Panel 4: Implementing Social Policy In India Wednesday, April 19 th (1:30-2:45pm) 13 th Symposium on Development and Social Transformation.

Panel 4: Implementing Social Policy In India

Wednesday, April 19th (1:30-2:45pm)

13th Symposium on

Development and Social Transformation

India’s Population: An Overview

Anuradha Chagti

Panel 4: Implementing Social Policy In India

13th Symposium onDevelopment and Social Transformation

INDIA’S POPULATION: INDIA’S POPULATION: AN OVERVIEWAN OVERVIEW

ANURADHA CHAGTIANURADHA CHAGTI

The Teeming MillionsThe Teeming Millions 1027 Million on 1st

March 2001.

Population multiplied by 5 times in the last century.

Second most populous country in the world.

Poised to cross China’s population by 2045.

History of Population Growth History of Population Growth

Although the birth rate in India has been falling since the 1960s, it was only during 1991-2001 that it fell significantly faster than the death rate - so bringing about a clear reduction

India is now entering the second phase of the demographic transition.

Population Characteristics Population Characteristics The decadal growth rate of

India’s population was 21.3% in the last decade. Great variation among the states with Bihar recording the highest decadal growth rate of 28.4% and Kerala the lowest at 9.4%.

Uttar Pradesh continues to be the most populace state with a population of 166 million.

The density of India is 324 persons per square. West Bengal has the highest density (904) followed by Bihar (880)

Population Characteristics Population Characteristics (cont)(cont)

Sex ratio is 933. Kerala highest Sex ratio is 933. Kerala highest sex ratio (1058) and Haryana the sex ratio (1058) and Haryana the lowest (861)lowest (861)

The child sex ratio (0-6 age The child sex ratio (0-6 age group) 927 in 2001. The sharpest group) 927 in 2001. The sharpest decline has been in the richer decline has been in the richer northern states. northern states.

The literacy rate for population The literacy rate for population seven years and over was 65.4% seven years and over was 65.4% in 2001. Highest in Kerala 90.9% in 2001. Highest in Kerala 90.9% and the lowest Bihar 47.5%. and the lowest Bihar 47.5%.

For the first time since For the first time since independence an absolute decline independence an absolute decline in the number of illiterate in the number of illiterate persons: by 32 million during the persons: by 32 million during the last decade. last decade.

Is the Growth Sustainable?Is the Growth Sustainable?

Questions are being raised about India’s ability to sustain such a large population especially in the realms of

Health and education

Food and water

Environmental damage

Government Initiatives Government Initiatives Pre 1990’s Pre 1990’s

Dominated b demographic goals. Target Dominated b demographic goals. Target oriented. Foriented. Focused primarily on sterilization, ocused primarily on sterilization, largely obviating client choice and limiting largely obviating client choice and limiting availability to a narrow range of services.availability to a narrow range of services.

1997 onwards1997 onwardsApproach shifted to address health and Approach shifted to address health and family welfare. Focus on client choice, family welfare. Focus on client choice, service quality, gender issues and service quality, gender issues and underserved groups, including adolescents, underserved groups, including adolescents, post menopausal women and men post menopausal women and men

Challenges Challenges

Expanding servicesExpanding services

Informed ChoicesInformed Choices

Access to quality careAccess to quality care

TrainingTraining

Monitoring and Monitoring and evaluationevaluation

Message developmentMessage development

Future ProjectionsFuture ProjectionsProf Swaminathan :

TFR trends from 1971-96 for larger States, TFR of 2.1 for the country achievable only by 2026. Estimated population of 1,409 million in 2026 and stable level of 1,628 million by 2051.

National Population Policy 2000 projections:If the TFR of 2.1 by 2010 then 1,330 million in 2026 and in 2046 reach a peak of 1,417 million.

There is a 200-million difference — almost as much as Indonesia's demographic size — between the two levels of projected populations — a clear indication of the need to take the task of population stabilization seriously

Policy implicationsPolicy implications (i) Decentralized Planning and Program (i) Decentralized Planning and Program

ImplementationImplementation

(ii) Convergence of Service Delivery at Village Levels(ii) Convergence of Service Delivery at Village Levels

(iii) Empowering Women for Improved Health and (iii) Empowering Women for Improved Health and NutritionNutrition

(iv) Child Health and Survival(iv) Child Health and Survival

(v) Meeting the Unmet Needs for Family Welfare (v) Meeting the Unmet Needs for Family Welfare ServicesServices

(vi) Collaboration With and Commitments from Non-(vi) Collaboration With and Commitments from Non-Government Organizations and the Private SectorGovernment Organizations and the Private Sector

THANK YOUTHANK YOU

The Evolution Of The Family Welfare Program In India

Tapan Ray

Panel 4: Implementing Social Policy In India

13th Symposium onDevelopment and Social Transformation

Evolution of the family welfare program in India

Tapan Ray

Evolution and Delivery ofFamily Welfare Programme in India

• Tyranny of Targets – The Fourth Plan (1966-74)• Emergency excesses in the field of sterilizations (mid –70s)

• Voluntary sterilization camps re-started with the new technology of laparoscopic sterilization (1980s)

• 1992 – Eighth Five Year Plan – calls for review of targets

• 1994 – Changes in the approach to Family Planning service delivery since ICPD

• 1996 – Target Free Approach announced• 1999 – Community Needs Assessment Approach (CNAA)

• 2000 – National Population Policy

Evolution of Maternal and Child health programmes in India

Year Milestones

1952 Family Planning Programme adopted by Govt. of India (GOI)

1961 Dept. of Family Planning created in Ministry of Health

1971 Medical Termination of Pregnancy Act (MTP Act)  1971

1977 Renaming of Family Planning to Family Welfare

1978 Expanded Programme on Immunization (EPI)

1985 Universal Immunization Programme (UIP)+ National Oral Rehydration Therapy (ORT) Programme

1992 Child Survival and Safe Motherhood Programme (CSSM)

1996 Target-free approach

1997 Reproductive and Child Health Programme -1 (RCH-1)

2005 Reproductive and Child Health Programme -2 (RCH-2)

Pressure for undergoing sterilization, undermining human rights

Health repercussions of hastily done sterilization operations in makeshift camps–

infections, complications, failure rates, sometimes death

Inadequate attention to safety-inadequate screening and follow-up

Health services do not have provisions to deal with women’s genuine health

problems

Poor quality of curative services

Adverse Effects of a Population Control Programme

International Conference on Population and Development Cairo 1994

• Adoption of the Programme of Action on population and development for the next 20 years

• New strategy emphasized the linkages between population and development

• Focus on meeting the needs of individual women and men rather than on achieving demographic targets

• Empowering women and providing them with more choices through expanded access to education and health services promoting skill development and employment

• Importance of equity in gender relations• Enhance access to appropriate information and services

Attaining the Millennium Development Goals

Infant Mortality in India

• Infant mortality rate (0-1 year) per 1,000 live births (UNICEF estimates)

World 55DevelopedRegions………………………6

8474

6863

0102030405060708090

1990 1995 2000 2003

Year

Source: WHO

Child Mortality in India

• Children under five mortality rate per 1,000 live births (UNICEF estimates)

World 80DevelopedRegions………………………7

123

10494

87

0

20

40

60

80

100

120

140

1990 1995 2000 2003

Year

Maternal Mortality in India

• Maternal mortality ratio per 100,000 live births (WHO, UNICEF, UNFPA)

World 400DevelopedRegions…………………14

570

440

540

0

100

200

300

400

500

600

1990 1995 2000

Year

MDGs and the Tenth Plan Targets

Goal 4 : Reduce child mortality

• Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

• Tenth Plan targets infant mortality rate (IMR) of 45 per thousand live births by 2007 and 28 by 2012

MDGs and the Tenth Plan Targets

Goal 5 : Improve maternal health

• Target 6: Reduce the maternal mortality ratio by three-quarters between 1990 and 2015

• Tenth Plan targets reduction in the maternal mortality ratio from 4 in 1999-2000 to 2 per 1000 live births in 2007 and 1 by 2012

 IndicatorTenth Plan

Goals  (2002-2007)

RCH II Goals (2005-2010)

NP Policy 2000 (by 2010)

MD Goals (by

2015)

Population Growth

16.2% (2001-2011)

16.2% (2001-2011)

- -

Infant Mortality  Rate

45/1000 35/1000 30/1000 28/1000

Under 5 Mortality Rate

- - - Reduce by 2/3rds from 1990 levels

Maternal Mortality Ratio

200/100,000 150/100,000 100/100,000

Reduce by 3/4th from 1990 levels

Total Fertility Rate

2.3 2.2 2.1 -

Couple Protection Rate

65% 65% Meet 100% needs

-

Key Facts Decline in IMR but maternal mortality high

Inter- and intra- state variations in levels and in rates of change (Kerala 14 Orissa 96)

Clustering of deaths in a few states

Gender disparity in infant mortality

Maternal education and female literacy

Strong inverse association with immunization coverage

Ante-, neo-, and post-natal care improvements will help reduce IMR

The MDGs CAN be attained

Goals of NRHM• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

• Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition.

• Prevention and control of communicable and non-communicable diseases, including locally endemic diseases

• Access to integrated comprehensive primary healthcare

• Population stabilization, gender and demographic balance.

• Revitalize local health traditions and mainstream AYUSH

• Promotion of healthy life styles

What are the problems?

Basic housekeeping is lacking in this sector;

Efficiency – converting interventions to outcomes is poor;

Data systems are inadequate and needs to be strengthened in numerous dimensions – including coverage and quality;

Proper alignment of incentives.

How can this be done?

Improve social service delivery. This is difficult since:

It is more difficult to standardize quality across services than products, as there is people to people interaction;

Quality of service can be intangible;

Intimate contact between service provider and service user

Some of these concerns could be addressed through improving monitoring and evaluation.

Universalizing Education In India

Manmeet Mehta

Panel 4: Implementing Social Policy In India

13th Symposium onDevelopment and Social Transformation

Education Policy in India

Universalizing Elementary Education

Symposium on Development and

Social Transformation

Manmeet Mehta Spring 2006

Scope Of The Presentation

• Background • Education for All – ‘Sarva Shiksha Abhiyaan’• Goals• SSA : A Critical Examination

– Design – Financing– Implementation

• Progress so far ( January 2006)• Recommendations

Sarva Shiksha Abhiyaan: Highlights

• Sector-wide, Umbrella Program• Decentralized planning and

implementation – ‘Mission Mode’• Context- specific interventions• Partners – DFID, UNICEF, World Bank,EC• Elementary Education : 68% share of total

education expenditure in the Tenth Plan • States Commitment

– Maintained at pre SSA 2000 levels– 75:25 from 2002-2007– 50:50 from 2007 onwards

Background• Multipartisan rhetoric • • World Education Forum, 2000

• From DPEP to SSA– Access– Equity– Quality

• Policy shift– National Level, Sector Wide Program– Legislative Support– Political Will

SSA : Objectives • Increasing access

– Increasing Enrolment – Improving transition rate– Improving infrastructure – Education Guarantee Scheme

• Improving equity– Girls– SC/ST– Disabilities

• Improving quality– Teacher training – Pupil Teacher Ratio – Context specific curriculum ( BRC & CRC)– Improvement in student performance

Flow of Funds

Ministry of HRD

State Govt. Treasury

State Implementation

Society

District

Central Government

SSA Framework: A Critical Glimpse

• Multiplicity of implementation agencies at the district level

• No fixed criterion for release of Finances from the Center – 6 States (Sep 2005) lagged behind scheduled

disbursements

• Staffing and training• Inter-state variations in performance• Is it really innovative enough?

– Infrastructure design• For e.g. Classroom design

Financial Framework

• Education Cess of 2% on Personal Income • Investment by World Bank, DFID and EC• No fixed criterion for release of funds by

Center• Sep 2005-State expenditure represented

only 25% of the total allocation. • States Financial Commitment increases on

a progressive basis – Do they have the resources?

• Avoiding fund constraints

Implementation

• Multiplicity of Implementation Agencies at the District Level

• Decentralized Planning– Training for BRC and CRC staff critical– Incorporating feedback

• Low level of awareness of procurement procedures

• State Absorptive capacity • Transparency in operations• Addressing innovation – infrastructure,

teacher training

Progress so far – Jan 2006

• Access – As on November 2005, only 9.6 million

children of 6-14 years are out of school.– As on March 2005, 187 million( out of 194 mn)

children of 6-14 years are enrolled in schools, including alternative systems

– Infrastructure being increased ( but below target level)

• New Schools operationalized (92%)• Additional Classrooms ( 68%)• Toilets (70%)• Drinking Water facility (69%)

• Equity – Share of girls in primary school enrolment is

47% and for Upper primary stage, it is 45%– Share of SC in total enrolment in primary is

21.3% and in upper primary, it is 19% – Share of ST in total enrolment is 10.3% in

primary and 8.2% in upper primary stages.–  Share of children with disabilities is 1.37%

in primary and 0.96% in upper primary

Progress so far – Jan 2006

• Quality – Assessment and Evaluation for setting

benchmarks for student performance in Grade 3,5,7 and 8

– Technical deficiency – 27 % of teachers trained against

sanctioned– Over 95% of BRC and CRC sanctioned 

becoming operational

Progress so far – Jan 2006

Recommendations

• Rationalizing the implementation structure• Training – BRC/CRC/ Teachers • Accounting procedures strengthened

– Hand book, Training, Internal audit mechanism• Tools for monitoring quality interventions• Social Mapping

– Rajasthan : Child Tracking System• Progress leveraged on quantity and

expanded scope of coverage• The critical parameter : Quality of

Education and Schools

NGOs And Government: Collaboration At The Cutting Edge

Chandan Sinha

Panel 4: Implementing Social Policy In India

13th Symposium onDevelopment and Social Transformation

NGOs and Government in

India: Collaboration at the Cutting edge?

byChandan Sinha

Two Questions

Is collaboration among GOs and NGOs at the district level in India necessary and desirable for effective service delivery?

If so, how may it be achieved?

Focus: India, District level, Service Delivery

State-NGO Relationships: Perspectives Competition – a zero sum game Principal-agent relationship Exchange - NGOs as contractors NGOs as para-statal organizations Dangers of legitimizing the status quo

Changing viewpoint Consultative Contractual Collegiate

NGO-State relations in India

Post-independence growth

State as promoter

Central Social Welfare Board

Five Year Plans

Rural Development, Social Welfare, Health, Environment

District Level Scenario

Each ploughs a lonely furrow

Mutual suspicion and distrust

Sporadic project based interaction

Avoidance or interference/encroachment

The Wages of Isolation …

Vulnerable populations sans services

Duplication of development investment

Poor provision of certain types of services

Expensive and inefficient service delivery

Wastage of scarce resources

Is Collaboration Necessary? Or Desirable?

To ensure coverage of vulnerable population

To better utilize scarce resources

To better employ each other’s strengths & nullify weaknesses

To enhance efficiency & effectiveness of service delivery

Collaboration: What can Government Bring to it?

A constructive policy framework

Main source of NGO resources

Replication, scaling up and mainstreaming of NGO innovations

A critical role in developing capacity

NGOs acquire legitimacy

Collaboration: What can NGOs Bring to it?

Local knowledge

Community development experience

Experimentation & innovation

Operational flexibility

Induce institutional reforms

Advocacy - issues of social change

Collaborative Relationships: A Typology

Primary

Secondary

Supplementary

Complementary

Partnership

Role of the District Officer

Establish Coordinating Committees at the district level

Joint Action Committees re specific projects

Develop standardized formats for agreement System of periodic meetings

Maintaining databases

Role of State Government

Issue policy guidelines for the establishment of formal mechanisms

Thank you!

Panel 4: Implementing Social Policy In India

Wednesday, April 19th (1:30-2:45pm)

Anuradha Chagti India’s Population: An Overview

Tapan Ray The Evolution Of The Family Welfare Program In India

Manmeet Mehta

Chandan Sinha

Universalizing Education In India

NGOs And Government: Collaboration At The Cutting Edge

13th Symposium onDevelopment and Social Transformation