From the Commonwealth Games fiasco to the problem of endemic child malnutrition, India has been receiving critical scrutiny from the Western press. The Games are a high-profile, time-bound project that has struggled from the start, despite more than enough money and time being available to do it right. Malnutrition is a hidden problem, with no deadlines, no bridge collapses, and no obvious villains. But are they both symptoms of the same set of problems? Is there something in common that keeps us from getting things done, whether it is getting ready for a sporting event or feeding undernourished children?
It cannot be culture, despite the claims of a witless official that the Games facilities were the way they were because Indians have lower standards of cleanliness. Cultural factors can affect the treatment of girls versus boys, and attitudes towards time and fate can matter in all sorts of ways, but India has shown that it can do things to match the best in the world. That was the story of India?s software pioneers. Indians abroad also have no problem with matching the best wherever they are. Indian attitudes are not the culprit.
Perhaps it is the quality of governance that is to blame. The discussion of problems with the preparation for the Commonwealth Games has noted corruption and mismanagement. Government money often gets diverted before it reaches its intended beneficiaries. India?s successful software firms, after all, were not government-owned. But the Delhi Metro, already well begun in its initial phase and vastly expanded in time for the Games, is a government project that has functioned effectively. One possibility is that the quality of governance is ruled by voters. Famines cost votes, malnutrition does not.
A cricket-related mess might hurt politicians more than the Commonwealth Games, which are more for the elite, while cricket has a mass following. Governance also translates into management, so something that is politically important may get managed better. The quality of management depends not just on the people in charge, but on the complexity of the problem. The Delhi Metro is a complex engineering project but does not require the level of coordination that the entire Games effort did. Malnutrition turns out to be one of the most complex health challenges that India faces.
One suggestion in the Western press has been that the government needs to lead a charge against malnutrition. Apparently, this is how China dramatically reduced its incidence of child malnutrition, from levels similar to India?s to those that are now only a sixth. The Chinese approach to the Beijing Olympics also had this fervour. The idea here is that an authoritarian government is not necessary, just one that is focused on the most important problems. Brazil, too, has succeeded by focusing on nutrition.
But India does have its schemes and missions. An Integrated Child Development Service (ICDS) has run for 35 years. More recently, the National Rural Health Mission (NRHM) has created a sense of the need to transform the health status of India?s poor, in particular. NRHM provides more money, and is catalysing attempts to retool public sector delivery of health services. In keeping with my earlier observations, it seems that having a clear focus and engaging effectively with the private sector are important for success. A good illustration comes from the simple attempt to get more mothers to deliver in a hospital or clinic, rather than at home. The Chiranjeevi scheme in Gujarat and the Merry Gold network in Uttar Pradesh are two different examples of how this can be done well.
But institutional childbirths are just a small step towards improved health outcomes. Reduced maternal and infant mortality have to be accompanied by better quality of life. In particular, it seems that the first year or two of children?s lives need the most attention. ICDS, despite its focus, may still be spread too thin, in terms of its target population. At the same time, nutrition depends on quality of food, freedom from diseases that deplete nutrients, and parent education. That represents a broad range of interventions, which somehow have to be effective in concert. The NRHM has perhaps not yet achieved the change in institutional structures of governance at the local level that is needed: coordination across government departments, timely flows of funds, and provision of extrinsic (like money and recognition) and intrinsic (like feelings of fulfilment) incentives for the thousands of people engaged in these efforts.
The embarrassment of the Commonwealth Games will be soon forgotten. But 10% growth and true poverty reduction will need serious reductions in child malnutrition. That is what India needs to get done. Those better-nourished children will even win some medals for India one day.
The author is professor of economics, University of California, Santa Cruz