Communitisation of Health Institutions and its Impact

Photo Credit: HIFA 15

National Rural Health Mission (NRHM) is a unique programme that has recognised capacity, knowledge and skill of the communities to plan, implement health policies and monitor public health institutions. Various institutionalised community processes of NRHM such as Accredited Social Health Activists (ASHAs), Village Health Sanitation and Nutrition Committee (VHSNCs), Rogi Kalyan Samiti (RKS) and Community Monitoring provides ownership and responsibility directly to community to actively contribute in the overall aim to seek universal access to equitable, affordable and quality health care which is accountable and at the same time responsive to the needs of the people. A radical policy change in the form of NRHM has actually pushed the idea of people centered planning and decision making or communitisation in health system. How this idea has been actually implemented at ground level in the first phase of NRHM that ended in 2012, is a matter of great concern. Government of India has extended NRHM with same principles, so it is now necessary to understand the implementation of community processes and their impact.

Various evaluations of NRHM in the last couple of years shows mixed results about implementation and impact of various community processes. ASHA program remain the back bone of the community process and works as the primary link between community and public health system. Country has recorded a substantial increase in utilisation of services such as institutional deliveries, immunisation, ANC checkups and family planning but recorded less impact on health seeking behaviour of people. However, an evaluation by Planning Commission reveals that because of inadequate emphasis on skills, training and supportive monitoring, ASHAs are less functional and effective in tasks related to community level counseling, care provisions and community mobilisation work.

As a policy, NRHM has institutionalised roles, responsibilities and power of the community in deciding community level health needs, making health system friendly to the local people and contributing in delivery of quality care by health institutions. RKS constituted in each public health institution involves active participation of community, patient and civil society in assessing need of institutions and making them responsive and accountable to public. Review of RKS reveals that members of RKS are unclear about their role, rights and overall objective. Mostly RKS discuss fund utilisation issue in their meeting. There are very few evidences where RKS are found discussing non-budgetary issues such as improving IPD/OPD cases, outreach work, absence of health personal etc. On the other hand, VHSNC ensure micro health planning, implementation and monitoring at village level. Fifth Common Review Mission (CRM) of NRHM reveals that though VHSNCs are active in spending fund allocated to them, but the village health plan is not yet institutionalised anywhere and there is no clear model or clarity in its role and utility. There is an increase in utilisation of untied funds for VHSNCs but had limited involvement of PRI in health planning process and in the function of VHSNC.

Community monitoring is another institutional mechanism introduced by NRHM to communitise function and accountability of health institutions. The community as well as the Patient Welfare Committees is expected to monitor the performance of the health facilities on various parameters using techniques such as jansunwai.   But this process has given least priority during entire phase of NRHM. The idea was successfully implemented in nine states on pilot basis that resulted in increased utilisation of services and accountability. But unfortunately, no state government except Karnataka took it forward as integral part of health system.

Level of health institution communitisation varies from state to state and hence health care utilisation also differs across states. Fifth CRM conducted in 15 states found that more than 50% of expected in-patients are seen in public sector health institutions of Himachal Pradesh, Sikkim, Goa, Rajasthan, Odisha and Karnataka. It is interesting to observe that in these states communitisation process such as VHSNCs, RKS, PRI participation and institutionalisation of community monitoring are in place and functioning remarkably better. On the contrary, states like Jharkhand, Uttar Pradesh, Gujarat and Chhattisgarh have given less priority to communitisation process and resulted into less turn out in public health institutions. According to 5^th CRM in these state less than 30% of expected in-patients are seeking public sector hospitalisation.

Various evaluations of NRHM reveal that it has not achieved its target and is still much behind from its targets of first phase. However, NRHM has recorded a faster improvement in health service utilisation, quality care and availability of health institutions in its first phase of implementation. Communitisation process involved in it has great role in this improvement as it is revealed through various evaluations. It raises a need of strengthen and mainstreaming such process for future success. Traditional mindset of functioning in public health institutions needs facilitation to accept and imbibe the spirit of community driven system.
 

-Jeet Singh

 

 

Voicing violence: Has the new Act made a difference?

Photo Source: www.indiatimes.com
 

A 16-year-old girl in Kolkata was gang raped twice in October, the second time immediately after she registered an FIR with the police. The rape of the minor is an example of how despite the passage of a stringent Act against sexual crimes and a promise of providing an environment of greater safety for women to speak against violence, not much has changed in actual terms.

The Criminal Law Amendment Act that came into existence in March 2013 amended various sections of the Indian Penal Code (IPC), the Code of Criminal Procedure and the Indian Evidence Act, with an aim of providing a strong deterrent against crimes like rapes. The Act inserted Section 166 A in the IPC which provides for rigorous punishment up to 2 years for public servants disregarding directions while investigating rape. In addition, the Protection of Children from Sexual Offences (POCSO) Act was also strengthened. POCSO envisions police as child protectors. Under it, the police is required to make arrangements for the care and protection of a child who has been sexually abused.

However, these provisions did nothing to save the Kolkata rape victim. In fact, her registering the FIR and then pursuing it led the culprits to allegedly burning her alive. According to the Justice Varma Committee report that guided the fast track passage of the Criminal Law Amendment Act, “Failure of good governance is the obvious root cause for the current unsafe environment eroding the rule of law, and not the want of needed legislation”. The report also warned that in the absence of “attitudinal changes”, mere changes in law cannot correct the gender bias that plagues Indian society.

Statistics justify the observations of the committee. A year after the Act came to function; rape and other crimes against women have increased, rather than decreased. Delhi alone has seen a 129% increase in rape. Compared to 2012 when 680 cases were registered, 2013 saw 1559 registered cases.

A victim who speaks out against rape not only requires legal protection, but also support from society. However, the mindsets of people are largely unchanged. Many, including those in authority, continue to believe that women ‘invite’ rape by dressing in a certain way, stepping outside their homes after a certain hour or visiting certain places. The question then becomes if change in legal procedures can bring about reform in society?

There are differing views on this among activists; some like Dr. Nandita Shah, co- Director Akshara asserts that some changes are definitely visible. While the judicial, medical and police structures are still inadequate, what has changed since the passage of the law is that it has broadened the definition of rape which she views as a positive change. “Earlier traumatic experiences of sexual assault would make a victim feel stigmatized, but now with the broadening of rape to include non-penetrative assault, such victims are encouraged to speak out and seek justice”. She points out to the Tehelka case where the journalist pointedly referred to the new law while seeking a trial for rape.

Others like Kavita Srivastava, National Secretary; People's Union for Civil Liberties (PUCL)feel that while Criminal Law Amendment Act was welcomed as changes relating to criminal law and sexual violence came after 31 years, there is still a long way to go before the law achieves its stated purpose. “We welcomed the processes (behind the law) as it was demanded from the streets and the Verma committee report was extremely participatory. However, nine months since it has been implemented, it is clear that the police still does not know the new law. Though some trainings have been conducted, it will take a long time for the Thana level police to know the sections and in particular the application of the Law. Lay persons and survivors of violence are even further removed from knowing the changes and therefore do not directly feel empowered. Unless the attitude of the police changes, the law will be a change agent only on paper”. 

 A year has passed since the Delhi gang rape shook the collective conscience of the country. While a larger discussion on women’s safety continues to be kept alive by media, activists and academia, there seems little impact of the Criminal Law Amendment Act on the lives of women sufferers of sexual violence. Though, the new Act addresses sexual crimes committed by those in position of authority, often, police medical practitioners, advocates, even judges make voicing violence more difficult for women, rather than encouraging them. For one, court processes and police procedures need quick adaptation to the changes in law and then implement them. If mere change in law equated changed attitudes, then the police would have ensured protection of the minor in Kolkata by sending her to a shelter and prevented her death.  Further, while change in law may serve as a first step, there remains a need to spread awareness to create an environment of sensitive support, so that the law benefits women both in letter and in spirit.

 

-Divashri Mathur   

Skilling India’s Youth for Better Employability: Policy Evaluation

Students being trained at ITI Gurgaon; Source: www.livemint.com

During past nine years, the idea of skilling youth has attracted attentions both nationally and internationally and there has been a continuous large scale ongoing debate on this issue even in India along with transformation. The major driving force behind such transformation is actually rooted to the persistent rise of economic aspirations of different sections of the society, especially amongst its growing youths, who are seriously exposed to the challenges unemployment and opportunities. The untiring strive for collective efforts to improve the systemic delivery of services in skill training is rather very impressive.

As per Census 2011, India has 583 million of youth population aged between 10-35 years, out of which 398 million (68%) are in rural areas. About 68% of India’s population is below the age of 35 years, increased from 60% in 2001. The dropout rate for Classes I-X in school education is about 60% in 2007-08. The dropout rates for SC and ST students are even higher at 68% and 78% respectively. As per NSS data, in the age group of 15-29 years, the proportion of persons received formal and informal vocational training is very negligible at 2% and 8% respectively. There is also a huge mismatch between skills trained and needs of the market. In fact, the issues of employability become a major concern implying that the youth lacks not just generic skills but huge technical skills which market demands. This shows that our youth are in big trouble, who are neither in school nor in training institutions for skilling. This is a big threat to the much cherished window of demographic dividend. The United Progressive Government (UPA) has taken several meaningful policy measures to arrest this trend and improve the employability of youth.

 

There has been a paradigm shift since 11^th Five Year Plan with regard to the public policies on skill development in India. An inclusive framework was devised involving subject experts, industries, civil society and international community through the Coordinated Action on Skill Development, which was created with a three tier institutional structure in 2008, including (i) Prime Minister’s National Council on Skill Development (PMNCSD) for overall policy directions, (ii) National Skill Development Coordination Board (NSDCB) under the Planning Commission for policy coordination among different stakeholders, and the (iii) National Skill Development Corporation under the Ministry of Finance in public private partnership mode to foster and catalyze the efforts of private sector involvements in skilling the youth in India.

Subsequently, the Government of India also announced the National Policy on Skill Development in 2009 with an objective to provide skill training to 500 million persons by the year 2022 when India become 75 year after Independence. This policy is the guiding document for the country as a whole and provides a very comprehensive set of innovative and radical policy measures for addressing the major challenges faced by the skill training sector in India. Besides, several measures for systemic and structural reforms, the Policy promotes greater Choice for trainees and Competition among training institutions with transparency and accountability. It also paves practical ways for skilling informal sector workers who constitute more than 94% of workforce.

Thus, both the Coordinated Action on Skill Development and the 2009 Policy played vital role for several innovative skill training schemes/programmes in the last 7-8 years initiated by both Central Ministries/Departments and State/UT governments. In fact, almost all the State/UT governments have established the State Skill Development Missions of their own with inclusive framework in order to bring necessary structural changes for improving employability of youth.

There are two major players in skilling the youth which are NSDC and Ministry of Labour & Employment. Till November 2013, the NSDC has partnered with 2,202 training institutes including mobile training centres and trained about 9.91 lakh persons, out of which they have placed 6 lakh persons (60.5%) since 2009. The Ministry of Labour through its Skill Development Initiative (SDI) Scheme based on Modular Employable Skills (MES) trained about 16 lakh persons since 2007-08.

However, in order to address the skilling issues to a greater extent by bringing systemic and structural reforms, the UPA government has set up a dedicated permanent institutional structure, namely the National Skill Development Agency (NSDA) under the Ministry of Finance by subsuming the PMNCSD and NSDCB in 2013. The NSDA is an autonomous body and aims to coordinate and harmonize the skill development efforts of the Central and State Governments and the private sector to achieve the targets of skilling youth. Moreover, the NSDA has mandate to bridge the social, regional, gender and economic divide in skilling youth through ensuring the skilling needs of the disadvantaged and marginalized groups like SCs, STs, OBCs, minorities, women and differently-abled persons. The NSDA has also been asked to take affirmative action as part of advocacy by the NSDA. The quality of training is something which the NSDA should address holistically by partnering with industry and civil society and by ensuring both supply and demand sides of the skilling youth. Such measures hopefully can help in addressing the challenges of skilling youth in India with better employability and future.
 

B.Chandrasekaran

 

Defining Poverty and BPL: A Persistent Policy Challenge in India

Photo Source: INQUIRER.net

Poverty in India is believed to be widespread, and defining poverty and identifying poor has always been India’s persistent challenge. The concerns around the definitional clarity of the poverty and Below Poverty Line (BPL) has been well acknowledged decades back by the prominent visionaries of our nation like Pandit Jawaharlal Nehru and Dadabhai Naoroji and later by the policy making institutions like Planning Commission.

National Planning Committee under Pandit Nehru recognised the prevailing poverty and thus made an effort in 1936 with a policy objective to “ensure an adequate standard of living for the masses, to get rid of the appalling poverty of the people”. Towards this end, the Committee defined goals for the total population in terms of nutrition (involving a balanced diet of 2400 to 2800 calories per adult worker), clothing (30 yards per capita per annum) and housing (100 sq. ft per capita).

However, even after realising and accepting the concerns for so long, an inconsistency has been recognised between the conceptual level of understanding and the practical ways of estimating poverty and the identification of poor households. At conceptual level, definition of poverty is involved both in the estimation of proportion of population living in poverty (a macro level estimate) and the identification of poor households for targeted delivery of various poverty alleviation programmes. In practice, however, the two approaches have followed different paths. The overall estimation of poverty is based on the data available from NSSO’s (National Sample Survey Office) all-India sample survey of household consumption expenditure, whereas identification of poor households requires a census, which necessarily goes by visible and quickly assessable indicators of level of living. Though the poverty ratio majorly depicted the falling trend in both rural and urban India from 1973-74 to 2009-10, the total population under poverty in both rural and urban areas kept on increasing (from 321.3 million to 354.68 million) throughout the same period, as per the Planning commission data.

Though, it is well accepted that till India’s economic liberalisation policy, poverty was an instrument to ensure basic necessities like food, but in the post liberalisation phase with greater accessibility, the idea of poverty gradually underwent changes. Much later in the year 1999-2000, NSSO introduced a method of Mixed Reference Period (MRP) measuring consumption of five low-frequency items (clothing, footwear, durables, education and institutional health expenditure) over the previous year (365 days recall period), and all other items over the previous 30 days, in order to get a stable expenditure pattern for non-food items. A poor himself defines his poverty more broadly by including lack of education, health, housing, empowerment, humiliation, employment, personal security and more. Thus considering the relevance of the factors, other than income taken into account even by a poor person to define their poverty, it becomes even more significant to capture the housing conditions, work profile and other indicators of social and economic status of the households, in order to rightly benefit the vulnerable & needful masses of the country. A study by the Oxford Poverty and Human Development Initiative using a Multi-dimensional Poverty Index (MPI) found that there were 650 million people (53.7% of population) living in poverty in India.

In regard to the concerns raised related to the identification of the households and the relevance of the factors other than income contributing to poverty, the Socio Economic and Caste Census (SECC) was launched on 29th June 2011 in the country. It is being carried out by the respective State/Union Territory Governments with the financial and technical support of the Government of India for the identification of BPL households in both rural and urban areas and would generate information on housing conditions, work profile and other indicators of social and economic status of the households in both the areas. This data could be used to identify the vulnerable or poor households. The census comprises of exclusion, inclusion and deprivation criteria approved by the Cabinet.

Thus it is being realised over the period of time at policy level that the process of inclusion and benefiting the masses with the poverty alleviation programme could be a possible solution since, the evolution in the methodology of BPL census has resulted in reducing the margin for inclusion/ exclusion significantly. Despite such drastic moves, there still remains continuous attempt amongst Indian policy makers to look for an ideal definition of poverty.

Recently the Rangrajan Committee (formed by Planning Commission in 2012 to review the existing methodology of estimating poverty and expected to submit their report by 2014) was formed to redefine poverty and examine Tendulkar methodology. The report is expected to give a new definition of poverty and based on that country will re-estimate the number of people below the poverty line.

-Shruti Issar

UPA’s Policy Reforms in Skill Development



Photo Credit: National Skill Development Corporation (NSDC)

In the recent years the significant acceleration of economic growth rate in India has lifted quite sharply upward the demand for higher level of skilled manpower. According to B.B. Bhattacharya’s study (2008), a disaggregated analysis shows that higher education in general and skill formation in particular has given India a competitive edge in services sector’s growth.

The study also revealed that with growing demand for highly skilled work force in both India and abroad the supply of highly skilled work force in India is now failing to keep pace with demand. As a result there is a danger of India losing its international competitiveness in skill induced economic growth.

Keeping in perspective, the United Progressive Alliance (UPA) government initiated many policy reform processes particularly in the area of vocational training and skill development sector through Ministry of Labour & Employment. Policy reforms were introduced for expansion and modernisation of the existing vocational training institutions by partnering with industry and civil society organisations through the Public Private Partnership (PPP) mode. The government has also been implementing a number of innovative skill training programmes which have coherently created afresh vocational training facilities in the country. During 2008-09, government launched a broad based Skilling Mission for training of 500 million persons by 2022. Various Central Ministries/Departments/Organisations have been given specific targets which have been rigorously followed up through several initiatives based on the National Policy on Skill Development, 2009.

 

All the 1,896 government ITIs (January 1^st, 2007) were taken up for upgrading into Centres of Excellence. First, the upgradation of 500 ITIs was announced in the Budget 2004-05. Out of 500 ITIs, 100 ITIs were taken up from Domestic Funding and 400 ITIs were taken up through the World Bank funding. Upgradation of remaining 1,396 government ITIs was started in 2007-08 through Public Private Partnership mode. The PPP mode has been implemented in the form of Institute Management Committees (IMCs) to ensure greater and active involvement of industry in all aspects of training. There are significant improvements in the modernised ITIs both in terms of percentage of trainees pass outs and finding jobs within a year.

The other major initiative was the Skill Development Initiative (SDI) Scheme based on Modular Employable Skills (MES) launched in 2007 to provide vocational training for early school leavers and existing workers, especially in the unorganised sector to improve their employability. The scheme facilitates afresh skill training through MES as per demand of markets. It also provides scope for directly testing and certification of skills acquired informally through Empanelled Assessment Bodies. More than 7,125 Vocational Training Providers are imparting skill training under the Scheme with 1,400 short term modules covering 60 sectors. So far, more than 1.6 million persons have been trained/tested since inception of the scheme.

The National Skill Development Corporation, set up in 2009 in PPP mode have mandate of training about 150 million people or 30% of 500 million by 2022, has partnered with 2,202 skill training institute/centres across the country and trained about one million persons and placed 6 lakh persons (61%) in the job market.

 

According to the Planning Commission, as on January 1^st, 2007, there were 5,114 ITIs/ITCs in the country with a seating capacity of 7.42 lakh. As on April 1^st, 2010, there were 8,039 ITIs/ITCs with a seating capacity of 11.15 lakh in the country. Thus, the last three years (2007-08 to 2009-10) had seen an increase of 2,925 ITIs/ITCs, which is 57% of the number of institutions set up in the first 60 years of Independence! By December 11, 2013, there were 10,750 ITIs/ITCs with seating capacity of 15.23 lakh in the country.

 

There are several other institutional reform initiatives for bridging the mismatch of skilled persons and the markets needs through Labour Market Information Systems, National Skills Qualification Framework, Sector Skill Councils, National Occupation Standards, Accreditation of Institutions and Quality Assurance, Assessment and Testing Bodies, etc. All are underway in massive efforts!

 

-B.Chandrasekaran

 

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Collective Voice and Collective Action through Women Self Help Groups

A silent movement for community driven development is shaping up in many villages of Uttar Pradesh with hundreds of women organised in Self Help Groups (SHGs). A team of seven young researchers from RGICS visited two such villages, namely Sarai Damu and Nebi in Rae Bareilly, to understand the modus operandi of the SHGs organised under Rajiv Gandhi Mahilla Vikas Pariyojana (RGMVP). 

In contrast to many villages in India that tell sad story of poverty, poor sanitation, unclean environment, dysfunctional hand-pumps, helplessness and vulnerable women, what we saw in the two villages of Rae Bareli was remarkably different. Sarai Damu and Nebi are clean villages with basic amenities and strong women who take decision for the family and village.

Key to this positive story is the role of women SHGs in the two villages, implemented by RGMVP. RGMVP is a rights-based organisation which organises poor rural women into community organisations in the form of SHGs, each having ten to twenty women. The program considers “women as the central agents of change”. In the two villages, a three-tier structure is in force, comprising of the SHGs (consisting of 10–20 poor women), Village Organisations (VOs) and Block Organisations (BOs).

Jamvati, an SHG member narrated her initial struggle to join the Self Help Group. Her husband opposed to the idea, because of which she had to borrow money from her friend to become an SHG member. With time, loans from the bank and benefits started to flow in. Now her family insists her on attending village meetings regularly. In her own words: “Pehle jab SHG se judne ki baat ki to pati ne paise dene se mana kar dia. Maine apni saheli se paise udhar maange aur ladhke pariyojana me hissa lia. Samay ke saath bank ka paisa aur faayda aane laga. Ab mere parivaar wale khud mujhe gaanv ki sabha me jaane ko kehte hain. Sab samay ki baat hai!”

The SHG women members informed us about the day to day functioning of the SHGs. The SHGs organise regular meetings to discuss issues ranging from loans, government schemes, issues like sanitation to personal problems. In addition, two meetings every month are conducted at the block level with have two from each SHG. These representatives share information with all the villagers. In these villages women are shapers of socio- economic discourse. With assistance from RGMVP, vocational trainings and information camps are also organised in these villages.

It is clear that the SHGs hold great promise. Apart from financial independence, the model has brought about a change in the social order in these villages. It has enabled women to overcome their fears in approaching higher authorities and the police to voice their rights. As of June 2013, RGMVP has reached out to over 1 million poor households in 252 blocks of 41 districts in the most backward regions of Uttar Pradesh. More villages would be covered by RGMVP. If the SHG models are integrated with political trainings, these empowered women can easily be nurtured as political representatives giving wings to the idea of grassroots democracy.

-Mahima Malik

How to Reduce Texting while Driving - Using Innovative Methods in Policy-Making

The most widely used policy intervention to reduce texting while driving is banning drivers from

Photo Credit: American Civil Liberties Union of Virginia

using hand-held and/or hands-free mobile phones. However, many studies claim that such bans, when enforced strictly, at best have a temporary effect in bringing down accidents before drivers resume old habits. Also, enforcing such bans is challenging because it is difficult to see whether a driver is texting unlike intoxicated driving where sobriety checkpoints serve as an effective enforcement mechanism. Given the above facts, can stronger enforcement or greater publicity and outreach help in significantly deterring texting while driving?

It is well-known knowledge that texting while driving can be life threatening, just as smoking is injurious to health. Yet the human mind defies existing knowledge and rational behaviour to indulge in reckless actions. How do we alter irrational human behaviour to save more lives?

The answer may lie in using behavioural science to design interventions and nudges that can prevent unreasonable human behaviour. In Mumbai, behavioural scientists have brought down the number of deaths resulting from crossing a railway track by enforcing innovative interventions that alter the behaviour of trespassers at vulnerable spots.  Similarly, “texting zones” in New York State that provide motorists with a pull off area to park and use their cell phones can possibly help in delaying the use of cell phones. High level mobile use, according to a study by University of Illinois, is associated with two behavioural determinants - perceived social norms and degree to which individuals see mobile phones as a part of their self. If policy interventions aim at targeting these behavioural traits it might lead to minimising such irrational behaviour. Of course, such measures would require a systematic collection of qualitative and quantitative data on road accidents caused by mobile phone usage.

Scientific and evidence based interventions aimed at targeting reckless behaviour can help in strengthening existing policy measures like bans and public awareness. Such interventions should emerge from out-of-the-box thinking that dredges such irrational behaviour into the realm of awareness and rationality.

Karishma Mutreja

"Water-Stressed" India

Photo Credit: USAID

The data released by the National Sample Survey Organization has once again brought the focus on the abysmal state of drinking water and sanitation in India. According to the report more than half of rural households in India don’t have toilet infrastructure and drinking water facilities within their homes.  Even the Census 2011 data released last year showed that 36 per cent households still have to fetch water from a source located within 500 metres in rural areas and 100 metres in urban areas.

The UN report on “Progress on Drinking Water and Sanitation-2012” reported that India houses 16 per cent of the world's population as compared to only 4 per cent of its water resources. 45 percent of India's children are stunted and 600,000 children under five years of age die each year largely because of inadequate water supply and poor sanitation.

In this context, UNICEF came up with the report “Water in India: Situation and Prospects” with the aim to contribute to efforts by the Government of India and partners to manage water resources more effectively during implementation of the Twelfth Five Year Plan. According to the report, the total utilizable water in India is higher than the current usage of water. However, because of the spatial variation in distribution of water, 71 per cent of India's water resources are available to only 36 per cent of the area. The current levels of service provision in many locations do not meet the minimum rights, and the monitoring of water supply is done in terms of coverage and not end use. Another reason for water crisis is the increase in population which has resulted in a reduction in per capita average water availability in the country. The national per capita water resource availability has declined considerably over the years and of particular concern is the disparity in water footprints of the rich and the poor.

So what is the way forward? Given these social realities of India, the report argues “that redefinition of needs has to become part of public debate, including how much water should be given free, how much should be at an affordable price, and to whom should this subsidy go?”There is sustained pressure from various quarters of society to transform the role of government from service provider to facilitator so it can provide the requisite level of financial and policy support to communities and community-based institutions. Today one of the biggest challenges for India lies in devising a “sensible mix of decentralized responsibilities and authority to local institutions and also providing large-scale investment to redirect the surplus water to water deficit areas.”

The advent of the Independent Regulatory Authorities or IRAs at the state level are new mechanisms which are expected to usher in sweeping fundamental and comprehensive changes in governance in this sector.

India can also explore the prospects and challenges of public-private partnership in water management. There have been a few success stories of PPP model but there are concerns about their ability to deliver services without interfering with the idea of human right to water. Further, the water privatization agenda in the PPP model needs better scrutiny from the water pricing perspective.

New models for community’s self- regulation and capacity building by civil society can impact the overall framework of people-centred development with more political and financial powers for the community to implement water-related projects.

India has an enormous governance deficit when dealing with changing water scenarios. With the overlapping powers and responsibilities of central and state governments, the overall sustainable vision for water development, conservation and management remains missing.

Understanding that there are social differences within communities, water is also a social factor and its access is socially constructed. Therefore overall water coverage data does not give an understanding of who is accessing and who is not. Further disaggregation of data at household and caste\community level will be a better indicator of individual's water access. Also de-linking water from land tenure may be the first step towards looking at water from a much more equitable lens.

Amrutha Jose Pampackal and Hansa Kaul

Bridging the Skill Gaps: Role of Education and On-the- Job Training

Photo credit: NSDC

Are “greater investment in education and training a prerequisite for employability, or can skills be built through jobs?” This question has become quite pertinent in the context of the job market where available skills are not fitting in well with the demands of the economy. The possible approaches to tackle this challenge are explored in the World Development Report, 2013. 
                                                                              

Skill mismatches are arguably growing rather than shrinking. Today, more than one-tenth of 15 to 24 year olds worldwide are functionally illiterate. Without numeracy and literacy skills, the prospects of improving employment opportunities and earnings, whether in agriculture or in urban settings, are thin.

Employment opportunities are seen to increase the demand for education, which systems then have to meet. Often privilege in access to jobs distorts the signals. It hurts and discourages, rather than encourages, the building of skills. Thus policy interventions should focus on ensuring that signals are adequately transmitted and incentives are provided to continue skill accumulation by the young and those of working age alike. In India, informing rural women about job opportunities led to increased schooling for girls and delayed marriage and childbearing for women. 

The report points out that though the straightforward response to skill mismatches would be for private firms or individuals to upgrade skills through further education or training—but several factors act as constraints like the market constraints. For example, lack of information about employment opportunities, transportation costs, or housing market failures may be the real reasons why workers do not take available jobs. Small firms and farms seldom have the necessary funds for training and education.

Institutional failures often end up replacing market failures. But many countries are trying to create oversight entities, to separate quality control and management of providers from financing. In India, the National Skills Development Strategy is based on the principle that the institutions in charge of training, certification, and accreditation should be strictly separated. On the negative side, scattered responsibilities across many Central Ministries, distance from the private sector and slow response to rapidly changing skill needs are some of the problems which continue to plague such systems.

The report emphasises that just as skills are important for jobs, the reverse is true as well. Many technical and social skills can be built through experience in the workplace. Apprenticeship programs, fostering the integration of education and learning through jobs, exist in various shapes around the world. The report suggests that informal apprenticeship can be strengthened through its gradual integration into national training systems. In France, Germany, and the Netherlands has a dual system credited with fast and structured employment integration. “But the dual system requires more than the right economic incentives—it is based on a social contract between employers, trade unions, and government.” Private sector commitment, including financing of training and continuation even in times of economic downturns, is fundamental. 

On-the-job training is consistently found to go hand-in-hand with higher labour earnings and productivity increases, even more so in developing than in industrial countries. But only a fraction of workers have access to it; those with less education and those working in smaller and informal enterprises seldom have the opportunity to benefit from training. Inequitable access and poor quality are key constraints in many countries and the reach of Technical and vocational education in rural areas is often very limited. 

In countries like Korea, industrial projections of manpower supply have taken a backseat to the country’s new initiatives emphasizing quality and relevance of education and skills development. The Korea University of Technology and Education (KUT) established the Bridge Model, a three-way partnership involving a single major enterprise and clusters of small and medium enterprises (SMEs) that serve as its main subcontractors. The major enterprise contributes technical knowledge, the SMEs bring in the employees to be trained, and the University supplies the teaching facilities and content.

Today the focus is gradually shifting from merely ensuring an adequate supply of skills to delivering demand-responsive, quality- skills development programs.

 

Medical Tourism in India

Source: gtp headlines

India had witnessed as many as 850,000 medical tourists in 2011 and is likely to provide its medical services to an astounding 3,200,000 medical tourists by 2015, according to an ASSOCHAM estimate.

Medical tourism came into being as there emerged a phenomenon wherein people began to travel across the globe for medical treatment. The term, medical tourism, was coined by mass media and travel agencies that took note of this mushrooming phenomenon.

India, for its part, has had a rich history of providing medical services to people from all corners of the world.  India’s ayurvedic treatment and yogic practices have always been attractive. However, in the current scenario, India along with a bunch of other South Asian countries have been drawing millions from European countries for being able to provide technologically advanced treatment that are at par with global standards in a timely manner and at affordable rates. Medical tourism is turning out to be a lucrative opportunity for most developing countries including Thailand, Singapore, Malaysia and India to earn revenue and improve economic growth. India is said to have the potential to attract 1 million health tourists per annum which is likely draw US$ 5 billion to the economy. The CII-McKinsey, in its report, had suggested earlier that medical tourism would fetch $2 billion by 2012 instead of $ 333 million as estimated in 2006-07.

Despite the promising potential, medical tourism has attracted some criticism both from the service providers as well the consumers. Currently, only private hospitals are involved in providing medical services to tourists. The public sector hospitals lag behind, although the CII has been making efforts to make public hospitals medical tourism sites. There is also the view that medical tourism caters to the elite from abroad for whom the cost and charges are easily affordable. But for a mostly poor nation like India, medical treatment remains a challenge. Despite having free medical services in certain cases in government hospitals, it does not cover all ailments and delivery mechanisms continue to be hostile in many cases.Thirdly, critics feel that if public hospitals are also included in providing medical services to foreigners, it will lead to neglecting the poor and needy. On the other hand tourists face difficulty with regard to accessing reliable information about hospitals, understanding local language, reporting fraud or any contention to the correct authority, etc.

As far as policy is concerned, India lacks a specific policy that deals with medical tourism. Nevertheless official measures have been taken in order to encourage medical tourism like relaxation of visa norms, issuing special medical visas, recognising the economic potential of medical tourism in the National Health Policy, offshore campaigning and marketing, etc. The absence of a regulatory body and an organised structure for medical tourism needs to be dealt with in depth as well.  Consequently, there is an increasing need to formulate an inclusive policy on medical tourism keeping in mind both- the consumers as well as providers.

Pallavi Ghosh and Neha Singh

Unleashing the power of rural women through Self-Help Groups

 

A World Bank report shows the impact that Self-Help Groups (SHGs) can have in empowering rural women. SHGs can bring social and political transformation– not only economic. A typical SHG in India consists of 1-20 poor women who meet to pool savings and discuss issues regarded important. SHGs lower the barriers to collective action, helping women to mobilize and pursue their interests.

The report investigated outcomes of a Self-Help Group programme facilitated by the Self-Employed Women’s Association (SEWA) in Dungarpur District, Rajasthan in India. Dungarpur is considered a highly backward district with a population of 11 lakhs, 65% of which belong to the Scheduled Tribe communities.

In villages where the programme was run, women were invited to join an SHG for a nominal fee of Rs.5, and members were trained by SEWA. Once a month, the SHG met to set savings targets. Funds collected were used to open a bank account that was linked to the SHG. Members could take loans as necessary, with an interest rate as determined by the SHG.

The report examined the impact of the programme on two groups of women - SHG members only and second, on all the women in the villages (including the non-members).

The impact of SHGs was studied in economic terms (savings of women), social terms (where they willing more to assert themselves at home) and civic terms (participation of women in Gram Sabhas, their role in addressing grievances like faulty water). The results confirmed that the SHG programmes had significantly improved the economic, social and civic conditions of the women members. SHG members participated in group activities, their savings and non-farm employment opportunities increased. This was by a large amount (e.g. 55% for group participation and 21% for saving). Similarly, the programme enhanced the voice of women in domestic affairs and civic power particularly through greater engagement with Gram Sabhas.

For villages as a whole, the intervention led to the increase in group participation and savings (albeit by expectedly smaller amounts than above). Women’s say in domestic decision making increased. However the intervention did not have as striking an effect on civic and political engagements. Comparing the two impacts suggests that conditions of women as a whole in SHG villages can be economically and socially (although maybe not civically) beneficial, even if not all women join them. This increases SHGs value for money.

However, intensive research needs to be done to understand precisely which components of the programme had the biggest impact in enhancing rural women’s power. However the report does suggest that training and education modules were useful, particularly in increasing women’s savings.

From 1999, the Government of India has been funding the SHGs. This was first through the Swarnajayanti Gram Swarozgar Yojana, which was replaced in 2011 by the NRLM. This report supports the transformative power of SHGs and therefore strengthens the NRLM goal, of mobilizing all rural and poor households into membership-based groups by 2015. It will therefore be important to make sure that SHGs are appropriately and sufficiently funded.

 

-by Anirudh Mathur

 

Report Link:

http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2013/07/29/000158349_20130729093041/Rendered/PDF/WPS6547.pdf

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