CContents Preface 1. Health 4-16 2. Nutrition 17-28 3. Drinking Water and Sanitation 29-62 4. Employment 63-71 5. Urban Poverty 72-80 6. Governance 81-109 7. Social Exclusion – Adivasis 111-117 Dalits 118-123 Minorities 124-134 Women 135-141 Disability 142-155 Children 156-166 8. Education 167-180 9. Rural Development 181-190 10. Climate Change 191-199 1 Preface By foregrounding the need for “incluPsive growth”, the Eleventh Five Year Plan (EFYP) sought to make a major shift in the development strategy of the Indian state. This was borne out of the realisation that while at one level, India’s economy had recorded an impressive growth rate of 8.9%, during the Tenth Plan period; at another level, large sections of the population remained untouched by the development trajectory of the nation. Responding to the critical need for bringing people into the exercise of assessing how far the schemes and programmes of the Eleventh Plan have worked for them, a number of civil society organisations came together to facilitate a People’s Mid Term Appraisal of the Eleventh Five Year Plan. The main objective of the People’s Mid Term Appraisal is to add people’s voices to the crucial exercise of evaluating the Plan as well as recommend forward looking strategies. The process involved three strategies: • Building a larger coalition to democratise the discourse on development planning in the country; • Building a strong evidence base to critically assess the functioning of the Plan and thereby suggest future directions; and • Taking people’s voices regarding the Plan to the relevant policy makers. Seeking to build synergy between research and praxis, papers were commissioned to development policy analysts who adhere to a pro-people perspective and strive to articulate people’s concerns and expectations in the discourse on policies and planning in the country. The key objective of this exercise was to assess from a people’s perspective, the larger policy framework and the programmes/schemes in the Eleventh Five Year Plan. This report compiles these papers. The research papers presented in this report analyse certain important thematic areas in the Plan such as Education, Nutrition, Health, Water Supply and Sanitation, Agriculture, Governance, Rural Development, Urban Poverty and Employment, from the lens of socially disadvantaged groups. Using the broad framework of assessing policies, implementation, budgets and institutional mechanisms, each paper seeks to engage with the following questions: • What is the present scenario in terms of outcome indicators and development deficits? Does the policy framework recognise ‘rights’ or ‘entitlements’? • What were the commitments made in the EFYP with regard to i) goals and objectives of the EFYP and; ii) measures/initiatives envisaged in the EFYP for achieving the goals. • How can we assess the performance of the EFYP? Is the policy framework underlying the EFYP adequate? • Have adequate budgetary resources been allocated for the major programmes/schemes in the EFYP? • Have the major programmes/schemes in EFYP been implemented effectively? In addition to focussing on each of the selected thematic areas from the lens of social exclusion, a separate section on Social Exclusion also forms part of this report, with papers on dalits, adivasis, women, minorities, children and the differently-abled. 2 The present version of the report is a work-in-progress. It has been put together, mainly for the purpose of the National Consultation of the People’s Mid Term Appraisal, to be held on February 4-5, 2010, in New Delhi. The papers will be further refined, based on the inputs received through the National Consultation, and the final compilation will be brought out soon. We hope this report will help pave the way for registering people’s voices in the planning process. It will be an important advocacy tool for engaging with policy makers, both at the national and state level, to list questions not only around the implementation of specific programmes and schemes, but simultaneously to also raise larger questions around the very process of planning itself. This initiative would not have been possible without the wholehearted support of many friends and fellow travellers. We remain indebted to all our contributors- Aditi Kapoor (Alternative Futures), Amit Sengupta and Deepa (Jan Swasthya Abhiyan), Dipa Sinha (Right to Food Campaign), Indira Khurana and Romit Sen (Water Aid), Kamal Nayan Kabra (Former Professor, Indian Institute of Public Administration), T. Haque (Council for Social Development), Kaushik Ganguly (Centre for Budget and Governance Accountability), Plan India, Paul Divakar and Abhay Kumar (National Campaign on Dalit Human Rights), P.S. Vijay Shanker (Samaj Pragati Sahayog), Radhika Alkazi (Aarth Astha), Rama Kant Rai (National Coalition for Education), Rajesh Tandon (Society for Participatory Research in Asia), Sharit K. Bhowmik (Professor, Tata Institute of Social Sciences), Shirish Kavadi, Amit Narkar, Chitra Desai and Sandeep Pattnaik (National Centre for Advocacy Studies), Vibhuti Patel (Professor, SNDT University), Zakia Soman (Bharatiya Muslim Mahila Andolan ). Special thanks are also due to our panel of reviewers – Abhijit Das (Health), Amitabh Kundu (Urban Poverty), Manu Alphonse (Dalits), Himanshu Kulkarni (Water and Sanitation), Janaki Rajan (Education), Mazhar Hussain (Minorities), Razia Ismail Abbasi (Children), Reetika Khera (Nutrition) and Virginius Xaxa (Adivasis) – for their critical feedback on each of the papers. We are grateful to all our state and regional partners, for engaging with this process. And, we acknowledge with gratitude the support extended by UNDP. Amitabh Behar and Yamini Mishra On behalf of the Organising Committee of the People’s Mid Term Appraisal of the Eleventh Five Year Plan 3 Health HAmit Sen Gupta and Deepa, Jan Swasthya Abhiyan The paper reviews the provisions for health in the Eleventh Five Year Plan (EFYP) and draws on existing national level data and from primary data collected as part of the People’s Rural Health Watch (PRHW) initiative by the Jan Swasthya Abhiyan. The PRHW activity was carried out over a two-year period, between January 2006-2008, through surveys over 2006-2008, in the National Rural Health Mission (NRHM) high-focus states of Madhya Pradesh (MP), Uttar Pradesh (UP), Bihar, Rajasthan, Jharkhand and Chhattisgarh. In order to locate our discussions on the mid-term review of the Eleventh Plan document, we start with an understanding of the state of health and health care in India. State of People’s Health in India Healthy living conditions and access to good quality health care for all citizens are not only basic human rights, but also essential accompaniments of social and economic development and policies and programs need to be implemented in the framework of quality health care for all and access to basic determinants of health as a basic right. Merely 42.0% households overall use piped drinking water with the percentage even lower at 27.9 in rural areas, 44.5 % have access to a toilet facility, with 25.9% in rural and 41.4% live in a pucca houses, (NFHS-3) a far cry from the goals envisaged by the EFYP. Malnutrition and Anaemia . The percentage of ever married women aged 15-49 years who are anaemic increased to 56.2 % in 2005-06 from 51.8 % in 1998-99. The percentage of pregnant women aged 15-49 years who are anaemic increased to 57.9 % in 2005-06 from 49.7 % in 1998-99. 55% of women and 24% of men are also anaemic, thus showing that large sections of the Indian population is deprived of access to adequate and balanced nutrition. The data on prevalence of chronic malnutrition in later years is also an indication that childhood under-nutrition translates into chronic malnutrition and stunting during adult life – especially among women. Disturbing trends have been highlighted by the NFHS-3: Anaemia amongst children between 6-35 months has increased to 79% overall (NFHS-3), with 72% in urban and 81% prevalence in rural areas, from 74% overall (NFHS-2). Among the 81 percent of children under six who are in areas covered by an anganwadi centre, only one- third receive services of some kind from the centre and only 26% of children under 6 and preschool received any supplementary nutrition from an anganwadi centre. Thus, in the entire country, only 20% of the children receive supplementary food from ICDS centres. Even within this, in many areas, caste discrimination continues to be a barrier in expanding to vulnerable populations. Undernutrition is clearly not limited to children but also among women, poor and marginalised sections as is evident from the indicators above. Communicable Diseases Communicable Diseases are experiencing a resurgence - including Tuberculosis (TB), Malaria, Chikungunya, Dengue, Encephalitis, Kala azar, Dengue and Leptospirosis. India still records the highest number of deaths in the world every year from TB – about 3.7 lakh, and 418 persons per 100,000 are estimated to be suffering from tuberculosis infection that needs medical treatment. 4 . The number of cases of Malaria has remained at a high level of around 2 million cases annually since the mid eighties. By the year 2001, the worrying fact emerged that nearly half of the cases are of Falciparum malaria, which can cause the deadly cerebral malaria. Environmental and social dislocations combined with weakening public health systems have contributed to this resurgence. Concurrently, the earlier system of surveillance has fallen into disarray, thereby compounding the problem. Diarrhea, dysentery, and acute respiratory infections continue to take their toll because we are unable to improve environmental health conditions. Around 6 lakh children die each year from diarrhoea. It could largely be prevented by universal provision of safe drinking water and sanitary conditions, and most of these deaths can be prevented by timely administration of oral rehydration solution (ORS). However ORS is presently administered in only 33% of cases in urban areas and 24% in rural areas — a situation that has actually worsened in the last five years.