Rabindra Kumar Jena
It has often been argued that the fundamental problem with implementation of Government programmes in India is that most of our policies are not in touch with realities. While this is a structural problem, and based on opinions of policy experts, one can say that there is perhaps some substance in that allegation. However, on careful study of the data provided in the public space itself, one can see that the problem is much more serious than just the lack of goof policy. It is actually the blatant denial of the seriousness of a problem, especially in sectors like health and education, where it is expected that the public funding by the government should bare the bulk of the reform responsibilities. I would like to elucidate this point using the example of the health sector in the country.
We all know that as far as the figures and data used for the shaping of government policy is concerned, we rely on data provided by the Government itself. The primary problem with this is that since the Government ministries have a lot of simultaneous issues to deal with, the data available through the government records are generally not up to date with the latest reality. Inspite of that, they are fairly reliable. However, on closer analysis, one can see how there is a dangerous trend developing. This is especially clear in the health sector. Here it may be important to point out, that unlike reports of other stakeholders in most development or public service issues, the government does take the reports by the United Nations seriously. This is because not only is India a signatory to the Millennium Development Goals, which make it necessary to corroborate with data provided with the UNDP, but because this data reflects India’s progress on these issues internationally, in order of ranking, with other nations.
In conjunction with this, it is interesting to note that the Government’s latest National Health Policy, passed in 2015, not only does not recognise its failure to meet several targets, as pointed out by the UNDP data, but also differs on a significant margin from the UNDP data itself. These discrepancies, if red carefully, are glaring, and point to a much larger problem in the system, as I shall elucidate in the later half of my article.
Let us take for an example the data provided by the Government of India’s Ministry of Health and Family Welfare , from its Draft National Health Policy 2015, which is arguably the government’s most recent estimates. The ministry estimates show that India is almost about reach the Millennium Development Goals (MDG) with respect to the indicators of maternal and child survival.The MDG target for Maternal Mortality Ratio (MMR) as set by the United Nations is 140 per 100,000 live births and the Government estimates show that at the rate India is achieving its success, we will reach an MMR of 141 by 2015, which means we will not only meet the UN target but exceed it. Again, this is a repeated pattern with the case of under-5 mortality rate (U5MR), where the UN MDG target is 42 and the central government estimates that India will reach this goal as well by the end of 2015.
However, the UNDP data, based on 2015 figures, paints an altogether different picture. UNDP’s report states- between 1990 and 2006, there has been some improvement in the Maternal Mortality Rate (MMR) which has declined to 254 per 100,000 live births as compared to 327 in 1990. However, despite this progress, India is expected to fall short of the 2015 target by 26 points. The report further states that delivery in institutional facilities has risen slowly from 26 percent in 1992-93 to 47 percent in 2007-08. Consequently, deliveries by skilled personnel have increased at the same pace, from 33 percent to 52 percent in the same period. By 2015, it is expected that India will be able toensure only 62 percent of births in institutional facilities with trained personnel. Thus, universal coverage remains to be achieved to a great extent, and unlike what the government data seems to project, we do have a problem at hand.
This is a pattern, as stated above, that gets repeated in other indicators as well. As far as the MDG to reduce mortality among children under five by two-thirds, UNDP’s data shows that India’s Under Five Mortality (U5MR) declined from 125 per 1,000 live births in 1990 to 74.6 per 1,000 live births in 2005-06. U5MR is expected to further decline to 70 per 1,000 live births by 2015. This means India would still fall short of the target of 42 per 1,000 live births by 2015. Major states in the heartland of India are likely to fall significantly short of these targets, by more than 20 points.
Is this simply a problem of lack of synchronization of the ground reality and the data at the most official level? Or is it a bigger problem of actually being in denial about the conditions that plague the country right now? This is particularly important in the health sector, where the government data would suggest that we can now have health policies that need not require as much funding from the government. And yet, our actual condition in the rural health sector, as discussed by me in earlier articles, is proof enough of how much more effort is needed. If the government does not even acknowledge that it is short of meeting its targets, the policies and measures taken by the government will also reflect the same. And this will lead to a vicious cycle, as it is in the danger of leading to now, of such policies then not doing anything to improve the actual conditions, and our real rural health indicators getting only worse.
Rabindra Kumar Jena, Member of Parliament, Loksabha ,Balasore (Odisha)