Ravindra H. Dholakia

INTER-RELATIONSHIP BETWEEN ECONOMIC GROWTH, SAVINGS AND INFLATION IN ASIA

The present study examines the inter- relationship between economic growth, saving rate and inflation for south-east and south Asia in a simultaneous equation framework using two stage least squares with panel data. The relationship between saving rate and growth has been found to be bi-directional and positive. Inflation has a highly significant negative effect on growth but positive effect on saving rate. Inflation is not affected by growth but is largely determined by its past values, and saving rate is not affected by interest rate. These findings for countries in Asia with widely divergent values of aggregates are very relevant for development policies and strategies.

Access of the Rural Poor to Primary Healthcare in India

The 11th Five-Year Plan of India emphasises the wider and better coverage of services, such as primary healthcare for the majority of population. For this purpose, various healthcare related programmes have aimed at the vulnerable sections of the society traditionally using social criteria like Scheduled Castes (SC) and Scheduled Tribes (ST) populations. Although they are found to have marginally worse health outcomes than the national average, they are far better than the one’s for the poor on economic criteria. The present article examines the coverage of basic primary healthcare services among the below the poverty line (BPL) population in rural areas of India and provides direct empirical evidence. Data used for the study was from a primary sample survey of rural BPL households in six states of India. The results of the survey showed that the coverage of primary healthcare services, such as ante-natal care (ANC), institutional deliveries, and immunisation was very low among the BPL population. Moreover, results of a comparison of the SC and ST and non-SC and ST population within the sample of the selected households showed that the former had a relatively poorer coverage compared to the latter. The focus of the programme for improving coverage of primary healthcare services should be on the BPL population. If it is done, it would also result in the improvement of coverage among the SC and ST population. Merely focusing on the SC and ST population will leave the poorest of the poor ignored and unattended.

Improving Access, Service Delivery and Efficiency of the Public Health System in Rural India

3 Acknowledgements This book is the product of a request made by the Ministry of Health and Family Welfare, Government of India to an International Advisory Panel (IAP) on the National Rural Health Mission (NRHM) to undertake a mid-term evaluation of the functioning of the NRHM. The work leading up to this book was undertaken with the generous support of the Government of Norway and we gratefully acknowledge the Norwegian Governments support and the support we received from the Bill and Melinda Gates Foundation for convening seven IAP meetings in Delhi over three years. We would like to record our sincere thanks to the Honorable Dr. Manmohan Singh, Prime Minister of India for having given us the opportunity to work with him and his cabinet members over the last several years. It has been our profound privilege to collaborate with Dr. Singh and senior policy makers in the Government of India. We owe a special debt of gratitude to all IAP members for providing valuable insights during the IAP meetings: Dr. Of the above IAP members, special thanks are due to Stephen Leeder, Mathuram Santosham, Awash Teklehaimanot and Walter Willett for their contributions in this Report. 4 The field data collection was undertaken by a team at the Indian Institute of Management at Ahmedabad. We are grateful to Surbhi Grover from the Harvard Medical School for fieldwork and reporting and Shreekant Iyengar, Prabal Singh and Prakash Parmar for their help in primary data collection, collation and tabulation. We thank all the respondents of our primary survey among the major stakeholders in the NRHM for sharing their views and information so kindly and generously. We also thank the district health functionaries of the selected districts who supported and cooperated with our survey team to enable us to complete the survey work in time. Over the years, we have benefitted immensely from our discussions with and thank

Scaling Up Primary Education Services in Rural India

We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services (in Uttar Pradesh, and Madhya Pradesh) in the area of primary education, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of these two states? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more schools, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example. Nirupam Bajpai is Senior Development Advisor and Director of the South Asia Program at CGSD. He is also a member of the UN Millennium Project. Ravindra H. Dholakia is Professor of Economics at the Indian Institute of Management at Ahmedabad in India. Jeffrey D. Sachs is Director of the Earth Institute at Columbia University and Special Advisor to the United Nations Secretary General, Kofi Annan. During the week of November 14, 2005, Nirupam Bajpai submitted this paper to His Excellency, Dr. A P J Abdul Kalam, President of India and the Honorable Dr. Manmohan Singh, Prime Minister of India. Nirupam Bajpai also presented and discussed this paper with Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, Digvijaya Singh, General Secretary, All India Congress Committee and former Chief Minister of Madhya Pradesh, Babulal Gaur, Chief Minister of Madhya Pradesh, Mulayam Singh Yadav, Chief Minister of Uttar Pradesh, Vijay Singh, Chief Secretary of Madhya Pradesh and R Ramani, Chief Secretary of Uttar Pradesh and several other senior civil servants in Delhi, Bhopal and Lucknow.

Scaling Up Primary Education Services in Rural Tamil Nadu: Public Investment Requirements and Reform

We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services in the area of primary education, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of the state? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely constructing more schools, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example. Nirupam Bajpai is Senior Development Advisor and Director of the South Asia Program at the Center on Globalization and Sustainable Development, The Earth Institute at Columbia University. He is also a member of the United Nations Millennium Project. Ravindra H. Dholakia is Professor of Economics at the Indian Institute of Management at Ahmedabad in India. Jeffrey D. Sachs is Director of the Earth Institute at Columbia University and Special Advisor to the United Nations Secretary General, Ban Ki Moon. Nirupam Bajpai presented this paper to Dr. Manmohan Singh, Prime Minister of India, Montek Singh Ahluwalia, Deputy Chairman, Planning Commission of India, K S Sripathi, Chief Secretary, Government of Tamil Nadu, V K Subburaj, M Kutralingam, Principal Secretary, School Education, R. Palaniswamy, District Collector, Villupuram, and M Rajendran, District Collector, Tiruvannamalai.

Scaling Up Primary Health Services in Rural India

We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services (in Uttar Pradesh, and Madhya Pradesh) in the area of primary health, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of these two states? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more health clinics, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example. Nirupam Bajpai is Senior Development Advisor and Director of the South Asia Program at CGSD. He is also a member of the UN Millennium Project. Ravindra H. Dholakia is Professor of Economics at the Indian Institute of Management at Ahmedabad in India. Jeffrey D. Sachs is Director of the Earth Institute at Columbia University and Special Advisor to the United Nations Secretary General, Kofi Annan. During the week of November 14, 2005, Nirupam Bajpai submitted this paper to His Excellency, Dr. A P J Abdul Kalam, President of India and the Honorable Dr. Manmohan Singh, Prime Minister of India. Nirupam Bajpai also presented and discussed this paper with Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, Digvijaya Singh, General Secretary, All India Congress Committee and former Chief Minister of Madhya Pradesh, Babulal Gaur, Chief Minister of Madhya Pradesh, Mulayam Singh Yadav, Chief Minister of Uttar Pradesh, Vijay Singh, Chief Secretary of Madhya Pradesh and R Ramani, Chief Secretary of Uttar Pradesh and several other senior civil servants in Delhi, Bhopal and Lucknow.

Sacrifice Ratio and Cost of Inflation for the Indian Economy

Traditional concept of the Sacrifice Ratio measures the loss of potential output sustained by the society in the medium term to achieve reduction in the long-run inflation by one percentage point. This concept is critically examined and generalized to include episodes increasing the long-run inflation rate to gain higher growth of output and employment and hence reduction in the poverty proportion in the medium term. Since the concept needs measurement through a shifting short-run equilibrium of dynamic aggregate demand and supply in terms of inflation rate and output attributable to monetary policy interventions, its estimation is challenging. There are two alternative approaches to estimate the ratio, the direct one and regression based. Both have their relative merits and demerits. The regression based approach provides one unique average estimate of the Sacrifice Ratio for all episodes but allows holding other factors constant. The direct approach provides separate estimates by episodes but fails to hold other factors constant. The Sacrifice Ratio turns out to be in a narrow range of 1.8 to 2.1 for deliberate deflation and 2.8 for inflation in India. On the other hand, benefits of one percentage point reduction in trend rate of inflation are at best 0.5 percentage points increase in long-term growth of output that occurs after 4-5 years. This has implications on policy to disinflate.

Improving the Integration of Health and Nutrition Sectors in India

It is a critical time for India to prioritize nutrition in its health and development agendas. While dismal nutrition indicators persist, and the countrys levels of hunger are considered ―alarming‖ on an international index, India is expected to miss the Millennium Development Goals targeting hunger and undernutrition. Without a targeted, multi-sectoral approach to nutrition, India is still struggling to deliver evidence-based interventions during the most important windows of opportunity. At the same time, the National Rural Health Mission (NRHM) and its Accredited Social Health Activists (ASHA) are gaining ground in delivering critical, community-based health services for women, children, and families. The current period of service delivery innovation and quality improvement presents an important opportunity to better integrate nutrition into health, and to push nutrition programming reform in the country. Recognizing this critical opportunity for nutrition programming innovation and integration in India, this report will examine the following research question: How can a nutrition strategy be better integrated into health programming? In pursuing this question, the paper intends to explore mechanisms for better integration in health planning at national, state, and district levels, and strengthened operational integration between frontline health workers and their supervisory structures. It will also examine how current nutrition efforts, namely Integrated Childhood Development Services (ICDS), can be more functional and thereby be better integrated into maternal and child health services. This report draws largely upon field visits throughout the country, and a field survey conducted in Chhattisgarh, Bihar, Uttar Pradesh, and Rajasthan with anganwadi workers (AWW), Accredited Social Health Activists (ASHA), and young mothers. Our findings from the field highlight strong needs for nutrition-focused outreach to families, and more structured collaboration between health and nutrition initiatives at community, block, district, state, and national levels. With these findings, we recommend actions to be taken within policy, human resources, and operations:  We argue that India requires nutrition leadership at national, state, district, and community levels. A concrete, proactive national nutrition policy is needed to unite fragmented nutrition initiatives, hold relevant departments to nutrition outcomes, and drive nutrition programming in high-focus districts. A similar push has already been initiated by the Department of Women and Child Development.  We recommend that states reinforce this commitment to nutrition by creating inter-ministerial councils to emphasize political will towards state nutrition policy and planning.  We strongly recommend the creation of a community advocate for nutrition, termed an Accredited Nutrition Activist in …

Increasing the Availability of Skilled Birth Attendance in Rural India

Key considerations in the availability of skilled birth attendance will be a critical component in national efforts towards ensuring universal health coverage in India. This paper aims to examine opportunities for strengthening skilled birth attendance at the primary level by (a) exploring relevant models of rural primary and community-level skilled attendance, both India and internationally, that have achieved positive health outcomes; (b) assessing the current skilled birth attendance coverage in India and means to achieving greater coverage of skilled attendance and enhanced linkages in the continuum of care; and (c) recommending opportunities and required investment for scaling-up skilled attendance within NRHM. Five high-focus NRHM states were selected for regional sampling in data collection (Assam, Bihar, Uttar Pradesh, Madhya Pradesh, and Rajasthan) as they are among the poorest and most populated states in the country. Two districts in each state were selected for variability in geography and health indicator performance. Within each district, questionnaires were administered to a sample of health workers across blocks and at the health facility level, including nursing staff and medical officers. Semi-structured interviews were conducted with state and national-level progammatic staff and health officials. Several key issues have emerged from our primary research about the availability of skilled birth attendance, many of which are widely recognized: (a) there are serious, persistent gaps in safe delivery capacity at the primary level, especially sub-centres and remote PHCs, despite efforts to decentralize care through NRHM; (b) SBA training targets are not being met across states; (c) SBA training quality is poor, particularly practical components; (d) there is a need for improving the rational distribution of SBA-trained staff into facilities with capacity, and to high-focus catchment areas, which limits skills development and/or maintenance, and also care outcomes; (e) quality of care post-training is not well monitored or supervised, so skills are not necessarily well applied or further developed; (f) health worker availability is largely insufficient at primary care levels, particularly nursing staff; (g) gaps in information between providers exist, particularly for use in point-of-care support, despite several means of data collection and tracking; (h) serious system gaps remain in equipment, supplies, and timely referral transport; (i) Indias patriarchal society has considerable implications for the valuation and welfare of women providers in health services, particularly nursing cadre. Our primary research highlights immediate requirements for more targeted systems strengthening, particularly for sub-centres that can provide intranatal care, and for PHCs depending on …

Trends in Regional Disparity in Human and Social Development in India

In the present paper, we have examined trends in regional disparity in human and social development by considering numerous indicators other than State Income. We found no support to the general impression prevailing in the recent literature that disparity is increasing over the last two decades when we subjected the trend to statistical significance test. We considered numerous output as well as the input indicators for the purpose. In very few indicators, the disparity showed an increase, whereas in a large number of indicators it either remained the same or actually declined over the last two decades. The state governments’ efforts in the social sectors were perhaps a major reason for the outcome. Except education, in all other social sub-sectors, the interstate disparity in the government effort markedly declined during the 1990s compared to the 1980s. In education, it remained the same. Our findings in this paper point to a very clear policy prescription. The social and human development is considered by all the state governments as very important and a priority sector in their development strategy. The way they are making efforts in these directions is reducing disparity across states although each state has been acting on its own. This is perhaps because of the felt need of people and the polity in states. Explicit objective of reducing regional disparity in social and human development in the central planning may not, therefore, be specially required. Augmenting the revenue resources of states allowing the states to access public borrowings directly would enable most of them to concentrate on their priority areas – based on the local felt need. It is likely to address the issue of regional imbalance and disparity in a much better and efficient way without imposing excess burden since it would allow exploiting complementarities in growth and equity.