While Prime Minister Narendra Modi readies to address the United Nations General Assembly on September 27, it is observed that appallingly, India has fallen short of fulfilling the UN millennium development goals (MDGs) set for between 2000 to 2015. It is feared that this will lead to India missing its 2015 MDG targets. Modi's address to the UN coincides with the start of year-long negotiations preceding the expiry of MDGs at the United Nations.
MDGs range from halving poverty levels, achieving universal primary education levels, reducing child mortality and improving maternal health, providing clean drinking water and sanitation to all, combating HIV/AIDS, malaria and tuberculosis, ensuring environmental sustainability and partnering with developed countries for global development.
Indian researchers have pointed out that India is largely off track in completing the MDGs and they have heavily criticised this lax approach. Health initiatives taken by India in the last decade are not enough to achieve the MDGs, they say. It will miss the targets for reducing under-five mortality rate, infant mortality rate and maternal mortality rate by a significant margin. Immunization targets against measles and targets for proportion of births attended by skilled health personnel will also be missed.
The first goal of the MDGs involves halving the number of people that live in extreme poverty and earn below $1.25 a day. Experts said that India has not met this goal. They emphasise that the below poverty line (BPL) set by the Indian government of a person earning Rs 32/per day in villages and Rs 47/per day in cities are way below the MDG indicators of poverty. “India defines BPL standards way below the UN definitions. The extent of poverty is so huge that the Arjun Sengupta Commission set up by the GoI, two years back, observed that 77% of the Indian population earns below $2 or Rs 122 a day," observed Professor Biswajit Dhar, Centre for Economic Studies and Planning, Jawaharlal Nehru University (JNU), New Delhi.
Even though the second goal for enrolling children to attain primary education received a huge thrust due to introduction of the Right To Education (RTE), experts have questioned the quality of education meted out. “If we factor in the dimension of quality of primary education, we are grossly falling short of the ideal standards. Also the student population transiting from primary to secondary education levels fall below 40%, which means that we are failing to impart basic skills to people so that they may be worthy of the job market,” explained Dhar.
India has put up a dismal performance as far as fulfilling Goals four and five for reducing child mortality and improving maternal health are concerned. MDGs demand that the death of expectant mothers and new borns as well as children under five be reduced by two thirds between 2000 to 2015. While Sri Lanka, China and Bangladesh have zoomed ahead and effectively reduced the number of women and children dying in their countries, India continues to see high rates of maternal and child mortality.
The India Infrastructure Report 2013 – 14 on universal health coverage released by IDFC Limited on Thursday points out that India is likely to miss a majority of the MDGs by a significant margin as it steps into the target year 2015. India ranks below several Asian countries - Thailand and China) as well as neighboring Sri Lanka, Bangladesh and Maldives as far as fulfillment of MDGs are concerned.
52 out of every 1000 children in India under the age of five die due to multiple illnesses. MDGs require these levels to go down to 42 per 1000 live births. “Lack of access to clean drinking water causes higher incidence of diarrhea and deaths of children under the age of five. In rural areas as many as 58 children die of 1000 live births, higher than the national average,” said Sambit Basu, director, IDFC Limited. A Save the Children report compiled in 2013 indicates that respiratory infections, diarrhoeal diseases and parasitic diseases cause the largest amount of child deaths. In Madhya Pradesh, Assam, Odisha and Uttar Pradesh children dying below the age of one, stand above 50 deaths per 1000 live births even as MDG goals dictate that the levels should be halved to 25 deaths per 1000 live births.
Access to drinking water resources has improved but the quality of water and infestation of microbacteria in it has not been assessed, point out experts. “Though over 90% households have access to drinking water the quality of water being clean is not guaranteed. This causes a spurt of diseases which claim lives of people,” Basu told dna.
The Goal five of reducing maternal deaths has taken a severe beating in the Indian context. Twenty-seven percent of all deliveries in pregnant ladies occur at home in India. While in Sri Lanka only 35 of one lakh women may be dying due to pregnancy related complications, in India the number stands at at 178 deaths per lakh. In the UK, barely 12 women of one lakh die due to child birth. “India was expected to reduce it to at least 109 deaths per one lakh, but it has failed to fulfill the MDGs. Sepsis and haemorrhage caused during deliveries that occur at home can be prevented through proper check ups but care is not reaching expectant mothers in India,” said Basu.
The deaths can be linked to non-fulfillment of Goal three in the MDGs that deals with women empowerment in India. “Most women are not able to practice contraception techniques of their choice. Moreover, information regarding sexual education and rights is not being provided to young people by GoI,” said Dr Kalpana Apte, Assistant Secretary General, Family Planning Association of India.
However, goal eight talks about global partnership for development, a commitment that developed countries have faltered on. “The MDGs were crafted by the donor communities in developed countries. But they have not been honest enough to come up and tap the commitments by backing it with enough finance. The official aid from these countries has dwindled whereas funding from private organisations has increased,” said Dhar.
Experts said that not enough resources were being allocated indigenously by countries or by international communities to fulfill the goals. While all developed nations were expected to contribute 0.7% of their GDP towards achievement of MDGs, they have failed to commit enough finance. “While US may spend 17.6% of its GDP on health, Chile spends 7.4% and China spends 5%, India spends not more than 3.7% on financing health schemes. This is paltry and insufficient,” said Basu. It is speculated that Modi may call for funding and aid commitments to fulfill MDGs and further Sustainable Development Goals (SDGs) from 2016 – 2030 that replace MDGs. “India and China have been helping developing countries by giving financial aid, but the PM is expected to reaffirm that this cannot replace fund flow from the developed nations,” said Dhar.
Amit Narang, Counsellor, Permanent Mission of India to the United Nations confirmed in a statement, "The debate on South-South Cooperation (in which was belatedly added North-South Cooperation as well) informed us that South-South cooperation can supplement but cannot substitute or dilute the obligation and quantum of North-South aid flows."
Eight MDGs will give way to 17 Sustainable Development Goals (SDGs) and 169 targets post-2015 which will be debated and later adopted for implementation between 2016 – 2030 by 193 countries in the United Nations.
Despite experiencing spectacular economic progress over the last two decades, India ranks a pitiful 136 out of the 187 countries on Human Development Index (HDI).
India is falling short on particular goals including Goal 1 for eradication of extreme poverty, Goal 4 and 5 for reducing child mortality and maternal deaths by two thirds and Goal 6 for combating HIV/AIDS, Tuberculosis and other diseases.
Current levels of infant mortality rate (children dying between 0 – 1 year) are at 42 per 1000 live births while the target is to reduce it to 28.
While all children under-one should be immunized for Measles only 74% immunization has occurred.
India's poor position amongst countries in global health indicators:
India’s world ranking in health outcomes is embarrassingly low. Of 194 countries, India ranks 164 (NMR), 145 (IMR), 122 (MMR), 162 (immunization coverage for measles in one-year olds).
*Neonatal Mortality Rate (NMR) – Babies between 0 – 1 month, deaths per 1000 live births
*Infant Mortality Rate (IMR) – Babies between 0 – 1 year, deaths per 1000 live births
*Under-five Mortality Rate (U5MR) – Babies between 0 – 5 years, deaths per 1000 live births
*Maternal Mortality Rate (MMR) – Women dying per 1,00,000 pregnancies
*Immunization levels of under-one year children for Measles
Goal 4 – India has not reduced Child Mortality by two-thirds.
Goal 5 – India has not reduced maternal mortality rate (MMR) by two thirds.
Goal 6 – To halt and reverse spread of HIV/AIDS, TB, Malaria has not been achieved
Goal 7 – Halve by 2015, proportion of people without sustainable access to clean drinking water and basic sanitation
Source: India Infrastructure report 2013-14, IDFC Limited
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