Author: Surjit S Bhalla
Publication: Financial Express
Date: September 22, 2018
URL:      https://www.financialexpress.com/opinion/modis-sanitation-pro-women-and-pro-poor-if-open-defecation-free-works-under-mortality-rates-should-have-fallen/1322285/

One of the signature reforms of PM Modi, announced from the ramparts of the Red Fort on August 15, 2014, was the Swachh Bharat Abhiyan programme.

India’s performance in poverty reduction, since the early 1990s, has been remarkable. A constant criticism has been the lament that, while the decline in consumption poverty has been large, the improvement in social indicators like education and mortality has not been as commendable. Absolute poverty declined from 46% in 1993-94 to only 13 % in 2011-12 (Tendulkar poverty line of Rs 30 per capita per month in 2011-12 prices and/or World Bank international poverty line of $1.90 PPP dollars per person per day). This lack of comparable change in socio-economic indicators has been a consistent phenomenon, and all governments in India have been criticised for this failure. Socio-economic data has shown that improvement in indicators for women was not as good as that for men. Hence, while much had been achieved, gender equality was still lagging in India.

One of the signature reforms of PM Modi, announced from the ramparts of the Red Fort on August 15, 2014, was the Swachh Bharat Abhiyan programme. The major component of this programme was to make India OD (open defecation) free by October 2019, the 150th birth anniversary of Mahatma Gandhi, the original proponent of an OD-free India. Unfortunately, our reformers forgot his message as they proceeded to make India modern and prosperous but attempted to do so without improvements in sanitation. The PM boldly stated that open defecation was a major blot on India’s progress, and a major drawback for gender equality in education and safety. Simultaneously, PM Modi announced the Beti Bachao, Beti Padhao (save the daughter, educate the daughter) initiative (aka, reform).

These announcements have to be put in perspective of what was expected from PM Modi. Many self-styled economic reformers believed then (and believe today) that PM Modi should have begun to privatise the economy. The fact that he didn’t showed that he was not an economic reformer. Let us first recognise the boldness of the OD initiative. First, as a surprise to all the upper classes, in India and around the world, a taboo conversation word—defecation—was openly discussed, and by the PM no less. Here, we were expecting growth enhancing reforms, and the PM was talking about defecation. That close to 50 % of rural India was indulging in this practice came as a shock to most. This is not what the elite, especially the upper-class elite belonging to the “poverty study” group, had even discussed in private, let alone in public.

Over the last few years, there actually has been a concerted campaign to bad-mouth the toilet campaign. Newspaper stories have emerged about the “fact” that the building of toilets has been exaggerated. For the many toilets that have been built, many do not have enough water. I, myself, have seen “popular” pictures of farmers’ unused bathrooms being used for storage of grain. Academic analysts warned of a quick-fix; attitudinal change was required, and this was painfully slow. When the first survey results of toilet usage were published (done by the Quality Council of India in 2016), they were criticised for biased sample selection i.e., only high-performing areas were chosen for the survey, and hence could not be relied upon as indicative of what was happening in the backward areas of India (e.g., Bihar), states which were not part of the survey.

A few days ago, finance minister, Arun Jaitley, described the Swachh Bharat programme as the most important reform initiative of the Modi government. That is some endorsement given that Modi’s BJP government has introduced a large set of economic reforms e.g., demonetisation (reduction of black money and enhancement of direct tax revenues); the introduction and implementation of the Insolvency and Bankruptcy Code (IBC), a reform that has not been given the credit due, as of yet, and GST.

How accurate is Jaitley’s claim that this has been a mega achievement of the Modi government? Most critics (analysts) have dismissed it as usual election year exaggeration. What are the statistics about the decline in open defecation? How can long entrenched social attitudes change so quickly, especially when “expert” studies have shown that this is a long and arduous journey that barely started four years ago. Government statistics do not help because they are government statistics, and hence not that credible. As an aside, the same critics readily accept a badly constructed back-series on GDP data in India. Why? Because this back-series upgraded the GDP growth rates observed in UPA-I and UPA-II. If there is another reason for the ready acceptance of the back-series by the Congress (and its cheer leaders), the nation has yet to learn.

A few days ago, the UN released data for under five mortality rates for 180 countries for the period 1990 to 2017. Apart from the safety and dignity of women, open defecation has major implications for mortality, and especially the mortality rates of children. If OD-free India has been even partially successful, it should show up in mortality rates for small children (under the age of 5). Note that looking at the pace of mortality reduction is not a very stringent test for the success/failure of the OD programme. It is not a stringent test because mortality decline is affected by at least four other important factors—income growth, technological advances (medicine and vaccination), improvement in water supply and education of women. All of these indicators are improving in India, so one cannot attribute the reduction in under-5 mortality to the reduction in OD. Possibly, OD is the most important, but how does one prove it?

The attached table presents data for levels, and the average rate of decline, per year, for India, 1990 to 2017. The largest annual pace of decline for female under-5 mortality (as well as for males) was observed during the ten-year period 1990 to 2000. Most socio-economic indicators, unlike income indicators, cannot be analysed in simple rates of change. This is because many socio-economic indicators have floors and ceilings e.g., life-expectancy, education and mortality. For example, the under 5 female mortality rate has shown virtually no improvement for Sweden between 2010 and 2017—a decline from the rate of 2.8 (per 100,000) in 2010 to 2.6 in 2017. This is only a decline of (log) 7.4%, compared to over a 40 % decline for India.

Given this caution about floors and ceilings, how does one evaluate India’s performance? The first goal is to compare like with like i.e., compare India to its peers, loosely defined as emerging economies (aka, developing countries) with a population greater than 5 million. The second is to compute ranks of performance with rank equal to 1 for the country with the fastest rate of decline. Data for India are presented in the table and the reader can, at leisure, interpret the levels and changes. I want to concentrate on India’s rank (among 76 countries) in 2017. India achieves the rank of 7 for female under-5 mortality, a large improvement over the 15th rank just two years earlier!

Yet another performance indicator is the pace of improvement in female mortality relative to that of males (the difference in the rates of change). For this indicator, India is the best performing country in the emerging world. Finally, the male/female sex-ratio indicator (the number of betis saved) rank for India is number 2. This improvement will be assessed in detail in another article. One must give credit where credit is due. Academics said such a fast rate of change was not possible. Well known bureaucratic inertia in India meant that, even if theoretically (academically) possible, implementation of the OD campaign would face insurmountable hurdles. Add to it the so-called caste factor preventing success.

Why did the programme succeed beyond all calculations? Because it was a pro-poor, pro-female, campaign. Because it improved the safety and dignity of women. Because it was (shockingly!) very well administered. And because it was a high-profile PM campaign.

- The author is a Contributing editor, Indian Express and part-time member of the PM’s economic advisory council.