The more enduring challenges for the current regime in Madhya Pradesh lie beyond agriculture and in managing health and education. Taking care of the three together would translate into holistic growth that is long lasting.
Amidst news of farm loans being waived, no dues certificates being issued, manifestos have been prepared stating that a separate krishi or farmers’ budget will be announced and that loans defaulted on by farmers will only be regarded as civil offences and not criminal ones.
Till May 2019, 19.97 lakh farm loans have been waived, the government says. It has also claimed that it is buying wheat at Rs 2,000 a quintal – a definite hike from the Central government’s rate of Rs 1,840 and one which allows farmers a direct benefit of Rs 160 per purchase.
Under the Mukhyamantri Kisan Samriddhi Yojana, 20.71 lakh metric tonne of wheat claimed to have been procured from 2,88,788 farmers has been sold by mandi samitis.
A host of other remedies have been promised, like better storage facilities, superior equipment and so on. However, health and education need equal attention, and though these two sectors have seen improvement, they remain dismal enough to be regarded as one of the prime focus areas.
The farmer distress is being addressed and rightly so, but vital indicators like the infant mortality rate, the maternal mortality rate and the grim results of educational surveys need to be studied and acted upon too.
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How healthy is health
NITI Aayog CEO Amitabh Kant has pointed out that states like Madhya Pradesh are holding India’s development back as they lag behind on important indicators, as standards of education fall and the infant mortality and maternal mortality rates stack up against what could well be a backdrop of agricultural and infrastructure growth.
A study, ‘Burden of Child Malnutrition in India: A View from Parliamentary Constituencies’, has noted the high prevalence of malnutrition, wasting, stunting, anaemia and the problem of undernutrition among children in Madhya Pradesh, among other BIMARU states. BIMARU is an acronym formed out of the names of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh and aims to resonate the Hindi word bimar or ill as a reflection of the poor economic condition of these states.
On health and education, Madhya Pradesh’s averages alone are far worse than the Indian average. For example, infant mortality is 47 deaths per 1,000 births – which is significantly higher than India’s figure of 34. When it comes to the mortality rate of children aged below five, 65 children die per 1,000 births in the state – a figure at par with the east African country of Djibouti.
This number is the second worst in the country after Uttar Pradesh’s 78, according to the National Family Health Survey. One possible explanation behind the low mortality figures of children under five can be that only 54% of children in Madhya Pradesh receive vaccinations – a figure which is eight points lower than the national one that stands at 62%.
A maternity ward of a hospital in Madhya Pradesh. Photo: DFID
If one ventures deeper into a region-wise break up in Madhya Pradesh, alarming facts come to light. The rate of stunting in Sheopur is 52.1%, which is equivalent to that of Haiti – a poor country that faces natural disasters. Balaghat’s rate of 32% stunted children equals Bolivia, according to the 2015-16 National Family Health Survey and the Business Standard report on it. Mind-boggling, isn’t it?
Education alert
An Annual Status of Education Report (ASER) survey was conducted in Madhya Pradesh in October 2018 that involved engaging with students from rural government schools in the state. Chilling statistics have emerged from it. Nearly 17% of children could not recognise basic letters while 14% could not do basic arithmetic, higher than the corresponding Indian figures which are 15% for reading and 12% for arithmetic.
Madhya Pradesh’s total literacy rate stands at 70.6% with rural areas registering 65.3% and urban areas 84.1%.
This gap is close to double in rural and urban areas and acts as the prime hurdle in executing development strategies undertaken in and by the state. If district-wise literacy rate it to be studied, then Balaghat has the highest rate of 76.8% and Alirajpur the lowest, 33.2%.
An improvement in the condition of education can only happen if two aspects are taken care of: quality of education and equality for all. From value-based education, we are moving toward reducing education to a mere service trade where the course is being set depending on prevailing market trends. To worsen the situation, expenditure on education has also been reduced significantly.
The problems
The average earning of 37% of households in Madhya Pradesh does not exceed Rs 5,000. This figure indicates one in every three households in the state and is the highest in the country for such low income, according to the Employment-Unemployment Survey (2015-16).
Add to that the cost of health finance that has steadily been increasing and has lead to inequity in access to healthcare services. More attention needs to be diverted to making healthcare centres affordable to all and to the formulation of policies that specifically target this inequity. The Central government’s layout for expenditure on healthcare, however, has declined over the past few years, except for in 2017-2018, according to the National Health Profile 2018.
Source: National Health Profile 2018
During 2015-2016, India spent only 1.02% of its public expenditure on health. The trend seems to be alarming – as finance towards health tends to decline, so does the attention it gets. If the amount spent on health in the state of Madhya Pradesh is seen, it validates the fact that the state does not do enough. It spends Rs 716 per person per year on health – the lowest in the country and an amount that can only be compared to the Rs 733 spent by Uttar Pradesh, another underdeveloped state.
Indeed, it is a matter of worry that states like Uttar Pradesh that are regarded as backward in terms of overall development and where situations relating to law and order arise on a daily basis, also have a better track record than Madhya Pradesh. The health spending comparison is glaring as Uttar Pradesh has particularly low ratings both for medical services offered and management of healthcare.
The state had allocated a total of 4.17% of its expenditure on health while the current national average stands at 5.05%, according to the National Health Profile of 2018.
The mid-day meal scheme that aims to encourage more students to come to school, thereby reducing the dropout rate while ensuring that their nutritional requirements are met, comes with its fair share of problems. As many as 61,058 (75.06%) primary schools do not have a separate kitchen for mid-day meals. There is no drinking water in 20,031 schools, reports Media for Rights.
Dalits are ignored while hiring cooks for the scheme, leading to the effort faltering on the social equality count as well. In tribal areas of Bundelkhand and Baghelkhand, there is no supply of ration, hence there is complete non-availability of any kind of mid-day meal. This points towards clear discrimination of lower-caste communities by upper-caste ones.
What can be done
Kofi Annan rightly said, “Literacy is a bridge from misery to hope.”
Multiple studies have shown that women’s empowerment would improve children’s nutritional status and overall health. Health and women empowerment go hand in hand. As a result of women’s literacy being the fourth lowest in Madhya Pradesh (59.4%), health parameters have consequently taken a beating.
Women’s education and improving their literacy rate has to be a priority for all governments. Educated women have a significant effect on their families.
Madhya Pradesh’s total literacy rate stands at 70.6% with rural areas registering 65.3%. (Representational image) Photo: akshayapatra/Pixabay
So here is what can be done. As far as all-round education is concerned, a national mission should be started to ensure that by 2022, every child can actually read, write and do simple math by the time they finish Class III to counter the results of the ASER survey mentioned above. Apart from this, part-time primary school teachers and trainees should be hired to focus especially on those left behind. Universal preschools through Anganwadi childcare centres can ensure children receive a formal education. Vocational training is also a vital part that should be strongly encouraged in education as opposed to its sole thrust on theoretical learning.
If one talks about health, the most obvious way which is often overlooked while dealing with health issues is to make use of people’s primary point of contact in healthcare systems – the physician they consult regularly for what they believe to be minor ailments. They can pass on useful public health messages like the need to immunise children, the necessity of women’s education or basic information like not cooking in closed environments (something which is a very common cause for respiratory diseases).
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The government will also have to recognise that informal providers of primary healthcare are not going anywhere and should instead train, test and certify them. Medical education should allow for intermediate degrees that produce practitioners licensed to practice over a limited range of cases which nonetheless see a huge number of people fall prey to them. This will also take the pressure off hospitals that have a paltry patient-doctor ratio.
The problem of Ayushman Bharat lies in the fact that it does very little of primary healthcare. A budgetary allocation of less than Rs 1 lakh per centre has been allocated to the 1.5 lakh health and wellness centres that will be set up. This kind of minor upgrading will do very little to improve existing facilities in sub-centres or primary healthcare centres, let alone introduce new methodology.
Emancipation in isolation, where just one sector of the population grows, while the others remain neglected, cannot be treated as all-round growth and development. If farmers are to be kept safe, the state also has to have policies in place that take equal care of health and education. Holistic, long-lasting growth is real advancement. Issues key to societal reform must not be lost sight of.
Health and education are key to that societal reform. The newly-elected Congress government under Kamal Nath has made what I believe is the correct start by making its agenda amply clear – remedy to people’s distress is a priority. All it needs to do is to view health and education through the same prism of social distress.
Aparajita Pande is a lawyer and spokesperson for Indian National Congress, Madhya Pradesh. She tweets @MissyPetunia.