United Nations Millennium Development Goals

Millennium Development Goal
- A Long Journey and Alluring Destination


By
Dr. B.Yerram Raju
Economist and Director (Research and Projects)
Development & Research Services (P) Ltd.
Hyderabad
Dr. D.Vasudeva Rao
Economist and Development Practitioner

Dr. B.Yerram Raju is an Economist and Director (Research and Projects) at Development & Research Services (P) Ltd.
and Dr. D.Vasudeva Rao is an Economist and Development Practitioner:
The views expressed are personal.
 


ABSTRACT

UN goals, as they should, have been lofty and their achievement rests on the member-nations' drive and initiative as well as timely budgets and resources. MDG Goals are no exception. In the wake of unprecedented recession, with the completion of two-thirds of the target period, MDG Goals may need revision.

India, in fact, did not lag behind UN in setting its sights high in all the key areas of human development. India has been on a high growth path with a target of annual ten percent growth in GDP by the end of the eleventh five year plan (2010-15), the year by which the MDG period also ends. Drag on the economy in the farm sector is a continuous worry because it is the sector that houses still 55-60 percent of the population and it is again the rural areas that pose a threat to the survival of the poor.

The country successfully eliminated the starvation deaths and famine that overtook us in pre-independence days. Still, its continuing low level of Human development index is a cause for worry and the journey we have to travel in reaching the UN Millennium Development Goals (MDG) is baffling. It is acutely conscious of the fact that the road to poverty alleviation is rugged, thorny and needed lots of investments and strategic approaches in the fields of education, health, energy and employment sectors.

The paper examines some of the initiatives India took and the results achieved in these four areas in consonance with the MDGs based on a few field studies of some of the globally funded projects in India. The sectors we covered, therefore, include: Education, and Health. In the end, we would venture to suggest, based on such experience, some doable.

The Paper is divided into four parts: Part 1 dealing with the background; Part 2 dealing with Education, Part 3 dealing with Health; and Part 4 the Way Forward. The authors argue that convergence of anti-poverty programmes right at the village level, decentralized administration, continual monitoring and evaluation, and social audit should be the way forward for the MDG attainment.
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MILLENNIUM DEVELOPMENT GOALS -
A LONG JOURNEY AND ALLURING DESTINATION

"In 2000 the world set itself goals to cut poverty, disease and illiteracy. It will take more than aid to meet them." (The Economist July 7th 2007)

UN is famous for setting goals and it cannot be blamed if the goals are not achieved as it is the member nations that should put their budgets and resources in place at the right moment and drive their energies towards achieving them. One should be happy if there is such effort and earnestness. Safe water and sanitation for all a goal set for achievement by 2000- is still a goal with us and though the Indian Budget of 2008 promised it all, it remains a mirage. But the efforts are on and like this there are many other UN goals. In 2005, the call to make 'poverty a history' by the UN received a cynical vote of 3% in the UK. But it is a fact that the goal of bringing down people with less than one dollar a day is almost within reach. Almost 32% of the people in the developing world lived on less than a dollar a day in 1990. Going by the same measurement, in 2005 it fell to around 19% and it would have shrunk still further had we been spared of the unprecedented recession since 2007. The MDG goals needed recast in such context though the India story remains good. A large domestic market with less reliance on exports; slow but steady continuation of economic reforms; sensible monetary management; discovery of gas reserves that can improve the Government balance sheet; plans to spend massive amounts on infrastructure like roads and power; simplification of indirect taxes on a non discretionary basis and a programme to uniquely identify each citizen making them electronically connected, are some of the reasons for optimism.
We are on the high road to high growth.

'India's economic growth never fell below 5.8% (see chart), in the recent past. India's merits special caution, its budget deficit topping 10% of GDP in the fiscal year that ended on March 31st cautions the Economist, London in its June 1, 2010 issue.



Millennium Development Goals

1. Halve the proportion of people living on less than a dollar a day
2. Achieve universal primary education
3. Educate boys and girls equally
4. Reduce the mortality rate among children under five by two-thirds
5. Reduce the maternal mortality rate by three-fourths
6. Halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases
7. Halve the proportion of people without access to safe water and sanitation
8. Increase aid and improve governance.


The Reserve Bank of India (RBI), which has raised interest rates twice in 2010, still has work to do and as we write the article, RBI is mulling over another rise in basic rates to tame the inflation because it is aware that high inflation hurts the poor the most. But we should always prefer inflation to unemployment. The employment rates are fortunately rising because of the growth in the manufacturing and services sectors. Drag on the economy in the farm sector is a continuous worry because it is the sector that houses still 55-60 percent of the population and it is again the rural areas that pose a threat to the survival of the poor. The country successfully eliminated the starvation deaths and famine that overtook us in pre-independence days. Still, its continuing low level of Human development index is a cause for worry and the journey we have to travel in reaching the UN Millennium Development Goals (MDG) is baffling. It is acutely conscious of the fact that the road to poverty alleviation is rugged, thorny and needed lots of investments and strategic approaches in the fields of education, health, energy and employment sectors. The paper examines some of the initiatives Indian Government took and the results achieved in these four areas in consonance with the MDGs based on a few field studies of some of the globally funded projects in India. The sectors we covered, therefore, include: Education, and Health. In the end, we would venture to suggest, based on such experience, some doable. The Paper is divided into four parts: Part 1 dealing with the background; Part 2 dealing with Education, Part 3 dealing with Health and Part 4 the Way Forward.

The United Nations Hot Springs Conference, as far back as 1943, proclaimed "The first cause of hunger and malnutrition is poverty; and the first cause of poverty is lack of work." Mahatma Gandhi, father of the Nation who believed in simplicity and not rhetoric reinforced it: "To the poor and hungry, God is bread and appears in the promise of work."

The Constitution of India, through the various clauses of Fundamental Rights and Directive Principles of the State Policy, has provided for 'Social Security' both directly and through implied provisions. Article 41(in Part IV Directive Principles) already provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work etc. That the mandate of Article IV has remained unfulfilled is obvious from the slow pace of reduction of poverty levels. It took eleven Five Year Plans to realize that education, health, social security and means of livelihood are not to be seen as ultimate outcome of development but should form crucial to the very process of development.

If we set aside the issues of definition and measurement of 'poverty' and look at some constitutional provisions, some interesting facts are worthy to note in the Indian context.

Till the amendments to Article 40 of the Constitution (73rd and 74th Amendments) poverty had no mention in any section of the Constitution of India. Right to life of Article 21 of the Constitution implies many rights such as dignity, health, environment, clean water, free education and shelter. Article 47, one of the important Directive Principles, states that raising the level of nutrition and standard of living and improvement of public health are primary duties of the State. Synergy and convergence of the three components of the Article 47 are crucial for eliminating poverty as defined by Sen. Article 39 sets out policy principles to be followed by the State. Our Five Year Plans sought to alleviate poverty in such context through a large number of programmes with liberal flows from the State exchequer. This only gives credence to the strong impression gaining ground those Indian planners foresaw the social security concerns of successive generations ahead of the MDG fixation way back in 1950s.

Human development is a process of enhancing human capabilities to expand choices and opportunities so that each person can lead a life of respect and value. The three essential capabilities are for people: (1) to lead a long and healthy life (life expectancy at birth) (2) to be knowledgeable (educational attainment reflected in adult literacy which is reflected b the combined gross primary, secondary and tertiary enrolment ratio) and (3) to have access to resources needed for a decent standard of living (reflected through GDP per capita. Income enters the HDI as a proxy for a decent standard of living and as a surrogate for all human choices not reflected in other dimensions).

Another area of concern is the growing level of urbanization and the migration of population from the rural to the urban areas with no commensuration livelihood opportunities. A little over 45% of the world's population, even now, lives in urban areas. Quantity of employment is bound to be a major challenge. It is unlikely that the philosophy of providing something as better than nothing would hold a grand gateway for the future. Much more challenging would be providing sustainable livelihood opportunities for these growing quantities to pursue.

PART 2
The Macro Picture

India's centrally planned economy is governed by what the Planning Commission decides every five years after a consensus is reached between the States and Centre through the National Development Council. Without entering into a debate over such approach, we would just review the achievements in so far as the MDG is concerned. Annual budgets both of the Centre and States allocated resources sparsely among the competing claims of different sectors in the process of development. Regional balanced development to ensure equitable distribution of resources has itself been a distant goal. This part reviews the achievements of Elementary Education and Health Sectors.

ELEMENTARY EDUCATION
Growth of Literacy

Table 1:

Literacy Rates 1951 2001

                            Male   Female Total
1951                     24.95  7.93   16.67
1961                     34.44  12.95  24.02
1971                     39.45  18.69  29.45
1981                     56.50  29.85  43.67
1991                     64.13  39.29  52.21
2001(provisional)     75.85  54.16  65.37

Enrolment Ratios

The Gross Enrolment Ratio (GER) at the primary and upper primary levels improved significantly between 1950-51 and 1999-2000,from 42.6 to 94.9 in the case of primary levels and from 12.7 to 58.79 for upper primary levels. The gap between boys and girls in GER at the primary and upper primary levels has declined significantly from 28.5 and 29.6 percentage points respectively in 1990-91 to 19 and18 in 1999-2000.

The total number of teachers increased from 6,24,000 in 1950-51 to 3.2 million in 1999-2000, an increase of more than five times. However, the teacher-pupil ratio (TPR) has not shown improvement over the years save exceptions. Despite an increase in the number of habitations and population, the coverage of both primary and upper primary schools, in line with the norms, has increased significantly. Of the one million rural habitations, presently, about 1,00,000 habitations remain unserved as per prescribed norms.

Mid-Day Meal Scheme

The National Programme of Nutritional Support to Primary Education commonly known as the Mid-day Meal programme was launched in 1995. Under the scheme, cooked meals are served with calorie value equivalent to 100 gm of wheat or rice per student per school day. The number of children covered under the programme has risen from 33.4 million in about 3,22,000 schools in 1995-96 to 105.1 million students in 7,92,000 schools spread over 576 districts in 2000-01. It is targeted to cover 107.2 million children in 578 districts during 2001-02.

Convergence as a Strategy for Optimum Utilisation of Resources:

Cost effectiveness and efficiency in the delivery of services under various educational programmes, which are mostly affected by the socio-economic and political conditions, can have a far-reaching impact on the most important determinant of development, i.e., human capital formation. Effectiveness of the delivery of services in the social sector also needs a high degree of integration and convergence in the planning and implementation of programmes of related social sectors. Services like literacy, elementary education, primary health care, nutrition, mother and child care, family welfare and rural development have strong linkages and can only be strengthened through an appropriate integrated approach which will optimise public expenditure and reinforce the effective delivery system. All efforts would be made in the Tenth Plan to achieve convergence both in the formulation of schemes/programmes as well as in their implementation through effective coordination at the national/state level and lower levels of administration.

SECONDARY EDUCATION

Secondary education serves as a bridge between elementary and higher education and prepares young persons between the age group of 14-18 for entry into higher education. The number of secondary schools in India increased from 7,416 in 1950-51 to 116,820 in 1999-2000. The impact of recent initiatives undertaken for the universalisation of Elementary Education is resulting in an increased demand for the expansion of secondary education.

The focus in the Ninth Plan was on reducing disparities, renewal of curricula with emphasis on vocationalisation and employment oriented courses, expansion and diversification of the open learning system, reorganisation of teacher training and the greater use of information and communication technology.

HEALTH:

Reducing the Child and Maternal mortality rates Vs Goals of National Health Policy:

Improvement in the health and nutritional status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition services with special focus on under served and under privileged segments of the population. Over the last five decades, India has built up a vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors. It has also developed an integrated health management system acutely conscious of the fact that the allopathic system of medicine has a cost structure slightly out of reach of the poverty groups. The other popular systems are traditional Yoga, Unani, Ayurveda, and Homeo. Among these Unani and Ayurveda systems are based on herbal wealth in the forest and tribal areas. These do not require the high-end physicians or support based surgical interventions . Even bone and dental fractures, acute hepatitis found an easy cure with some herbs locally available in rural areas at least cost.

Table 2: Time Trends (1951-2000) in Health Care

Item/Year

1951

1981

2000

SC/PHC/CHC

725

57363

1,63,181 (99-RHS)

Dispensaries/Hospitals

9,209

23555

43,322  (95-96-CBHI)

Beds (Private & Public)

1,17,198

5,69,495

8,70,161 (95-96-CBHI)

Doctors (Modern System)

61,800

2,68,700

5,03,900 (98-99-MCI)

Nursing Personnel

18,504

1,43,887

7,37,000 (98-99-INC)

Malaria (Cases in Mn)

75

2.7

2.2

Leprosy (Cases/10000 population)

38.1

57.3

3.74

Smallpox eradication(Number)

NA

NA

>44,887

Guineawormeradication (Number)

     

Polio (Number)

NA

NA

>39,792

Life Expectancy (Yrs-RI)

36.7

54

64.6

Crude Birth Rate

40.8

33.9 (SRS)

26.1 (SRS)

Crude Death Rate

25

12.5 (SRS)

8.7 (99-SRS)

Infant Mortality Rate

146

110

 70 (99-SRS)


Source : National Health Policy 2002:
SC: Sub center; PHC: Primary Health Center; CHC: Child Health Center;

Table 3:
Health indices of various social groups

                        IMR       U5MR    %Under nutrition
SC                     83.0      119.3        53.5
ST                     84.2      126.6        55.9
Other disadv        76.0      103.1        47.3
Others                61.8      82.6         41.1
India                  70         94.9         47

Source : NHP, 2002

Table 4:
Urban/rural health indicators

BPL(%)                    IMR        U5MR              % Children Under-nourished
Urban                      23.6       44   63.1          38.4
Rural                       27.1       75   103.7         49.6
Total                       26.1       70   94 .9         47.0

Source : NFHS-2: IMR: Infant Mortality Rate; U5MR: Under Five Mortality Rate.

NHP2002- Goals to be achieved

Eradicate polio and yaws                                                  2005
Eliminate leprosy                                                             2005
Eliminate kala azar                                                           2010
Eliminate lymphatic filariasis                                               2015
Achieve zero level growth of HIV/ 2007
Reduce mortality on account of TB, malaria and AIDS            
other vector and water- borne diseases by 50 per cent           2010
Reduce prevalence of blindness to 0.5 per cent                      2010
Reduce IMR to 30/1000 and MMR to 100/100,000 live births      2010
Increase utilisation of public health facilities from the
 current level of <20 per cent to >75 per cent                        2010
Establish an integrated system of surveillance,
 national health accounts and health statistics.                      2005
Source : National Health Policy (GoI) 2002

Table 2: Time Trends (1951-2000) in Health Care

In all the States, ASHAs/link workers have facilitated the households' links with the health facilities.
Strengthening of the PHCs for 24x7 services is a priority of the NRHM: 30% of the 22,370 PHCs in the country were working for 24x7 on March 31,2009
Over 159.92lakh women have been brought under the Janani Suraksha Yojana for institutional deliveries in the last three years.
9,073 doctors, 1,875 specialists, 20,977 staff nurses have been appointed on contract in the states so far, reducing the human resource gaps in many institutions.
2,698 CHCs have completed their Facility Surveys and 700 their physical upgradation so far.
Indian Public Health (IPH) Standards have been finalized and a first grant of Rs.20lakh was made available to all the district hospitals of the country to improve their basic services, given the increased patient load due to JSY and other programmes.
Project Management Units have been set up in 576 district and 3,474 blocks of 34 states.
IPA standards developed for eight different level of public institutions in health, provide a basis for all programmes in the health sector.


Anti-Poverty Programmes (See Annexure 1 for the numerous programmes that the Government of India implements)

The major anti-poverty programmes aimed at providing self-employment and supplementary wage employment to people living below a defined poverty line have been in existence for over two decades. However, these have been restructured periodically in order to improve their efficacy as instruments of poverty reduction. Swarnajyanati Gram Swarozgar Yojana (SGSY) marking the fifty years of Indian Republic subsuming three earlier programmes is a holistic one, through formation of self-help groups with capacity building, selection of activity clusters, infrastructural support, technology, credit and market access as essential ingredients built into the programme. SGSY is a process oriented programme with a focus on social mobilization and group formation in the first phase, thrift and credit amongst the members of the group augmented by a revolving fund in the second phase, and access to credit from micro finance institutions in the third phase. Micro enterprises are taken up when groups acquire the entrepreneurial abilities, know-how and market access in the fourth stage. Local people are trained as animators and facilitators through a systematic programme especially in areas where NGOs do not exist.

Similarly a single wage employment programme, namely, the Sampoorna Gramin Rozgar Yojana (SGRY), merging the Jawahar Rozgar Yojana and Employment Assurance Scheme, wherein the benefits would accrue to the people by way of direct transfer benefits through wage payments with some indirect benefits accruing through the creation of rural infrastructure has been launched in the Tenth Plan. Under the SGRY the payment of wages would be partly in food grains and partly in the form of cash, which would ensure a minimum level of food security for the poor. At the village level the works would be largely labour intensive for creation of rural infrastructure. Further in selective backward districts, it is envisaged that 100 man-days of employment would be generated per person with an element of guarantee.

Food and Nutritional Security

One of the significant aspects of Indian economy in the post independent era has been that famine and pestilence stopped visiting the people, thanks to the successive interventions of the Government in regard to food security. Yet it is conscious that the future is not insured by either the present or the past. There are lags in food production; increase in population; soils are losing fertility due to either soil erosion or water depletion or both in traditionally high growth areas. A policy for sustained attention towards food security is imperative which is sought to be addressed through the National Food Security Bill, 2010, currently under debate.

Family should be the focus for providing the food security and the present public distribution system as a delivery mechanism needs strengthening both in quantitative and qualitative dimensions. In terms of quantity, 60kgs of cereals make an ideal basket for a month per family of five members, meaning an increase by20kgs from the current level. It is extremely important that the target should be the poor family alone, which calls for proper definition and identification of such poor families. This Food Security Scheme needs to be integrated with the Mahatma Gandhi national rural income guarantee programme [MGNREGP] so that the 100 days of assured employment that should go without gender bias, would guarantee both the cash wages and PDS to only the deserving.

In order that the nutritional value of food for the poor gets under way, it is necessary that the cultivation of millets that took a beating during the last three decades had to be regenerated. The Action Plan for Agricultural Development at the district levels has to consciously rebuild the cultural practices in this direction. Once the millets and oil seeds production resume to the expected levels, then it would be possible to provide the much needed food and nutritional security. Therefore, the broad question still hangs in balance: Do the suffering poor need to wait until production of millets gets going, prices assured to the producing farmer, and gets into the distribution loop? If Government of India were to think that its responsibility ends with handing down an Act, food security would not arrive. In the context of the recommendations of the 13th Finance Commission that has redefined the contours of distribution of resources of the exchequer between the State and Center from the divisible pool, the abilities of the State to raise resources is limited. Therefore, the Central Government has to find resources for the FSA to take effect on the field.
 

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   Published on IndianFaculty.com: 27/04/2012

 Source: E-mail 27/04/2012

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