India: The road to wider prosperity

Dr. Devendra Kothari

Population and Development Analyst

Forum for Population Action

On factors holding India back, my biggest disappointment is the low level of human development.

Bill Gates,

Co-Chair, Bill and Melinda Gates Foundation

Times of India, November, 2017

Happy 2018!

This is the season of resolutions. Let's discuss what should be New Year resolution for India. Prime Minister Narendra Modi, while addressing a joint meeting of the US Congress on June 8, 2016, shared his dream: “empowering every Indian by the 75^th anniversary of India’s independence, through many social and economic transformations”. I think in the coming year India must earnestly initiate the process of empowering people.

For this, India has to address a range of contemporary questions. Among these, the question of human development is most important for sustainable and inclusive India.[1] Development economics in recent years have become more people centric than before. It has rediscovered that human beings are both the means and the end of economic development process, and without Human Development that process becomes hollow rhetoric. Therefore, India must quickly develop an agenda to expedite the process of human development. And, this will help to resolve most of the problems faced by the contemporary India since I strongly believe in the phrase: Change One Thing and Everything Changes.

Central to Human Development approach is the concept of capabilities. Basic capabilities valued by virtually everyone include: good health, access to knowledge, and a decent material standard of living. Other capabilities central to a fulfilling life could include the ability to participate in the decisions that affect one’s life, and to have control over one’s living environment. HD is, therefore, about the real freedom ordinary people have to decide who to be, what to do, and how to live. HD based strategies have been used as a weapon to empower people in many developing countries; these have proven to be quite effective.

 

Why Human Development? The Human Development Report 2016, released by UNDP, does not speak very high about India’s achievement in enlarging people’s capabilities and improving their well-being. India ranks 131 of 188 when it comes to the Human Development Index. This puts it in the ‘medium’ category. The HDI combines a country’s average achievements in health, education and income. The commenting on India’s HDI listing, Bill Gates and Ratan Tata noted:  “Human capital is one of India’s greatest assets. Yet, the world’s fastest growing economy hasn’t touched millions of Indian citizens at the bottom of the economic pyramid.”  [2]

 

India houses enclaves of comfort for the few but are by no means redemptive for the many. In fact, inequality has accelerated in recent decades, according to Lucas Chancel, co-director of the World Inequality Lab at the Paris School of Economics.  The top 1% richest individuals in India captured 6% of total income in the early 1980s, and the value is now of 22%. Overall, the bottom 50% (app. 650 million people or 130 million families) in India still has little access to basic goods such as quality education, health or sanitation. Much more, therefore, can be done in terms of investments for the bottom income groups. “This will substantially increase income growth rates at the bottom, and the growth rates of the economy as a whole”, argued Prof. Chancel. [3]

This makes a strong case that India must convert its vast deprived population to a competitive advantage by enhancing productivity, and human development is one of the most important (or only) stimulants to that outcome.

The definition of HD as “enlarging people's choices'' is very broad, encompassing many issues. One has to narrow it down. To start with, the process of human development must focus on improving the quality of school education; enhancing primary health; strengthening WASH factors (Water, Sanitation and Hygiene), reducing gender gap; and most importantly, stabilizing the population by reducing incidence of unwanted child bearing and infant mortality. In addition, we recognize that shifting of access labour from agriculture to non-agriculture sectors and managing climate change including the quality of air are important inputs too in the process of human development.

The five areas we focus in this post by no means provide a comprehensive agenda to unlock the human potential, but we believe these are among the most significant inputs in the prevailing situation, if pursued as a package, as noted below:

1. Ensuring quality school education: [4]

Is India’s education system geared enough to meet the challenge of low productivity? Considering India’s poor education system from top to bottom one cannot be too optimistic about it. To improve the quality of education, the elementary education is the first step towards that direction.  There are many problems faced by India’s school education, however, the following four areas are crucial: 1) Empowering teacher, 2) Strengthening vocational education, 3) Promoting digital technology, and 4) Enhancing community participation.

2. Promoting healthy life: [5]

The positive health outcomes ultimately contribute to better educational outcomes and a more productive and higher-skilled labor force. India, therefore, must convert its young population to a competitive advantage; and primary health and nutrition are foundational to that outcome which promotes healthy life.

Most of the challenges facing India’s health system can be attributed to under investment and the inefficient use of resources, as argued by Dr. Prabhat Jha of the Centre for Global Health Research, University of Toronto.  [6]  An inadequate number of doctors as well as sub-standard training and a poor network of public hospitals, coupled with bureaucratic bungling, means India often struggles to spend even its meager allocated budgets.  As a result, the promise of universal health coverage will remain unfulfilled unless health is prioritized, as argued by Dr.  K. Srinath Reddy, President of the Public Health Foundation of India. [7] 

There is an urgent need to develop an effective healthcare delivery system, which addresses both communicable and non-communicable healthcare needs. For this, India needs to adopt an integrated national healthcare system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors in the secondary and tertiary sectors.

3. Improving WASH factors:[8]

UNDP emphasizes that clean water and proper sanitation can make or break human development. [9]  The data from the World Health Organization and UNICEF, among others, indicate that it is the poorest, the young and the women and girls who suffer most from poor WASH (Water, Sanitation and Hygiene) services.[10]  Improvements to WASH, therefore, represent a good economic investment to unlock the human potential, since better WASH facilities means good health and higher levels of school achievement hence greater productivity.  “A study by the World Bank estimates that nearly 40% of India’s children are physically and cognitively stunted, primarily because of the lack of sanitation. Such a large proportion of our future workforce not being able to reach their full productive capacity poses a serious threat to our biggest strength – our demographic dividend”, referred by Arun Jaitely, India’s Finance Minister. [11]

In other words, better living conditions are key social determinants of human development agenda. Any improvement in access to toilet facilities, water, electricity and LPG is likely to result in a considerable reduction in domestic drudgery especially for girls/women, freeing up their time for other activities including schooling and perusing professional life.

 

4.  Promoting gender equality:[12]

It is impossible to think about the welfare and sustainable development of India unless the condition of women is improved.  It appears that female's abhivyakti (expression), khvaab (dream), or kalpana (fantasy) frightens us. And we want to regulate it by hook and crook. It appears “women are not born, but made”; what better than India to exemplify this statement by Simone de Beauvoir, made some 70 years ago.  [13]  The chains, therefore, that tie women down are not only external but are welded together invisibly by dint of growing up in what is still a patriarchal society. Hence, we have to create conducive environment where women can chase big dreams and contribute country’s welfare and development. It is therefore important to address the root causes of gender discrimination manifested through son-preference and daughter-neglect. One has to recognize that high GDP or economic growth   alone does not automatically empower women nor does it reduce gender inequality.

What do we do then? No doubt, expanding education and employment opportunities will help in achieving gender equality but that may take more time. To expedite the process, “we need men to be allies”, as argued by the Co-Chairman of the Bill and Melinda Gates Foundation, Melinda Gates, in her article: Women Transform Societies, based on Indian experiences. [14]  Expanding her argument, she writes: “women's empowerment can't be just about women; it also has to be about men - the fathers, brothers, husbands, and sons – with whom they live their lives”.

India’s sex ratio is the worst among the ten largest countries in the world by population – and it has been getting worse. There are 108 men per 100 women in India, as compared with China’s 106, figures from the United Nations showed. Thus, the path ahead looks long, winding and hazy. However, the present administration shows the promise and will to clean the path, albeit slowly. India is very lucky that present government recognizes that gender equality is part and parcel of the country's future; and campaigns like “Beti Bachao, Beti Padhao (save the girl child, educate the girl child) will help to arrest the epidemic of missing girls by removing the gender inequality.  In addition, there is a strong emphasis on mindset change through training, sensitization, awareness raising and community mobilization on ground.

5. Stabilizing population: [15]

With India confronting a host of major crises relating to poverty, governance, corruption (especially at the day-to-day level), social and religious conflicts, why should anyone be concerned about population?  The simple answer is that virtually all the major problems that confront India today relate in some critical way to galloping population. With density already great and living standards low, a continued increase in number means continued tragedy. The country already has over 1,335 million people (2017) and is adding more than 160 million each decade with 12 million young people entering the workforce each year.

China and India are the two most populated countries of the world. In 1990, population of China was 302 million more than India (Table 1). Due to higher population growth of India, population difference between these two countries is coming down quickly. In 2017, population of China is 70 million more than India. And in 2025, India will be the world most populated country of world with approximately 1.45 billion people. This has increased the pressure on resources whether natural or administrative.  Population density of India is 450 people per square km compare to 150 of China in 2017. So, India is three times denser than China.  The table also reveals that pressure of population, measured in terms of persons per square km., has increased significantly since 1990. It increased by slightly less than two times in last 27 years whereas the corresponding figure for china is 1.2 times.   China is 4th and India is 7th largest country in terms of area

Table 1: Population of India and China – a comparative statement, 1990-2050

Year	India			China
	Population in million	Yearly change in million	Density (P/Km²)	Population in million	Yearly change in million	Density (P/Km²)
1	2	3	4	5	6	7
1990	870	17.7	293	1172	20.3	125
2000	1053	18.5	354	1283	8.6	137
2010	1230	17.4	414	1397	7.6	145
2017	1339	15.0	450	1409	6.0	150
2020	1383	14.8	465	1425	5.5	152
2030	1513	12.2	509	1441	0.5	154
2040	1605	8.2	540	1417	-3.2	151
2050	1659	4.5	558	1364	-6.0	145
Source:  Worldometers  (www.Worldometers.info)

Current population growth in India  is mainly fueled by unwanted fertility.  Around three in ten pregnancies are unintended/unplanned or simply unwanted by the women who experience them and these pregnancies result in births that spur continued population growth.  Around 27 million children are born in India every year, and out of this about 7-8 million births could be classified as unwanted.  It is estimated, based on the National Family Health Surveys, around 450 million people out of 1335 million in India in 2017 were the result of unwanted pregnancies. With such a large number of people resulting from unwanted pregnancies, how can one think about using them for the nation building?   The consequences of unwanted pregnancy are being reflected in widespread malnutrition, poor health, poverty, illiteracy, unemployment, regressing governance as well as increasing scarcity of basic resources like food, water and space despite concerted developmental efforts since 1991. 

How to implement the HD agenda?

The implementation strategy is based on a ‘whole child’ concept - that is child and his /her family - for human development efforts. The paper, therefore, proposes a framework – HDPlus - to unlock the human potential. The focus will be all government school-going-children aged 6-14 and their families. They will be provided all the selected human development inputs, if needed. Additional inputs could be added looking to the needs of particular people/area so this framework is being titled as “HDPlus”. It will be implemented by the government agencies in collaboration with civil organizations like PulsePolio campaign in the 1990s and 2000s. [16] Further, the focus of the various government schemes like Swachh Bharat, Skill India, Beti Bachao, Beti Padhao, Ujjwala Yojana, Saubhagya Yojana, etc. will be on the families of Government-school-going-children.

In sum, the main concern today is the impairment of human potential, which is not allowing India to reap its rich demographic dividend. Human Development, therefore, is more than a goal in itself. It is a precondition for meeting the challenges of reducing inequality, promoting sustainable development and building good governance. It is high time that the Government of India and research institutions focus on developing effective and smart human development agenda to unlock the human potential. 

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[1] This post is based on the author’s recent work on Human Development, in which he argues: HD is the only option to resolve India’s myriad problems; and it can be a manifesto for change, since he believes in the phrase: Change One Thing and Everything Changes. For details see his forthcoming paper: Kothari, Devendra. 2018.”Nurturing Human Development: A strategy for New India”, FPA Occasional Paper, Forum for Population Action, Jaipur, India. For further information, contact: dkothari42@gmail.com.

[2]Bill Gates and Ratan Tata. 2016. “New nutrition report underscores the importance of leadership in addressing stunting in India”, Times of India at https://blogs.timesofindia.indiatimes.com/toi-editorials/new-nutrition-report-underscores-the-importance-of-leadership-in-addressing-stunting-in-india.

[3]  Lucas Chancel and Thomas Piketty. 2017.  “Indian income inequality, 1922-2014: From British Raj to Billionaire Raj?”  WID, World Working Paper Series No. 2017/11, World Inequality Lab, Paris School of Economics.  Also refer: Sharad Raghvan.  2017. ‘High growth does not necessarily mean high inequality, says Lucas Chancel’, The Hindu at http://www.thehindu.com/business/Economy/high-growth-does-not-necessarily-mean-high-inequality-says-lucas-chancel/article21653028.ece

[4] For details on education, refer: Kothari, Devendra. 2017. “Managing school education in India”, in Administrative Change, Vol. XLIV No. 2, pages 78-89.

[5] For details on health, refer: Kothari, Devendra. 2016.  “India needs efficient healthcare system for overall development” at: http://kotharionindia.blogspot.in/2016/06/india-needs-efficient-healthcare-system.html

[6] Jha and Laxminarayan. 2009. Choosing Health: An entitlement for all Indians, Centre for Global Health Research, Toronto.

[7] Reddy. KS. 2015.  “India's Aspirations for Universal Health Coverage”, N Engl J Med (373), pp.1-5.

[8] For details, refer:  Kothari Devendra. 2017.  “Water, Sanitation and Hygiene and human development in India” at: http://kotharionindia.blogspot.in/2017/04/water-sanitation-and-hygiene-and-human.html. Also see: Kothari Devendra. 2012. “West Bengal: Household amenities with special reference to water, sanitation and hygiene (WASH) and their implications” , Working paper   UNICEF, West Bengal, Kolkata.

[9] UNDP. 2006. Human Development Report 2006 - Beyond scarcity: Power, poverty and the global water crisis, United Nations Development Programme.

[10] Refer article: “WASH: water supply, sanitation and hygiene Human rights that are crucial to health and development” at:http://www.unicef.org/wash/files/1_WSSCC_JMP_Fact_Sheets_1_UK_LoRes.pdf.

[11] Jaitely, Arun. 2017. “Swachh Bharat: Universal sanitation is at the core of India’s development agenda, let us realise its promise”. TOT Edit Page at: https://blogs.timesofindia.indiatimes.com/arun-jaitleys-blog/economics-of-swachh-bharat-universal-sanitation-is-at-the-core-of-indias-development-agenda-let-us-realise-its-promise/

[12] Kothari, Devendra. 2014. “Empowering women in India: Need for a Feminist Agenda”, Journal of Health Management, 16 (2), pp 233-43. Also refer:  Kothari, Devendra. 2017, “India must go for gender equality”, Blog: Population and Development in India at:  http://kotharionindia.blogspot.in/2017/03/india-must-go-for-gender-equality.html 

[13] The Second Sex (French: Le Deuxième Sexe) is a 1949 book by Simone de Beauvoir, in which the author discusses the treatment of women throughout history.  The Second Sex is often regarded as a major work of feminist philosophy and the starting point of second-wave of feminism.  

[14] Gates, Melinda. 2016. “Women transform societies”, Times of India at: Blogs.timesofindia.indiatimes.com/toi-edit-page/women-transform-societies/

[15] Kothari, Devendra. 2014. “Managing Unwanted Fertility in India: Way Forward”, in Suresh Sharma and William Joe.   (eds.):   National Rural Health Mission: An Unfinished Agenda. Pp 25-36, New Delhi: Bookwell. Also see: Kothari, Devendra. 2016.” India: Why population matters?” Blog: Population and Development in India at: http://kotharionindia.blogspot.in/2015/04/india-why-population-matters.htm

[16] And the PulsPolio campaign, initiated to eradicate the polio in the country, could be the guiding strategy to unlock the human potential. PulsePolio was an immunization campaign initiated by the Rotary International and carried out by the Government of India to eliminate polio in India by vaccinating all children under the age of five years against the polio virus.