Panel 4: Implementing Social Policy In India Wednesday, April 19 th (1:30-2:45pm)

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

2. 13th Symposium on Development and Social Transformation Panel 4: Implementing Social Policy In India India’s Population: An OverviewAnuradha Chagti

3. INDIA’S POPULATION: AN OVERVIEW ANURADHA CHAGTI

4. The 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.

5. 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

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

7. 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)

8. Population Characteristics (cont) • Sex ratio is 933. Kerala highest sex ratio (1058) and Haryana the lowest (861) • The child sex ratio (0-6 age group) 927 in 2001. The sharpest decline has been in the richer northern states. • The literacy rate for population seven years and over was 65.4% in 2001. Highest in Kerala 90.9% and the lowest Bihar 47.5%. • For the first time since independence an absolute decline in the number of illiterate persons: by 32 million during the last decade.

9. 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

10. Government Initiatives • Pre 1990’s Dominated b demographic goals. Target oriented. Focused primarily on sterilization, largely obviating client choice and limiting availability to a narrow range of services. • 1997 onwards Approach shifted to address health and family welfare. Focus on client choice, service quality, gender issues and underserved groups, including adolescents, post menopausal women and men

11. Challenges • Expanding services • Informed Choices • Access to quality care • Training • Monitoring and evaluation • Message development

12. Future Projections Prof 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

13. Policy implications • (i) Decentralized Planning and Program Implementation • (ii) Convergence of Service Delivery at Village Levels • (iii) Empowering Women for Improved Health and Nutrition • (iv) Child Health and Survival • (v) Meeting the Unmet Needs for Family Welfare Services • (vi) Collaboration With and Commitments from Non-Government Organizations and the Private Sector

14. THANK YOU

15. 13th Symposium on Development and Social Transformation Panel 4: Implementing Social Policy In India The Evolution Of The Family Welfare Program In IndiaTapan Ray

16. Evolution of the family welfare program in India Tapan Ray

17. 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

18. 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)

19. Adverse Effects of a Population Control Programme • 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

20. 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

21. Attaining the Millennium Development Goals

22. Infant Mortality in India • Infant mortality rate (0-1 year) per 1,000 live births (UNICEF estimates) World 55 Developed Regions………………………6

23. Source: WHO

24. Child Mortality in India • Children under five mortality rate per 1,000 live births (UNICEF estimates) World 80 Developed Regions………………………7

25. Maternal Mortality in India • Maternal mortality ratio per 100,000 live births (WHO, UNICEF, UNFPA) World 400 Developed Regions…………………14

26. 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

27. 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 MDGs and the Tenth Plan Targets

28.  Indicator Tenth 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 -

29. 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

30. 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

31. 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.

32. Howcan 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.

33. 13th Symposium on Development and Social Transformation Panel 4: Implementing Social Policy In India Universalizing Education In IndiaManmeet Mehta

34. Symposium on Development and Social Transformation Education Policy in India Universalizing Elementary Education Manmeet Mehta Spring 2006

35. 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

36. 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

37. 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

38. 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

39. Flow of Funds Central Government Ministry of HRD State Govt. Treasury State Implementation Society District

40. 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

41. 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

42. 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

43. 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%)

44. Progress so far – Jan 2006 • 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

45. 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

46. 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

47. 13th Symposium on Development and Social Transformation Panel 4: Implementing Social Policy In India NGOs And Government: Collaboration At The Cutting EdgeChandan Sinha

48. NGOs and Government in India: Collaboration at the Cutting edge? by Chandan Sinha

49. Two Questions • Is collaboration amongGOs 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

50. 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