India’s double fault


With some states in India boasting of rural incomes, comparable with Brazil and Turkey, and others competing with Ghana and Malawi, India is a study in contrast.

At times when most Indian policy makers are insistent that India needs to step up its growth rate from 8% to 10% a year, the World Bank feels the real challenge is not accelerating growth but sustaining it, while spreading its benefits more widely.

The Bank’s Development Policy Review report for India released on Wednesday highlights some of the more starting inequities in the country’s growth so far. It also focuses on some shocking evidence of the poor quality of service delivery in areas like health, education and drinking water.

It makes the point for instance that some parts of India like rural Orissa or rural Bihar have poverty figures that are quite similar to those in countries like Burundi and Malawi, while in others like rural Punjab, poverty levels are almost akin to Turkey and better than more developed Latin American countries like Brazil and Mexico.

It points that the acceleration in growth in the 1990s has been far from uniform. Low income states like Bihar, Madhya Pradesh, Orissa, Uttar Pradesh and Rajasthan have, on average grown at exactly the same pace in these two decades. Medium income states like Andhra Pradesh, Karnataka, Kerala, Tamil Nadu and West Bengal have grown significantly faster on averge in the 1990s.

But even their average growth rate of 3.8% in the 1990s has not matched up to average of 5.5% chalked up by Gujarat and Maharashtra. At the other end of the spectrum, high income states of the north like Punjab and Haryana have seen growth slow down sharply in the 1990s. Thus, the decade has been regional disparities widen rather than narrow down.

That’s not all. Development isn’t just unevenly spread across states. The picture within states too is rather patchy. In terms of infant mortality rates, for instance, the worst off districts in well-performing states like Gujarat, Maharashtra or Karnataka have higher figures than the average for the poorest states—Uttar Pradesh, Orissa, Bihar, Madhya Pradesh and Rajasthan.

Again, the gains in terms of wage increases among workers are very unevenly spread. The average daily wage for the lowest tenth of the working population has increased by just Rs. 5, while the top of the scale, the highest tenth has witnessed an increase of Rs. 90 per day.

It’s a study in contrast. If urban India offers competitive services ranging from low-skill jobs at call centers to high-skill activities like software engineering and biotech, half the workforce is involved in agricultural, which is growing slowly and provides poor work conditions.

On the issue of service delivery, the report collates telling data from several studies which combine to paint a rather grim picture.

A particularly worrying conclusion is that in some areas, indicators have actually got worse in recent years. In health care, for example, while polio vaccination in 1998-99 covered 66.1% of the relevant population, in 2002-03 it covered only 57%. Fully immunization coverage similarly dropped from 52% too 44.6%. Measles vaccination had slipped from 58.1% to 55.2%, which means Bangladesh now has a higher number.

The quality of education provided leaves a lot to be desired with a study showing that about half the students in Class V could not read even at Class II and two-thirds could not solve division problems meant for those studying in the second grade.

The report points out the irony that while India is fast developing s a preferred destination for medical tourism, the quality of primary health care even in a city like Delhi is such that a typical doctor in a public primary health center is more likely to recommend a harmful treatment than to o the patient any good. Medical practice at these levels is yet to reach the “do not harm� standard, the report points out.

While there are several options examine by the report in terms of what can be done to rectify the situation, one common thread running across it is that “to fix the pipes, you must first fix the institutions that fix the pipes�.

In other words, what is needed is not more of the same, but a radical reform of the institutional structures in services delivery which must result in improved accountability to those that consume these services and hence hopefully to superior service delivery.