Saturday, March 29, 2008

Modi Series Part 5: Why women particularly like Modi?

Aspect 1: Chiranjeevi Yojana reducing Maternal and infant Mortality Rates

If one goes by the trends of gender in voting pattern in 2007 elections, in many constituencies, women have caused the swing factor in favor of Modi. Gone are those days when women would vote for the same person which her husband, son or other family member voted for. This fact is confirmed by Women NGO's. In fact, the women factor was so strong that immediately after the BJP victory, Congress President Sonia Gandhi pressed for the need of women friendly budget.

When Modi claimed that he has done a lot to women, I felt he is much like any other ordinary politician- heavy in rhetoric, empty in facts. CNN-IBN which is pro Congress and anti-Modi once organized "Face the nation" in Ahmedabad amidst politicians and the public . Mallika Sarabhai (one of the guests) was making anti-Modi statements and the audience was very agitated at her. All across the show, Rajdeep was continuously raising women's safety issues and criticizing the government. At the same time in the audience - most of whom were youth (men and women) were screaming and when asked they said - it is very wrong to criticize Modi who has ensured highest safety for women. Of course, the sample size may be too small to assess, but the fact is that Gujarat has the least crime rate for women -something which cannot be ignored.

If Modi is indeed accused that under his rule women are unsafe, we must then question why despite having a woman Chief Minister, Delhi tops the crime rate in women. If Modi has brought in safety and law and order, why Shiela Dixit failed?.

That apart, the "Chiranjeev" scheme launched by the Gujarat government under the initiative personally taken by Modi has received accolades even outside India. Here are 2 articles confirming this. Article1 Article2. The article says Government of Gujarat received Asian Innovative Award by Singapore Economic Board and Wall Street Journal, Asia.

Scheme's purpose: Gujarat has the worst infant mortality rate in the country. While Kerala is the best in that sense 99% of baby deliveries take place in established institutions rather than non-institutions, Gujarat is at the other end of this major problem. There are only about 2000 gynecologists for 1,00,000 women in the country. And in Gujarat is far worse. In fact the infant mortality rate is 57 while that of the nation is 63.

Implementation: Initially done in 5 districts viz, Banaskantha, Dahod, Kutch, Panchmahal, and Sabarkantha. Later upon its success, it was extended to all over the state. Because the state has 3/4 of gynecologists working in private sectors and over 30-40% vacancies are in the government sector, the government first made a committee that would look for a public private partnership. According to this, a Memorandum of Understanding (MoU) was signed between private doctors and the government. The District Health Officers (DHO) role was changed to that of supervision and monitoring the process. The private doctors were hired in a region specific to backward villages and actually in a meeting in which private doctors, medical providers, government officers, NGO all took part and collectively decided on the payment issue. Rs. 20,000 was paid in advance to every such doctor who is going to help pregnant women deliver normal babies (complex cases were also included). Later they will be paid on a fixed rate depending upon how many women they save. Also, Below Poverty Line cards were issued to women who were below poverty so that those women can avail free treatment. If BPL cards did not reach certain villages, the Sarpanch or Taluk level officer can authorize a letter stating that the women can get treatment. Also, doctors had to reimburse Rs.200 for conveyance, Rs.200 for misc expenses to women. The operations were conducted in the private hospitals themselves as government ones did not have any sufficient equipments. The list of such hospitals (private) specific to area was published in local languages and sent to all villages so that they know where to go in case of emergency.

The text below is directly taken from the article

Policy context in Gujarat has encouraged the involvement of private providers in provision of health care services. Over the years the Department of Health and Family Welfare, Government of Gujarat has implemented a number of initiatives to foster public-private partnership to address some of the key public health issues. Some of these initiatives are as follows:
· Involving private sector in construction of PHCs and for this 39 PHCs from 12 districts have been identified.
· Five Community Health Centres (CHCs) and one PHC in Chansad are being run by community based organisations.
· Gujarat has significant presence of NGOs and out of 1500 registered NGOs 400 NGOs are working in health and allied activities. The state Government provides active support to these institutions. With assistance in RCH programme, a Mother NGO scheme was introduced to build technical skill of smaller NGOs in RCH services.

Also, Government of Gujarat explored the idea of developing and implementing maternity insurance scheme to cover the BPL families. Broad guidelines for designing and developing proposals on a maternity insurance scheme included
(a) covering treatments in designated public and private institutions on a cashless basis,
(b) sum assured would account for compensations in case of maternal death,
(c) including transport allowance and incentive to TBAs,
(d) inclusion of pre-existing conditions like hypertension and complications (arising from abortions),
(e) a sum of Rs.10,000 was assured in the baby’s name in case of maternal death. Insurance providers showed interest in offering this insurance.

However, linking and developing linkages with the private institutions and providers remained an important constraint. The institutional mechanisms to ensure this were not readily available. Also, it was envisaged that NGOs could handle IEC activities, developing awareness, develop linkages with private providers and ensure quality of care, and monitor the scheme. However, owing to the limited capacities and resources, inadequate technical capacity and scale of operations, it was not feasible to implement large scale insurance scheme. Moreover, insurance companies were also sceptic in taking up a stand alone maternity insurance scheme, as envisaged by the government. Realising the constraints, DoHFW decided to explore an option of voucher scheme.

The paper further explains the logistics and operational aspects in detail. The voucher scheme, in particular, has become popular because the patient has the right to choose the doctor. So, a healthy competition has begun amongst doctors. So, everyone is working in that spirit.

Institutional deliveries increased from 38% to 59% in just one year. Overall, generated a huge change in villages.

Good, yet problems: The paper also explores the fact that lack of specialty doctors still pose a problem in addition to improper checks in reporting fraud and negligence. Although the paper says it is good, the only complaint it has is that the District Project Control Co-ordinator should be entrusted with more powers to report fraud. Also, monitoring scheme can be more modernized.

My take: I feel technology must be used at every stage so that dependency on just written reports may decrease. It can also help in reducing fraud. Access to information by concerned officials can be done centralized so that anyone can access it. When a new change happens, there is bound to be problems and criticism. However, I feel that a state went so far in having such a scheme is an inspiration in itself. If we apply a similar plan to every other state we can drastically reduce maternal mortality rate which is 389 for every 100,00 live births in 1998 to 100 in 2010.

Aspect 2: Beti Bachao Andolan

Narendra Modi personally walked to some of the districts which were very backward in women's education and personally enrolled girls in schools. This led to all his team of IAS officers and other bureaucrats to do the same. Every year in peak summer when temperature soars to 45 Celsius, the officials personally go and take care and ensure girl child is enrolled in school. As a result, the dropout rate has come down to 3% from 49% within 4 years.

Also, he launched a state wide campaign in telling people about not to discriminate in gender on babies. He personally toured all villages, not during elections time, but in 2006 when the committee presented a report to him. This shows he was very serious in this matter and took personal interest. Usually what happens is politicians make such statements in one place and expect officials to spread in various places, money is given, but in reality no work is done. In that context, Modi personally intervened is a good aspect of his leadership.


Ok...All these schemes really worked well because Modi was personally involved and government officials were scared of him as he could sack them when they were proved incompetent. What happens in the absence of him? I guess the guarantee that these officials will work with the same commitment is unsure. However, these steps are sure to go down a long way in changing the society. I had also read some where about "Naari" Adalats where only women's cases are fought exist in Gujarat. I am not too sure on the ground if they exist.

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