Asia-Pacific, Civil Society, Development & Aid, Headlines, Poverty & SDGs

DEVELOPMENT: ‘Get Back to Basics, South Asia’ – Oxfam

Marty Logan

KATHMANDU, Nov 11 2006 (IPS) - Every 30 minutes an Afghan woman and six Indian women die in childbirth, yet annually India welcomes 150,000 “medical tourists” who fly in for cheaper treatment than they can receive at home in the ‘developed’ world.

It is time that South Asia’s governments got back to investing in essential services for their own citizens, says a new report by Oxfam International.

“When you have to pay your own money to access services either you don’t do it, if you’re very poor, or you go to a very cheap provider,” said report author Swati Narayan, adding with a wry smile: “India has 1.5 million ‘quacks’.”

Based on secondary information and Oxfam’s own experience in the region, ‘Serve the Essentials’ was released in Nepal’s capital Friday.

According to the former vice-chairman of the country’s National Planning Commission, Shankar Sharma, 55 percent of Nepal’s health workers have been deemed ‘absentee’ and 10 percent of posts in its schools remain vacant. According to Narayan, Nepal’s government needs to hire 52,000 health workers and about 20,000 primary school teachers in order to provide adequate services for its 25 million people.

“That more and more people are being left behind in a region which is experiencing skewed economic growth needs to be highlighted,” says the report. “The increasing levels of inequality are clearly unhealthy and unsustainable.”

Not only that – such slow progress threatens the international Millennium Development Goals (MDGs), eight targets set by world leaders in 2000 to end extreme poverty. “If the current state of slow progress of delivery of essential services is maintained, the region is unlikely to reach the MDG goal of reducing child mortality until after 2020,” says Oxfam.

The 2006 MDG progress report found that India, Nepal and Afghanistan were almost on track for reaching the goals but “would need to look beyond the MDG targets to catch up with the rest of the region”. Bangladesh was among the Asia-Pacific nations falling further behind in the race to 2015, adds the report, released in October.

Oxfam repeatedly cites the success of the Sri Lankan model: invest heavily in initial programmes and infrastructure and reap the benefits for decades after. In the 1950s and ’60s, governments in Colombo devoted five percent of GDP (15 percent of their budgets) to education. Today that is down to three percent of GDP yet the state still provides free education for all children up to university, and private schools are outlawed from classes 1 to 9.

Wealth is not the determining factor for success, argues ‘Serve the Essentials. “Government actions matter more than national income.high achievers systematically prioritise and provide critical investments in order to create sustainable long-term, cost-effective essential service delivery mechanisms.”

But money must be spent more wisely than it sometimes was in the past. At least 20 percent of government – and donor – spending should go to essential services, but hand in hand with measures to stem corruption, such as right to information laws, argues the report. And at least 15-20 percent of states’ recurrent spending should be on non-salary items, like school chalkboards. Today, the region’s governments dedicate more than 95 percent of education spending to salaries.

The report advises South Asian leaders to: – eliminate user fees in health and education; – provide services universally not only to targeted groups (precious resources are spent determining who should get services instead of delivering them) and; – increase women’s role in community decision-making, starting with girls’ education, said Narayan.

Besides providing free schooling for boys and girls, Bangladesh pays a stipend for girls who attend secondary school. “All of this has ensured that there are as many girls as boys in schools,” said the report’s author. Once educated, “it is easier to hire and train women as nurses and mid-wives (as in Sri Lanka and India’s Kerala state), who are direly needed to cut the incidence of maternal mortality, adds ‘Serve the Essentials’.

The growing role of NGOs and the private sector in delivering basic services also needs to be regulated, the report argues. For example, in the water sector, three-quarters of aid has been spent on large systems of piped water and sewer connections.

“Instead, low-cost technologies like standpipes, hand pumps, gravity-fed systems, rainwater collection and latrines need to be promoted as not only are they more sensitive to local needs but also have proven to be greatly cost effective in terms of each incident of diarrhoea death averted,” it adds.

“Pockets of success indicate that change is within reach – the most crucial ingredient is political commitment to uphold the rights of the population and deliver what they need,” concludes Serve the Essentials.