CHILD HEALTH & EDUCATION

India’s areas of darkness

A devastating indictment of shining post-liberalisation India’s child health and education record by Unicef has caused barely a ripple in the imposing offices of the country’s top politicians and bureaucrats. Or in middle class India. 
Dilip Thakore reports

In any western democracy the ground would have trembled, media editorials would have thundered, ministers would have resigned and perhaps the government would have fallen. But in the sovereign, socialist, secular, democratic Republic of India whose Constitution promises to secure justice, liberty, equality and fraternity to all citizens, the release in Delhi of State of the World’s Children 2008, a United Nations Children’s Fund (Unicef) report, on January 22 caused barely a ripple. In the airy offices of the country’s top politicians and bureaucrats housed within the imposing red sandstone structures of (architect) Edward Lutyen’s New Delhi, and in the administrative capitals of India’s 28 state governments and seven Union territories, it was malingering and business as usual.

On the contrary a few days later on January 26, the country’s ruling neta-babu class staged a grand Republic Day parade in the nation’s capital showcasing the country’s military might as armoured vehicles mounted with heavy duty howitzers, battle tanks and splendidly attired mounted troops filed along the Rajpath which leads from the 340-roomed presidential palace to the houses of Parliament even as screaming squadrons of mach 3 jet planes thundered overhead. In the preparations leading up to this archaic Soviet-style grand annual parade (at which France’s glamorous new President Nicholas Sarkozy was the chief guest) and in its after glow, SWC 2008’s devastating indictment of shining post-liberalisation India for tolerating the world’s worst child healthcare and nutrition record was greeted with resounding silence. Nor was contemporary India’s subsidies and privileges grabbing new 200-million strong, epicurean middle class engaged in an orgy of conspicuous consumption, in any mood to remind the Congress-led, 17-party coalition UPA (United Progressive Alliance) government at the Centre, of its obligation to address this vital issue with deep implications for the country’s future.

Comments the preamble of SWC 2008 which states that “every day on average more than 26,000 children under the age of five die around the world, mostly from preventable causes” and examines the child healthcare records of 195 countries around the world: “Child mortality is a sensitive indicator of a country’s development and telling evidence of its priorities and values. Investing in the health of children and their mothers is not only a human rights imperative, it is a sound economic decision and one of the surest ways for a country to set its course for a better future.”

Quite obviously this self-evident truism is news to India’s 28,000-strong Planning Commission which since India proclaimed itself a republic in 1950, has drawn up eleven elaborate five year plans to mastermind national development. According to SWC 2008, over 2 million Indian children aged below five died in 2006. They were perhaps the fortunate ones because 30 percent (38 million) of fast-track India’s 126 million children are low birth weight infants; 43 percent (54 million) are moderately to severely underweight; 20 percent (25 million) are moderately to severely wasted, and 48 percent (60 million) are moderately to severely stunted.

Even as benighted babus in South Block, New Delhi are pre-occupied with devising elaborate strategies to prompt the Big Five nations of the UN Security Council to invite India to their exclusive top table, in terms of social welfare and child healthcare in particular, shining India with absurd superpower aspirations, is in the bottom league of pathetically under-developed nations such as Madagascar, Mali, Haiti, Malawi and inevitably, Bangladesh and Pakistan (see table p.32).

Astonishingly, despite obvious logic that good health is a prerequisite of industrial and economic productivity, government (Centre plus states) outlay for public health - currently 1.2 percent of gross domestic product (GDP) – has never exceeded 2 percent of GDP against 5-7 percent which is de rigeuer in developed western democracies. While India’s 11,200 government hospitals and 22,669 primary health centres are notorious for their appalling hygiene, lack of supplies and staff absenteeism, private spending on medical services aggregates an estimated 4 percent of GDP and is a major cause of rural indebtedness which has provoked 155,000 reported farmer suicides during the decade 1995-2006.

Moreover it is pertinent to note that the pathetically meagre outlays for public health indicated above relate to curative health services. In the domain of preventive health services, post-independence India’s record is worse. According to SWC 2008, almost 150 million Indian citizens don’t have access to improved drinking water sources and even more shocking, a mere 33 percent of the population has access to adequate sanitation facilities - statistics which explain the country’s high under-five child mortality toll of 2 million per year.

Informed opinion is divided on why professedly socialist independent India has continuously neglected preventive and curative healthcare. Cynics believe that it’s the unstated official policy response to maintain the balance between rising life expectancy and high birth rates. Others – particularly Left/liberal intellectuals - believe that grudging social sector spending is the natural consequence of the hijack of the Indian state by the urban bourgeoisie which has fashioned post-independence India into a democracy of the middle class, by the middle class, for the middle class. This privileged class within the organised sector of the economy is covered for medical expenses by stringent laws which make it mandatory for governments, corporates and other employers to provide comprehensive medical care. The remaining 90 percent of the population is left to the mercy of over-crowded government hospitals, the country-s 22,669 dilapidated, empty primary health centres and essentially to the depredations of 600,000 flourishing private physicians countrywide.

“India’s depressing child development indicators highlighted by SWC 2008 have profound implications for the future of the country. Eighty percent of the brain development of 43-48 percent of children under five who suffer severe malnutrition and stunting, has already been thwarted. The Union government’s ICDS (Integrated Child Development Services) programme was launched in 1975 to prevent this scenario. But although the government claims ICDS coverage of the entire country geographically, only 19 percent of children under five have been brought under the purview of the programme. Article 45 of the Constitution of India requires the State to provide free and compulsory education to all children up to the age of 14. However the 86th amendment to the Constitution makes it mandatory for the state to provide free and compulsory elementary education to children between the ages of six-14. By this stratagem the right to early childhood care and education of 170 million children below six years of age has been snatched away. Unfortunately there is a singular lack of political commitment to care for the nation’s children in their vital formative years. This is a grave mistake with monumental consequences for the future of the country,” says Bhopal-based Dr. Anil Sadagopal, an alumnus of the University of Technology, California, former dean of academics at Delhi University and a highly respected educationist who helped draft the much-lauded National Curriculum Framework for School Education, 2005.

Although critical of the consistent failure of the Central and state governments to raise their combined outlay for education to 6 percent of GDP per year as recommended by the Kothari Commission way back in 1966, Sadagopal connects India’s abysmal child mortality, malnutrition and stunting record with chronic income deprivation of the great majority at the base of the country’s iniquitous social pyramid. “Even though Article 43 of the Constitution directs the State to secure all workers in industry and agriculture a ‘living wage’, the best that the Central and state governments have been able to do is to legislate minimum wages which enable purchase of food with 2,400 calorie content per day. This grudging minimum wage policy does not take into consideration the cost of workers providing housing, clothing, education and healthcare for their families. As a consequence 75 percent of the population lives in dire poverty as confirmed by the Arjun Sengupta Committee’s report (2007) which says that 836 million Indians survive on Rs.20 or less per day. Widespread child and adult malnutrition is the natural outcome of the grudging national minimum wage policy which has set the bar too low,” argues Sadagopal.

Dr. K.R. Nayar, professor of social medicine and community health at Delhi’s highly-rated Jawaharlal Nehru University is also critical of government failure to implement the ICDS programme with sufficient rigour, despite the country’s huge population of 126 million under-five children. “SWC 2008 and its disturbing data is telling evidence that there is no synergy between the government’s anganwadi centres (crèches) and its other departments entrusted with child healthcare duties. In the immediate term we need to strengthen such institutions and improve their coordination so that needy children receive nutrition, and vitally important early childhood immunisation treatment. But in the long term, the purchasing power of parents at the bottom of the social hierarchy has to be improved so they can feed their children on their own,” concurs Nayar.

Widespread income deprivation and inequality which characterises professedly socialist India - the bottom 40 percent of the population earns only 19 percent of national income while the top 20 percent receives 45 percent, according to SWC 2008 - also deprives the overwhelming majority of the country’s 450 million children of access to quality education. While the growing number of Indian middle class households whose number is estimated at 40 million enroll their children in the country’s 189,520 private schools, some of which rival the best in the world in terms of infrastructure, pedagogies and learning outcomes, the great majority of over 160 million low-income households are obliged to enroll their children in the 929,345 Central, state and local government schools characterised by dilapidated buildings, crowded classrooms, chronic teacher absenteeism and abysmal learning outcomes.

Since EducationWorld was launched in 1999 upon an indifferent public with the mission statement “to build the pressure of public opinion to make education the No.1 item on the national agenda”, the pathetic condition of the public (government-run) school system has been repeatedly highlighted in this publication. Yet instead of welcoming this initiative and its suggestions for sharing best pedagogic practices to develop the nation’s abundant and high-potential human capital, this publication has had to endure the continuous hostility and suspicion of the high and mighty in government, and great and good in Indian industry.

Thus the Union human resource development minister and officials in his ministry routinely refuse interview or data-sharing requests and even more surprisingly, captains of industry - the prime ‘consumers’ of trained and skilled youth emerging from the education system - with whom your correspondent had developed personal acquaintance and rapport in previous avatars as the first editor of Business India and Businessworld, have been suspicious of and reluctant to subscribe to the human capital development objectives of EducationWorld. 

This conspicuous lack of empathy and pervasive indifference to the public education system, which at the start of any given academic year enrolls an estimated 174 million children, of whom 53 percent drop out of school before they reach class VIII because of prevailing conditions of gross negligence, explains why over 350 million Indian citizens are comprehensively illiterate, and trapped in a vicious cycle of illiteracy-low productivity-low income-poverty. With politicians and educrats more focused upon creating employment for favoured teachers than upon learning outcomes, and Indian industry conspicuously lacking the philanthropic culture of American business and industry (see book review p.82), it’s hardly surprising that post-independence India’s national development effort is defined by a massive wastage of human capital. With the economy growing at an unprecedented 9 percent per annum currently, this has resulted in a severe shortage of skilled workers and professionals.

The extent to which the original sin of neglecting child healthcare (as testified by SWC 2008) has been compounded by indifference to formative elementary education is highlighted by the Delhi-based National University of Educational Planning & Administration which published its devastating Elementary Education in India 2005-06 – An Analytical Report last July (2007). According to this path-breaking survey which for the first time covered all 604 of the country’s administrative districts under its computerised DISE (district information system for education), of the country’s 1,124,033 schools (of which 87 percent are in rural India) 46,364 primaries don’t have a building; 15,791 don’t have a single student; 121,794 schools have only one teacher; 190,299 don’t provide drinking water and 539,535 (over 50 percent) don’t have toilets.

EEI 2005-06 offers other horror statistics which highlight the scale of neglect of public education ritually offered to children of low-income families who can’t afford even the modest tuition fees charged by the country’s 63,410 state government-aided private schools patronised by the lower middle class. Among them: 107,276 elementary schools (primary and upper primary) are single classroom institutions. Moreover 700,000-plus of the country’s 1.124 million schools don’t have electricity, and only 37 percent of the country’s schools have separate toilets for girl students, the major cause of widespread women’s illiteracy (46 percent) countrywide. Typically, despite its shocking revelations EEI 2005-06 (see EW September 2007) received little coverage in the mainstream middle class media obsessed with page 3 inanities, the cricket circus and puerile Bollywood gossip.

The consequence of the twin neglect of child healthcare and early education is reflected in the poor learning outcomes of the estimated 100 million children who complete primary school. Towards the end of every year over 20,000 volunteers of the Mumbai-based NGO Pratham, which inter alia manages over 2,500 balwadis (crèches) and remedial education centres, fan out across the country to assess learning outcomes of students enrolled in rural government primaries in 485 districts across the country. The results of the survey are published in Pratham’s Annual Status ofEducation Report (ASER).

According to ASER 2007 released last month to the public, 58.3 percent of class V students in rural India can’t read simple textbook passages which they should have learned to read in class II. Neither can 37 percent of children in class VII solve simple division sums which they should have learned in class II. In short, the depressing ASER surveys reveal that children attending government schools learn precious little for a variety of reasons including ill-health, teacher truancy or incompetence, unsupportive infrastructure and high teacher-pupil ratios.

This statistical mountain of evidence which is glaring testimony to child healthcare and education neglect on a globally unprecedented scale, exasperates the small minority of bona-fide educators and intellectuals who can see beyond the self-delusional shining India hype of venal politicians and the country’s subsidies-grabbing, greedy middle class. “Political and bureaucratic apathy is the most important reason for child healthcare and education being given least priority by successive governments at the Centre. Its conspicuous inability to implement the action programme of the Cairo Agreement 1994 to safeguard and enforce children’s rights, is clear demonstration of the Central govern-ment reneging on its social contract. The vicious circle of lack of education leading to poor earning capability which in turn strikes at the health of newly born infants has created a crisis in Indian society,” despairs Dr. K.S. Natarajan, principal of the Saraswathi Vidyalaya Matriculation Higher Secondary School, Chennai and promoter-director of the Krida Foundation (estb.2002) engaged in early education research, content creation and teacher training.

“A quarter of the world’s annual total of new-born deaths is ‘contributed’ by India. Even these shocking figures understate the vast scale of the problems that affect child health during the neonatal period. For example more than a million of India’s children who survive birth asphyxia each year suffer problems such as cerebral palsy, learning difficulties and other disabilities,” adds Natarajan.

Curiously, there is a national reluctance to make the connection between the country’s deplorable child healthcare record and the poor learning outcomes of the Indian education system as a whole. The factual learning rather than critical thinking propensity of India’s 33 million secondary school children (and teachers) is well known and documented. Moreover it’s also well known that the overwhelming majority of the country’s college and higher education graduates are far from industry-ready and unemployable.

According to a recent McKinsey Global Institute study commissioned by the Delhi-based NASSCOM (National Association of Software Services Companies), 75 percent graduates of the country’s 1,346 engineering colleges are unemployable in industry. In the circumstances, it’s hardly surprising that the government, farm and industrial productivity of Indian adults is less than half of the western world.

Against this backdrop of a colossal waste of human capital, knowledgeable educationists have begun calling for radical thinking and innovative out-of-the-box solutions. Describing the India-related data presented in SWC 2008 as “extremely alarming”, Dr. Arun Nigavekar, currently Raja Ramanna fellow at the Science and Technology Park of Pune University and former chairman of the Delhi-based University Grants Commission, calls for a concerted effort by government, NGOs, nutritionists and universities to address the national problem of child malnutrition at the grassroots within local communities. “As the SWC 2008 statistics indicate, the task of providing comprehensive early childhood healthcare and nutrition is too big for the Central and state governments. Therefore they need to shed their ideological prejudices and involve proven NGOs, dieticians and nutritionists with awareness of local conditions, to ensure that all children receive adequate healthcare and nutrition in their early formative years. Moreover all universities which provide extension services to local communities should be mandated to include early childhood care and education within their curriculums. National programmes such as ICDS and other initiatives urgently need micro-level planning and implementation to address this alarming problem which has vast implications for the country’s future,” says Nigavekar.

This plea for a mindset change to address a problem with “staggering implications” for the country’s future, is seconded by Dr. Shaheen Mistry, an alumna of Mumbai and Manchester universities and promoter-director of Akanksha (estb.1990), a Mumbai-based NGO which tutors slum and street children after office hours on the premises of corporates and education institutions. “SWC 2008 highlights the need for change in the national mindset. Indian society as a whole needs to believe that every child can achieve if given good education. Therefore at the practical level, national investment in early childhood and primary education has to increase sharply, and in particular be canalised into low-end government and aided schools. Society as a whole also needs to show greater appreciation of the teaching profession. We need to pay teachers better and accord them greater social respect, so that better qualified youth enter this profession. In the final analysis we have to squarely confront the issue of inadequate investment in our children,” says Mistry.

Six decades down freedom road during which despite many ideological wrong turns, the Indian economy has transformed into one of the fastest growing worldwide thanks to the can-do spirit and resilience of its creative minority, the solutions to the huge problem of vastly under-developed human resources are well known. As the authors of SWC 2008 say: “The basis for action - data, research, evaluation - is already well established. It is time to rally behind the goals of maternal, newborn and child survival and health with renewed energy and sharper vision, and to position these goals at the heart of the international agenda to fulfill the tenets of social justice and honour the sanctity of life.”

But before we press for positioning these humane goals at the heart of the global agenda, let’s first place them at the heart of shining India’s national agenda.

With Hemalatha Raghupathi (Chennai); Gaver Chatterjee (Mumbai) & Autar Nehru (Delhi)