The Millennium Development Goals summarised
THE LONG ROAD TO THE MILLENNIUM DEVELOPMENT GOALS 2015

  • Goal 1 - poverty and hunger - cut by half the number of people who live on less than $1US per day and who suffer from hunger
  • Goal 2 - education - make sure that all children start and finish primary school
  • Goal 3 - girls - ensure that as many girls as boys go to school
  • Goal 4 - infants - cut back by two-thirds the number of children who die before they reach the age of 5
  • Goal 5 - mothers - cut back by three-quarters the number of women who die when they are having babies
  • Goal 6 - disease - stop diseases like HIV and AIDS, Malaria, TB from spreading further
  • Goal 7 - environment - cut in half the number of people who lack clean water, improve the lives of people who live in slums and promote policies that respect the environment
  • Goal 8 - global partnership - promote greater cooperation among all nations with special concern for fairer deals for poor countries in trade, aid, debt, new technologies etc.

Goal 1: Eradicate Extreme Poverty and Hunger

  • Reduce by half the proportion of people living on less than a dollar a day
  • Achieve full and productive employment and decent work for all, including women and young people
  • Reduce by half the proportion of people who suffer from hunger

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG1 aims to eradicate extreme poverty and hunger.

Definitions

  • Poverty: The definition the Government of India uses to measure poverty differs from that used by international agencies. The UN uses income as an indicator, and the Government of India measures poverty based on calorific consumption.
  • Malnourishment: Norms for weight-for-age, height-for-age, and weight-for- height are used to measure malnutrition in children. For adults, the Body Mass Index is used as a measure.

MDG 1 progress
Description Target 2015 Latest Available Status
Percentage of population below poverty line 19 28 (2004-05)
Percentage of people Undernourished 31 33F, 28M (2005-06)
Percentage of children underweight 27 46 (2005-06)

Progress: The Planning Commission expects India to meet the target related to reducing poverty and to miss the nutrition targets.

Poverty: 28% of the population of India lives below the poverty line (BPL). 77% lives under $2 a day (1993 PPP), equivalent to about Rs 20.

Poverty: Disparity in poverty exists amongst different states ranging from one in twenty people being BPL in Jammu & Kashmir to nearly half the population of Orissa being BPL.

Malnutrition: One in two children suffers from malnutrition. One in three of the adult married women in the country are underweight.

Anaemia: Three in four children under three years of age and one in two adult women are anaemic.

Malnutrition leads to diseases and is estimated to lower the country's GDP by two to three percentage points

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG1 aims to eradicate extreme poverty and hunger. The following table lists some of the other goals and targets at global, regional and national levels.

Goals/Targets Indicators/Approach

Target 1.A: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day

Target 1.B: Achieve full and productive employment and decent work for all, including women and young people

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger
  • Proportion of population below $1 (PPP) per day
  • Poverty gap ratio
  • Share of poorest quintile in national consumption
  • Growth rate of GDP per person employed
  • Employment-to-population ratio
  • Proportion of employed people living below $1 (PPP) per day
  • Proportion of own-account and contributing family workers in total employment
  • Prevalence of underweight children under-five years of age
  • Proportion of population below minimum level of dietary energy consumption

Goal 1: Eradication of hunger poverty

Goal 2: Halve proportion of people in poverty by 2010

Goal 3: Ensure adequate nutrition and dietary improvement for the poor
  • Adequate safety nets; emphasis on developing early warning system i.e. food security mapping
  • Use of national poverty lines for target setting; proportions and absolute number of the poor
  • Include nutritional awareness & provision for vulnerable groups
10th Plan: Reduce poverty ratio by 5% by 2007 and by 15% by 2012
Provide gainful, high quality employment

Approach Paper to 11th Plan: Reduce head count ratio of consumption poverty by 10%
10th Plan
  • Reduce malnutrition among children of age group 0-3 years to half its present level
  • Create 70 million new work opportunities
  • Reduce educated unemployment to below 5%
  • Raise real wage rate of unskilled workers by 20%
Job guarantee--Enact National Employment Guarantee Act:

100 days employment per year at min wage for 1 person in every rural, urban poor and lower middle class household
  • Double flow of rural credit in 3 years
  • Strengthen PDS
  • Antyodaya cards for all at risk of hunger

The definition used by the Indian government to measure poverty differs from that used by the UN. This can result in differences in the measurement of progress towards achieving these goals.

Term UN Definition Government Definition
Poverty Line Income based- < US $1 a day in (1993 PPP terms which translates to approx. Rs 10 in 2007) Food consumption based: 2400 cal/day for rural 2100 cal/day for urban (both are about Rs 12/day)
Malnutrition For children: underweight: 2 z-scores below international reference for weight for age, stunting: 2 z-scores below norm for height-for-age, wasting: same measure for weight by height.
For adults: Body Mass Index (BMI), body weight in kilograms divided by height in meters squared (kg/m2). (World Bank). Underweight <18.50 BMI, normal weight 18.50 to 24.99, overweight = 25.00. (WHO)
Same as UN definition
Note: A z-score measures how an individual fares compared to a reference population. Assuming normal distribution for the reference population, a child would be termed underweight, stunted or wasted if he or she is in the bottom 2.3% of the reference population.

MDG Target and Status
Indicator 2015 Target Projected value 2015 Status By Govt. definition (Year) By UN. Definition (Year)
% population BPL 18.8 9.0 On track 28% URP, 22% MRP (2005 8.7% below $1; 77% below $2 PPP (2005)
% adults undernourished 31.1 39.2 Off track Adults (15-49) : 33% (F) 28% (M) (2005-06) Same as Government data
% children undernourished 27.4 29.6 Off track 46% underweight, 38% stunted, 19% wasted (2005-06) Same as Government data
Note: Uniform Recall Period (URP) refers to consumer expenditure data based on all items in past 30-days. Mixed Recall Period (MRP) refers to consumer expenditure data based on 5-non food items in past year and all the remaining items in the past 30 days.

Goal 2: Achieve Universal Primary Education

  • Ensure that all boys and girls complete a full course of primary schooling

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG 2 aims to achieve universal primary education.

Definitions

  • Literacy: Percentage of the population who can both read and write with understanding of a short simple statement on everyday life. (UN)
  • As per the Census of India, a person aged 7 years and above who can both read and write with understanding in any language is taken to be literate.
  • The National Literacy Mission defines literacy as acquiring the skills of reading, writing and arithmetic and the ability to apply them to daily life.
  • In India, 'primary education' usually refers to grade I-V, 'upper primary' refers to class VI-VIII, 'secondary' refers to class IX-X, 'higher secondary' to class XI-XII. Tertiary education refers to college. There is some variation among states.

MDG 2 progress
Description Target 2015 Latest available status
Net enrolment in primary education 100% 85% (2003-04)
Literacy rate of 15-24 year olds 100% 73% (2001)
Proportion of pupils starting grade 1 who reach grade 5 100% 70% (2005-06)

Sarva Shiksha Abhiyan: SSA is the government's flagship program for elementary education. The government allocated Rs 9760 crore in 2007-08.

Out of School: The Government estimates there were about 95 lakh students out of school in 2005. In Bihar, 17% of children are out of school, and in Jharkhand, 11%.

Infrastructure: In 2005, 57% of schools had a blackboard at the ground level, 9% had a computer, and 47% had a common toilet facility for girls and boys.

Quality of Education: The National Planning Commission has highlighted quality of education as a main area of focus for the government. An NCERT study indicated that the mean percent of achievement of class 5 students was 59 for language and 47 for mathematics.

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG2 aims to achieve universal primary education. The following table lists some of the other goals and targets at global, regional and national levels.

Goals/Targets Indicators/Approach
Target 2A: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling
  • Net enrolment ratio in primary education
  • Proportion of pupils starting grade 1 who reach last grade of primary
  • Literacy rates of 15-24 year olds, women and men
Goal 13: Access to primary/communal school for all children, boys and girls

Goal 14: Completion of primary education cycle

Goal 15: Universal functional literacy

Goal 16: Quality education at primary, secondary and vocational levels

  • Availability of school within walking distance in every village/island/urban centre
  • Universal retention rate at the primary level
  • Acceptable level of teacher-student ratio
  • Training of teachers at all levels
  • Acceptable level of English & computer literacy
10th Plan: All children in schools by 2003; all children to complete five years of schooling by 2007-09-19 Attain literacy rate of 75%

Approach Paper to 11th Plan: All schools in India should have physical infrastructure and quality of teaching equivalent to Kendriya Vidyalayas Attain literacy rate of 85%
  • Reduce sharply or remove altogether drop-out rates
  • Move towards raising public spending in education to 6% of GDP
  • Access to primary and upper primary schools within a walking distance of one and three km respectively for children between 6-14 years of age
Raise public spending in education to at least 6% of GDP with at least half spent on primary and secondary sectors

Introduce a cess on all central taxes to finance the commitment to universalize access to quality basic education

Mid-Day Meal Scheme
  • Set up a National Commission on Education
  • Set up Quality Checks for Mid-Day Meal Scheme
  • Universalise Integrated Child Development Services

The definitions used by the Indian government to measure literacy differ slightly from those used by the UN.

Term UN Definition Government Definition
Literacy Rate Percentage of the population who can both read and write with understanding of a short simple statement on every day life. As per the Census of India, a person aged 7 and above who can both read and write with understanding in any language is taken to be literate.

Indicator 2015 Target By Govt. definition (Year) By UN. Definition(Year)
Net enrolment ratio in primary education 100% 85% (2003-04) 95% (2005)
Literacy rate of 15-24 year olds 100% 73% (2001) 76% (2001)
Proportion of pupils starting grade 1 who reach grade 5 100% 70% (2005-06): Apparent survival rate-(the number of students in grade 5 as a ratio of the number in grade 1) 73% (2004

Some Ingredients for Universal Primary Education and Literacy

Target: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling.

The Planning Commission points out in its Approach Paper to the 11th Plan: "Starting from expenditures as a first step, one can track immediate outcomes such as the construction of school facilities, the filling of vacancies and training of teachers, success in enrolment, and reductions in drop out rates, but the final outcome is really the quality of education provided." It states that "the ultimate test of the strategy must be defined in terms of final outcomes." Factors that help promote universal primary education include:

Access

  • According to the Ministry of Human Resources and Development, 95% of the rural population living in 826,000 habitations have a primary school within 1 km and 85% have an upper primary school within 3 km.
  • The government's performance audit report on SSA reported delays ranging between one and nine months in supplying free textbooks in seven States/UTs.
  • According to the government's performance audit report of SSA, a large number of schools in most of the States/UTs were functioning without buildings and other infrastructural facilities like drinking water, toilets and separate toilets for girls, electricity, compound walls, etc. In 2005, 57% of schools had a blackboard at the ground level, 9% had a computer, and 47% of schools had a common toilet facility for girls and boys.
  • The Ministry of Labour has devoted resources for special schools to mainstream child labourers.
Attendance (both teachers and students)
  • In a nationwide survey conducted by the NGO Pratham in 2005, 71% of enrolled children in primary schools were in class on the day of the visit. According to a World Bank study conducted in 2004, 25% of teachers were absent from school, and only about half were teaching, during unannounced visits to a nationally representative sample of government primary schools in India.
Learning outcomes and quality-related issues
  • An NCERT study indicated that the mean percent of achievement of class 5 students was 59 for language and 47 for mathematics. There are other studies that also highlight issues of quality and achievement in schools.
  • Only 25% of the total primary school teachers are graduates and another 11% post-graduates. Even where teachers exist, as the Planning Commission points out, the quality of delivery is poor and those responsible are not held accountable.
Literacy
  • The 10th Plan called for the need for merger of various adult literacy programmes including the Total Literacy Campaign. The Approach Paper to the 11th Plan has noted the need for regular monitoring of the NGO-initiated literacy programs.

Literacy rates are lower among Scheduled Castes and Scheduled Tribes.
Literacy varies both by population and by state. There is a large variation between the literacy rates among both states and social groups.

Among social groups, Scheduled Tribes and Schedules Castes have the lowest literacy rates, whereas Christians have the highest.

State-wise, Kerala (91%), Mizoram (89%), and Lakshadweep (87%) have the highest percentage of literates in their population, whereas Bihar (47%), Jharkhand (54%) and Arunachal Pradesh (54%) have the lowest.

Literacy Rates

Apparent Survival Rate
(Proportion of students in Grade 5 to those in Grade 1)

Major National Initiatives


In 2002, the Government of India passed the Constitution (86th Amendment) Act, 2002, making elementary education a fundamental right for all children in the age group of 6-14 years. The government initiated the Sarva Shiksha Abhiyan (SSA) as the national plan for the universalisation of elementary education in a time bound manner. The major goals of SSA include: (a) all children (age 6-14 years) in school by 2005, (b) focus on elementary education of satisfactory quality, with emphasis on education for life, (c) bridge all gender and social category gaps by 2010, and (d) universal retention by 2010.

The National Curriculum Framework, 2005 emphasises relevance, flexibility and quality for modernising the system of education. It states that examinations and availability of physical resources should not be the sole criterion for judging quality; curricular choices should be made on the basis of a child's context and; teaching should be professionalised.

The 10th Five Year Plan (2002-07) allocated about Rs 29,000 crore towards elementary education, 75% higher than the allocation for the 9th Five Year Plan. A number of initiatives aim to improve primary education.

Budget Allocation and Expenditure Trends and Achievements
Allocation under 10th Plan: Rs 17,000 crore

Central government expenditure in 2006-07:Rs 10,145 crore

Central government budget in 2007-08: Rs 9,760 crore
Over 10 lakh new Elementary Schools have been opened; 93,000 school buildings have been completed/in progress; About 5 lakh additional teachers have been appointed; Free text books are being distributed to all girls and SC/ST boys (5 crore) in classes 1 to 8.
2006-07: Rs 200 crore was budgeted and only Rs 100 crore was utilised

2007-08: Rs 80 crore budgeted
DPEP is being phased out. It is now operational in only two states covering 17 districts
2007-08 budget: Rs 6,592 crore

Allocation for 2006-07: about 23 lakh tonnes rice & wheat
Provides cooked mid day meal with 450 calories, 12 grams protein, and adequate quantities of micronutrients to all children studying in classes 1-5 in Government and aided schools.

112 million children were covered under this scheme in 2004-05, and 120 million in 2005.

There are other schemes such as the National Programme for Education of Girls (NPEGL), Kasturba Gandhi Balika Vidyalaya (KGBV) and the Early Childhood Care and Education programme. While SSA limits financial provisions for girls' education in the form of free text books and innovations at district levels, NPEGL focuses on providing additional support for education of underprivileged/disadvantaged girls at the elementary level. Similarly, KGBV was launched in August 2004 to set up 750 residential schools at the elementary level for girls belonging primarily to the SC, ST, OBC and Minorities in Educationally Backward Blocks, where female literacy is below the national average.

Early Childhood Care and Education (ECCE) centres aim to support girl children to avail primary education by preparing children aged 3-6 years old for entry into schools (thereby also freeing older girls from sibling care, enabling them to attend school). The Integrated Child Development Scheme (ICDS) is the biggest program under ECCE.

What has worked: Shiksha Adhikaar Yatra

The state of Haryana has expedited its infrastructure building activities for education and launched a number of innovative initiatives to meet the deadlines set for Elementary Education For All (EEFA) initiative. The Haryana state government launched an extensive exercise of mapping its education resources and identified the areas of concern that required intervention from the state, which were followed up by prompt execution. As a first step the state executed its plan to construct 10,641 new school buildings. Of these, 10,435 have been completed at the time the ministry filed its report with the CAG in May 2006. According to the CAG report, the government had completed 4,220 works and another 4,383 works were being completed against a target of 11,050 works. This compares very favourably against many other states.

To support these initiatives of improving its physical infrastructure for education in Haryana, the state's department for elementary education introduced innovative interventions to mobilise and improve enrolment. One such intervention was The Right to Education Walk or Shiksha Adhikar Yatra - Haryana (SAY-Haryana), which was conceptualised by the Centre for Alternative Dalit Media and an umbrella body of dalit organisations, National Conference of Dalit Organisations (NACDOR). The Yatra was conceptualised to transform people from passive receivers to stakeholders in the state's education system. It aimed to create a sense of ownership, leading to demand for quality education for their children, and subsequently people's participation to ensure that the demand was met. It meant initiating a dialogue with people in villages, uncovering barriers to enrolment, persuading people to participate in the process of overcoming the twin challenges of poor infrastructure and teaching quality, and above all, overcome their own cultural and gender biases to send all their children to school.

NACDOR trained its activists to communicate these messages and encouraged out of school children to enrol in schools. They also distributed Shiksha Adhikar Cards (Right to Education Cards) to out of school or school going age children or their parents to claim admission in schools. The SAY (Shiksha Adhikar Yatra) had targeted to enrol at least 68,000 children in schools. Immediate evaluations revealed that the enrolment figures had crossed 100,000.
Source: Adapted from a note by OXFAM.

Goal 3: Promote Gender Equality and Empower Women

  • Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels by 2015

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG3 aims to promote gender equality and empower women.

Definitions

  • Gender Parity: Gender Parity Index (GPI) is a ratio of Girls Gross Enrolment Ratio (GER) to boys Gross Enrolment Ratio (GER) in a given level of education. It is used as an indicator of females' level of access to education compared to males'.
  • Gross Enrolment Ratio (GER): The number of students enrolled in a level of education, regardless of age, as a percentage of the population of official school age for that level. (The gross enrolment ratio can be greater than 100% because of grade repetition and entry at atypical ages.

MDG 3 progress
Description Target 2015 Latest available status
Ratio of girls to boys in primary education 100% 91% (2005)
Ratio of girls to boys in secondary education 100% 70% (2003)
Literacy rate of 15-24 year olds 100% 80% (2001)

  • According to the 2001 Census, the total population literacy rate was 65% with 75% of the male population and 54% of the female population literate.
  • The gender gap increases at higher levels of education. At the primary level, 95 girls are enrolled for every 100 boys; this ratio reduces to 88 girls per 100 boys at the upper primary level.
  • According to the Government of India only 18% of women in 2004 were engaged in wage employment in the non-agricultural sector.
  • In 2007, roughly 10% of Members of Parliament in the Rajya Sabha and 8% in the Lok Sabha were women.

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG3 aims to promote gender equality and empower women. The following table lists some of the other goals and targets at global, regional and national levels.
Goals/Targets Indicators/Approach
Target 3A: Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels by 2015
  • Ratio of girls to boys in primary, secondary and tertiary education
  • Share of women in wage employment in the non-agriculture Sector
  • Proportion of seats held by women in national parliament
Goal: Reducing social and institutional vulnerabilities of the poor, women and children
  • Achieve gender parity at both primary and secondary levels
  • Acceptable coverage of girl students at all levels
  • Eradication of social ills such as dowry, female foeticide, trafficking of women and children, bonded labour, child marriage, etc.
10th Plan: Reduction in the gender gap in literacy by at least 50% by 2007
Approach Paper to 11th Plan: Lower gender gap in literacy by 10 percentage points.
  • Provide adequate and need-based training to women to enable them to enter all sectors of the economy on an equal footing with men
  • Strengthen women's political participation and their role in all levels of decision making
Introduce legislation for 1/3 reservations for women in Vidhan Sabhas and in the Lok Sabha
Enact legislation on domestic violence and against gender discrimination
Remove discriminatory legislation
  • Earmark at least 1/3 of all funds flowing into panchayats for programmes for the development of women and children
  • Expand schemes for micro-finance based on self-help groups

The main definition used to measure gender disparity is the Gender Parity Index. The Indian government defines gender disparity in the same way as the United Nations.
Term UN Definition Government Definition
Gender Parity Index (GPI) GPI is measured as the Gross Enrolment Ratio (GER) of girls divided by that of boys at a given level of education. Same as UN definition
Gross Enrolment Ratio (GER) GER is the number of students enrolled in a level of education, regardless of age, as a percentage of the population of official school age for that level. (The gross enrolment ratio can be greater than 100% because of grade repetition and entry at atypical ages.) Same as UN definition

Indicator 2015 Target By Govt. definition (Year) By UN. Definition (Year)
Ratio of girls to boys in primary, secondary and tertiary education Primary: 100%
Secondary: 100%
Primary: 91% (2005)
Secondary: 70% (2003)
Tertiary: 66% (2003)
Same as Government
Ratio of literate women to men, 15-24 years 100% 80% (2001) Same as Government
Women in wage employment in non-agriculture sector NA 18% (2004) Same as Government
Proportion of seats held by women in national parliament 33% by 2009 (Common Minimum Programme) Lok Sabha: 45 of 542 (2007), i.e., 8%;
Rajya Sabha: 25 of 245 (2007), i.e., 10%.
Same as Government

Some Ingredients for Decreasing Gender Gap in Education

Target: Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels by 2015.

The Ministry of Human Resources and Development's District Information System for Education (DISE) report notes that "the goal of universal primary education may not be realised unless and until all girls are brought under the education system." In its Chapter on Elementary Education for the 11th Plan Working Group Report, the Ministry cites factors to consider when decreasing the gender gap:

  • Strengthen the formal school system and make it more gender sensitive. Create more formal schools for girls in Muslim areas, for specific OBC communities in Northern and North-western India, and in other areas where girls are pulled out after primary education. Systematic monitoring of education quality is also necessary.
  • Increase women teachers. To create more schools for girls, initiate a 5-10 year strategy to increase the pool of educated women trained to teach.
  • Appropriate and relevant curricula for the education of older girls who are not in school. Formulate and implement follow-up mainstreaming strategies with mechanisms to provide ongoing support to the newly mainstreamed children.
  • Classroom, school environment, and community support. Given prevailing cultural practices and also a growing sense of insecurity among girls in mixed schools, appointing older women as escorts can be helpful.
  • Systematic tracking of funds allocated for girls' education and special focus group (SC, ST, Muslim, OBC and remote areas).
  • Separate projects for girls at risk and revamping funding norms. Currently all special efforts are budgeted under "innovations" with a fixed allocation of Rs 15 lakh per district. Flexible norms would allow separate projects to be designed for areas with low female literacy rates and enrolment.
  • Address double disadvantage faced by girls who belong to certain social and religious groups. In addition to gender-specific challenges, girls who belong to SC and ST communities face certain problems in education that are not experienced by other groups. For SC children, specific disadvantages stem from the social discrimination, segregation and lack of access to resources and opportunities because of their status. ST children experience relative isolation and neglect as well as the destruction of their way of life and cultural differences.

The gap between boys and girls in school is higher for Scheduled Castes and Scheduled Tribes.

Source: NIEPA; PRS
According to the Ministry of Human Resources and Development, the share for both SCs and STs is higher than their share in the total population at the primary stage; for STs the share comes down at the upper primary stage. However, the gender gap, i.e., the gap between boys and girls in school is higher for both SCs and STs than for the other groups.

In a nation-wide government study, 47% of total SCs enrolled were girls and 46% of total STs enrolled were girls.

Ratio of Girl to Boy Enrolment Rates in Primary Education

Gender Gap in Literacy (Ratio of Literacy Rate of Women to that of Men)

Gender Gap in Literacy (Ratio of Literacy Rate of Women to that of Men)

Some Ingredients for Elimination of Gender Disparity

Target: Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels by 2015.

According to the National Literacy Mission, the Ministry of Human Resources and Development and multi-lateral agencies, a number of factors contribute to lower rates of literacy among women. They include:

  • Gender-based equality. According to the Ministry of Human Resources and Development, social discrimination and economic exploitation also contribute to lower female literacy.
  • Decrease occupation of girl child in domestic chores. 20% of women who never attended school reported that they were required for household/family business or outside work.
  • High enrolment of girls in schools. Enrolment and attendance in schools contributes to increased literacy. In 2005, the Gender Parity Index in all areas for primary education was 0.89. The ratio of girls enrolment to boys enrolment gets worse at higher levels of education.
  • Retention rate and drop out rate. Though the enrolment rate is increasing every decade, attendance and retention are both important to increase literacy.
  • Learning of basic skills of literacy and numeracy in the early primary classes of 1 and 2. According to the Ministry of Human Resources and Development, learning deficits in later primary classes of 3 to 5 is often due to an inadequate foundation for these basic skills in the early classes.
  • Eliminate acute economic deprivation and social disabilities. Social and economic disadvantages accentuate the problem of illiteracy among female children, scheduled castes and tribes, children in rural areas, and child labourers.

Literacy rates are lower among females than males, and among SC/STs than the national average.
According to the 2001 Census, the total population literacy rate was 65% with 75% of the male population literate, and 54% of the female population. The literacy rate among Scheduled Castes is 55% (42% among female SCs and 67% among male SCs are literate). Among Scheduled Tribes, 47% of the total population is literate, (59% males and 35% of females).

The gender gap for the literacy gap is higher in rural areas than in urban areas. In 2001, the literacy rate in rural areas was 71% among males and 47% among females, a gap of 24 percentage points. In urban areas, the literacy rate was 86% among males, and 73% among females, a gap of 13 percentage points.

Major National Initiatives

A number of initiatives aim to increase literacy and decrease the gender gap. The National Literacy Mission, started in 1988, notes, "Since women account for an overwhelming percentage of the total number of illiterates, the National Literacy Mission is for all practical purposes a mission of imparting functional literacy to women." To sustain adult literacy the NLM also provides Post Literacy Campaigns and Continuing Education Programmes. The National Programme for Education of Girls at Elementary Level (NPEGEL) is specially tailored to ensure that girls have access to elementary education.

Budget Allocation and Expenditure Trends and Achievements
Allocation under 10th Year Plan: Rs 1,000 crore

2006- 07 Allocation: Rs 813 crore (NPEGEL is now part of the flagship programme for elementary education, Sarva Shiksha Abhiyan)
31,450 "model schools" developed
2 lakh teachers trained in gender sensitisation
Free uniform to 2 crore girls
10th Plan Outlay for NLM Authority: Rs 10 crore

10th Plan Outlay for Literacy Campaigns: Rs 95 crore

Total allocated for adult education in 10th Plan: Rs 1250 crore
120 million persons made literate
Gap in male-female literacy has decreased from 25% in 1991 to 22% in 2001
Female literacy increased by 14%; male literacy by 11% between 1991 and 2001
60% of beneficiaries under NLM are women
Out of total 600 districts in country, 597 districts are covered by NLM
Launched in 1989, 100% Dutch-funded

GoI funded since 2003-04

Budget 2007-08: 34 crore
Seeks to mobilise and organise marginalised rural women for education by creating a learning environment
Covers almost 16,000 villages spread over 63 districts in 9 states

Other schemes include the Kasturba Gandhi Balika Vidyalaya (KGBV) and the Early Childhood Care and Education that aim to improve girls' performance in education. KGBV was launched in August 2004 to set up 750 residential schools at the elementary level for girls belonging primarily to the SC, ST, OBC and Minorities in Educationally Backward Blocks, where female literacy is below the national average. Mahilya Samakyha aims to address women's perceptions of themselves and helps to create a learning environment. Early Childhood Care and Education (EECE) centres aim to support girl children to avail primary education by preparing children aged 3-6 years old for entry into schools (thereby also freeing older girls from sibling care, enabling them to attend school).

What has worked: Mahila Samakhya in Bihar

Mahila Samakhya (MS) in Bihar was initiated as an integral component of the Bihar Education Project (BEP) in 1992. One of the main aspects of the MS project is the formation of Mahila Samoohs women's groups. The sahyoganis (women volunteers) and the samooh women act effectively as the providers and disseminators of the relevant information on education, health, nutrition, social and gender issues etc. The samoohs have emerged as vocal and effective informal forums that have gained community respect and acceptability in handling cases of private and public harassment of women on all fronts. While addressing a wide range of issues the underlying experience of all the samooh members has been of attitudinal change towards girls, women and society and a strong belief in their own capabilities and self worth.

MS has been working continuously on awareness generation and information dissemination through: (a) community mobilisation activities, (b) sammelans and melas at cluster, unit and district levels for advocacy, (c) print media, (d) folk media such as issue based folk songs and nukkads (street plays) developed in local context, and (e) meetings to celebrate international and national days/events.

Samooh members of Rori Dhia village in Gaya District share: "Our language, way of talking and thinking has changed. Now we don't waste our time in gossiping, we try to think together, be together, work together, act together for the upliftment and welfare of women, family and village." The women admitted that now they play a decisive role in the decision-making process of their families as well as other forums. They also felt that their work is taken up on a priority basis at the government offices. In villages where samoohs are strong, women actively participate in Gram Sabha meetings and raise issues on development work for the village.

Girls' education has been MS Bihar's focal agenda. There is an apparent increase in the overall literacy status (enrolment, retention of girls particularly) in the areas where samoohs have been working very strongly. Samooh members have been elected as the President, Secretary or members of Vidyalaya Shiksha Samiti (School Education Committee). In Gaya district out of the total 249 villages covered by MSP, 36% of the villages have 100% enrollment in the primary school. As of December 2004, MS reaches out to 34 blocks across 9 districts of Bihar.

Source: Adapted from a note by UNICEF.

Goal 4: Reduce Child Mortality

  • Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG4 aims to reduce child mortality.

Definitions

  • Under-5 mortality rate: Probability of dying between birth and exactly five years of age expressed per 1,000 live births.
  • Infant mortality rate: Probability of dying between birth and exactly one year of age expressed per 1,000 live births.
  • Neonatal mortality rate: Probability of dying within the first 28 days of life.

MDG 4 progress
Description Target 2015 Latest Available Status
Under five mortality rate 41 87 (2003)
Infant mortality rate 27 58 (2005)
Proportion of 1 year old children immunized against measles n/a 59 (2005-06)

  • According to the Planning Commission, India is unlikely to achieve the targets for child mortality and infant mortality by 2015.
  • Malnutrition contributes to over 50% of child deaths.
  • India has the highest number of births (20%) and neonatal (first 28 days of birth) deaths (30%) in the world. Neonatal mortality (40 per 100,000 live births in 2002) constitutes 60% of infant mortality and over half of all deaths under-5 years of age.
  • Over three-fourths of neonatal deaths occur among infants who are born with low birth weight (weighing less than 2.5 kg at birth). In India, one-third of all neonates (children 28 days or younger) are underweight.
  • In 2005-06, 59% of children aged 1-year received measles vaccination in India.
  • Of every four children that die before reaching the age of five years, one dies in the first three days since birth.

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG4 aims to reduce child mortality. The following table lists some of the other goals and targets at global, regional and national levels.
Goals/Targets Indicators/Approach
Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
  • Under five mortality rate
  • Infant mortality rate
  • Proportion of 1 year old children immunized against measles
Goal: Child health
  • Universal immunization of children
  • Universal practice of breast feeding
10th Plan: Reduction of Infant Mortality Rate (IMR) to 45 per 1000 live births by 2007 and to 28 by 2012

Approach Paper to 11th Plan: Reduce infant mortality rate (IMR) to 28
  • Reduce malnutrition among children of age group 0-3 years to half its present level
  • Focus on reducing the incidence of anaemia and malnutrition among adolescent girls to break the cycle of ill-health and maternal and infant mortality
Protect the rights of children
  • Expand nutrition programmes on a significant scale, especially for the girl child

The Indian government follows the definitions used by the UN for measuring child mortality rate and infant mortality rate.
Term UN Definition Government Definition
Under-5 mortality rate Probability of dying between birth and exactly five years of age expressed per 1,000 live births. Same as UN definition
Infant mortality rate Probability of dying between birth and exactly one year of age expressed per 1,000 live births. Same as UN definition

MDG Target and Status
Indicator 2015 Target Projected value 2015 Status By Govt. definition (Year) By UN. Definition (Year)
Under-5 mortality rate 41 54.8 Off track 87 (2003) 85 (2004)
Infant mortality rate 27 48.1 Off track 58 (2005) 58 (2005)
Proportion of 1 year old children immunized against measles n/a n/a n/a 59 (2005-06) 58 (2005)

Some Ingredients for Reduction of Infant and under-5 Mortality

Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

According to the 2005 India's progress report on the UN MDGs, a number of factors will help reduce the prevalence of infant and child mortality:

  • Adequate maternal and newborn care: The first few days and weeks of life are the most risky. 20% of under-5 child deaths occur on the first day, 25% within the first 3 days, 37% within the first week. Neonatal mortality (40 per 100,000 live births in 2002) constitutes 60% of infant mortality and over 50% of under-5 child mortality. Success in this area involves convergence of multiple efforts in many sectors other than health and family welfare.
  • Prevent neonatal diseases: The principal causes of neonatal deaths and neonatal disorders (bacterial infections (52%), asphyxia (20%), prematurity (15%) and neonatal tetanus), pneumonia, diarrhoea, and measles. Birth injuries are an additional cause.
  • Access to quality healthcare and institutional deliveries (birth in hospitals or health centres). There is a correlation across states between the proportion of non-institutional deliveries and IMR and NMR rates. Kerala has the lowest IMR (14 per 1000 live births) with nearly universal institutional deliveries, whereas Uttar Pradesh has less than 25% institutional deliveries and IMR of 73. Nurses also play a crucial role in neonatal care, and improving nursing skills is a priority and a challenge.
  • Decrease malnutrition. Malnutrition contributes to over 50% of child deaths. Given the high prevalence of malnutrition among children, the government is promoting exclusive breastfeeding up to the age of 6 months and breastfeeding and complementary feeding until 2 years of age.
  • Birth weight. Over three-fourths of neonatal deaths occur among infants who are born low birth weight (weighing less than 2500 g. at birth). In India, one-third of all neonates (28 days or younger) are underweight.
  • Reducing the neonatal mortality rate. According to the National Planning Commission, the country cannot achieve its 10th Plan target of reducing the IMR to 45 per 1,000 live births by 2007 and 28 by 2012 unless it simultaneously achieves the enabling goal of bringing down the NMR to below 19 per 1,000 live births by 2010. They note that this fact does not seem to be considered in programme design.

Infant Mortality Rate is higher in rural areas than urban, and higher for girls than boys
IMR has been steadily declining in India from 146 in 1951 to 58 in 2005. However, the rate of decline in IMR slowed after 1993. Before 1993, the rate decreased at about 3 points per year, but after 1993 the rate decreased at 1.5 points per year. Since 1995, the rate of decline has improved to 2.25 points per year.

IMR varies among gender as well as among urban and rural populations. The IMR for the girl child is worse than the IMR for the boy child in both rural and urban areas. In rural areas, the girls' IMR is 66 per 1,000 live births compared to the IMR for boys of 62. In urban areas, girls' IMR is 43, whereas the IMR for boys is 37.

Infant Mortality Rates

Measles Immunization

Some Ingredients for Increasing Immunization against Measles

Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

Measles and other vaccine preventable diseases account for many under-5 and infant deaths. Under the Global Plan for Reducing Measles Mortality (2006-10), WHO and UNICEF have identified India as one of 47 priority countries that make-up 95% of global measles death. According to the WHO, the number of reported cases of measles in India has been increasing since 2000. In 2000, 38,800 cases were reported, whereas in 2006 close to 61,000 cases were reported. According to the Comptroller Auditor General (CAG), the Ministry of Health and Family Welfare and multi-lateral agencies, there are a number of factors that help achieve universal immunization:

  • Effective immunization: According to WHO, failure to deliver at least one dose of measles vaccine to all infants is the primary reason for continuing prevalence of childhood measles and mortality. According to the Ministry of Health and Family Welfare, immunization sessions are not being held regularly in the community. The Ministry also cited "reporting of actual number of children vaccinated" as an implementation issue.
  • Improved delivery of services: MHFW also attributes staff vacancies, particularly of the health workers in the sub-center, lack of training and orientation of staff, inadequate mobility of health workers and problem of delivery of vaccines to failures in immunization. The UN also cites ensuring cold chain and vaccine storage services as important requirements for effective implementation of vaccination programmes.
  • Decrease malnutrition: According to WHO, severe measles is particularly likely in poorly nourished young children. Those particularly prone to a severe case are children who do not receive sufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.
  • Avoid complications from measles: Children usually do not die directly from measles, but rather from its complications, more common among children below the age of five years. Complications include blindness, encephalitis, severe diarrhea, ear infections and severe respiratory infections.
  • Government targets for immunization must be relevant to demographics: According to the Comptroller Auditor General, targets fixed for immunization of children had no relationship to the demographic profile, and were not based on any baseline survey.

A lower proportion of children from disadvantaged groups are vaccinated against measles

In 2005-06, 59% of children aged one-year received measles vaccination. Measles vaccination varied among social groups. There was an 11 percentage point difference in vaccination between Scheduled Tribe children (46%) and Scheduled Caste children (57%).

This number also varied by income. Among the lowest fifth of the population, 39% of children received measles vaccination, whereas 85% of the highest fifth of the population (wealth-wise) were vaccinated.

Major National Initiatives

There are a number of national initiatives that aim to reduce infant and under-5 mortality. The umbrella scheme under which most of the other schemes fall is the Reproductive and Child Health Programme. The National Health Policy has prioritized the implementation of the National Immunisation Programme. The cornerstone of the child health care system is the immunisation of children against six preventable diseases: tuberculosis, diphtheria, pertussis, tetanus, polio and measles. The Expanded Programme on Immunisation (EPI) was started by the Government of India in 1978 with the objective of reducing the prevalence, mortality and disabilities from these six diseases by providing free vaccination to all eligible children. Vaccination against measles began in 1985-86. A number of initiatives aim to reduce child and infant mortality.

Budget Allocation and Expenditure Trends and Achievements
2006-07 estimated spending: Rs 1338 crore

2007-08 Budget: Rs 1672 crore
RCH Phase II approach: integrated management of Neonatal and Childhood Illnesses (IMNCI), home based newborn care, promotion of breastfeeding and complementary feeding, control of deaths due to Acute Respiratory Infections (ARI), control of deaths due to diarrhoeal diseases, supplementation with micronutrients Vitamin A and iron, universal immunisation programme.
This scheme falls under the RCH head As of 2006-07, 75 districts across the country have initiated implementation of IMNCI.

Programme is to be introduced throughout the country in a phased manner.
Introduced in country in 1985, became part of RCH in 1997.  

There are a number of other schemes, including the Diarrhoeal Disease Control Programme, the Acute Respiratory Infection (ARI) control programme (both merged under the Child Survival and Safe Motherhood Programme), and the Border District Cluster Strategy. The IMNCI programme was initiated to achieve the National Population Policy's goal of attaining an IMR of 30 per 1,000 by 2010. Under IMNCI, baseline workers are trained in the management of measles, malaria, pneumonia, diarrhoea and malnutrition in a holistic manner with appropriate health facilities. Also, the community is to be involved in the recognition of the sick child so that there is no delay in seeking treatment.

The Border District Cluster Strategy provides focused interventions for reducing infant and maternal mortality rates by 50% over the next 2-3 years in 49 districts in 16 States of the country. The Diarrhoeal Disease Control Programme was started in 1978 to prevent death due to dehydration caused by diarrhoeal diseases among children under 5 years or age. The Union Budget also provides for routine immunisation against six vaccine preventable diseases: In 2007-08, Rs 300 crore was allocated, compared to Rs 266 utlilised in 2006-07.

What has worked: Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

A group of women - all frontline health and nutrition workers -- are listening attentively to a medical officer from a rural primary health centre as he explains how mothers in one of the poorest rural communities in India can be taught to save their newborns, including low birth weight, sick ones, when the nearest doctor is far away. The accent is on developing skills so the trainees learn by doing: 50% of the 8-day training session is devoted to actual case management of young infants (0 - 2 months) in hospital and community settings.

UNICEF is a key player in the national effort to operationalise an innovative, newborn-centric child survival strategy called Integrated Management of Neonatal and Childhood Illness (IMNCI) - used to strengthen the skills sets of community workers. Millions of newborns in India die before their first birthday as they do not get the basics. This is the glaring gap being addressed by IMNCI. The key components of IMNCI include: (a) A home visitation programme to promote best practices for the young infant, (b) a special provision for follow-up of the low-birth weight baby at the village level, (c) reinforcement through meetings of womens' groups and community-level activities and a linkage between the village and home, and (d) facility-based assessment at PHC, sub-centres, and hospitals through referrals.

At the heart of IMNCI lies the post-natal home visit by a trained community worker. The idea is not new but innovation lay in giving it a structure. The most powerful evidence of the IMNCI's potential is the energized nutrition worker whose confidence has surged ever since she realized she now has the skill to save babies. "Earlier, I would give general advice, like telling a mother to breastfeed her baby. Now, I show her the correct way of doing it," says Meera Watte, 40, an anganwadi (nutrition) worker.

"I was able to save [the baby] because I could identify the imminent danger and successfully motivate [his parents] to take him to the hospital" says a trained anganwadi worker in Orissa. The district level data suggest that Mayurbhanj district now has significantly lower Infant (59.2) and Under-Five Mortality Rates compared to the state averages. Of the total births reported in the 14 IMNCI blocks, 95.5% were examined within two months of birth.

First piloted in selected blocks in 6 districts in as many states (Maharashtra, Gujarat, Rajasthan, Madhya Pradesh, Orissa and Tamil Nadu) in the country between 2002 to 2004, IMNCI is being currently implemented in nearly 25 districts across the country.
Source: Adapted from a note by UNICEF

Goal 5: Improve Maternal Health

  • Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
  • Achieve, by 2015, universal access to reproductive health

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG5 aims to improve maternal health.

Definitions
The United Nations and most signatory countries (including India) use the maternal mortality ratio as an indicator of maternal health.

  • Maternal Mortality Ratio (MMR): Number of maternal deaths per 100,000 live births of women aged 15-49 years.
  • Maternal Death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

MDG 5 progress
Description Target 2015 Latest Available Status
Maternal Mortality Ratio <109 301*(2001-03)
Proportion of births attended by skilled health personnel N.A. 48.3% (2005-06)

  • *Data on MMR varies depending on source. The Sample Registration System of the Government of India estimates MMR at 301 in 2001-03, a decline from 398 for 1997-98 while WHO, UNICEF, UNFPA and World Bank estimate it to be around 450 between 2001-03.
  • The Planning Commission projections indicate that India will miss the MMR target for 2015.
  • According to estimates by UN agencies, the occurrence of a maternal death is 41 times more likely in India than of a maternal death in the US, and 10 times more likely than in China.
  • Nine states-Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam-constitute nearly half the country's population account for two-thirds of maternal deaths.
  • In 2005-06, about 48% of births were assisted by skilled health personnel (about 75% in urban areas and 39% in rural areas). 41% of the deliveries were in hospitals or health centres (69% in urban and 31% in rural areas).

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG 5 aims to improve maternal health. The following table lists some of the other goals and targets at global, regional and national levels.
Goals/Targets Indicators/Approach
Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Target 5B: Achieve, by 2015, universal access to reproductive health
  • Maternal mortality ratio
  • Proportion of births attended by skilled health personnel
  • Contraceptive prevalence rate
  • Adolescent birth rate
  • Antenatal care coverage (at least one visit and at least four vists)
  • Unmet need for family planning
Goal 1: Maternal health
  • Increased presence of skilled birth attendants
  • Care before birth
  • Rapid decline in TFR (total fertility rate, i.e. the number of children per woman) to reach the replacement level (2.1) within a definite period to be specified by each country
10th Plan: Reduction of MMR to 200 by 2007 and to 100 by 2012

Approach Paper to 11th Plan: Focus on reducing the incidence of anaemia and malnutrition among adolescent girls to break the cycle of ill-health and maternal and infant mortality
  • Reduce current level of the Maternal Mortality Ratio from 301 to 100 (11th Plan)
  • Reduce anaemia among women by half
Raise public spending on health to at least 2-3% of GDP with focus on primary health care National Rural Health Mission (NRHM) aims to:
  • Reduce MMR to 100
  • Reduce total fertility rate to 2.1
  • Improve facilities for institutional deliveries under the Janani Suraksha Yojana

The definitions used by the Indian government to measure maternal mortality ratio differ slightly from those used by the United Nations.
Term UN Definition Government Definition
Maternal Mortality Ratio Maternal deaths per 100,000 live births Number of maternal deaths per 100,000 live births of women aged 15-49 years.

MDG Target and Status
Indicator 2015 Target Projected value 2015 Status Govt. Estimates (Year) UN Estimates (Year)
Maternal mortality ratio (MMR) 109 405 Off track 301 (2001-03) 450 (2001-03)
Proportion of births attended by skilled health personnel NA NA NA 48 (2005-06) Same as Government estimates

Some Ingredients in Reducing Maternal Mortality

Target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

There are a number of factors that will help reduce maternal mortality in India. According to the National Planning Commission and UN agencies, these include:

  • Access to skilled care and emergency obstetric care: Two-thirds of maternal deaths in India are on account of five causes: haemorrhage, sepsis, hypertensive disorders, abortion and obstructed labour. Most of these deaths are preventable by ensuring access to skilled providers during delivery and immediate post partum period, and timely management of life threatening complications. Simultaneously community level actions should promote utilization of services from skilled providers and identified emergency obstetric care facilities.
  • Institutional deliveries: The death rate due to complications arising within births attended by a skilled practitioner is only a fraction for that of home births or births at facilities without skilled staff. According to NFHS-3, in 2005-06 about 41% of births were institutional deliveries (about 69% in urban areas and 31% in rural areas).
  • Access to safe and early abortion services: Poor access to early and safe abortion services forces clients to seek services from illegal and unsafe sources. Abortions related complications account for 8 percent of all maternal deaths.
  • Access to affordable, quality family planning and reproductive health services to prevent and manage unintended pregnancies and unsafe abortion. NFHS-3 estimates that family planning needs of 13.2% of married women are not met.
  • Socio-economic factors that increase the risk of maternal death: (1) early marriage (which results in early pregnancies, increasing the risk of maternal death), (2) short birth intervals often leads to complications, (3) high number of children, (women who have four or more deliveries are at a much higher risk for maternal death) and (4) low levels of education among females. In 2005-06, 45% of women aged 20-24 were married by age 15. NFHS-3 data shows that a disproportionately lower number of births among disadvantaged social groups such as SCs, STs, and OBCs are attended by skilled personnel. This is also true among the poorer sections of society.

Fewer proportion of Scheduled Caste and Scheduled Tribe births are attended by skilled personnel
Maternal mortality is influenced by a range of socio-economic factors including level of education, cultural misconceptions, and economic dependency. Hospital based data shows that states that have relatively better socio-economic status and higher educational levels (such as Kerala, Karnataka, Tamil Nadu, and Maharashtra) also have lower rates of MMR.

According to the Sachar Committee Report on the Social, Economic and Educational Status of the Muslim Community of India, Muslims tend to have a slightly lower rate of maternal mortality than other groups.

Maternal Mortality Ratio

Deliveries Attended by Skilled Birth Attendants (SBAs)

Major National Initiatives
A number of initiatives aim to reduce maternal mortality. The Government of India launched the National Rural Health Mission (NRHM) in 2005 to improve basic health care delivery system in India. A major goal is to reduce India's MMR. The Reproductive and Child Health Programme Phase 2, the flagship programme in the NRHM, aims to enhance access for skilled attendance at birth and emergency obstetric care to women in rural areas and urban slums. The programme also aims to improve utilisation of services through effective behaviour change communication strategies.

Budget Allocation and Expenditure Trends and Achievements
Union Budget 2007-08 allocation: Rs 9,839 crore 320,000 Associated Social Health Activists (ASHAs) have been recruited and over 200,000 have received orientation training.
ASHAs (guidelines prescribe 1 ASHA per 1000 population).
100% centrally-sponsored, gives mothers and ASHAs cash incentives for institutional deliveries Reports from States indicate significant increase in institutional deliveries because of demand side financing under Janani Suraksha Yojana.
2006-07 estimated spending: Rs 1338 crore
2007-08 Budget: Rs 1672 crore
RCH Phase II approach: states to prepare 5-year plans linked to clear outcomes, performance benchmark, service package to ensure availability of essential infrastructure, states will have different requirements.

The Integrated Child Development Scheme (ICDS) also provides supplementary nutrition, health care check-ups before and after delivery, and health and nutrition education to pregnant women and breast-feeding mothers.

Launched in 1997, the Reproductive and Child Health programme aims to improve the health status of the most neglected sections of the Indian population, women and girls of socially disadvantaged groups, particularly those living in remote, rural settlements. RCH service delivery includes integration of services at all levels, different need-based approaches per district, and a focus on the younger age group. For tribal and remote areas a special package has been devised to expand the role of birth attendants in these areas, to train local women to deliver basic RCH services including safe delivery services, to initiate mobile clinics and to construct clean delivery rooms.

What has worked: Janani Suraksha Yojna ( Maternity Security Scheme )

Recognizing the challenge of continued high maternal mortality and morbidity in India especially amongst poor and marginalized communities, the programme supports a cash incentive scheme for promoting institutional deliveries. An amount of Rs 1400 is given to the mother in addition to transport assistance in rural areas. In urban areas amount of cash incentive is less. As nearly 80% of maternal deaths in India are attributable to direct obstetrical causes, ensuring institutional deliveries will result in timely management of life threatening obstetric complications.

In order to mobilize poor and marginalized women in remote rural areas and urban slums, community based volunteers known as Accredited Social Health Assistants (ASHAs) are active. More than 300,000 ASHAs are engaged in the task of identifying pregnant women, ensuring mandatory ANC and accompanying these women to nearby health facilities for delivery. They are reimbursed for their time accompanying women to institutions and also staying with woman. The national Reproductive and Child Health programme (RCH-phase II) provides necessary resources for hiring human resources, upgradation of physical infrastructure, procurement of equipments/drugs for delivery of quality obstetric care and immediate newborn care to cater for demand generated.

Janani Suraksha Yojana (JSY) has increased institutional delivery from 0.6 million in 2005 to over 3 million by 2007 and is expected to reach 6 million in the next year. Considering there are an estimated 28 million deliveries each year in the country, this constitutes nearly 25% of all deliveries. A recent review of the scheme commissioned by UNFPA, UNICEF and GTZ highlighted that the scheme has been successful in addressing equity objectives and large number of women from marginalised and vulnerable communities.

Source: Adapted from a note by UNFPA.

Goal 6: Combat HIV/Malaria and Other Diseases

  • Halt and begin to reverse the spread of HIV/AIDS
  • Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
  • Halt and begin to reverse the incidence of malaria and other major diseases

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG6 aims to combat HIV/Malaria and other diseases.

Definitions

  • HIV prevalence: The definition the Government of India uses to measure HIV prevalence among 15-24 year old pregnant women differs from that used by international agencies. The UN measures this as the percentage of 15-24 year old pregnant women whose blood samples test positive for HIV. The Government measures this as the percentage of all pregnant women who visit certain identified clinics whose blood samples test positive for HIV.
  • Prevalence of Malaria and Tuberculosis: The number of people who have contracted these diseases per 100,000 population.

MDG 6 progress
Description Target 2015 Latest Available Status
HIV Prevalence Among 15-49 year-old Pregnant Women No target set 0.55 (2006)
Prevalence rates of malaria NA About 157 cases per 100,000 people (2006)
Death rates with TB NA 30 per 100,000 people (2004)

HIV/AIDS: About one in 300 adults is estimated to be infected with HIV. According to National AIDS Control Organisation's (NACO) estimates, India had 23 lakh people infected with HIV in 2007.

Malaria: In 2006, 16.7 lakh malaria cases were reported in India, i.e., one in about 630 persons.

Tuberculosis: Every year there are approximately 18 lakh new cases and the annual risk of becoming infected with TB is 1.5%.

Polio: There was a sharp increase in the number of polio cases in India in 2006 (676 confirmed cases up from 66 cases in 2005). India is one of four countries along with Pakistan, Nigeria and Afghanistan where polio is still endemic.

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG6 aims to combat HIV/Malaria and other diseases. The following table lists some of the other goals and targets at global, regional and national levels.
Goals/Targets Indicators/Approach
Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
  • HIV prevalence among 15-24 year-old pregnant women
  • Condom use at last high-risk sex
  • Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS
  • Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years
  • Proportion of population with advanced HIV infection with access to antiretroviral drugs
  • Incidence and death rates associated with malaria
  • Proportion of children under 5 sleeping under insecticides treated bednets and proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs
  • Incidence, prevalence, and death rates associated with tuberculosis
  • Proportion of tuberculosis cases detected and cured under directly observed treatment short course
Goal: Affordable health care

Goal: Child Health

Goal: Improved hygiene and Public health
  • Universal immunization of children
  • Access to primary health case services operated by paramedics
  • Access to affordable medicines
  • Training rural medical practitioners
  • Awareness raising programmes to combat major diseases.
  • Raising awareness of important aspects of public and social hygiene
10th Plan: 25% reduction in prevalence of and mortality due to malaria by 2007 and 50% by 2010

50% reduction in mortality due to tuberculosis by 2010

Approach Paper to 11th Plan: Take care of special needs of people who are HIV positive; recognise the feminine face of HIV and accord it the highest priority

No explicit mention of malaria or TB
  • 70% of new smear positive tuberculosis patients detected and 85% of such cases cured
  • Annual Blood Examination Rate (ABER) over 10% and Annual Parasite Incidence (API) 1.3 or less
Raise public spending on health to at least 2-3% of GDP over the next five years, with focus on primary healthcare

Take steps to ensure availability of life saving drugs at reasonable prices
  • Revive Public Sector Units manufacturing critical bulk drugs
  • Launch National Rural Health Mission (NRHM)

The definition used by the Indian government to measure HIV prevalence differs slightly from that used by the UN. This can result in differences in the measurement of progress towards achieving these goals.
Term UN Definition Government Definition</td>
HIV prevalence among 15-24 year old pregnant women Percentage of pregnant women ages 15-24 whose blood samples test positive for HIV HIV prevalence among pregnant women attending antenatal clinics in identified hospitals selected at sentinel sites
Prevalence of malaria Number of cases of malaria per 100,000 people Same as UN
Death rate due to TB Number of deaths caused by TB per 100,000 people Same as UN
MDG Target and Status
Indicator 2015 Target Projected value 2015 Status By Govt. definition (Year) By UN. Definition (Year)
HIV Prevalence Among 15-24 year-old Pregnant Women No target set NA Not applicable 0.55% (2006) NA
Prevalence rates of malaria NA NA NA 16.7 lakh cases, i.e., about 157 cases per 100,000 population (2006) Same as government
Death rates with TB NA NA NA 30 per 100,000 (2004) Same as government

Some Ingredients for HIV/AIDS Reduction


Target: Halt and begin to reverse the spread of HIV/AIDS by 2015

There are a number of factors contributing to the prevalence of HIV/AIDS in India. According to the United Nations, several structural factors need to be addressed and adequate availability and access to prevention and treatment services need to be ensured in order to reserve the spread of HIV/AIDS.

  • Social and economic factors. Extreme poverty often forces women and young girls into sex trade, which increases their risk of exposure to HIV. The HIV epidemic in turn perpetuates poverty by reducing the economic, social opportunities of the affected household. These socio-cultural and economic factors also play an important role in determining the working and living conditions of migrants.
  • Gender equality. Gender inequality contributes to women's vulnerability to HIV across the country. Women's decision making regarding sexual activity is limited by social norms that make it difficult for them to obtain information on HIV and negotiate safe sex practice within and outside marriage.
  • Reducing stigma and discrimination. Stigma and discrimination act as a barrier to effective programme implementation. Such attitudes of people involved in implementing HIV/AIDS related programmes can affect quality of services towards people living with HIV. Police harassment and ostracism by family and community drives the epidemic underground and decreases the effectiveness of prevention efforts.
  • Correct information. Lack of correct information as well as myths and misconceptions associated with HIV has further strengthened and perpetuated stigma against people living with HIV. NFHS-3 indicated that 83% of males and 57% of women have heard of AIDS. However, only half of rural women demonstrated awareness about AIDS and among women with no education, only 30% had ever heard of AIDS.
  • Prevention of mother to child transmission. Without effective prevention measures, the risk of transmission from an infected mother to her child, before or during child birth, is 15-25%. If the mother breastfeeds her newborn until 18-24 months, that risk increases to 30-45%. According to WHO, only 3.9% of all pregnant women accessed HIV mother-child transmission services in 2005 and 2% of HIV-infected pregnant women received treatment to prevent transmission to their children.
  • Protected sexual activity. In India, HIV has spread mainly through unprotected sexual activity. High prevalence rate of HIV is found among commercial sex workers and men having sex with men. However, in north-eastern India, the spread of HIV has been fuelled primarily by injecting drug users. Infected blood as a source of fresh HIV infection is not yet common. Transmission from mother to newborn is also quite low.

Accurate knowledge regarding contracting HIV/AIDS is much lower among women than men
The percentage of HIV cases is high among commercial sex workers, injecting drug users, and men having sex with men. However, infection from blood transfusions and transmission from mother to newborn is low.

Awareness is lower among poorer people. On an income scale, 9% of the women in the bottom fifth of the population said that they were aware that using condoms can prevent HIV/AIDS whereas 70% of the top fifth displayed this awareness.

Awareness of HIV/AIDS Among Female Population

Malaria Cases in 2005

Some Ingredients for Reversing Malaria and Other Major Diseases

Target: Halt and begin to reverse the incidence of malaria and other major diseases by 2015

Malaria prevention and control in the country is undertaken through the National Vector Borne Diseases Control Programme (NVBDCP). According to the UN, there are a number of factors to consider when facing the challenges of reducing malaria and TB:

Malaria:

  • Elimination of the malarial parasite and managing the disease includes (a) early case diagnosis and complete treatment, (b) strengthening of referral services, (c) epidemic preparedness and rapid response.
  • Reducing the risk of transmission, includes (a) indoor residual spraying in selected high risk areas, (b) use of insecticide treated bed nets, (c) use of fish that feed on mosquito larvae, (d) anti larval measures in urban areas, (e) minor environmental engineering for reduction of breeding grounds.
  • Ensuring that the rural, tribal and vulnerable population has adequate coverage and access to malaria control services at a reasonable quality proportionately with the burden of disease that they suffered. The UN cites lack of Drug Distribution Centers and Fever Treatment Depots in remote areas as a challenge to be addressed for malaria progress.
  • Other challenges: Rapid urbanization, colonization of forest fringes, movement of persons and various developmental activities all increase risk of spreading malaria.
Tuberculosis
  • Controlling and Preventing TB. The strategy to control TB includes government commitment to TB control, case detection, standardized treatment regimen of six to eight months, a regular uninterrupted supply of anti-TB drugs, and a standardized recording and reporting system.
  • Improvement of quality in poorly performing states/districts and addressing health system weaknesses in some large states, involving all major public & private sector health care providers, and the establishment of state level intermediate reference laboratories are all challenges that need to be addressed in order to improve progress on TB reduction.
Polio:
  • Eliminating polio. There was a sharp increase in the number of polio cases in India in 2006 (583 confirmed cases up from 66 reported cases in 2005). India is one of the four countries along with Pakistan, Nigeria and Afghanistan where polio is still endemic. The Global Polio Eradication Initiative Strategic Plan 2004-2008 focuses on four objectives (a) interruption of polio virus transmission; (b) achievement of certification of global polio eradication; (c) development of products for the cessation of OPV; and (d) mainstreaming of the Global Polio Eradication Initiative.

A smaller proportion of children from disadvantaged groups are immunised than others.
Immunisation rates vary across social groups. For polio immunization, while the all India average is 78%, only 65% of ST children under 1-year of age have received 3 doses of polio vaccine. Similarly, the all India rate for children who were fully immunized (against BCG, measles, and 3 doses each of polio/DPT) in 2005-06 was 44%. The rate among STs was 31% and among SCs and OBCs about 40%.

Immunisation cover is slightly worse in rural areas than in urban areas. 77% of children under 1-year of age in rural areas were immunised against polio; the figure for urban areas was 83%.

Major National Initiatives
The National Health Policy (NHP) sets out a number of goals to address HIV/AIDS, malaria and other major diseases. NHP aims to reduce mortality by 50% on account of TB, malaria, other vector and water-borne diseases, to achieve zero level growth of HIV AIDS, and to increase health expenditure by govt to 2.0% of GDP by 2010. The National AIDS Prevention and Control Policy envisaged and the National Health Policy, 2002 reaffirmed effective containment of the infection levels of HIV and AIDS in the general population so as to achieve zero growth of infection by 2007. The government initiated the National AIDS Control Project (NACP) in 1992 with the objective of slowing the spread of HIV in India to minimise the impact of AIDS. NACP II focussed on strengthening India's capacity to respond to HIV/AIDS on a long term basis. NACP III aims to halt and reverse the HIV/AIDS epidemic by 2011 through integration of prevention, care, support and treatment programmes. The nationwide Universal Immunization Programme (UIP), launched in 1985 aims to reduce prevalence of and mortality from six vaccine-preventable diseases (diphtheria, pertusis, total tetanus, neonatal tetanus, polio and measles).
Budget Allocation and Expenditure Trends and Achievements
Union Budget Allocation 2007-08: Rs 720 crore

Union Budget Utilisation 2006-07: Rs 637 crore
Number of integrated counselling and testing centres (ICTCs) increased from 982 in 2004 to 1475 in 2005 3394 in 2006, and 4132 in 2007.

Over 1230 blood banks have been modernized to ensure blood safety

In 2006-07, 1250 million condom pieces distributed under free supply and 593 million under social marketing; an increase from 2001-02 (733 million and 444 million pieces respectively)
Seven North Eastern states having tribal population are being provided 100% central assistance since December 1994 Intensified Malaria Control Project (IMCP) supported by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) is being implemented in 106 districts across 10 states covering a population of 100 million

About 5 lakh Drug Distribution Centres, Fever Treatment Deports and malaria clinics established until 2005

54 lakh bed nets have been supplied free or at highly subsidized rates to the high risk areas of endemic states

The revised National Malaria Drug Policy has been implemented
RNTCP Phase II total outlay from Oct 2006 - Sep 2011: Rs 1,156 crore

Includes Rs 765 crore credit from World Bank and commodity assistance of anti-TB drugs from DFID through WHO from Rs 287 CRORE
Over 55-fold expansion in RNTCP coverage since 1998, leading to total coverage of the country by March 2006

Diagnostic facilities in nearly 11,800 laboratories throughout the country have been established

Since inception, programme has initiated over 6.3 million patients on treatment

Under the National Rural Health Mission, there are six major Disease Control Programmes, including the National Leprosy Education Mission, the National Vector Borne Disease Control Programme, the National Blindness Control Programme, the Integrated Disease Surveillance Programme, the Revised National Tuberculosis Control Programme, and the National Iodine Deficiency Disorder Control Programme. The National Vector Borne Diseases Control Programme (NVBDCP) aims to prevent and control vector borne diseases, including malaria. Currently the programme is implementing the Intensified Malaria Control Project (coverage - 100 million in 106 districts of 10 states from 2005-06), which is assisted by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

Tuberculosis control activities are undertaken in the country through the Revised National Tuberculosis Control Programme (RNTCP). This programme began in 1997 and has undergone a massive scale up to cover all the districts of the country by March 2006.

What has worked: CHARCA

The Coordinated HIV-AIDS Response through Capacity Building and Awareness (CHARCA) project was initiated in 2002 to address and mainstream the gender dimension of HIV. By synchronizing the efforts of Government and UN agencies and civil society organizations, it sought to empower women between the ages of 13 and 25 years in six select districts across India-Bellary (Karnataka), Guntur (Andhra Pradesh), Udaipur (Rajasthan), Kanpur (Uttar Pradesh), Kishanganj (Bihar) and Aizawl (Mizoram). The objectives were to increase awareness levels, improve access to quality services, build capacities and enable an environment conducive for women to protect themselves against HIV. To achieve these goals, existing government and civil society initiatives were supported and supplemented and district based programme strategies formulated.

After a three year implementation period, the project was evaluated by the International Institute for Population Sciences with technical support from the London School of Economics and Political Science in 2007. Some of the key findings of this survey were:

  • 100% women in Aizawl and Guntur were aware of HIV preventive measures.
  • According to panel data, women in all districts had greater control over their sexual relationships. In Aizawl, as high as a 79 percentage point change was observed.
  • Reports of sexual violence dropped by 15 percentage points in Kishanganj and 14 percentage points in Bellary over the three years. No case was reported in Bellary or Guntur reported a case in the twelve months prior to the project's closure.
  • Panel data reflected a 35 percentage point increase in the number of women accessing public health centres for treatment of STIs.
  • 100% women in Aizawl and 98% in Guntur considered the project very effective as it contributed in their overall development.
To ensure continuity of programme initiatives after the project's closure, CHARCA handed its project strategies, district based models and knowledge products to the National AIDS Control Organization and State AIDS Control Societies.

Source: Adapted from a note by UNAIDS

Goal 7: Ensure Environmental Sustainability

  • Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources.
  • Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss
  • Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.
  • By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers.

The Millennium Development Goals (MDGs) were formulated in 2000 at the United Nations Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG7 aims to ensure environmental sustainability.

Definitions

  • Proportion of population with sustainable access to an improved water source: Percentage of the population who use any of the following types of water supply for drinking: piped water, public tap, borehole or pump, protected well, protected spring or rainwater. Improved water sources do not include vendor-provided water, bottled water, tanker trucks or unprotected wells and springs.
  • Proportion of population with sustainable access to improved sanitation: Percentage of the population with access to facilities that hygienically separate human excreta from human, animal and insect contact. Facilities such as sewers or septic tanks, poor-flush latrines and simple pit or ventilated improved pit latrines are assumed to be adequate as long as they are not public.

MDG 7 progress
Description Target 2015 Latest Status Available
Population with sustainable access to improved water source Rural:80.5%
Urban:94%
Rural:85%
Urban: 95%
Population with access to sanitation Rural:72%
Urban:72%
Rural:50%
Urban:83%

The Planning Commission expects India to meet the targets related to access to an improved water source and sanitation.

India has 16% of the world's population, but its share of fresh water sources is only 4%.

About three in five households in India do not have toilet facilities. Access to toilets is even worse among SC/ST and OBC households.

58% of schools in India have toilet facilities. There is a wide variation among states from Haryana (70% of the schools have toilets) and Punjab (87%) to Bihar (47%), Gujarat (67%),and Jharkhand (25%).

The Millennium Development Goals (MDGs) were formulated in 2000 at the UN Millennium Summit as a response to the world's main development challenges. There are eight goals to be achieved by 2015. MDG7 aims to ensure environmental sustainability. The following table lists some of the other goals and targets at global, regional and national levels.

Goals/Targets Indicators/Approach
Target 7A: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources

Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss

Target 7C: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation

Target 7D: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers
  • Proportion of land area covered by forest
  • CO2 emissions, total, per capita and per $1 GDP (PPP), and consumption of ozone-depleting substances
  • Proportion of fish stocks within safe biological limits
  • Proportion of total water resources used
  • Proportion of terrestrial and marine areas protected
  • Proportion of species threatened with extinction
  • Proportion of population using an improved drinking water source
  • Proportion of population using an improved sanitation facility
  • Proportion of urban population living in slums
Goal: Acceptable level of forest cover, water and soil quality, and air quality

Goal: Conservation of bio-diversity

Goal: Wetland conservation

Goal: Ban on dumping of hazardous waste, including radio-active waste
  • Reversing the process of deforestation, engaging traditional communities in forest conservation, promotion of social forestry
  • Water management
  • Control of waste and industrial discharges
  • Use of organic fertilizers
  • Improved waste management
  • Reducing air pollution
  • Discouraging leaded petrol
10th Plan: All villages to have sustained access to potable drinking water within the 10th Plan period

Approach Paper to 11th Plan: All rural households to have sanitation facility by the end of the 11th plan; all rural schools to have water supply and toilet facility by the end of the 11th plan
  • Increase in forest and tree cover to 25 per cent by 2007 and 33 per cent by 2012
  • Cleaning of all major polluted rivers by 2007 and other notified stretches by 2012
  • Check low coverage of rural sanitation leading to hygiene problems
  • Check growing problem of urban solid waste management
Provide drinking water to all sections of in urban and rural areas and augmenting availability of drinking water sources

Protect forests, and undertake social afforestation
  • Harvesting rain water, desilting existing ponds, etc
  • Assess feasibility of river linking and linking of sub-basins
  • Discontinue eviction of tribal and other forest-dwelling communities; co-operate with them to conserve forests
  • Safeguard rights of tribes over mineral and water resources
  • Village women to be encouraged to assume responsibility for drinking water, sanitation etc.

The definition used by the Indian government to measure the proportion of the population with sustainable access to an improved water source and sanitation is the same as that used by the United Nations.
Term UN Definition Government Definition
Proportion of pop. with sustainable access to an improved water source % of the population who use piped water, public tap, borehole or pump, protected well, protected spring or rainwater as their water supply for drinking. The definition does not include vendor-provided and bottled water, tanker trucks, unprotected wells and springs. Same as UN definition
Proportion of population with sustainable access to improved sanitation % of the population with access to facilities that hygienically separate human excreta from human, animal and insect contact. Sewers or septic tanks, poor-flush latrines and simple pit or ventilated improved pit latrines are adequate as long as they are not public. Same as UN definition
MDG Target and Status
Indicator 2015 Target Projected value 2015 Status By Govt. definition (Year) By UN. Definition (Year)
Population with sustainable access to improved water source Rural:80.5%
Urban:94%
Rural:100%
Urban:100%
On track
On track
Rural: 89% (2007), Urban: 91% (2004) Total: 86%, Urban: 95%, Rural: 83% (2004)
Population with access to sanitation Rural:72%
Urban: 72%
Rural: 95%
Urban: 100%
On track
On track
Rural: 50% (2008), Urban: 63% (2004) Total: 33%, Urban: 59%, Rural: 22% (2004)

Some Ingredients for Access to Drinking Water

Target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation

The UN documents that water coverage increased from 18% to 95% in the last 30 years, but that the government data shows a subsequent slippage to 85%. It points out that actual access to safe drinking water is significantly less due to seasonal water scarcity and other factors. The mid-term review of the 10th Five Year Plan, the United Nations and various governmental ministries discuss a number of factors that will help increase access to safe drinking water. These include:

  • Solid waste management: At a per-capita solid waste generation rate of 0.4kg/day, an urban population of 278 million generates 42 million tonnes solid waste annually. In urban areas solid and medical waste and hazardous chemicals are dumped into open landfills leading to groundwater pollution. Sanitary landfills and segregation of waste at the household level is totally absent.
  • E-waste management: It is estimated that 1,050 tonnes of electronic scrap is being produced annually. Refuse from discarded electronic devises with poisonous chemicals like lead, cadmium and mercury are also dumped in poorly managed landfills and contaminated water.
  • Pollution control: According to the Planning Commission, pollution control norms need strict enforcement in industries to ensure that effluents are treated before they are let into bodies of water. Without proper regulation of the use of fertilizers, pesticides, weedicides and insecticides, they make their way into surface and groundwater bodies.
  • Integrated water management approach, demand management, regulatory framework and clear entitlements to water is increasingly at the centre of conflicts between different states, sectors and communities.
  • Reliability of ageing hand-pump systems and vulnerability of both pipe and pump based water sources to faecal/ chemical contamination. Over 2 million (about 14%) communities contend with chemical contamination of drinking water, and even more water sources are bacteriologically contaminated.
  • Emergency preparedness and response is critical as India is exceptionally prone to natural disasters such as floods, cyclones, droughts, earthquakes and landslides. The reduction of the risk of outbreaks of diarrhoeal diseases requires intensive interventions to ensure access to safe drinking water, improved environmental sanitation and diarrhoea management.

A lower proportion of rural households have access to tap water than urban ones
Rates of household tap water vary a bit among social groups. The divide is large between urban and rural areas. Among social groups, Muslims have the lowest access to tap water in rural areas (18%) and SC/ST groups have the lowest access to tap water in urban areas (about 62%).

According to the Department of Drinking Water Supply under the Ministry of Rural Development, 226 lakh people were covered in 2005-06 under the Water Supply Program. Of the total population covered, 15.2% were Scheduled Caste, and 12% of Scheduled Tribes were covered.

Villages with access to Taps as Main Source of Drinking Water

Villages with access to Drainage System

Some Ingredients for Sanitation

Target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation

There is a direct relationship between water, sanitation and health. According to the Ministry of Rural Development, "Consumption of unsafe drinking water, open disposal of human excreta, lack of personal and food hygiene have a direct bearing on the high infant mortality rate, are the causes of a host of medical problems…and result in the indirect loss of working days." While the GOI launched the Total Sanitation Campaign (TSC) in 1999, acceleration of sanitation coverage has been a challenge over the last two years. According to UNDP and the Planning Commission, there are a number of factors that are required to achieve universal basic sanitation in India. These factors include:

  • Information, education and communication: According to the Planning Commission, studies have shown that provision of funds without education on sanitation will not change behaviour or attitudes towards rural sanitation. Getting families to adopt regular use of toilets, along with other critical hygiene practices, remains a challenge. Evidence indicates that in many states, a significant proportion of rural toilets are not used, calling for increased attention to sustainability and maintenance.
  • Resources: Many states are not able to provide funds for operation and maintenance costs for sewage treatment plants and common effluent treatment plants created under the National River Conservation Plan. Shortage of power to run these plans is also a constraint.
  • Effective and sustained use of facilities: According to the United Nations, the emphasis must shift from a focus on access to infrastructure, towards the effective and sustained use of facilities. Another related challenge is to ensure that behaviour change in hygiene practice receives the priority it deserves, rather than being treated as an 'add-on' component to hardware delivery.
  • Planned urbanization: Unplanned urbanization leads to adverse living conditions in terms of drinking water, sanitation, air quality and quality of employment. It also means conversion of productive land including wetlands, grasslands and forests resources for meeting urban infra-structure needs.

Disadvantaged groups including SC/ST and Muslims tend to have less access to sanitation.

SC/ST and OBCs are worse off than other social groups in terms of having any toilet facilities. In rural areas, Muslims have better access than the country average, though still almost half the Muslim households in India lack access to toilets.

Income plays a role in the coverage of houses with toilets. 26% of above poverty line (APL) households in rural areas have toilets. The corresponding figure is 18% for below poverty line (BPL) households.

The Department of Drinking Water Supply has communicated to States to give priority to 71,406 villages with over 40% SC/ST population for water and sanitation coverage. In 2005-06 25% of SC/ST out of 2.66 crore total population were covered.

Major National Initiatives

The National Water Policy (2002) emphasises conservation and sustainable use of water, and prioritises its use for drinking, hydro-power, agriculture, industries and ecology. Government programmes on water relate to extension of irrigation systems, watershed programmes and rainwater harvesting. The focus is on demand responsive and community managed programmes for drinking water, sanitation and water management in drylands and flood and drought-prone areas. The Government has increased the funding in the water and sanitation sector to ensure universal coverage from Rs 2100 crore in 2001-02 to Rs 8700 crore in 2008-09.

Budget Allocation and Expenditure Trends and Achievements
Union Budget Allocation 2007-08 (to supplement efforts of state governments): Rs 954 crore

2006-07 Utlilisation: Rs 720 crore
Operational in 578 of the 600 districts. Access to drinking water in primary schools has increased from 44% in 1993 to 77% in 2007, and access to sanitation in primary schools increased from 8% to 65% (TSC/SSA Estimates). While coverage in terms of access to infrastructure in India's 650,000 primary and 245,000 upper primary schools is accelerating, there are concerns about the quality of infrastructure, and the use and sustainability of facilities.
Revised budget 2006-07: 4050 crore

Budget 2007-08: 5850 crore
More than 3.7 million hand pumps and 1.73 lakh piped water schemes have been installed in rural areas.

As of April 1, 2007, 74.39% of rural habitations were fully covered, 14.64% partially covered and 10.07 % not covered.

Under Rajiv Gandhi Drinking Water Mission 55,512 habitations and 34,000 schools have been provided drinking water supply till December, 2006. More ambitious targets have been set for 2007-08 to deal with both non-coverage and slippage.
River-wise approved costs in 160 towns (2005-06): Rs 4736 crore So far a total of 34 rivers have been covered under the programme.

The present approved cost of NRCP projects covers pollution abatement works in 160 towns along polluted stretches of 34 rivers spread over 20 states.

There are a number of schemes that aim at ensuring universal water supply coverage and sanitation, including Total Sanitation Campaign, Accelerated Rural Water Supply Programme (ARWSP), a component of the Bharat Nirman Programme and Nirmal Gram Puraskar. The Government of India is in the process of moving away from direct implementation of services to facilitating and regulating service delivery instead. Rather than scaling up current programmes, the government is moving towards an alternative strategy for rural water supply and sanitation, based on a demand-responsive, community-managed approach. Authority and responsibility are to be decentralised to local government bodies (Panchayati Raj Institutions). The Total Sanitation Campaign (TSC) is demand-driven and is being scaled up nation-wide, replacing government-sponsored supply-driven schemes.

Drinking water supply is one of the six components under Bharat Nirman Programme. The objective is to ensure universal water supply coverage between 2005-06 and 2008-09. As part of this programme, community-based water quality monitoring and surveillance programme have also been started. Additionally, to encourage Panchayati Raj Institutions to implement sanitation schemes, Nirmal Gram Puraskar gives cash awards to those PRIs that have full sanitation coverage. Linkages with National Rural Health Mission (NRHM) are being established for water quality surveillance.

Additionally, according to the Ministry of Statistics and Programme Implementation, actual forest cover increased in India from 638879 square kilometres in 1991-93 to 678333 in 2002.

What has worked: 'Nirmal Gram Puruskar' (Clean Village Award),

Khandapur, a village mainly populated by tribals in the state of Maharashtra, was a small village of 152 households dependent on agriculture and dairy farming. Once ridden with epidemics like cholera, malaria, and dengue resulting from poor sanitation situation, Khandapur has recently been declared an Open Defecation Free 'Clean and Green' Village. An initiative under the Total Sanitation Campaign, Khadapur was awarded USD 1200 under 'Nirmal Gram Puruskar' (Clean Village Award), for achieving full sanitation coverage.

"It has not only sensitized us on our poor sanitary conditions but also mobilized us to ensure that all households, schools and anganwadi centres have access to toilets with full usage with no open defecation practice. Also we knew that once we achieve full coverage we might have an opportunity to win this award," says one villager.

The Government of India instituted this award on October 2, 2003 to recognize, encourage and facilitate local governing bodies such as Panchayati Raj Institutions (PRIs) and those individuals and organizations that work with them to achieve total sanitation. Already more than 5000 PRIs have been awarded NGP in the last three years. The NGP strategy appears to be the best means in recognizing their efforts as well as involving them in the sanitation programme.

The whole concept of NGP is to reward those districts, blocks, and gram panchayats, which have achieved full sanitation coverage with proper uses. The incentive amount varies from USD 1250 to USD 12,500 depending upon the level and size of the PRI. The criteria for selecting the PRIs for NGP are: (a) all households should have access to toilets with full use and there is no place for open defecation in the respective PRI, (b) all schools have sanitation facilities and are in use, (c) all co-educational schools must have separate toilets for boys and girls, (d) all anganwadis have access to sanitation facilities and (e) general cleanliness is prevailing in the village.

NGP is operational in 572 districts with a total outlay of around USD 2.7 billion. In 2007, more than 9,675 gram panchayats, 120 block panchayats and three district panchayats competed for this award.

Source: Adapted from a note by UNICEF.

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