#social sector programmes

On the 23rd of January, Savitri Sahu was woken up by the family of a woman who had gone into labour. We borrowed a tractor, she says, took her to the primary health centre, woke up the doctor and the nurses, got the delivery done. Given that most rural clinics we hear about lack doctors, nurses, medical supplies and are shuttered most of the time, what explains this unusually conscientious health centre, that too in underdeveloped Bastar? Is this a micro-experiment by a committed bureaucrat or NGO or an especially aware and vigilant community? No. Savitri Sahu and Ushamani Kashyap are Mitanins. They were trained by the government of Chhattisgarh to work as community health workers. At last count, Chhattisgarh had 60,000 such women, spanning all 54,000 hamlets in the state. Between them, they have almost halved infant mortality, radically improved childcare practices, and forced the health system to improve.

At a time when debate is raging on whether the Indian state can effectively deliver social services, the Mitanin programme illustrates one side of the discussion -- that, with a little reform, the state can indeed deliver. 

India has seen a rise in social sector spending since 2004. The outcomes, however, have been underwhelming. The best-known illustration of this phenomenon is the National Rural Employment Guarantee Act (NREGA) where the quality of assets and the number of jobdays created are far below expectations. It is the same story across programmes in health, education and elsewhere, says Mihir Shah,member of the Planning Commission.

"In Act after Act, we are just creating hardware. We are not creating software at all. All this is what I call the problem of U without Q. Universalisation without quality. That is the bane of all our programmes. Whether it is NREGA or ICDS (Integrated Child Development Services), the focus of the people, the government and civil society is always on scaling up. We always neglect the quality aspect. And universalisation with quality cannot happen unless it has been cracked at a reasonable scale first.”