meandering Afghanistan scenes in the first half of the ambitiously mounted film. Not only that would have given this international spy thriller that much-needed element – speed, it would have also made the lavishly mounted Afghan portion look less like a documentary (replete with sub-titles) on the life inside the Al-Qaeda.

In a nutshell, ‘Vishwaroopam’ is the story of a Muslim RAW agent who has spent time as a covert in the Al-Qaeda, who helps the US avert a `cesium bomb’ terror plot on New York. Kamal plays the agent who is undercover as a Hindu Kathak dance exponent (Vishwanath) in NYC.

The film has run into objections from Muslim organisations who have protested against the depiction of members of the community in the film. The Tamilnadu government, for reasons best known to it, banned the film, with other centres like Bangalore and Hyderabad delaying the screening at its theatres. My guess is that when more Muslims actually see the film, they would find the objections raised ridiculous because the villainous Muslims are all members of the Al-Qaeda. And a ‘good’ Indian Muslim is shown fighting the terrorists.

One of the objections raised is about the name Umar for the villain played by Rahul Bose. Umar bin-al-Khattab is the name of the second Khalifa in Islam and a revered figure. Wonder whether Taliban leader Mullah Mohammed Omar, who was accused of providing shelter to Osama bin Laden and Al-Qaeda terrorists too was asked to change his name by those protesting against ‘Vishwaroopam’.

Like in most of his films, ‘Vishwaroopam’ revolves around Kamal, who has also written, produced and directed it. The film has action of international class, some top-notch cinematography and yes, a lot of blood and gore. But an edge-of-the-seat thriller, it is not. The film is too slow and hardly the kind to inspire you to chew your nails. Yes, as a director, Kamal does bring in some special moments like the pathos of the young suicide bomber who has to do as his stone-hearted bosses order, or the grief of the woman when the wrong man is hanged at a kangaroo court in Afghanistan. But the film does not quite challenge Kamal the actor and the only part where he excels in is as the Kathak dancer, with graceful movements that would have made the choreographer Pt Birju Maharaj proud.

To give Kamal credit, cinematically, he takes us where few filmmakers have dared to in the recent past, bringing to life the story of a troubled land. It is a treat watching two extremely versatile actors – Kamal and Rahul Bose – sharing screen space. But Kamal the director falls below expectations. The film packs a punch only in parts, the climax is weak, with Kamal shortchanging the viewer with the promise of dealing with Umar only in Vishwaroopam 2. Much like counter-terrorism agencies, Kamal says there is still some work left to do.

The glamour element of the film is Pooja Kumar whose incessant tam-brahm chatter is presumably meant to amuse and I could see a number of Brahmin uncles in the hall, including my father, nod in approval. The rest of the cast, including Shekhar Kapur and Andrea Jeremiah are merely props in the Kamal army.

At the theatre in Hyderabad where I saw the movie, I found a significant number of youngsters who had travelled from Chennai just to watch Ulaganayagan in action. Perhaps that explained the loud cheer and whistles with which his entry on screen was greeted, the kind usually reserved for Rajinikanth. Kamal’s transformation from the effeminate Kathak dancer to a terrific fighter was the highlight of the film, with the fans reacting with shouts of ‘Thalaiva’.

At one point in the film, Pooja Kumar asks Kamal “Nee nallavana kettavana” (Are you a good man or a bad man?), inviting a knowing laughter from the Nayagan-aware audience. Kamal would be waiting with bated breath to hear from the Madras High court on Monday when they declare as ‘nalla’ (good) or ‘ketta’ (bad) his depiction of Muslims in ‘Vishwaroopam’.

BANKING FOR THE POOR: Micro credit gathers force

By M H Ahssan

There is now mounting hope that micro finance can be a large scale poverty alleviation tool. Banks too are shedding their old reluctance to lend to the poor, and are looking to tap the expertise of micro credit groups to create a new market.

India has one of the largest networks of bank branches in the world, but the hundreds of millions of poor in the country are largely out of it. Banks were nationalised three decades ago with the hope - and promise - that their services would reach the poor. But that goal is not even close to being met today. With 52,000 commercial bank branches, 14,522 branches of regional rural banks and 100,000 cooperative bank branches, the country is teeming with institutions that should be able to meet the credit needs of the people. But if you are poor, you're also probably out of luck with the banks; it is tough persuading them to even let you open a bank account.

The consequences have been devastating. Consider these numbers: 75 million households in India depend on moneylenders to meet financial needs; almost 90 per cent of people in rural India have no access to insurance; 50 million households are landless and need small credit to start some economic activity. And even families earning Rs.4000-5000 a month in urban areas spend huge portions of their earnings to service debt.

But out of necessity and enterprise, those locked out of the banking world have found a way out. It is called micro credit - the extension of small loans to individuals who are too poor to qualify for traditional bank loans, as they have no assets to be offered as guarantee. In India, micro credit has worked largely through self-help groups. Predominated by women, these are formed with simple rules - save, accumulate and give loans to each other. Globally, it is slowly proving one of the most effective strategies to neutralise poverty. Micro credit lending institutions are currently estimated to reach some two million households in India.

Can a mere five hundred rupees change a life? This sounds implausible, as prices spiral by the day. But in numerous villages in India, this miracle is quite real; millions of poor women are today using small loans to rewrite their present and future. Many of them have not ever seen the corridors of a high school, but are using common sense to propel their entrepreneurship and group business activities. Dr. C. Rangarajan, Chairman, Economic Advisory Council of the Government of India, points out, "Micro credit can aid employment and sustain households giving them opportunities they never had before." It is called micro credit with good reason. The size of the loan is typically small. The borrower is usually battling against poverty. The repayment schedule is simple and short. And, the activity for which the loan is taken is often of a small nature. But poor women, who are in the forefront of the micro credit movement, use the small loans to jumpstart a long chain of economic activity from this small beginning. As they have enormous pride in their integrity, they repay quickly and reliably, not wanting to be seen as defaulters. Then, they begin again, this time with a bigger loan - and keep expanding their profit base until they do not need the loans any longer.

Micro credit has given women in India an opportunity to become agents of change. The movement has made them more confident than ever helping them to explore new horizons, new dreams. The most active states are Andhra Pradesh and Tamilnadu. Other states where such self-help groups are making a dramatic difference are Karnataka, Himachal Pradesh and Uttaranchal. Sheila Dikshit, Chief Minister of Delhi, says: "Micro finance will be the future mantra for alleviation of poverty. I have met women who say that 500 to 800 rupees makes all the difference as it dramatically changes their standard of life."

A late start, and a long way to go
That is the positive side of the story. The negative one is that India's demand for micro credit is Rs.500 billion, and only Rs.18 billion of this amount has been generated so far; there is still a long way to go. Nearly 7.5 million poor households in India desperately want access to financial services to meet immediate needs. Almost 36 per cent of the country's rural households have to look for credit outside the formal sector. A World Bank study of over 6000 families in Andhra Pradesh and Uttar Pradesh, two of India's largest states, shows that 87 per cent of them have no access to credit, 85 per cent had no access to insurance and 56 per cent borrow from moneylenders. The poor need banking services more than credit, as they need to safely secure their little savings or remittances coming from their men folk who migrated in search of work.

The chief culprits are the banks, who continue to see the poor women - rural as well as urban - as unworthy of credit, and is only slowly awakening to the possibilities. Points out Jayshree Vyas, Managing Director of the SEWA Bank at Ahmedabad which mainly has self employed street vendors as account holders: "We started a bank as the women demanded it. They wanted a place to put their savings. The banking sector earlier never respected self-employed women." Today, the SEWA bank in Ahmedabad is a model for others to replicate. It has deposits of over Rs.100 crores got from nearly 250,000 women. It is the biggest poor women's bank in the world.

Even the few banks who now belatedly recognise the potential in rural banking lack the capability to serve this market, which has been neglected for so long, and need intermediaries to help build their capacity to do business with small borrowers. V.K. Chopra, Chairman and Managing Director, Corporation Bank, admits, "Lending without any collateral for commercial banks to the poorest of the poor in rural areas is very difficult as banks do not have the expertise or facilities in these areas. That is why micro finance institutions should step in. Today's banks are flush with money. If micro finance institutions are strong, banks will readily lend to them."

That there are significant opportunities for banks in micro credit is now unquestioned. Banks like ICICI are exploring how it could reap the benefits from the micro finance revolution. Nachiket Mor, Executive Director, ICICI says: "A lot has been done in Andhra Pradesh, but we want to build 250 micro finance institutions to build a network in 600 other districts each one serving a million households. It will involve around Rs. 200,000 crores and it is not an unreasonable dream." Mor feels that the micro credit movement must now move beyond their members and look at financing for roads and water.

The larger banks also need the micro credit institutions for other reasons, besides expanding their opportunities. The micro credit institutions have considerable experience in dealing with the cultural realities of life for the rural poor. Every self-help group and micro financing institution in India has been through a great learning experience in the last few years. Every day has been an experience. Women need to guard their savings even in a bank fighting off pressures from the family. Says SEWA Bank's Vyas: "We found women begging us not to send them any letters or bank statements. They even asked us to keep their passbooks, as they did not want their husbands to know they had money, as then they would be pressurized to withdraw it. More often than not, it would be spent frivolously on gambling or alcohol." Large banks are wary of this cultural minefield, and will look to their micro credit partners for help in steering the course.

Even the few banks who now belatedly recognise the potential in rural banking lack the capability to serve this market, which has been neglected for so long, and need intermediaries to help build their capacity to do business with small borrowers. V.K. Chopra, Chairman and Managing Director, Corporation Bank, admits, "Lending without any collateral for commercial banks to the poorest of the poor in rural areas is very difficult as banks do not have the expertise or facilities in these areas. That is why micro finance institutions should step in. Today's banks are flush with money. If micro finance institutions are strong, banks will readily lend to them."

That there are significant opportunities for banks in micro credit is now unquestioned. Banks like ICICI are exploring how it could reap the benefits from the micro finance revolution. Nachiket Mor, Executive Director, ICICI says: "A lot has been done in Andhra Pradesh, but we want to build 250 micro finance institutions to build a network in 600 other districts each one serving a million households. It will involve around Rs. 200,000 crores and it is not an unreasonable dream." Mor feels that the micro credit movement must now move beyond their members and look at financing for roads and water.

The larger banks also need the micro credit institutions for other reasons, besides expanding their opportunities. The micro credit institutions have considerable experience in dealing with the cultural realities of life for the rural poor. Every self-help group and micro financing institution in India has been through a great learning experience in the last few years. Every day has been an experience. Women need to guard their savings even in a bank fighting off pressures from the family. Says SEWA Bank's Vyas: "We found women begging us not to send them any letters or bank statements. They even asked us to keep their passbooks, as they did not want their husbands to know they had money, as then they would be pressurized to withdraw it. More often than not, it would be spent frivolously on gambling or alcohol." Large banks are wary of this cultural minefield, and will look to their micro credit partners for help in steering the course.

Looking ahead
What will it take for micro credit to become a mainstream mode for lending? One option is to provide other financial services similarly built around small amounts of money, such as micro insurance. There is tremendous scope to design well-adapted insurance products for the poor in the insurance sector as well; this will reduce their vulnerability to environmental influences - weather and pests - as well as diminish the risk should they - or their livestock - become ill unexpectedly. Such additional products will expand the micro finance platform, and even encourage more new directions. Credit schemes specifically tailored for urban areas can also help; urban micro finance, unlike its rural counterpart, has not mushroomed despite the rising numbers of urban poor.

The potential of micro credit to tackle poverty should not blind us to the fact that lending to the poor has to be regulated just like other lending, perhaps even more carefully considering their already weak economic standing. Some experts believe that as the movement spreads and grows, it will be apt to have a regulator in place. Titus says: "We need some ground rules. The movement must not be allowed to degenerate as it expands." Mahajan says that unless a responsible regulator is in place, very little will happen with savings. But many others are wary of regulation, and remind us that micro finance must be allowed to blossom without any interference that could choke off its potential. Malcom Harper, Professor Emeritus, Cranfield Inenstitute of Management, is of the view that the greatest challenge is to keep politicians out of the way as the movement grows, as they will just see it as a way to distribute money and not empower people.

But regulation is likely sooner or later. Self help groups today handle Rs.5,600 crores of disbursement. Just four micro finance institutions in Hyderabad alone have disbursed Rs.1400 crores. The National Bank for Agriculture and Rural Development forecasts that by 2008, about one million self-help groups would be taking loans from the bank, with a total membership of around 17 million people. Over a quarter of poor Indian households will by 2009 likely have access to formal financial services if current trends continue. With such large amounts and widespread participation comes inevitable government responsibilities to check unethical practices.