Changing gears: Can the open defecation conversation move beyond subliminal patriarchal messaging?

By Mukta Naik and Kimberly Noronha, both Senior Researchers at CPR

In today’s fast paced, slogan-driven policy environment, the pressure by the political masters (and indeed, the polity) on the bureaucracy to deliver on promises is enormous. The Prime Minister’s declaration of a “Swachh Bharat” by October 2019, complete with the status of an Open-Defecation Free (ODF) India is a commendable goal. But in a scenario of tight deadlines, the temptation is to pluck low hanging fruit, which in this case is women’s dignity and honour.

Photo: Creative Commons License

We live in a patriarchal society; we don’t have to like it, but that is a fact. Patriarchal values are structured around women’s position and identity in society relative to men – largely linked to control over women’s sexuality. The protection of women’s dignity is linked to the honour of the household in particular, and the community at large under patriarchy. So, the logic holds, if you want SMART results, use existing cultural values to, as UNICEF advertises it, “take the poo to the loo”.

Consequently, on 2^nd October 2014, the Prime Minister thundered: “I feel most pained that even our mothers and sisters have to go in open. We have to remove this blot… We should do this much at least for the dignity of our mothers and sisters”. Following in his footsteps are the central ministries for Rural Development and, Drinking Water and Sanitation: Bahu betiyan bahar na jayein, Ghar mein hi shauchalay banvayein, [Daughters and Daughters-in-law shouldn’t go outside, build a toilet inside your house], declares Vidya Balan as the base message in a series of advertisements for Swachh Bharat.

Access to a toilet is a real problem for women in India, especially the poor. Does framing this problem in a patriarchal manner alleviate or exacerbate the problem? Photo credit: Mukta Naik

This strategy seems to be working. During a field visit to a jhuggi in north-west Delhi, the Cities of Delhi research team at the Centre for Policy Research encountered a young mother whose pride about the toilet inside their home, the only one in the jhuggis of about 300 houses, is expressed along the lines of honour and caste. The honour of the women is very important in her Rajput household, she tells us, and no expense is too little to make sure that our daughters remain untainted.

In a Kanpur slum where open defecation is the only option, a mother seeks out the help of NGO Shramik Bharti, a local partner of WaterAid to build a toilet in her home, after her 14-year old daughter got attacked by a drunk man while answering nature’s call one morning. For this mother, the motivation was clear but the larger gains were achieving dignity and police consent (as opposed to harassment) for improving quality of life in the slum through fresh construction.

Researchers Nikhil Srivastav and Aashish Gupta from RICE, opine about how campaigns, like the one featuring Vidya Balan, are patriarchal and reinforce the idea of the ghoonghat or pardah in states like Rajasthan where 94% of women practice ghoonghat/pardah (98% in rural Rajasthan) as per Census 2011. Further, they point out that the idea that toilets will reduce violence against women is problematic considering much of this violence happens within the home, something Indian society remains in deep denial of.

They conclude by suggesting that campaigns for sanitation must advocate changed behaviour for men instead of being stuck on the issue of women’s honour, and recommend that Rajasthan can learn from rural Uttar Pradesh where they found a message on a wall that read: “Shriman khatron ke khiladi, jao shauchalay, chhodo jhaadi” [“Dear Mister Fearless Adventurer, Use a toilet, leave the bush”].

The graffiti is in the right spirit of course, but there is many a feminist who could read subliminal patriarchal reinforcement in “Mister Fearless Adventurer”. For example, this phrase could be seen to be praising men who defecate in the open by appealing to their sense of machismo, and may end up reinforcing the behaviour the campaign seeks to avoid. Although the article does not state when the graffiti went up, both UP and Rajasthan had comparable open defecation (OD) figures in 2011 (Rajasthan: 64% OD population; UP: 63%), so the impact of the graffiti in Uttar Pradesh vis-à-vis the Swachh Bharat messaging in Rajasthan is not immediately clear.

While the article makes the necessary intervention against reinforcing patriarchal norms, in the race to be gender-sensitive to sanitation service delivery, are we missing out on one fundamental Weberian truth – in context verstehen? Men and women live together in society. Targeting one group to the exclusion of others is always going to lead to fall-out. Additionally, attempting to completely ‘sanitise’ the delivery of messaging from the ‘germ’ of culture (including that of patriarchy), may adversely impact OD figures if local communities are unable to relate to the cultural contexts of the messaging,

In her rejoinder to Srivastav and Gupta’s piece, Somya Sethuraman says that the authors have latched onto just one message, taking it out of context. Somya points to other advertisements that feature Vidya Balan, for example, giving diarrhoea tablets to a mother because she has sent out her daughter to defecate in the open and will, inevitably fall sick, therefore making health and not patriarchy the central message. According to her, these kinds of advertisements, all taken together, have had a positive effect, not just on the elimination of open defecation, but also on the overall empowerment of women in rural Rajasthan where a number of them have actually given up the ghoonghat / pardah.

Instead of making it an either-or fight of targeting just men or just women, what other low-hanging fruit can we offer government away from subliminal patriarchal messaging towards the focus of ODF behaviour? Bangladesh has seen an impressive 31% reduction in OD figures from roughly 34% in 1990 to just 3% in 2012. In Bangladesh, the media was not used to shame communities into defecating in household toilets (as is being done in India), but rather to reinforce ODF behaviour by focusing attention on best practices and health related outcomes. The recent declaration of the Nadia district’s (West Bengal) ODF status (which was presented and intensely discussed at the 1st Niti Aayog – CPR Open Seminar on “ODF Communities: A key step towards Swachh Bharat”, held in May 2015; read report here) was accompanied by a significant reduction in adverse health impacts. In the implementation of their strategy, women and school-going children were the main change agents.

Can we find stronger reasons — like improved quality of life, health, independence, and the intangible pride in one’s village or city —to reinforce the message against OD? And can we work with local communities to re-examine the real issues they face, from within and without?

The Niti Aayog – CPR 1st Open Seminar on “Open Defecation Free (ODF) Communities: A key step towards Swachh Bharat” was attended by about 100 experts, researchers, practitioners and policymakers. Photo credit: Kimberly Noronha

 

Gentrification causes homelessness? Simplistically linking problems does not translate to good housing policy

by Mukta Naik

Scholars, bloggers and journalists in the Global North, especially in the UK and the US, have drawn clear links between the process of gentrification and the increase in homelessness since the early 2000s. With the problem of homelessness growing steadily—some 60,000 people in New York sleep in shelters each night as per the Coalition for the Homeless, about 6,500 slept on London’s streets in 2013-24, 70% more than the number in 2010 as per local agencies—quite a bit of passionate soul searching has taken place over its causes. It has seemed logical to pin the blame on the gentrification of erstwhile poor, debilitated areas of the city. Global capital and the greed of investors, sometimes from far overseas, and even the idea of the global city have been named the villains. In short, global capital (the rich) has pushed out local capital (the middle class and the poor) and those at the lowest end of the ‘pushed out’ bunch are now on the streets.

This might well be true, but as this blog on Brooklyn’s homeless problem points out, the real failure lies in the inability of the city’s visionaries to understand that there are new and more complex problems at hand. Plugging the demand-supply gap is no magic solution and housing is far more complex than the solutions that emerge from the government’s simplistic slotting of households into broad income slabs.

Poor targeting in government schemes

New York Mayor Bill de Blasio’s affordable housing plan, which does an impressive dissection of incomes and housing rentals in the city is planning to “create and preserve 200,000 units of affordable housing for approximately 500,000 New Yorkers over the next ten years” along with soft support to the homeless in the form of eviction protection services, increased investments in shelters and a program to remove bottlenecks in allocating affordable units to those living in the shelters. What is not explicit in the plan, though, is the recognition that new “affordable housing” units will not be affordable to the majority of the homeless. New York is an example. This sort of poor targeting is a common ailment in policy and in housing policy particularly, where supply side thinking usually dominates.

What then is a possible inclusive housing strategy for this growing group of homeless (or other excluded groups) in the city? What is the role of housing in fostering better incomes and upward mobility among the working homeless? How can government look at housing provision creatively to address different types of poverty, different types of family units, different types of housing problems?

Ostrich syndrome: Won’t see the complexities, will stick to simplistic and seductive solutions

The point about the need to understand the real housing issues within the city, find the inter-connections and then target solutions has been made several times to the government in India as well. In the past five years of working with housing and urban development issues at micro Home Solutions and now at Centre for Policy Research, I have been involved in several consultations and meetings between experts and the government, with Union ministries like HUPA, the Government of Delhi as well as government institutions like DUSIB and DDA (Do read CPR project Cities of Delhi reports on these). At these meetings and workshops, evidence from research projects and pilot interventions have been presented to back demands for a more contextual approach to housing policy. Some of the suggestions have included government investigation into the need for rental housing for the working poor (and middle class), the support of incremental housing rather than its demolition, improved shelters for the homeless, more rational norms for measuring housing affordability and innovative mechanisms for the poor to transition from one type of housing to another, among others. While these suggestions are heard, they are rarely understood. Moreover, they pale in comparison to seductive solutions that propose to remove the jhuggis (slums), clean the city and rehabilitate slumdwellers in flats built in high-rise towers (read Cities of Delhi op-ed on rehabilitation/resettlement of slumdwellers and author’s critique of rehabilitation into high-rises) .

View from a Slum Rehabilitation project in Hadapsar, Pune: A complex reality
Photo credit: Mukta Naik

At these meetings, the link between gentrification and lack of adequate housing is often discussed. Politicians understand about market dynamics, they’ve seen enough of elite capture. Any subsidised housing the government offers, they know, will change hands and be appropriated by investors and middle- and high-income people; while the poor will build back the slum! At the same time, the Delhi government, for instance, is struggling to find solutions to fill thousands of empty affordable units located in inconvenient (read poorly connected) parts of the city.

Once again, the issue of correct targeting comes to the fore. Communities like the homeless or even renters remain excluded from policy conversations about government-provided housing, while those that are targeted by government housing schemes are unable to benefit from them for reasons of insensitive design and poor location/connectivity .

A new imagination for housing policy

In Delhi at least, there is no pretence that a larger supply of affordable homes will help the homeless. However, it is precisely in cities like Delhi, where the diversity in housing supply is considerable (much of it located in incrementally built quasi-legal areas of the city) and where mobility between housing types is commonly seen, that we have a chance to envision housing differently. In a bustling resettlement colony in northwest Delhi, we approach a rickshaw puller outside a community toilet complex to investigate the functionality of public toilet. He screws up his nose at us in disdain. “I don’t use that filthy toilet,” he says. “I live in a rental home and we have private toilet facilities.” He pays Rs 2500 a month to rent a room and live in dignity, he says, even if it means there is less liquidity for household expenditure and no remittances go home to the village.

Repeatedly, we observe housing aspirations that revolve around dignity and decent amenities on one hand, and those that obsess about property values and status on the other. Somewhere between these extremes lies the opportunity of a re-imagined housing strategy. One that can provide a life of dignity and a lever for upward mobility, but also create diverse forms of supply that answer to the peculiar complexities of poverty and housing need in our cities. But to realise this, the government needs to think out of the many straight jackets it has created for itself: the income classifications of EWS, LIG, MIG and HIG, the rigid space allocations for subsidised housing (we are ridiculously stuck at 25 sq.m. per household), of rental versus ownership housing, of public housing and public-private partnerships (PPP, the magical phrase with a touch of dread). Is it possible to imagine housing policy without strait jackets?

NITI Ayog & CPR seminar: “Open Defecation Free (ODF) Communities: A key step towards Swachh Bharat”

Swachh Bharat Abhiyan (SBA), India’s national-level mission on sanitation was arguably born from the realisation that open defecation figures in India remain high in both rural and urban areas. A large push to  construct individual household latrines, and convert insanitary (including pit latrines) into sanitary latrines is underway and the target is for India to be Open Defecation Free (ODF) by 2019.

NITI Ayog, the Government of India’s policy think tank and Centre for Policy Research partner to put the spotlight on this issue, which lies at the core of the Swachh Bharat Abhiyan’s success. The seminar titled “Open Defecation Free (ODF) Communities: A key step towards Swachh Bharat” will debate the definition of ODF communities and the evolution of a suitable matrix to measure the achievement of this status under the mission.

Seminar: Open Defecation Free (ODF) Communities: A key step towards Swachh Bharat

Date: Friday, 22 May 2015

Time: 3:00 pm

Venue: Room 122, Niti Aayog, Sansad Marg, New Delhi

For more information, click here 

You can also view the brochure: OSS1 Brochure-final

Lessons in urban development ignored

By Sama Khan

This op-ed appeared in The Pioneer on 5 May 2015 and can be accessed here

The Modi Government is repeating the mistakes of its predecessors by constructing new houses to meet its Housing for All goal. Past experience shows that the urban poor prefer the cheaper option of developing existing slums with basic amenities, writes SAMA KHAN

In order to pursue the goal of ‘Housing for All’ by 2022, Finance Minister Arun Jaitley had proposed to build more than two crore houses across the country. This would cover slum housing and affordable housing for the weaker sections.

In this context, it is worthwhile to take a look at how urban housing schemes have fared in the past. The Basic Services to the Urban Poor and the Integrated Housing and Slum Development programmes were launched in 2005 under the Jawaharlal Nehru National Urban Renewal Mission for integrated development of the slums.

Both the programmes were administered by the Ministry of Housing and Urban Poverty Alleviation. The objective of the BSUP was to provide housing either in-situ or in a new location with basic infrastructure amenities in a healthy environment. The BSUP and IHSDP involved construction of dwelling units, and only a few projects covered the upgradation of infrastructure amenities.

According to the Ministry’s database, a considerable number of houses have not been completed under the BSUP and IHSDP programme. Out of the total sanctioned houses under BSUP and IHSDP, 71 per cent have been completed and of these only 54 per cent of the total sanctioned units have been occupied whereas 29 per cent were under progress as on December 2014.

A report by the Comptroller and Auditor-General of India on JnNURM (2012) states that ineligible beneficiaries were able to gain benefits of the BSUP. There were shortfalls in the identification of beneficiaries, even though the guidelines proposed household survey of slums including livelihood and occupation profiles before the submission of the Detailed Project Report along with an understanding of the willingness of beneficiaries to relocate.

In many cases, the dwelling units constructed were of poor quality and hence some of the units remained unoccupied whereas others were occupied by ineligible beneficiaries. There were significant delays in the construction work due to the non-availability of land. In many cases, BSUP units were constructed on the peripheries of cities, without considering the willingness of the slum dwellers to relocate outside the city.

The Rajiv Awas Yojana, launched in June 2013, was yet another scheme launched by the MoHUPA to further accelerate the provision of housing for the urban poor. RAY was an improvement over the BSUP and it learnt from many shortfalls of the BSUP.

Unlike the BSUP, the RAY pronounced in-situ development as the preferred strategy for slum development suggesting either upgradation by filling gaps in housing and infrastructure or re-development, which is an overhaul of the entire slum.

However, according to the data on RAY, as on March only two per cent of the total sanctioned units have been completed and occupied. Thirteen per cent are under progress while construction is yet to start for the remaining 85 per cent. Within the sanctioned dwelling units, there has been a high preference for in-situ development/re-development projects under RAY.

The Ministry’s response to the Standing Committee on Urban Development on the slow pace of progress of the RAY was that while “in-situ redevelopment of slum is the preferred choice… it is a time consuming process as beneficiaries have to be relocated and places to be handed over to contractor for work. In many cases beneficiaries are reluctant to move and ULBs find it difficult to temporarily relocate slum dwellers.”

The Government now  plans on investing large amounts of money to build affordable housing. Thus, rather than improving the settlements, the Government aimed to create entirely new homes for the urban poor.

There seems to be an absence of any policy that targets the improvement of the living standards of slum dwellers. BSUP, IHSDP and RAY clearly point to a focus on construction of houses, with only a few projects covering the up-gradation of infrastructure amenities. Although the approach of construction of houses hasn’t yielded the desired results as a considerable number of these houses are incomplete, many of the completed houses are lying vacant and many others are occupied by ineligible beneficiaries. This approach fails to understand the unwillingness of the slum dwellers to relocate to a new location or to be temporarily relocated for in-situ redevelopment.

It also neglects the importance of providing citizenship rights to the urban poor and including them in the formal economy of the city. Up-gradation of slum settlements like provision of safe drinking water, sanitation and solid waste management is an important policy measure that should not be disregarded as it will allow the slum dwellers to improve their standard of living and will also provide them with land tenure security.

Rashmi Sadana talks on the Delhi Metro: ‘We are visioning it’

Rashmi Sadana, Assistant Professor of Anthropology at George Mason University, shared her research on the Delhi Metro with an interested audience at CPR on 28th April 2015. Her talk titled “We are visioning it”: Availing the Futures of the Delhi Metro presented a cross section of perspectives from bureaucrats, planners and users about this iconic infrastructure project in India’s capital city. 

Here is a storified record of the live tweets from the talk. Rashmi’s talk was the 63rd in the CSH CPR Urban Workshop Series that takes place on the last Tuesday of every month at CPR.

Failure in planning OR failure of planning? Reflections on the saga of Mumbai’s DP

The ambitious Mumbai Development Plan (DP) 2034, envisaged as a blueprint that specifies the land allocations, land use patterns, transportation networks and amenities for India’s largest metropolis, has been recently put on the shelf  for revisions following intense criticism on several fronts. It is to be revised and republished for public response within four months.

Iconic monument, Mumbai’s Gateway of India. Photo credits: Mukta Naik

 

The release of the plan into the public domain, itself a unique occurrence for Indian city planning, has facilitated an unprecedented amount of public debate and discussion. In the process, many hitherto unconcerned citizens have hopefully thought about the issues involved in deciding a future for their city. However, several burning questions remain. On the mechanics of planning a megacity like Mumbai. On the processes and institutions required. On responsibility. On why Indian cities are unable to plan. And on why they must learn to do so rapidly, or risk severe ecological and economic failure.

In this context, Poornima Dore’s crisp critique of planning in the context of the events unfolding around the Mumbai DP offers : Why India needs to invest in Planning. Poornima, who is associated with the Tata Trusts, is a Mumbaikar and a passionate advocate of responsible development. Her piece avoids theoretical musings and instead focuses on her thoughts on evolving a new, transparent and practical approach for planning our cities. This post was originally published on the SHRAM portal, the mouthpiece of the SHRAMIC in which Centre for Policy Research is an active partner.

As a teaser, here are some quotes that highlight her three main points:

Cities must be empowered to deliver

“It is critical to put in place systems, processes and people empowered to deliver, if cities are to act as engines of growth – without sputtering as we turn on the ignition.”

Governments must listen to credible professionals

“Mumbai and every city needs to be willing to invest in (and listen to) a credible team of urban planners, with tight deadlines and uncompromised deliverables.”

Standards are necessary, holding organisations and people up to them is critical

“Can we have more stringent norms for what is acceptable in the name of surveys and research, and can we blacklist agencies that have glaring mistakes in what they provide as data?”

Read her piece here

Of Manish Sisodia, transportation policy and Delhi’s smart city conundrum: A report from CONNECT Karo 2015

By Mukta Naik

The Stein Auditorium at India Habitat Centre is half empty and it’s the hour in which conference goers are eager for lunch to be served. We are attending the CONNECTKaro 2015, an annual and global event on sustainable transport and urban development organised by EMBARQ and WRI India. An esteemed Brazilian politician is speaking about his city’s sustainable transport strategies. The audience is politely bored. He finishes and there is some scattered applause and he leaves the stage.

At that moment, something changes in the air. The hall is full in a matter of minutes, lunch is forgotten and Amit Bhatt from EMBARQ is introducing Delhi’s Deputy Chief Minister Manish Sisodia to speak on his vision for Delhi. Mr Sisodia addresses the audience in Hindi, picking up issues important for urban development (a portfolio he currently holds, among many) and specifically for transportation which is the theme of the event. But before he does that, he spends some time talking about the idea of the smart city and what it means for Delhi. He presents a scenario in which an employed citizen is able to access amenities and live a dignified life. “Can we call a city smart if it does not provide safety and decent and affordable education and healthcare?”, he quips.

This critique of the smart city, of being overly focused on technology at the cost of inclusion, has been widely expressed by a number of experts. But by positioning the smart city discussion within the context of connections and connectivity, Mr Sisodia succeeds in putting the spotlight on the one aspect that will make or mar AAP’s performance in Delhi’s governance saga. AAP has taken the bull by its horns by focusing on the issue of inter-agency cooperation that has plagued the city for decades. Specifically, Mr Sisodia points to the coordination challenges between the AAP Delhi government, Delhi Development authority (DDA), which comes under the Union government, and the Municipal Corporation of Delhi, which is controlled by the opposite political camp. Further, he went on to call Delhi an unplanned city and one that can never be planned unless the authorities work in tandem. “Consumer, citizen or human being? How do government agencies see people?,” he asks even as he accuses the DDA of having a developer’s mentality.!

Mr Sisodia’s enunciation of Delhi’s transportation woes and AAP’s proposed solutions, which include a freshly designed BRT system, a revamped public bus system, CCTV cameras and trained security marshals on buses for women’s safety and the licensing and streamlining of intermediate public transport like e-rickshaws, came under a fair amount of questioning and introspection the the Q&A session. Many experts objected to their scrapping of the existing BRT corridor, others pointed to the need for human and not merely technological solutions to issues like women’s safety, rash driving, improper parking, etc. There was a suggestion regarding the restoration of existing cycling lanes in the city, and several suggestions with regards to sustainable transport solutions from people around the world.

But the question that Mr Sisodia did not really answer was the one raised by an elderly gentleman who appeared genuine concerned: “It doesn’t seem from your statement, Mr Dy Chief Minister, that you are working towards making Delhi into a smart city? Will our aspiration to be a smart city remain just another dream?” Clearly, even without any clarity on what a smart city is, the unending possibilities unleashed by the aspirations of smartness and technological competence, are now deeply lodged in people’s minds. The smart city may well be a difficult promise to keep for the Modi-led government; for Delhi, it seems that priorities lie elsewhere and bijli, paani and women’s safety will be the mantras by which the governance game will be played for the months to come.

Event: Nida Kirmani on ‘Fear and the City: Negotiating Everyday Life as a Young Baloch Man in Karachi’ 31 March 2015

How (not) to achieve Universal Health Coverage

By Susrita Roy, Research Associate at CPR

The concept of Universal Health Coverage (UHC) is guiding health policies across the world today, and India is following suit. UHC would mean that all of us will have access to affordable, accountable and appropriate health services of assured quality irrespective of our economic and social status.The government’s role will be both to guarantee and enable access to these services. Sufficient commitment toUHC by 2022 has been expressed by both the current as well as the erstwhile government. While the previous government had incorporated many of the recommendations of the High Level Expert Group for UHC in the 12^th FYP, this government has taken a visionary leap in the National Health Policy 2015 (draft) to propose “health as a fundamental right, whose denial should be justiciable”. However the approach adopted for praxis of UHC is what is confusing and often contradictory. One important contradiction is financing of health care through medical insurance.

Riding on insurance

Though the ruling party at the centre has changed, the Government’s appetite for financing health care through medical insurance seems to have carried over. The 12^th FYP formulated by the UPA government had proposed to reform the Rashtriya Swasthya Bima Yojana to “enable access to a continuum of comprehensive primary, secondary and tertiary care” especially for the BPL sections. And more recently the Union Budget 2015 has also promoted the financing of health expenditure through insurance by hiking the deduction on health insurance premium by more than 60%. There has been a deduction on the premium paid by senior citizen, but that is for only 9% of the population who are already vulnerable.

Whom does this hike affect? Largely it seems to affect only those of us who pay taxes and have medical insurance, and without doubt it is good news for us. Besides reduction in taxes, the good news may be at two levels, we can get more cover for our medical needs and also with this additional cover we can access services of corporate hospital instead of a private nursing home or a public sector hospital. And without doubt it is good news for both the insurance companies as well as for the private hospitals. The government has definitely guaranteed them profits.

Challenges for the UHC

However, this is bad news for achieving the goals of the UHC, especially when the allotment for public health programmes has not increased substantially from last year. Based on experiences of developed countries like Germany, which has a health care system financed through insurance, certain roadblocks for UHC can be identified. Firstly, with more people accessing services from secondary and tertiary health institutions, the ‘gatekeeper function’ that primary level care h performs will not continue. In the event of a disease outbreak (like H1N1 at this time), we will have to go to a private hospital, which may or may not admit us. The second problem will be an increased focus on curative services, instead of preventive and promotive care. Given that there is inherent asymmetry of information in the supply and demand of health care, this could imply that as patients we may be subjected to unnecessary tests and procedures that make money for private hospitals. Thirdly, with the rise in lifestyle diseases which medical insurance does not adequately cover, we will have to incur higher out of pocket expenditures for medicines and tests. Fourth and most important is that medical insurance will never reach the poor, who are a risky target for insurance companies due to the inherent vulnerabilities. For all these reasons, a health care system based on insurance can and should never be a way to UHC.

A long term view

If the insurance based model of financing healthcare is not viable, the only option is to expand the coverage of public health services as is available in many countries who have achieved UHC or those with good health indicators like Sri Lanka, Canada etc. The common indicator of comparing India with the countries is the government’s expenditure on health. By that measure India is surely very backward. It is well established that investing in public sector health services are far more equitable than any form of private provisioning as well as private financing.

However what gets missed out in these comparisons is the tax structure across countries. Based on the experiences from these countries, it may be advocated that India needs to raise the available resources through increasing taxes, especially direct taxes. This is the only way that the benefit of economic growth can be distributed among the entire population, of which health is an important one. However the current budget has not paid much attention to this issue; instead it has tried to appease tax payers by increasing deductions on taxes. If the current government is serious in making health a right, then it should shed these populist measures and shift to generating more revenues, which will not only increase spending in health but also other social sectors, all of which have seen budget cuts in the current fiscal year.

Event: Henrik Valeur: Talk on Social and Environmental Sustainability in Urban India (March 12, CPR at 3:45 pm)