Bad hygienic conditions affect rich and poor, no matter how high your walls are

Usually, our public discourse is dominated by economic reforms, even though the neglected social sector, including education and health, requires equal if not far more government attention. Has the one-year-old Modi government made enough effort to correct this imbalance?  Dipankar Gupta, director of Centre of Political Affairs and Critical Theory, Shiv Nadar University, shares his views on the subject, with Monobina Gupta.       

Q: In its one year in office, has the Modi government shown sufficient resolve to turn the situation around in health and education sectors? 
A:  There is a lot of controversy over numbers regarding government allocation to the social sector. On one side, the critics say that the actual sum dedicated to such activities has shrunk and, on the other hand, the Centre argues we have actually given more to the state by following the Finance Commission Recommendations. However, I say, that in such matters the test of the pudding is in its eating. It does not matter how much it cost, who baked it and in which kitchen. The point is: is the pudding yummy?
When we come to health and education we should use the same yardstick. Have government interventions really worked? This is more important than the money debate which can always be obfuscated. What can, however be stated as a general truth is that in terms of our financial outlay to health and education, we are way below even some of the middle income countries in the world. Health and education are not emphasised adequately -- primarily because it is believed that as India is poor, she does not have the capacity for universal health and education. As a result, target group approaches are adopted that specifically address the poor, in some cases like Rashtriya Swasthya Bima Yojna (RSBY), only below poverty line (BPL) families. Such targeted policies miss their mark because the better off, say middle class upwards, do not pay attention to them as they have nothing to gain from these initiatives. Consequently, these targeted drives which include food distribution, attract inefficiency, corruption and other forms of malfeasance. Those who can make a noise are not interested, for there is nothing in these programmes for them.

Q: What is your assessment of the present education and health systems? 
A: That our educational system is the way it is, in spite of Sarva Shikhsha Abhiyan, is a good example of the process I have earlier talked about. On the health front, as in education, there has been no diminution in out-of-pocket expenditure as far as Indian patients are concerned, nor any reduction in turning to private health providers. We must also note that the fall in infant mortality rate (IMR) and maternal mortality rate (MMR) has been at the same rate over the last 40 years, and more, showing that government policies have not really been effective on this score either.
The major reason all governments tend to underplay health and education is because of the mistaken belief that unless the country is rich, it is useless to even imagine doing anything approaching universal delivery of these services. At the same time, the targeted approaches fall short, for reasons I've just mentioned above.

Q: Has Modi’s Swachh Bharat campaign moved beyond rhetoric to make a difference on the ground?
A: We must remember, in this connection, that the drive towards better hygiene began way back in the mid 19th century in both UK and Germany, to take just two examples. At this time both these countries were struck by a new kind of poverty, viz, urban destitution. There was a genuine belief that miserable health conditions among the poor would also affect the non-poor, hence this was not something that could be accomplished in an enclave fashion. Government inspectors were out there checking sanitation, water pipes and also workers' dwellings. Among other things, the also scrutinised ventilation which, as was confirmed later, reduced TB in Britiain.

For these reasons the Swachh Bharat campaign is welcome, but it requires more administrative power. Given past performance, people are wary of too much heft in the hands of bureaucrats, but somehow this phenomenon has to be tempered if the Swachh Bharat campaign must succeed. There should be inspectors checking water and electricity overuse and, accordingly, those errant consumers ought to be charged more. In some cases, when they go beyond the outer limit, as decided by the authorities, keeping in mind family size, requirements for gardening, etc, then the sanctions must be heavier.

There should be inspectors with cameras that catch people who litter, or burn waste, or refuse to keep the area in which they live free of stagnant water. There was a time when I found inspectors were fining people for using hose pipes to clean their cars, sometimes even clean the trunks of the trees in their compound. This kind of vigilance seems to have died out, which is a pity.

Swachh Bharat also needs a vigilant municipality that does not allow leaking pipes and rubbish heaps. The government must include this aspect centrally in its mission to clean India. Finally, for Swachh Bharat to really take off we need community toilets where people are charged a nominal amount so that they are kept clean. Slum dwellers, for instance, could get a smart card for the family at a nominal charge which would allow them to use facilities for a month. While working out such a scheme, we might also include the provision for bathing from taps in these bathrooms which are calibrated for half a bucket per person. The basic point of Swachh Bharat is that bad hygienic conditions affect rich and poor and no matter how high your walls are, you cannot be protected. This is the lesson one can draw from early British and German experiences. Swachh Bharat requires punitive sanctions to accompany it and not just goodwill.

If done in this fashion then the campaign will succeed and every effort should be made to see that it succeeds. If we lose this opportunity now, it will be difficult to resurrect it later for, by then, a heavy coating of cynicism would also be in place that would be hard to scrape off. Another layer of dirt, you might say!

Q: How does the government face the massive challenge of urbanisation? Given that the number of urban poor is steadily rising, how does the government improve their quality of life? Do you think smart cities could be one way of meeting the daunting challenges posed by urbanisation?
As far as urbanisation is considered, we must, once again, not allow this initiative to run to the ground because of technocratic solutions. Smart cities should begin with the assumption that urban living is actually uplifting -- culturally, economically and ecologically. Once this is understood, then urban planning should start with the creation of public space and public aesthetics. Neither of the two are expensive. I am not sure how the "smart cities" campaign is shaping up, but, hopefully, the planners already know about public space and about the positive contributions that urbanisation can make. There is a lot of literature on this subject to back my views.