Livelihood, Health, Education And

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"Social Development:

Livelihood, Health, Education and

Women’s Empowerment — some emerging issues."

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India Contribution

1

Social Development:

Livelihood, Health, Education and

Women’s Empowerment — some emerging issues.

by: Mirai Chatterjee

Self Employed Women’s Association (SEWA)

SEWA Reception Centre,

Opposite Victoria Garden,

Bhadra, Ahmedabad 380001

Gujarat, India.

Phone : 91 – 079 –25506444 / 25506477

Fax : 91 – 079 – 25506446

Email:

Web site :

Social development has been on India’s overall development agenda since before our Independence. The leaders of our freedom movement, led by Mahatma Gandhi promoted the idea of “Swaraj” or holistic and integrated development, respecting the environment and the autonomy of local village communities. Social and economic development were viewed as intertwined, both necessary, if our people were to emerge from grinding poverty.

Consequently, development plans from the pre-independence era and after, laid special emphasis on social development. In the health sector, for example, the Sokhey and Bhore Committees prepared blue-prints for the health care system in India. This landmark, and still extremely relevant document, suggested decentralized public health services with a strong emphasis on investing in human resources, including developing local people as primary health care workers.

Similar committees and task forces were set up to plan for education, livelihood/employment and equal participation of women in nation-building and in the overall development of free India. The Planning Commission of India was established to provide an overall framework for the social and economic development of the country. Till today it prepares five-year plans for each sector and state. Currently, the eleventh five-year plan is under discussion and preparation.

Ten five-year plans later with millions of rupees in outlays, it is important to examine some of the issues emerging in health, education, livelihood/employment and women’s empowerment: where we have reached, where we are headed and some of the issues we face in the ongoing struggle for a society based on social justice and equality for all, as promised in our constitution.

This is by no means an exhaustive treatment of the issues at hand, but rather meant to stimulate discussion and debate on the issue of social development in modern India. Each of the above sectors will be discussed separately in this paper.

Livelihood/Employment

With a large population of working poor, livelihood and employment issues are bound to take centre-stage, because it is work and income that helps our people emerge from poverty and hunger. Time and again, and across the country and in all communities, our people say:

“If we work, we can eat and feed our children” or “We work for our stomachs”.

Employment and livelihood are the basic requirements of all Indians.

India’s huge, economically active population is its greatest strength. Yet to fully utilise this strength, it is critical we recognise its reality. Most of the Indian workforce is engaged in the vast informal economy—that is with no fixed employer-employee relationship or none at all. In fact, 93 % of the work force is informal. If we look at the female workforce, the numbers increase to more than 94%. This translates to about 350 million workers.

The informal economy accounts for 64% of GDP. It is the dominant mode of work and livelihood for most Indians. And yet, these workers do not enjoy security of work and income, nor statutory social security benefits. The labour of our hardy, resourceful workers contribute to the economic growth of our country, and yet they remain invisible, unprotected and vulnerable.

Some of the main issues that face the working poor, along with steps India is taking, are outlined here.

1. Perhaps the biggest issue is the lack of work and income security faced by the vast informal workforce. Informal workers work long, hard hours for very low wages or income. They are typically engaged in several economic activities at a time so that they can eke out a living. Many of the occupations and trades are hazardous—growing and processing tobacco, construction work and handling chemicals to name a few. Most do not get regular work—in fact, their whole lives centre around the quest for work to make two ends meet. Much of their work is seasonal. Since most informal workers are engaged in agriculture, their work lives are precarious and depend heavily on the monsoons. In the lean season or during drought, migration is common. These workers go to the nearest urban centre for work and sustenance.

Further, whenever work is available, income or wage levels are very low. Minimum wage levels set by the government are rarely met, and with a labour surplus and absence of strong unions in most places, the workers are forced to take whatever work and income they can get.

The recently enacted Rural Employment Guarantee Act (REGA) is an important step towards the work security of poor, rural households. It is truly a landmark piece of legislation, perhaps among the very few in existence anywhere. Through the REGA, one household member from every family in some of the poorest districts in India will get 100 days of employment, facilitated by the state. Thus, the state is guaranteeing a minimum level of work/employment to its poorest citizens. Soon the REGA will be extended to all districts in the country. And through the National Urban Renewal Mission, such guaranteed work and employment is likely to be extended to the urban poor as well.

1. Social Security—at least health care, child care, insurance, pension and shelter—is still not enjoyed by the mass of workers. While there are some workers’ welfare funds that provide protection and services and some social assistance programmes, there is work to be done, and models that can be replicated. In some states like Kerala, the workers’ welfare funds do reach significant numbers of workers. Similarly, the old age assistance, though modest, does reach some widows. But the millions of workers in the informal economy, for the most part, remain unprotected.

The National Commission of Enterprises in the Unorganised Sector (NCEUS) is attempting to change this situation by proposing a bill and appropriate services. If this is passed in Parliament, it will be a major achievement, as informal workers will by law be entitled to at least health, life and accident insurance, maternity benefits and pension. And states will be free to add on to this floor-level social security.

1. Environmental degradation—of our land, forests and water bodies—pose a direct threat to the most vulnerable of workers in India. With the deteriorating environmental conditions across the country, water has become a burning issue. And the cutting down of our forests, rampant use of pesticides, leasing land and forests for contract farming, mining and other industries, is forcing our people off the land and into penury.

Large-scale development projects—whether for mining, irrigation and other purposes—have not only become controversial but also have spawned people’s movements, questioning the development choices and paths that we are taking.

Raw materials—like access to bamboo for rural artisans, cotton yarn for handloom weavers, fish and shrimps for traditional fisherfolk—are increasingly hard to come by for these primary producers.

Then there is the issue of changing markets due to both domestic and external changes in trade and marketing. Globalization is under close scrutiny both nationally and internationally for what it actually delivers to the majority of our citizens. This is an important subject in and of itself. But it merits at least a mention here.

Marketing linkages are required to ensure that workers get fair prices for their products. in our globalized world, stronger direct linkages between producers and buyers are essential to help support families, communities and eventually nations out of poverty.

To ensure that this indeed occurs, countries have to ensure that primary producers get all the support they need (access to raw materials, design development, working capital, capacity-building, knowledge of markets, among other inputs) to maximize marketing domestically.

At the international level, governments, people’s organisations and NGOs, need to ensure that producers’ interests are safeguarded, and that they get remunerative prices for their products. In particular, direct and indirect subsidies in developed countries for products like agricultural produce, must be removed. It is only then that rural people working on the land, will have a chance to emerge from poverty.

1. Skill development or upgradation, with appropriate technical and design inputs are among the much-needed livelihood and employment-related inputs. While we have excellent higher, professional education institutions, we still lack polytechnics and institutes that serve workers, offering them new skills, exposure to technology and linking them with new employment and livelihood opportunities, as well as market linkages. There are the ITIs, but we need many more such technical training institutes that will make our young people and workers more skilled and employable in the new national and global context.

One example of what can be done is that of the Confederation of Indian Industry (CII). It is currently running a programme of skill upgradation, with certification by the ITIs.

In sum, while livelihood and employment are the key to poverty reduction, and indeed the very survival of most Indians, we still have very far to go in terms of providing work, income and social security at the household level to our people.

While lately this is appearing more on the development agenda, it deserves much more attention, given that it is still the top priority of most Indians—certainly the more than 90% of workers in the informal economy.

Health

Huge and impressive strides have been made in the health sector since independence. There have been significant changes:

a)Reduction of morbidity and mortality across all regions and communities in India. Reduction has been particularly dramatic in communicable diseases, infant and child mortality. Maternal mortality has also declined, and life expectancy has increased markedly for both women and men (See Appendices1,2).

The birth rate and fertility levels in India, as a whole, have also fallen, and we are in the process of a demographic transition (See Appendix 3).

b)Increases in skilled human resources in health has resulted in greater availability of health care providers in all parts of the country. Indeed, India has now become one of the main exporters of doctors, nurses and other skilled health personnel globally.

c)Health has become a major political priority. From new policies to increased media attention, the importance of health is visible on a variety of fronts. As a result of people’s movements, a growing evidence base and an overall recognition of the critical role of health in a nation’s development, the current environment is ripe for even more rapid change and progress.

While there is no question that we have moved forward, a number of difficult issues have emerged, ones that we must grapple with squarely, if we are to move towards our ultimate goal of health for all, and with equity.

Some of the main issues are highlighted here.

1. The dramatic declines in morbidity and mortality levels are unevenly spread across the country. There are marked regional differences, disparities by gender, community and income level. In sum, the improvements in levels of health are unequally distributed. There is a gradient, with some states, communities and males at the top and others, including women, tribals, dalits, remote mountain and desert communities at the bottom.

The above inequitable trend in health is best illustrated by the now celebrated case of Kerala. For a number of socio-economic, cultural and structural reasons, Kerala has among the best health and education indicators in the country: 16.4 per 1000 live births for infant mortality compare to 43.8 as per the national census. Literacy rate is over 90% in Kerala, compared tot he national average of 65%. This is in sharp contrast to Bihar, Orissa and some of the other “weaker” states (Uttar Pradesh, Madhya Pradesh, Jharkhand, Chhatisgarh, Rajasthan and parts of the North-East and Uttaranchal).

1. There is uneven distribution of skilled health personnel in the country, with 80 per cent of doctors providing their services in the urban areas, and especially the large metropolitan ones. Most of rural India does not receive the benefits of a functioning public health system with life-saving services. To counter this, the government has recently instituted a National Rural Health Mission – a programme to ensure integrated services at the village level, with significant financial outlays for infrastructure and personnel, including a village-level female social health activist called ASHA. This mission is also promoting public-private partnerships, especially in the poorest states, to ensure that services actually reach people.

1. Resource allocation in the health sector has on the whole been inadequate and skewed, favouring curative care through large tertiary hospitals, mainly in urban areas. Public health, preventive medicine and health education have received much fewer resource allocations. In fact, family planning as a sector has obtained a huge chunk of resources, as if fertility can be dealt with in isolation from other social inputs.

1. Implementation or actual delivery of services has been mediocre at best, and very poor in many states, especially for our rural citizens. While Kerala, Goa, Tamil Nadu and some regions of other states have shown marked improvement in both health status and services, other areas are still causes of concern.

The main problem is that the system does not deliver—doctors do not go to the villages or even to the district-level, their and others’ non-performance is not dealt with because of their economic and political clout, medicines and other equipment do not reach or are under- and unutilized and life-saving supplies of blood and other essentials are just not available for the mass of Indians.

In many areas, corruption is an issue. Medical supplies never reach where they should and instead end up on the black market, transfers of health personnel in government occur frequently, and there are irregularities in procedures which accompany the ordering of goods and public tenders. In Karnataka state, a whole commission has been set up to detect and stem corruption in the public health system.

1. There is a huge and totally unregulated private health care system in India. Today 80 per cent of all Indians go to private health providers, spending vast sums out of pocket. In fact, health-related expenditure is the number one cause of indebtedness and assetlessnes among the poor.

The private health sector does provide timely, much-needed care, and in situations where often the public health system functions poorly or not at all. However, the care is not always rational and of acceptable quality. And it is always more expensive than public services.

In our experience of organizing health insurance for the poor, we have seen that private providers cost three to five times more than the same health public services. Moreover, there is a strong tendency to over-prescribe medicines, promote unnecessary diagnostic tests and hospital admissions.

In fact our experience has prompted us to develop tie-ups with local hospitals—government, trust and private—in order to ensure high quality, appropriate care and at low cost.

6. Health insurance is almost non-existent in India, especially for the working poor. As mentioned above, with spiraling medical costs, sickness has become the number one cause of indebtedness amongst poor families, pushing them deeper into poverty.

Education

This is a sector that has been given prime importance by all governments since Independence. Gandhiji himself advocated a holistic and value-based education, rooted in our culture and in our ground realities. He called this “Nai Taleem” or “ New Education/Training”. This type of education was designed to open the mind, encourage questioning and also prepare young people for a life of service to India and Indians, especially the poor.

India has undoubtedly made several important gains in education. Literacy levels for both women and men have increased since Independence and basic infrastructure like schools and colleges exist in most states. There have been recent serious efforts to re-vamp our school curriculum to one which is both holistic, culturally sensitive to our plural society. Our specialized and professional education institutes—the IIMs, the IITs, architecture, design, engineering and medical schools and colleges—are among the best in the world. Professionals graduating from these and other educational institutions in India are among the most coveted and highly paid. A case in point is the famed Silicon Valley in the U.S. where a high proportion of successful “techies” are Indians. Bangalore’s growing IT sector has also attracted world attention as a centre of excellence.