State Responsiveness to Poverty: A Comparative Study of development interventions in the Indian States of Andhra Pradesh and Madhya Pradesh The India Study Team: K. Jayalakshmi Tasnim Khorakiwala Gopinath Reddy Ratna Reddy Vikas Singh Anne Marie Goetz Rob Jenkins October 2003 1 TABLE OF CONTENTS INTRODUCTION 4 PART I: 4 I. a Background on the Study and on the Importance of Watershed Programmes 4 The role of political parties in the process of implementation 5 I.b Findings Emerging from the AP Watershed Study 6 Sample selection and research approach 8 Main research question 10 Political Profile of the Sample Villages 12 Contractors and Politics: Three Scenarios 17 Relations Between PRIs and PSGs: Four Types 18 Conflict Ridden 18 Competitive Checking 19 Political Nexus 19 Passive Observation 22 Overcoming Decentralisation and Reservations: Party Building through Participatory Stakeholder Groups 24 Likely Impact on the Poor 28 Policy Implications 30 I. c Findings Emerging from the MP Watershed Study 33 District I: Raisen 37 Micro-case study 1: Mahgaon (Raisen District 41 Micro Case Study No. 2 – Ambadi (Raisen District) 46 District 2: Ujjain 48 Micro Case Study No. 3: Piploda (Ujjain) 52 District III: Sehore 54 Micro Case Study No. 4: Dabhoti (Sehore) 54 Micro Case Study No. 5: Amla (Sehore) 56 I.c Findings Emerging from a Comparison of the AP and MP Watershed Studies 59 PART II: 64 II.a Comparative key issues and main questions 64 Responsiveness to the poor in health sector – key problems 66 II. b Findings from the AP health Study 70 Community Health Workers and the Primary Health Delivery System in Tribal Areas of Visakhapatnam, Andhra Pradesh 70 Health status and the public health care infrastructure in tribal Areas 70 The Tribal Health Plan 72 Approach to the study 75 Description of the field sites 76 Prevention, Treatment, and Referrals in the Minumuluru PHC Area 79 The centrality of family planning in the primary health system 84 The politics of primary care and health outreach services 88 Incentives systems and power relations in the health sector 91 Summary 93 II. c The Patients’ Welfare Committee System in MP 94 Structure and functions of the RKS 96 2 Income and Spending 98 Access to public health facilities by the poor 100 Politics on the RKS Committees – the Competition for Financial Gain and Social Advantage 105 The politics of elite engagement -- Indore 108 The politics of elite engagement - Badnagar 110 Civil Society engagement with the RKS 115 Accountability of the RKS 116 Summary 116 II.d Comparative Analysis of AP and MP Health Sector Reforms 117 PART III: 120 III. a Health and Agriculture Programmes: Different Dynamics, but similar outcomes for the poor 120 Social Mobilisation and the Voice of the Poor 120 Spin-offs for the poor when elites collude or when service providers compete for excellence 121 The Contract Culture 122 Front-Line Staff Responsiveness to Pro-Poor Reforms 123 III.b The Role of State Level Factors 124 Differing Dynamics of Party Competition 124 Levels of Government – Decentralising with one hand, Recentralising with the other 126 Parallel Institutions 127 Bibliography 128 Interviews 129 3 INTRODUCTION This study examines pro-poor development initiatives in two Indian states that have, in general, been responsive to poverty. Each state has a chief executive who, supported by a core group of political leaders and civil servants, has devised and maintained a sustained commitment to programmes and institutional reforms ostensibly aimed at addressing the needs of poorer constituencies. The purpose of the study was to assess those political and institutional factors that assist in realising the promise of these innovations, as well as those factors that constrain the process of pro-poor change. This study consists of four components: two studies on Madhya Pradesh (one on agriculture and one on health); and two in Andhra Pradesh (one on agriculture and one on health). The design of the study has enabled the research team to draw conclusions on the basis of four axes of comparison: a) Between locations of differing types, but within the same state and implementing the same programme; b) Between programmes in the same sector, but operating in two different states. c) Between programmes in different sectors, whether within the same state or across states; This report is organised as follows: Part I reports on the agriculture-sector component of the study, which focuses on governance aspects of watershed development programmes. It examines the comparative dimensions ‘a’ and ‘b’ above. Part II reports on the health-sector component of the study, which focuses on programmes directed at improving the responsiveness of service-delivery. It too examines the comparative dimensions ‘a’ and ‘b’ above. Part III addresses the remaining comparative dimension, examining the differences between health and agriculture programmes in the two states (axis ‘c’). We conclude by assessing whether these differences have been more marked in one or another of the two states, drawing on general variables associated with their respective political systems. PART I: POLITICS, PARTIES AND WATERSHED DEVELOPMENT IN ANDHRA PRADESH AND MADHYA PRADESH I. a Background on the Study and on the Importance of Watershed Programmes There are several macro studies available of the politics of policymaking processes in these two states. These include thematic studies on public-expenditure management in Andhra 4 Pradesh1, on health, land reform and forestry initiatives in Madhya Pradesh2, and on the politics of policy making generally in both states.3 There also exist a number of micro studies of agriculture policy implementation in the two states. These focus primarily on an analysis of technical factors contributing to implementation bottlenecks4, and include the series produced under the sustainable livelihoods research programme coordinated by the ODI. The latter have been especially interested in the question of the best means of implementing these programmes, and have thus examined the relative performance of state-administered and NGO-run programmes.5 In order to avoid duplication, this component of the study has sought to fill a gap that rests somewhere between these two types of analysis. It maintains the focus on politics found in the macro studies, but examines these at micro levels through an analysis of policy implementation. To achieve this general objective, the study team sought to: § identify in detail the mechanisms through which anti-poverty programmes designed by generally responsive states get subverted in the process of implementation; § identify the political and institutional factors that allow these mechanisms of policy subversion to persist; § identify the factors which allow reasons why, in some instances, the degree of subversion to be reduced; This paper’s approach to the study of politics includes two key elements that are missing in existing studies, and which require close analysis if the dynamics of policy subversion are to be understood in sufficient detail. The study examines: § The role of political parties in the process of implementation. o While numerous studies deal with factors that could be considered political in the broad sense of the term – including such issues as conflict between different social groups, the dynamics of leadership, and difficulties of collective action – they have not entered into a detailed analysis of the role of partisan conflict at many levels in influencing outcome patterns. § The relationship between Panchayati Raj Institutions (PRIs) and Participatory Stakeholder Groups (PSGs): o While concerns about the lack of clarity about the respective roles of these two parallel bodies – one democratically elected as part of the formal representative institutions of governance, the other appointed in order to managed a specific 1 Foster et al, 2001 2 Joshi, 2003 3 Manor, 2001 4 Reddy, 2000 5 Farrington and Lobo, 1997; Knox, Swallow and Johnson, 2001 5 set of programmatic initiatives – there has been very little empirical, and yet theoretically informed, investigation into relations between them. Numerous state anti-poverty interventions in the agriculture sector have been undertaken throughout India, including such high-profile schemes as the Integrated Rural Development Programme. One of the most notable set of programmes in recent years has been those involving the creation and maintenance of low-tech irrigation infrastructure. While watershed development schemes that use funds provided by the central government are governed by rules issued by ministries in New Delhi (most notably those produced by the Ministry of Rural Development), there is a fair degree of variation between states in the way in which watershed development programmes are designed. Andhra Pradesh and Madhya Pradesh are among the most visible implementers of the watershed development concept among India’s states. Both states have funded a large number of watersheds. In fact, Andhra Pradesh has a higher percentage of its rain-fed areas than any state in India covered under the watershed development programme. Just as importantly, both have taken administrative measures to brand their watershed development programmes. In Mahdya Pradesh this has taken the form of the Rajiv Gandhi Mission for Watershed Development, whereas in Andhra Pradesh the state government has pursued an action plan pursuant to a 1995 state-level expert committee that examined the prospects for watershed development. Whether watershed development responds to the needs of the poorest of the poor is a big question. For, watershed is a land-based technology while poorest of the poor households often fall under the landless category. Hence, by nature, watershed development addresses only a part of the problem. But, how far watershed development programme addresses the issues pertaining to the landed poor, small (1-2 acres of land) and marginal (less than 1 acre of land) farmers who form majority of the poor. While land less account for about 20 per cent of the rural households, small and marginal farmers account for 60-70 per cent.