Blog Post Year: 2018

Yes, how many deaths will it take till we know

…that too many children have died?

I adapt this from Dylan’s famous 1962 lyrics, but it is nowhere more true than for Adivasis or tribal peoples (called Scheduled Tribes) in India.

Come monsoon, the Indian media is rife with stories of child deaths in tribal areas, frequently reported as “malnutrition deaths”. Kalahandi district in Orissa for instance, had been a metaphor for starvation due to press reports dating back to the 1980s. Melghat area in Maharashtra has similarly surfaced in the press especially during the monsoon when migrant Adivasis return to their villages and to empty food stocks in the home. This is followed by public outrage, sometimes by public interest litigation and often a haggling over numbers.

 

A disproportionately high number of child deaths are concentrated among adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of adivasis.

We recently published a working paper that looks at child mortality among India’s adivasis – the starkest manifestation of their deprivation. We find that an average Indian child has a 25 percent lower likelihood of dying under the age of five compared to an adivasi child. In rural areas, where the majority of adivasi children live, they made up about 11 percent of all births but 23 percent of all deaths in the five years preceding the National Family Heath Survey 2005. While there has been progress in child survival over the years, and much greater vigilance, which often leads to these stories surfacing in the media at all, the fact remains that children in tribal areas are at much greater risk of dying than those in other areas.


Our analysis based on national data from the National Family and Health Survey 2005 has three findings. First, a disproportionately high number of child deaths are concentrated among adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of adivasis. Any effort to reduce child morality in the aggregate will have to focus more squarely on lowering mortality among the adivasis. Second, the gap in mortality between adivasi children and the rest really appears after the age of one. In fact, before the age of one, tribal children face more or less similar odds of dying as other children. But these odds significantly reverse later. This calls for a shift in attention from infant mortality or in general under-five mortality to factors that cause a wedge between tribal children and the rest between the ages of one and five. Third, the analysis goes contrary to the conventional narrative of poverty being the primary factor driving differences between mortality outcomes.

There are many small and very important initiatives that have lowered child mortality among adivasis, but how do you scale them up?

India is not alone in having such poor outcomes for its adivasis – called “indigenous peoples” in the global context. A recent global report on indigenous peoples edited by Gillette Hall and Harry Patrinos was released yesterday in New York at the UN Permanent Forum on Indigenous Issues. And it shows remarkable congruence in the processes and outcomes that exclude indigenous peoples the world over.

Very soon, a new report on social exclusion in India that we have been working on will be ready for review – and it also addresses adivasi deprivation using national data. We look at poverty rates and the fact that adivasis in 2004 were where the average Indian was twenty years ago. I will keep you posted through this blog.

Maitreyi Bordia Das is Senior Social Protection Specialist in the South Asia Human Development Department at the World Bank in Washington DC. This piece was cross posted from Maitreyi’s Blog. Log on to read more of her posts.

Mid Day Meal Scheme – Centralisation is no panacea

The National programme for Nutritional Support for Primary Education commonly referred to as the Mid Meal Scheme (MDM’s) is aimed at providing supplementary nutrition to primary school children with the overall objective of enhancing enrollment, retention and participation of children while simultaneously improving their nutritional status. Under the scheme every child in every government school and government assisted primary school is provided with a prepared mid day meal with a minimum calorie content of 450 calories and 12 grams of protein on a daily basis for a minimum of 200 days.

A far cry from providing such benefits, the functioning of MDM’s in Delhi has most recently been found to impede rather than improve the nutritional status of children in government schools. Last week 29 children studying in a government girls middle school in Hauz Qazi near Ajmeri Gate, fell ill after consuming ‘choley puri’ served as part of the mid day meal. While a case was registered with the police, school and government authorities responded by dismissing claims of illness pointing out that they were psychological in nature. According to the State Education Minister, Arivnder Singh Lovely, ‘somebody had spread a rumour that there was an insect in the food due to which students started feeling sick’. This incident comes in the wake of a similar case in the November 2009 when 125 children from a government school in Trilokpari fell ill after consuming the mid day meal. Following large scale protest by parents and opposition parties the Delhi government responded by suspending the MDM scheme for two days to review it’s functioning. Additionally the license of the society responsible for providing such food was also cancelled and samples of the contaminated food were taken for examination.

Ironically such instances have emerged despite the move by the Department of Education (the nodal agency responsible for the implementation of the MDM scheme) to outsource the responsibility of supplying MDM’s to a number of NGO’s/Societies. Unlike states which follow a decentralized model wherein food is prepared within the school premises by a cook or a helper, the Department of Education has opted for a centralized model where an external agency prepares and supplies meals to schools. The rationale behind the adoption of this model was the belief that food prepared in a centralized kitchen would ensure the provision of hygienic and nutritious food as well as allow for the optimum utilization of infrastructural facilities. It was felt that only a centralized model allowed for mechanized food preparation which was touted as being efficient as it would simultaneously lower labour costs and by limiting the chances of human contact, also serve to lower the occurrence of food contamination. Moreover the reduced financial responsibility of the DOE within such a model was also an important motivation for its adoption. Today there are 11 NGO’s/Societies who operate a total of 13 kitchens and supply food to 1.1 lack children who are covered under the scheme.

Currently the MDM scheme is monitored by a range of bodies, the foremost being the School Mid-day Meal Committees (SMDMC). The (SMDMC) is constituted at the school level and comprises of the Head of School, Teacher in charge of the MDM, Home Science teacher, at least 3 mothers of children from different classes, the DDO of the school and one Vidyalaya Kalyan Samiti (VKS) member. These committees are empowered with the responsibility of receiving and monitoring the MDM’s on a daily basis. At the department level, a Zonal Level Steering Cum Monitoring Committee, comprising of the Education Officer of the zone, two principals, two parents and one VKS member is expected to draw up a month-wise programme of monitoring the distribution of the MDM and inform the DDEs (District Deputy Directors of Education) about the same. Education Officers (EO’s) are also expected to be present as far as possible in schools falling within their respective zones at the time of distribution of the MDM. The monitoring of the working of the SDMC’s and the Zonal level steering committee is the responsibility of the DDE’s. Complaints from parents, schools or service providers are examined and resolved by the DDEs. In addition MDM guidelines also allow for appointment of independent agencies to monitor and evaluate the agencies.

In spite of the formulation of such a robust monitoring structure, its implementation has been found to be far from adequate. According to a recent study conducted by the Supreme Court Commissioners Office regarding the functioning of the MDM’s in the city, the participation of beneficiaries particularly parents and children in monitoring bodies such as the SDMC has been found to be minimal. In many instances testing of food is only done once the food is delivered to the schools. Teachers often do not visit the kitchens to test the quality of food provided. Furthermore EO’s also rarely visit schools to oversee the distribution of MDM’s. In 2008 out of the 136.86 lakhs which were allocated towards Management and Monitoring Expenditure, the total expenditure under this head was only 1.40 lakhs (1%) with expenditure on school monitoring committees accounting for 0%. Moreover within the 1.40 lakhs which were spent, management expenses accounted for a bulk of the share. External monitoring and evaluation expenditure during that year was also reported as being nil.

Thus problems of food contamination and lack of quality hardly seem surprising in light of such ineffective systems of monitoring. The Department of Education’s eagerness in outsourcing the supply of food grains was not matched with an emphasis on strengthening the monitoring and accountability provisions. The centralized model was heralded as a panacea without due cognizance of the fact that unlike a decentralized model where the suppliers and the beneficiaries come in direct contact, the new model served to increase the distance between the suppliers and the ultimate beneficiaries making it more difficult for the beneficiaries to monitor the supply of services.

Gayatri Sahgal is a Research Associate with the Accountability Initiative.

Livemint series: MGNREGA Implementation in 5 States

The Mahatma Gandhi National Rural Employment Guarantee Scheme is considered one of the largest social safety nets of its kind, spending under which has totaled almost Rs. 80,000 crore in the past four years. Livemint has recently published an extensive series on MGNREGA, assessing its implementation in various regions. The record and status is patchy but hopeful, and continued government commitment to the program appears crucial for its success.

Uttar Pradesh: Bundelkhand is one of the least developed regions in India, making it an ideal environment to test the effectiveness of MGNREGA. The scheme has had few successes here and the defining narrative here is one of corruption and ignorance. To read the Livemint article, click here.

Chhattisgarh: With social progress and development widely considered effective barriers to the lure of Maoism, the success of MGNREGA in this region could prove especially significant. While initial results are hopeful, the state is still developing infrastructure to help MGNREGA projects take off. To read the Livemint article, click here.

Rajasthan: The MGNREGA appears to have altered both economic and social dynamics in the region. Almost two-thirds of the people employed under the scheme in this state are women, and their rising socio-economic independence is contributing significantly to their empowerment. To the read the Livemint article, click here.

Andhra Pradesh: The state is amongst the top-performers under the MGNREGA. Unlike most other states, officials in Andhra Pradesh have adopted an entirely different delivery model which bypasses the panchayats. The scheme has garnered impressive performance metrics with its unique delivery model which has  remained successful. To read the Livemint article, click here.

Orissa: The lack of significant change brought about by the MGNREGA scheme in the severely poor, drought-afflicted region of Kalahandi highlights that it has not been able to avoid the usual trappings that hinder the effectiveness of social development programs. Primarily due to low awareness, the scheme has failed in its promise to provide a reliable safety net for the poor. To read the Livemint article, click here.

NREGA wage payments through banks: Taking Stock

In May 2008, the Government declared that wage payments, under the National Rural Employment Guarantee Act, the world’s largest rural public works programme, would be made through banks. According to a recent announcement, under the new system of financial inclusion 8.60 NREGA workers accounts have been opened and about 82% of wages i.e. close to 17,000 crores have been disbursed through these accounts up to December 2009 – accounting for 70% of the expenditure under the programme. Although this new system has been hailed as a foolproof, cost-effective solution to reduce leakages and to promote greater transparency, the transition was rushed and several complications with the new system are now becoming apparent.

Delays in wage disbursement: The issue of delays in wage payments is one of the most serious problems with the system of bank payments. Reports from several states including Jharkhand, West Bengal, Chhattisgarh, Rajasthan, Madhya Pradesh, Uttar Pradesh and West Bengal indicate the problem of delayed payments and dwindling interest in employment under the NREGA is rampant across several states.

It is a well established argument that the coverage of banks and post offices in rural India is patchy and as a consequence workers especially in remote parts of the country find it difficult to travel long distances to collect their wages causing delays in payments. Interestingly though findings from a survey in UP and Jharkhand indicate that close to 90% of workers who lived more than 5 km from a bank/post office expressed a preference for bank payments over cash despite the distance, indicating the deeper problems lie elsewhere. An important cause of the severe delays in the disbursement of wages is the institutional incapacity of rural banks to handle the huge volume of accounts. The shortage of staff and technology is most acute in post offices where accounts are managed manually through log journals.

However, the cause of delayed payments is more complicated than this. There are several bottlenecks associated with the different steps in the wage payment process: Filling the muster roll, measuring work and matching with attendance, preparing payment orders, sanctioning of cheques by officials and finally crediting of wages in workers accounts by the bank. Centre-state financial norms are not always clear and often mired in politics causing significant delays in the flow of funds from the central to state governments. A detailed discussion on these delays at different levels can be found in a recently published article by Reetika Khera called ‘Wages of Delay’.

Although such delays legally entitle workers to unemployment benefit, compensation has rarely been paid which is a clear violation of the Act. The government has acknowledged this gap and has sought to rectify it by directing state governments to ensure that the ‘twin legal mandates’ of wage payment within 15 days and through institutional accounts are ‘scrupulously adhered to’. A host of directives follow such as holding of a monthly Gram Rozgar Diwas at the panchayat level in which issues of payment backlogs will be cleared, strict monitoring of timely payment of wages by the District Programme Coordinator etc.

The ‘Business Correspondent Model’ which is currently being rolled out by the government is an attempt to address this problem of delayed payments and ensure that the rural poor have timely access to financial services. How this works is that the business correspondent (BC) would, on behalf of the banks, for a commission, deliver financial services to ‘clients’ though appropriate technology like handheld computer devices. However, given that the problem of delays is more complex than a simple issue of institutional access, the solutions might lie beyond the scope of this administrative ‘innovation’.

Corruption: While the move of separating the implementation and payment agencies has countered the earlier forms of corruption such as siphoning of funds, some forms of embezzlement have persisted and some new forms have emerged. The first is through ‘deception’ where often the abhikarta (implementing agency) in collusion with the bank officials withdraws money from the accounts of workers without their knowledge. The second is through ‘exploitation’ where genuine workers withdraw their wages themselves but are forced to hand over part of their money to the contractor or sarpanch based on a pre-decided ‘deal’. The third method is where workers ‘collude’ with the implementing agency and fake names are entered in the muster roll on the basis of which wages are withdrawn.

While the first type of embezzlement can be effectively dealt with through strict enforcement of certain minimum safeguards such as ensuring money is only withdrawn by the account holder. The other two types of embezzlement are perhaps more difficult to counter because they are borne out of an essentially feudal, exploitative set up in which rural banks function.

Taking strict action against such corruption, the government has restated that unfair practices in the system of wage payments will be punishable under section 25 of the Act. However the record for invoking this clause has been quite abysmal. While enforcing this penalty clause which allows for a fine up to 1000 will ensure accountability to some extent, there is a pressing need to restore transparency safeguards already built into the act. Public scrutiny of wages through reading out muster rolls and regular updating of job cards needs to be reinstated. This is a powerful practice because it enables workers to verify their attendance and monitor wage payments themselves, thereby curbing corruption.

The switch to bank payments has without a doubt provided substantial protection against embezzlement and is a critical step towards ensuring greater accountability in the disbursement of wages under the NREGA. However, the issue of delays in wage payment needs to be tackled swiftly by both streamlining processes and mechanisms under the system of bank payments as well as reinforcing traditional safeguards.

Anindita Adhikari is a Research Associate with the ASER Centre.

UPA First-Year Performance Review: Mixed Results, Promising Future?

As the UPA-II completes its first year, there have been a series of articles in the media assessing its performance on various  fronts. Livemint has published a review of the UPA’s reform agena, <a href=”http://epaper.livemint.com/ArticleImage.aspx?article=19_05_2010_008_001&amp;mode=1″ target=”_blank”>Good Moves, Bad Press</a>, and posted a <a href=”http://dl.dropbox.com/u/1738449/UPA%20POLICY.mp3″ target=”_blank”>podcast  discussion</a> with AI’s Yamini Aiyar on the UPA’s successes and failures. <a href=”http://dl.dropbox.com/u/1962232/slideshows/POLICYUPApublish_to_web/index.html” target=”_blank”>Click here</a> to see a slideshow summarizing the major UPA policies. The  economy appears to have rebounded well after the global financial meltdown, but <a href=”http://www.livemint.com/2010/05/17210711/Government-seems-stalled-it-i.html” target=”_blank”>according to Rajya Sabha member N.K. Singh</a>, the government is stalling on the economic front and needs fresh initiatives and resolve. <a href=”http://blip.tv/file/get/Livemintpodcasts-EconomicReviewOfTheUPAsFirstYearInPower471.mp3″ target=”_blank”>Listen</a> to chief statistician of India Pronab Sen speak on the present state of  the Indian economy under the UPA and what predictions can be drawn for the  future, and view a <a href=”http://www.livemint.com/94B8802B-E2E3-49C1-BF79-0FBF010AA855ArtVPF.gif” target=”_blank”>graphic summary</a> on the ups and downs of the economy over the year.<br /><br /> The UPA  intended to focus on infrastructure development as a core interest over the past  year, <a href=”http://www.livemint.com/2010/05/19222953/Infrastructure-the-good-the.html?h=B” target=”_blank”>however its achievements on various infrastructure fronts have been mixed</a>.  Gokul Chaudhry, a partner at BMR advisors, provides perspective on the UPA’s challenges and successes in developing infrastructure in this <a href=”http://blip.tv/file/get/Livemintpodcasts-ReportCardTheUPAOnInfrastrucure165.mp3″ target=”_blank”>audio discussion</a>.<br /><br />Finally, the Economic Times’ Debate Section includes a  series on the UPA’s performance with perspectives from the CPI, the UPA, and  the Opposition. <a href=”http://economictimes.indiatimes.com/ET-Debate/articleshow/5951050.cms” target=”_blank”>Brinda Karat</a> comments on how the diminished presence of the Left this year  has led to a more opportunistic government, less focused on policies for the  masses and more interested in its own agendas and the desires of powerful special  interest groups. <a href=”http://economictimes.indiatimes.com/Opinion/ET-Debate/How-has-UPA-II-fared-in-the-first-year/articleshow/5951050.cms?curpg=2″ target=”_blank”>Salman Khurshid</a> points toward the transformations in rural India, and the  reforms made in education, law, and in areas concerning equality and minority empowerment as powerful indicators of the UPA’s success, and  optimistically highlights the potential success of policies on the horizon. <a href=”http://economictimes.indiatimes.com/Opinion/ET-Debate/How-has-UPA-II-fared-in-the-first-year/articleshow/5951050.cms?curpg=3″ target=”_blank”>Arun Jaitley</a> however, highlights the PM’s lack of control and what he  views as a tendency of the government to favour the corrupt.

Accountability News Update – 16 April 2010

A fortnightly round up of accountability news and views from around the world.

UK: Web-inventor calls for government data transparency
The inventor of the World Wide Web talks about the need for countries to open up and make public data accessible to all citizens.

Pakistan: Access to information now a fundamental right
The Right to Information is now a fundamental right in Pakistan following the insertion of Article 19A in the Constitution via the 18th Amendment Bill. Under article 19A, “Every citizen shall have the right to have access to information in all matters of public importance subject to regulation and reasonable restriction imposed by the law.”

US: Calls for ‘YouTube’ of Government data
US Technology Chief, Vivek Kundra has encouraged technology developers to create a ‘YouTube’ of government data in the US. The tool would enable people to “slice and dice” data to create mashups and web applications to reveal new patterns and carry out analysis.

UK: New Anti-bribery legislation comes into force
A new Bribery law in the UK heralds a clampdown on large UK businesses making payments to officials overseas to facilitate business, say experts. The new act has introduced an offence of corporate failure to prevent bribery. It is the first time such a law has existed in the UK. It also requires companies to have “adequate processes” in place to prevent such offences.

Canada: Delays leave access to information rights ‘totally obliterated’
A recent report on the performance of Canada’s Access to Information Act flags chronic delays as a serious impediment to citizens trying to access information. The report, entitled Out of Time, documents the extent of delays and identifies factors contributing to them, based on an assessment of how 24 federal institutions responded to access to information requests in 2008-2009. These institutions account for 88 percent of the requests Canadians submitted that year.

Brazil: Congress passes Right to Information Bill
The Lower House of the Brazilian Congress has approved a draft bill on the Right to Information. The RTI Bill now awaits approval by the Senate and if passed will give effect to the right to information enshrined in the Brazilian Constitution of 1988.

FAQs on NRHM Fund Flows

The National Rural Health Mission (NRHM) aims at strengthening the financial management structure and accounting systems so as to conform to best practices and meet accounting and auditing standards, at all levels. However, on several fronts, achievements have fallen short.

1. At what level can one identify the variations in reported figures?

Answer: The Comptroller and Auditor General (CAG) report observed that at times, variations were noticed between the funds releases by GOI and those received by State Health Society (SHS).
a) For FY 2007-08, the figures released to SHS, Andhra Pradesh (reported by GOI) was Rs. 597.83 crore. However the SHC reported to have received only Rs. 556.96 crore.
b) Even there is a gap between the funds released by SHS to District Health Society (DHC) and funds received by DHS. For FY 2008-09, Kurnool district in Andhra Pradesh had reportedly received only Rs. 951.75lakhs, however as per the SHC’s record, they have released Rs.1131.13 lakhs.

2. How regular is the fund flow from SHC to DHC?

Answer: Considerable fund remains with ICICI bank (banking partner in 13 states), both at State and District levels, till such time they were actually utilised. In Kerala, the monthly balance in the ICICI bank account of the SHS ranged between Rs. 17.52 crore to Rs. 86.12 crore during 2007-08. Average monthly balance worked out to Rs. 49.52 crore.

3. Does this unspent amount earn interest?

Answer: As per the NRHM framework, funds were to be kept in interest bearing bank accounts. However, in two States, unspent funds were not kept in interest bearing accounts.
a) In Assam, DHS Lakhimpur kept Rs.1.20 crore in current account
b) Similarly, in Bihar, SHS deposited Rs. 106.76 crore in March 2007 in non-interest bearing account
c) DHS, Bhojpur kept the NRHM funds in a current account and sustained an interest loss of Rs 37.42 lakh as of June 2008.

 

Cases of discrepancy between opening balance of SHSs and DHSs, difference between cash balance depicted in accounts and bank pass book, inconsistency between opening balance of the current year and closing balance of the previous year etc. were observed.

4. Has the money always get spent on prescribed line items?

Answer: As per rules, funds were required to be spent for the purpose for which they were intended. But that is not always the case.
For instance, for FY 2008-09, in Karnakta, Rs. 0.36 crores of NRHM fund was spent on purchase of
i) four wheelers under Kysanur Forest Disease Control Programme, ii) control of Handigodu disease, iii) and even on Mysore Dasara Exhibition.

5. What is the experience so far with the state wise audited reports?

Answer: Cases of discrepancy between opening balance of SHSs and DHSs, difference between cash balance depicted in accounts and bank pass book, inconsistency between opening balance of the current year and closing balance of the previous year etc. were observed.
In Bihar, four different opening balances as on 1 April 2005 were noticed in four different sets of documents of SHS detailed below:
Opening balance Amount (Rs. in crore) as on 01-04-2005
As per SOE——— ———————47.66
As per annual account of 2005-06 —-45.12
As per financial statement ————-52.67
As per Bank account ——————-43.78

6. So, after spending this huge sum of money every year, does all PHC/SC/CHS have atleast electricity facility?

Answer: No. For example, as per latest figures available, by the end of FY 2008-09,
A) In Bihar 72 SC and 30 PHC do not have electricity connection
B) In Arunachal Pradesh 37 SC and 5 PHC do not have electricity connection

7. Now that we know the problem, what is the solution?

Answer: There should be clear guideline for the nodal personnel to integrate data under various NRHM components at the DHC and SHS level.
a) Unique identification number for institutions (UIID), in line with UID, might make the fund flow tracking process easier to operate and monitor. It would provide the authorities a tool to make timely interventions.
b) We should also have a country wide unique accounting and reporting framework. The format should be user friendly and should not vary from state to state. As part of this new format the district level accountant should have the capability to consolidate realtime data presented in Rogi Kalyan Samiti’s (RSK) meetings.

Sruti Bandyopadhyay is a Research Associate with the Accountability Initiative

Health Care Spending Rising Faster Than Economic Growth In Industrialized Countries – OECD Health Data 2010

While India is still struggling to live up to the “Nine is Mine” dream (calling for 9% of GDP to be committed to health and education), according to OECD’s Health Data 2010, in leading industrialized countries, the health care spending is rising faster than economic growth. The study reports:

  • Average health spending in the 31 member OECD counties has increased from 7.8 percent of GDP in 2000 to 9.0 percent in 2008 –averaging around 8.4% of the GDP.
  • During the same period, health spending per person increased by 4.2% a year on average.
  • Governments of most OECD countries shoulder most of the burden of healthcare costs. Public expenditure has increased from an average of 12% of total government spending in 1990 to a record 16% in 2008.
  • United States tops the list, spending 7,538 dollars per person on health care in 2008, more than double the average 3,000 dollars for all OECD countries.

From Outlays to Outcomes- Getting Development from Development Expenditures

In August 2009, AI and the Centre for Development Finance, Institute for Financial Management and Research organised a conference entitled “From Outlays to Outcomes – Getting Development from Development Expenditures” in New Delhi. The papers presented at the conference have been featured in a special issue of India Review (Volume 9 Issue 2 2010). These include a section of guest editor papers, a number of papers discussing accountability in public expenditures in India, and a review essay on decentralization, institutions and accountability.