In an apparent rebuke of the Indian government’s ambitious welfare schemes, a noted economist has said nearly half of the country’s children aged below five will suffer from stunted growth, and many of them will probably be brain-damaged due to lack of iodine and iron. He also contested some official figures and claims on the efficacy of such state-run programmes.
Abhijit Vinayak Banerjee, Ford Foundation International professor in economics at the Massachusetts Institute of Technology (MIT), and a poverty and public goods specialist, said the state of maternal and child health in the country is worse than that in sub-Saharan Africa.
He said the government’s way of responding to the failure of such programmes was to typically raise spending, as is evident from its plan to spend 1% of its gross domestic product on the National Rural Health Mission (NRHM) compared with 0.9% now.
Banerjee, who is also a director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) at MIT, a pioneering institute that carries out field studies in various countries on what works in eliminating poverty and what doesn’t, said surveys by J-PAL have found much lower success rates than claimed by the government in its health and education programmes in many states.
For instance, compared with the National Family Health Survey-3 (NFHS-3) claims of a 27% full immunization rate in Rajasthan, only 20% of those surveyed were able to show full vaccination cards. In rural Udaipur, only 4.5% produced such documents.
Similarly, while NFHS-3 said 43% of children are given diarrhoeal remedies, J-PAL found that while 73% of mothers knew about the efficacy of such oral remedies in diarrhoea, only 23% actually used them.
“Hopefully, our work will be able to generate a culture of good evaluation and good evidence,” Banerjee told Mint. “It is important to question and throw out bad evidence.”
J-PAL, which has a field office in Chennai, is conducting more than 20 poor-related projects in 12 states across the country.
The much-publicized Integrated Child Development Scheme (ICDS), Banerjee said, works well by government parameters simply because they are placed in villages that are already performing well. “When you place them against other villages, the success vanishes,” he pointed out.
According to R. Gopala-krishnan, joint secretary in the Prime Minister’s Office, who has been involved with many government welfare programmes, “There is still a licence-permit regime in the health sector that keeps the country from generating more doctors and nurses.”
Also, he said, the anganwadi (village nutrition nurse) or health centre programmes suffer from conceptual defects. An anganwadi nurse is intended to take care of a population of 3000, covering over five-six villages, needing her to be located in a central area. That rule, he said, made her not only far off from most villagers, but also accountable to none.
Similarly, although the health centres are to be staffed by a doctor and a nurse each, they are not allowed to conduct surgical procedures or administer antibiotics, the remedies that the poor people desperately need. This has led to people avoiding such health centres and absenteeism of staff and scarcity of well-trained doctors to run them.
Banerjee felt that while the record of the Indian government is exemplary in many areas such as conducting elections or building roads, it has neglected more universalized public goods such as education, health and environment, especially in regions dominated by scheduled castes and scheduled tribes, wasting funds and energy.
The government needs to do five things to reach the poor effectively, he said. “Use technology aggressively, don’t demand too much time of the poor, experiment before you reach scale, and then universalize rather than targeting, which led to more corruption. Lastly, don’t be afraid to give money,” he said.
The public distribution system is one area where the government needed to universalize or withdraw.
“It is simpler to give money to the poor instead. Even spending the money on a few programmes that deliver would increase welfare a lot. For instance, supply free iodized salt or subsidized fortified wheat flour rather than grains,” he added.
Incentives also work wonderfully, especially to clear the general distrust the poor have for government schemes. In rural Udaipur, the immunization rate went up to 45% after families were given 3kg of pulses.