Encephalitis deaths not just a healthcare issue

India’s cricket captain Virat Kohli said that his side was not clinical enough with the bat to accelerate their run chase and thereby lost to England in the ongoing ICC Cricket World Cup. If the need for being clinical is so important in sports, imagine how much more important it is in the development process, which is multi-sectoral. This message was again driven home by the recent child deaths in Bihar.

The recent tragedy in Bihar, in which 162 children died due to acute encephalitis syndrome (AES), is the result of a combination of circumstances — poverty, illiteracy, malnourishment and a dysfunctional system for public healthcare. However, much of the blame for the deaths has fallen on the health sector that failed to respond appropriately to the situation. Commentators have been quick to point out the weakness in Bihar’s public health system in terms of infrastructure, manpower, health financing and so on. But the fault lines run deeper — and across other sectors.

If only the affected households had a decent and stable income, if only these homes knew and maintained a balanced diet, if only the government nutrition programmes had put malnourished children on nutritional supplements, if only the public healthcare system was strong enough to respond quickly and appropriately — many of these deaths could have been averted.

The government has had vertical fixes for each of these development challenges by way of national programmes, such as the National Rural Health Mission (NRHM) aimed at strengthening the public healthcare delivery system in rural areas, the Poshan Abhiyan to provide nutritional supplements, education programmes for children (Samagra Shiksha) and adults (Saakshar Bharat) and schemes to support farmers’ income. These programmes have been running for a long time, sometimes with the support of international development partners: The NRHM has been running for the last 15 year now, the nutrition programme has been running for a few decades. The child education and adult literacy programmes have been running in some form or the other for the last several years. Ditto for the programmes to support farmers’ income. These programmes have made some difference but nothing close to what was expected. Why?

These programmes have mostly taken the form of centrally sponsored schemes (CSS) that are co-funded by both the Centre and states but implemented solely by the states. Over the years, while the design of these programmes has evolved to give greater flexibility to states to do local adaptations, their implementation has remained weak. This is mainly on account of two reasons. One, many states have a dislike for CSS as these “instruments of development” have political overtones. Therefore, the states’ political will, resources and commitment to implement these schemes cannot always be assumed.

Two, even when a state is serious about implementing any CSS, it takes much stronger capacity, oversight and professionalism than that actually seen in reality. Anybody familiar with the ground reality would know about the ineffectiveness of the administrative machinery for want of resources, supervision and the culture of public service. In this kind of setting, implementing any public programme — whether a CSS or the state’s own programme — becomes a daunting task.

Fortunately, the winds of change are blowing. Two different forces are creating pressure on states to strengthen their local administrations. One is the stronger voice of the people in keeping with their rising aspirations and the other is the politics of development that is bringing state administrations to their toes in dealing with development challenges. These forces need further strengthening and support.

At the state level, one only gets to see the big picture. Finer details start to emerge as one goes down to the district, block, and village levels. It’s at the local level that one gets to see various inter-linkages and inter-connections across sectoral programmes. If vertical programmes are implemented in a piecemeal fashion or without respect to various inter-linkages, their impact will not get maximised and sustained.

Even when programmes get implemented well on the ground, their impacts remain limited for want of convergence. For example, of what good is having a decent school in a village if children have to stay away from it due to frequent diarrhoea? Similarly, of what good is having an excellent public health facility if the local people remain malnourished due to want of income?

The administrative machinery at the state, district, block and village levels ought to work in sync and with a strong commitment to results and programme convergence.

It’s true that some degree of convergence is built in the design of a few programmes such as health and nutrition. But the real convergence across programmes is to be achieved in their implementation at the local level for the all-round development of a region. District, block and village level administrations need to orchestrate this integration/convergence, even when none exists in the design of programmes.

Sustainable development is as much about human development as about the development of the surroundings in which people live and derive their sustenance from. This can come about only if the development process is thought of holistically and the local administration constantly strives towards achieving it. The programmes may be designed vertically but their convergence and integration on the ground is the responsibility of the local administration.

Sustainable development is about convergence, and convergence is about being clinical in our approach to development. As in the world of cricket, if we are not clinical enough — with development, we will keep getting bowled by some crisis or the other. This time around, it was the outbreak of encephalitis — tomorrow it will be something else.

The ongoing cricket World Cup is teaching us important lessons on the development front — we have got to be clinical, and we have got to be passionate!

The writer is a development economist, formerly with the Bill & Melinda Gates Foundation and theWorld Bank