The Karnataka court’s verdict to uphold the hijab ban has intensified the protest in the state. The row has been typically perceived by many as manufactured by the politicians pointing to the culture of politics in the state. While the jury is still out there on this, evidence on how state’s local culture constructs and deconstructs religious identity allows drawing conclusions with some definitiveness. The culture of state’s politics is one side of the coin. Considering its flip side – politics of culture, particularly of the religious cultural identity, is just as relevant.

Vani S. Kulkarni

Interestingly, Muslims used the same description of munda and hinda except from a different perspective: “we muslims are munda to make use of government provided resources”, a Muslim household member remarked, “but we are forced to be ahead because Hindus have pushed us hinda (behind) in accessing the higher quality resources.”

While such dissonance with sharing of valued-resources with a group that was religiously distinct was telling, it was around the dress code – wearing of the hijab, burqa and niqab wearing that the binary distinction – hinda and munda, sharpened.

The remark of a Hindu woman summed up such an ethos: “how can we access health insurance when large number of Muslim women in their long hijabs and long burqas are always in the queue ahead of us? The burqas certainly help them to hide their faces but the dress also makes them hypervisible to the hospital staff and that is how they end up being ahead of us using up all the time and space at the hospital. The burqas may hide their faces but they also make us invisible to the doctors and nurses because we get hidden behind their large burqas, and thus get left behind.”

Burqa ban isn’t unique to Karnataka. Many countries in the west have banned these articles of clothing and the justification for the ban globally ranges from concern about national security, integration into the mainstream society and feminist arguments such as, promoting women’s liberation. However, the cultural contexts in which bans operate are certainly unique and need to be explored. In Karnataka, the ban has surfaced in the colleges and in the education sphere at large but, as the evidence on reaction to the availing of health services indicates, the dissonance is much more deep-seated and widespread. While officially the ban is justified on grounds of need for uniformity and wearing of hijab is not seen as necessary to religious practice, such top-down rationale needs to be understood within the context of everyday local, cultural perception that Muslims are a threat to fair share of valued resources, including education and health of the country. Burqa and hijab are identity markers serving as reminders of presence of minorities, and even as the presence of the “other” who are being out of their place if they are spotted accessing valued resources. There exists a cognitive dissonance with the idea, practice and sight of burqa population in spaces where valued resources are available. It is politics of cultural identity of Muslims – the scepticism and sometimes intolerance for them as beneficiaries. The need for uniformity, social integration and women’s liberation as the top-down narrative (culture of politics) while serving as some explanation for the hijab ban, is at best a partial one. It is an intricate interaction on the ground between development and cultural perception of inclusion (or exclusion) of certain populations in the developkment process (politics of culture) that provides important clues to Karnataka’s hijab row. The latter narrative is made significant by its absence. I fear an unintended consequence of the hijab ban maybe deepening the schism between Hindus and Muslims.

Vani S. Kulkarni, Department of Sociology, University of Pennsylvania, Philadelphia, USA

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By Vani S. Kulkarni and Raghav Gaiha
NEW DELHI, India, Apr 20 2022 (IPS)

A trend of declining trust in governments and politicians can turn into a threat beyond some point.

John Adams, an astute political philosopher and second president of the US, was emphatic: “Remember, democracy never lasts long. It soon wastes, exhausts and murders itself.” This has been a subject of intense debate, with recent but mixed evidence. Is this an overly pessimistic view?

The debate, based on big international surveys (such as the World Gallup Poll and Economic Values Surveys) or specific ones, yields conflicting inferences. The key issue is whether loss of political trust (in governments and politicians) is a threat to democracy. A pessimistic view is based on how tax compliance varies with the level of political trust. When citizens believe government is acting for the common good, they see its decisions as legitimate and will be more willing to comply with them. They will pay taxes and obey laws, as this is the ‘right’ thing to do. Conversely, when citizens distrust the government, their willingness to obey its decisions is limited and they are less willing to pay taxes. Given the importance of taxes, a general lack of trust would destabilize the system.

Vani S. Kulkarni

Political trust also impacts the ability of government systems to fulfil their basic tasks for people. Low levels of political trust pose a challenge for the governability of contemporary liberal societies. Indeed, in the worst-case scenario, a vicious cycle emerges for governments and political trust. However, whether this would destabilize democracy is neither stated nor implied.

In India’s context, Vaishnav (2017) develops a model of the electoral market place. He analyses data on politicians, including members of state legislative assemblies (MLAs) and Parliament (MPs), winners and losers in elections, their criminal background, assets, ethnicity, re-election prospects and implications for the sustenance of democracy. In an electoral market, there are buyers (voters) and sellers (parties and politicians). Supply and demand factors are at work. This model is then used to explain the share of politicians with a criminal and wealthy background, their chances of winning an election and re-election and huge financial gains.

Across three recent general elections (2004, 2009 and 2014), a randomly picked candidate had a 6% chance of coming out on top. Compare this with a candidate with at least one criminal case: s/he had a nearly 18% chance of winning. The differences in state elections are slightly smaller but still stark: ‘clean’ candidates (eg, those with no pending criminal cases) have a 9.5% probability of winning, whereas candidates with criminal cases have a roughly 22% chance.

Raghav Gaiha

Our more recent analysis (Kulkarni, et al, 2022) raises a few concerns. Over the period 2004 to 2019, the share of criminal politicians in Lok Sabha elections has sharply risen, especially after 2014; 24% of the winners in the 2004 polls had a criminal background; this share rose to 30% in the 2009 general elections, 34% in 2014 and 43% in 2019. The share of criminal politicians is thus expected to rise further. Another related issue is that India’s two major parties continue to have considerably high shares of criminal politicians. Between the two main national parties, of 303 winners from the Bharatiya Janata Party in 2019, 116 (39%) had a criminal record, as against 29 (56%) of the 52 winners from the Congress party. This contradicts Vaishnav’s view that non-dominant but competitive parties worry more about winning a seat in a closely contested election than dominant parties for which the marginal benefit of winning a seat is relatively small. As both national and state elections have become more competitive, with a rise in the number of political parties in the fray, it is difficult to rule out the possibility that tainted politicians with huge resources will continue to be attractive to dominant parties as well. A more serious concern is that, with rising shares of politicians with criminal records, public trust in politicians first rises and then decreases after a turning point where about 40% of MPs have criminal records and only about a tenth of respondents trust politicians.

In sum, while the erosion of political trust is slow, it is consistent and may turn into distrust at some point, with a real risk of the demise of democracy.

Vani S. Kulkarni & Raghav Gaiha are respectively, lecturer of sociology and research affiliate, Population Aging Centre, University of Pennsylvania, USA.

This opinion editorial was first published in Mint, India.

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Off the main streets in Gonder, Ethiopia, poverty becomes starker. Credit: James Jeffrey/IPS

By Vani S. Kulkarni and Raghav Gaiha
PHILADELPHIA and NEW DELHI, Mar 13 2020 (IPS)

With about 109 million people, Ethiopia is the second most populous nation in Africa after Nigeria, and the fastest growing economy in the region. However, it is also one of the poorest, with a per capita income of $790.

About 80% of the Ethiopian population lives in rural areas, but these are increasingly migrating to urban areas due to a lack of job opportunities. However, with unemployment levels at 16.5%, the situation in urban areas offers even fewer possibilities of finding employment.

Poverty is predominantly a rural phenomenon in Ethiopia. While urban headcount poverty declined from 36.9 percent in 2000 to 14.8 percent in 2016, rural poverty only declined from 45.4 percent to 25.6 percent in the same period.

Unfortunately, the evidence on the role of health in reducing poverty is sparse. We, therefore, focus on rural disability as an impediment to promoting rural employment and reduction of rural poverty. Our analysis is based on the Ethiopia Socio-Economic Survey (ESS) covering 2011/12, 2013/14 and 2015/16. It is a nationally representative panel survey.

We sketch below (i) factors associated with rural disability in Ethiopia; (ii) factors associated with rural employment-especially the association between employment and disability; and (iii) association between rural poverty and disability and the underlying links.

Vani S. Kulkarni

About 13.77 % of the rural Ethiopian population suffered from disabilities in 2015-16. About 63% suffered from a single disability while the rest from multiple disabilities (>1). The largest share was of the age-group, 31-50 years, followed by the older age-group,51-70 years. These two age-groups together accounted for over 70 % of those suffering from a single disability. The largest share of multiple disabilities was of 51-70 years, followed by the oldest (>70 years) and 31-50 years. The combined share of 31-50 years and 51-70 years was about 67 %. If we go by prevalence of disability by age-group, it was highest among the oldest, followed by 51-70 years. A similar pattern was observed for multiple disabilities except that the prevalence among the oldest was just under 50 %.

Disability by gender shows a frequently observed contrast. The shares of females in both single and multiple disabilities-over 52 %- was higher in 2015-16. However, differences between prevalences by gender were low, with slighly higher prevalences among females.

The highest share of those suffering from one disability was of those belonging to largest households(>6 members), followed by those in lower-sized households (between 3-5 members). The latter, however, accounted for the largest share of multiple disabilities, followed by largest households. Prevalences within single and multiple disabilities offered yet another contrast. The highest prevalence of single disability was observed among those living alone, followed by those living in households with just two members. This is replicated for multiple disabilities, with the higher prevalence than of single disability.

Rural employment by duration in 7 days was classified into ranges of hours worked: 0 hour, 1-25 hours, > 25 hours in 7 days, and disabilities into none, 1 and > 1. The former refer to 2015/16 while the latter refer to 2011/12.

The largest share of those working 1-25 hours was associated with those without any disability, followed by those suffering from a single disability and then a sharp drop in the share of those with multiple disabilities.A similar distribution was observed among those working longer hours, >25 hours, with the largest share of those without any disability and lowest of those with multiple disabilities. There was a low reduction in proportions of each disability group working 1-25 hours, with the highest among those without disability, followed by those with a single disability and then among those with multiple disabilities. A similar pattern was observed among disability groups in longer duration of employment, >25 hours. Thus it follows that single and multiple disabilities-especially the latter-were associated with restricted hours of employment, compared with those without any disability.

Raghav Gaiha

There are two issues in rural poverty analysis: one is its persistence, and second is movement into and out of it over time. Just under one-half of extremely poor in 2011/12 remained so during this period, a lower proportion of middle class remained in it, and more than half remained affluent. About 30 % of extremely poor in 2011/12 moved up into middle-class and a little under a quarter into affluent in 2015/16. From middle-class under 30 % descended into extreme poverty and about 33 % became affluent. From affluent, about 29 % decended into middle-class and a much smaller proportion became extremely poor. Hence high persistence of poverty coexisted with considerable upward economic mobility.

As a vast majority of the Ethiopian rural population did not suffer from any disability, it is not surprising that they constituted largest shares of extremely poor, middle class and affluent in 2015/16. Their proportion of extremely poor was lowest and of affluent highest. The proportion of disabled who were extremely poor was lowest but higher than among disabled, and higher in middle class and affluent but again lower than among non-disabled. Thus disability wass associated with greater vulnerability to extreme poverty and restricted prospects of being in middle class.

In conclusion, the challenge of reduction in poverty remains enormous while not paying due attention to preventing and eliminating disability is likely to make it much harder.

(Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania, USA; and Raghav Gaiha is (Hon.) Professorial Research Fellow, Global Development Institute, University of Manchester, England, and Research Affiliate, Population Studies Centre, University of Pennsylvania, USA). The views are personal.

About 15% of the world’s population lives with some form of disability, of whom 2-4% experience significant difficulties in functioning. Disability is part of the human condition, and almost everyone will be temporarily or permanently impaired at some point in life, and those who survive into old age will experience increasing difficulties in functioning. Here the focus is on empirical validation of whether disabilities are associated with economic hardships through loss of employment and consequently impoverishment in rural India. The motivation stems from continuing neglect of health in the budgetary allocations –including the allocations for 2020-21.

Vani S. Kulkarni

The prevaence of dsability is 9.70 % in the rural population in 2012. Of the disabled, more than half (51.3 %) suffer from 2-4 disabilities. Persistence is also largest in this range of disabilities (about 31 % remain in it between 2005-2012).

Shares of those suffering from 1 disability are largest in the age-group 31-50 years, followed by 51-60 years. In the case of 2-4 disabilities, the largest share is found among those 31-50 years old, 51-60 years old and then among the older group,61-70 years. Shares of those suffering from >4 disabilities rise from those 31-50 years old to 61-70 years and then decline. Within the youngest (15-30 years), about 98 % do not suffer from any disability which declines among older age-groups (just under 50 % among the oldest >70 years). In the older age-group (31-50 years), a vast majority do not suffer from any disability, and small proportions suffer from a single and multiple disabilities. A similar pattern is observed among those in the age-group, 51-60 years, with substantially lower proportions without any disability and larger proportions suffering from single and multiple disabilities. Among the older, 61-70 years, the proportion without disability is considerably lower, but those with single and multiple disabilities rise,with about 30 % suffering from >4 disabilities. As aging grows rapidly, the burden of disabilities is likely to surge. But at the same time, high prevalence of disability among a large segment of the working age group is likely to have deleterious employment effects.

Employment in rural areas is disaggregated into four categories: no employment, <240 hours in the previous year (ie, previous to 2012), part time employment >240 hours, and full time employment (at least 250 days and at least 2000 hours).

Raghav Gaiha

Instead of using a poverty cut-off (the World Bank uses several), we have used terciles of per capita expenditure (at constant prices). The bottom tercile denotes extremely poor, the next middle class and the third affluent.

As non-disabled households are a huge fraction, it is not surprising that their shares are highest in each tercile. In the non-disabled households, the proportions are almost equally distributed among the terciles. In the lowest disability group (<0.31) at the household level, the proportion in the first tercile is lowest, and highest in the second and third terciles. The highest disability group (>0. 60), however, offers a contrast. Their proportion in the lowest tercile is highest compared with other disability groups but slightly lower than the proportion in the second tercile. Their proportion in the third tercile not just within this disability group but also across all other disability groups is lowest. Thus highly disabled are largely confined to extreme poverty with most restricted prospects of becoming affluent through barriers to long duration employment (including but not limited to discriminatory practices in hiring the disabled).

Ironically, while the SDGs assign high priority to preventing and overcoming disability, officially adopted by 193 countries including India, the FM’s budget for 2020-21 is not just a missed opportunity for growth stimulus but almost cruel to those experiencing persistent health deprivation by cutting the health outlay.

(Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania, USA; and Raghav Gaiha is (Hon.) Professorial Research Fellow, Global Development Institute, University of Manchester, England, and Research Affiliate, Population Studies Centre, University of Pennsylvania, USA).

Adapted from: Disabled and Extremely Poor, The Hindu, 6 March, 2020.

By Vani S. Kulkarni
PHILADELPHIA, Oct 26 2018 (IPS)

The challenges for the success of Ayushman Bharat are more than just at the financial and infrastructural level

On September 24, the government launched the grand government-funded healthcare scheme, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY). While some see its ambitious goals as its main strength, others are sceptical given the inadequate funding for the scheme, the weak infrastructure of primary health care centres, and the time required for the goals to be accomplished. However, nobody disputes the imperative of an insurance scheme as vast as the PMJAY, since every year about 36 million families, or 14% of households, face a medical bill that is equal to the entire annual living expenses of one member of the family. This frequently pushes many families into penury.

Two schemes, one focus

The euphoria over this scheme is reminiscent of the excitement over the Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008. Although the PMJAY is much wider in its reach than the RSBY (it covers 50 crore beneficiaries with ₹3,500 crore of government spending and provides benefits up to ₹5 lakh per eligible family), the central framework is the same: universal health care and health rights. The emerging discourse surrounding the PMJAY scheme resonates with those of RSBY. The focus continues to be on the top-down, deductive reasoning of the scheme, including issues such as allocation of funds for each illness, the types of care provided, financial considerations for empanelment of hospitals, types of illnesses covered, and transaction costs. These considerations matter. However, there are important missing links.

Vani S. Kulkarni

My recent study of RSBY in Karnataka yielded important insights that are pertinent here. Given that RSBY was embedded within the framework of universal health care and health rights, it is appropriate to pay attention to the existence of health rights in a local set-up. I discovered that the way beneficiaries of RSBY (Below Poverty Line households) perceived the scheme was not as a health right but in terms of the value it imparted, which was measured along multiple dimensions.

Households initially measured the value of the RSBY in terms of its material benefit and measurable impact. This included the financial ease it provided in taking care of illnesses, the expense and types of illnesses that the card covered, and the transaction costs it entailed — how easy it would be to use the card in terms of bureaucratic paperwork and formal procedures.

Beyond the visible impact

However, households also valued the RSBY beyond its visible impact. They had little value for the RSBY because of many reasons. One, officials who distributed the RSBY smart card did not provide information on how to use the card. Two, hospitals did not respect patients with the card, believing that they were availing medical care free of cost. Sometimes they did not honour the card either due to inaccuracy of fingerprints or lack of money on the card. Three, neighbours and family members did not discuss the utilisation of the card, making households perceive the card as just a showpiece: important to possess but not useful. Four, the lack of involvement and endorsement by local leaders further diminished the value of the card for the households.

The value of the RSBY was also derived in relation to the value of health itself. The difficulty in understanding the basic facts of the card and using it led households to opt for seeking medical care without the card. The value for one’s health undermined the value for the RSBY. As one household subsequent to repeated failed attempts to use the card lamented: “We lost time and money, and our illness got worse all because we wanted to use the card. I tell you, if you want to get well, if you really value your health, you cannot rely on this health card.” Next, the value of the RSBY card was derived in relation to the cultural ethos of health insurance. For a significant number of households, health insurance was perceived as a “bad omen” indicating the arrival of sickness and disease.

As the delivery of universal health care and health rights find yet another expression in India through the PMJAY scheme, it is more important than ever before to explore how citizens exercise their right to health and understand how it could be better practised. The biggest challenges for the success of the PMJAY scheme are not just financial and infrastructural at the local level, but how its value is perceived by the community.

Vani S. Kulkarni teaches sociology at the University of Pennsylvania, Philadelphia, U.S. Views are personal

This article was first published in The Hindu.

Credit: Neeta Lal/IPS

By Pratima Yadav, Raghav Gaiha, and Vani S. Kulkarni
NEW DELHI, Aug 21 2018 (IPS)

Old age morbidity is a rapidly worsening curse in India. The swift descent of the elderly in India (60 years+) into non-communicable diseases (NCDs e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) could have disastrous consequences in terms of impoverishment of families, excess mortality, lowering of investment and consequent deceleration of growth.

Indeed, the government has to deal simultaneously with the rising fiscal burden of NCDs and substantial burden of infectious diseases. As a recent Lancet report (2018) points out, failure to devise a strategy and make timely investment now will jeopardise achievement of SDG 3 and target 4 of a one-third reduction in premature mortality from NCDs by 2030.

Pratima Yadav

NCDs are chronic in nature and take a long time to develop. They are linked to ageing and affluence, and have replaced infectious diseases and malnutrition as the dominant causes of ill health and death in much of the world including India. The four NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) share a set of modifiable risk factors: unhealthy diet, physical inactivity, smoking, excessive use of alcohol and failure to detect and control intermediate risk factors such as high blood pressure, high cholesterol, high blood sugar and excess weight (Bloom et al. 2014).

Of the 56 million deaths worldwide each year, 38 million (68%) are due to non-communicable diseases (NCDs), and 16 million (more than 40%) of these deaths are premature (before 70 years of age).

The four NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) account for 42% of all deaths in India. These diseases contribute to 22% of disability-adjusted life-years in India (or DALYs—the combination of years lived with serious illness and those lost due to premature death). So the cost in terms of lives lost is horrendous.

Our analysis with National Sample Survey (NSS) data for 2004 and 2014 highlights some of these concerns in a striking way.

Vani S. Kulkarni

The burden of NCDs rose sharply among the old. It doubled among 61-70 years and 71-80 years and nearly tripled among 80 + years. In sharp contrast, prevalence of communicable diseases also rose but only slightly. So there are strong grounds for an epidemiological transition away from communicable diseases to non-communicable diseases among the old that require longer-term and more expensive solutions.

Between rural and urban areas, the latter had higher prevalence of NCDs and the disparity grew. This gap is largely attributable to greater dependence on processed food, and environmental pollution.

Comparison by gender yields an interesting reversal. In 2004, aged women had higher prevalence of NCDs than aged men, but there was a reversal in 2014. Part of the explanation lies in difference in health-seeking behaviour, with women more restricted in their access to medical care.

Highest prevalence of NCDs was observed among the widowed, followed by the divorced/separated and lowest among never married. Each of these groups recorded higher prevalence except never married who recorded a decline. Ostracised by society, widows often seek solace in slow death.

Raghav Gaiha

Does education make a difference? It does. Among the illiterates and those below primary, the prevalence rose while in all other categories of education it declined. The decline was sharpest among the graduates, followed by those with middle to higher secondary education.

NCDs are often associated with affluence and associated sedentary lifestyle and diets rich in carbohydrates and fats. So we examined the association between per capita income quintiles and NCDs. One striking feature is that both in 2004 and 2014, prevalence rose steadily across these quintiles except in the lowest/least affluent. Besides, prevalence rose more than moderately among the more affluent fourth and fifth quintiles. So the characterisation of NCDs as diseases of affluence is accurate.

Typically, socio-economic hierarchy comprises: the most disadvantaged STs, followed by SCs, OBCs and Others. Prevalence of NCDs was lowest among the STs, higher among the SCs, still higher among the OBCs and highest among the Others in 2004. This pattern remained unchanged in 2014. While the STs experienced a slight reduction, all other groups recorded increases in prevalence of NCDs—especially OBCs and Others.

While the recent National Health Policy 2017 and Niti Aayog have ambitious agenda for curtailing premature death and morbidity due to NCDs, the measly increase in this year’s budget is ironical. Indeed, the neglect of NCDs is worse than tragic given the prediction that cumulative losses in output between 2012 and 2030 due to NCDs may be as high as one-and-a half times of India’s GDP.

Pratima Yadav is an independent researcher; Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania; and Raghav Gaiha is (Hon.) Professorial Research Fellow, Global Development Institute, University of Manchester, and Visiting Scholar, Centre for Population Studies, University of Pennsylvania.

This story was originally published in Sunday Guardian

Excerpt:

By Raghav Gaiha and Vani S. Kulkarni
NEW DELHI, Nov 13 2017 (IPS)

Many recent accounts tend to dismiss productive employment of youth in rural areas in Africa as a mirage largely because they exhibit strong resistance to eking out a bare subsistence in dismal working and living conditions. We argue below on recent evidence of agricultural transformation that this view is overly pessimistic, if not largely mistaken.

Raghav Gaiha

Agriculture has a substantial role in meeting the youth employment challenge facing Africa. Even in a most optimistic scenario, non-farm and urban sectors are not likely to absorb more than two-thirds of young labour market entrants over the next decade. But there will be vast opportunities for the innovative young people in agricultural systems as they adapt to a range of challenges in the near future. These challenges relate to raising productivity in a sustainable way, integration into emerging high value chains, and healthy diets.

While the challenges are daunting, the potential benefits of addressing them are enormous. Higher prices, more integrated value chains, widening connectivity to markets in some areas, and greater private and public engagement in the sector are creating new opportunities. A major barrier is, however, strong negative preferences/attitudes of the youth towards agriculture.

A survey of rural in- and out-of school young people towards agriculture, based on field-work in two regions in Ethiopia, is remarkably rich and insightful (IDS Bulletin Volume 43 Number 6, 2012). Life as a farmer was tied to life in a village which most respondents saw as hard and demanding. Yet there was considerable heterogeneity in the views of the young. Participants in both regions concurred that agriculture has changed significantly over the last decade. The introduction and adoption of agricultural inputs such as improved seeds, fertilisers and better farming methods (such as slash ploughing, sowing seeds in rows, water pumps, modern beehives) have produced significant increases in productivity and earnings.

There were competing narratives on whether agriculture was becoming more desirable to young people as a result. Participants felt that these developments were making agriculture more and more profitable and therefore more appealing. But they felt that there was a huge obstacle in engaging in it – scarcity of land. Although the dominant view was that young people are disinterested in agriculture, some participants pointed out that this was not always the case.

A slightly more positive attitude towards agriculture was evident among young people who had left school, either failing to complete high school for various reasons or to qualify for higher level education. Although this group of respondents were equally aware of the grimness of traditional agriculture and the life of the common farmer, many were not dismissive of agriculture as a possible future livelihood, while a few even saw it as a preferred livelihood option, under improved conditions.

Recognizing agriculture as a viable employment option is even more challenging when economic and social restrictions related to access to productive resources (eg land, credit and improved seeds) are taken into account. All these limitations are exacerbated for young women who, in general, have no prospect of land access due to rules of inheritance, and who know that they will mainly have to work for their husbands (ILO, 2016).

Although the government considers rural educated youth as instrumental in bringing about a transformation in agricultural skills, knowledge and productivity, it has not effectively addressed either the attitude of many young people towards agriculture or the obstacles preventing their entry into the sector.

To create opportunities commensurate with the number of young people who will need employment, constraints on the acquisition of capital, land, and skills must be removed or relaxed.

A few selected initiatives are delineated below.

Allowing alternative forms of collateral, such as chattel mortgages, warehouse receipts, and the future harvest, can ease the credit constraints-especially for young farmers. The OHADA7 Uniform Act on Secured Transactions, in effect in 17 Sub-Saharan African countries, was amended at the end of 2010 to allow borrowers to use a wide range of assets as collateral, including warehouse receipts and movable property such as machinery, equipment, and receivables that remain in the hands of the debtor. Leasing also offers young farmers some relief, as it requires either no or less collateral than typically required by loans. A case in point is DFCU Leasing in Uganda, which gave more than US$4 million in farm equipment leases in 2002 for items such as rice hullers, dairy processing equipment, and maize milling equipment. Some outgrower arrangements prefinance inputs and assure marketing channels. In Mozambique, Rwanda, Tanzania, and Zambia, Rabo Development (a subsidiary of Rabobank) offers management services and technical assistance to financial institutions, which, in turn, finance supply chains with a range of agricultural clients.

The two aspects of land administration that matter most to young entrants to the labour force are the need to improve security of tenure and the need to relax controls on rental. Land redistribution will also enhance young people’s access to land. In general, policies and measures that help the poor to gain access to land will also help young people.

The growing food demand in Africa is a major avenue for agro-processing, which can easily be developed using small and medium-sized entities (SMEs). This option requires less capital, is more labour intensive and facilitates the proliferation of units in rural boroughs and small towns, offering employment and entrepreneurial opportunities, local value added and new incomes. Agro-processing SMEs can also facilitate the resolution of post-harvest problems, which are a significant issue in SSA resulting in a loss of revenue for farmers.

In the Niger Delta, for instance, the IFAD-supported Community Based Natural Resource Management Programme is promoting a new category of entrepreneur-cum-mentor called the ‘N-Agripreneur’. These N-Agripreneurs own and run medium-scale enterprises at different stages of food value chains. They deliver business development services to producers, especially young people, who are interested in agro-based activities, such as farming as a business, small-scale processing, input supply and marketing.

In order to enable young people to respond to the environmental, economic and nutrition challenges of the future, they must develop suitable capacities. A case in point is ICTs which can develop young people’s capacities, while improving communication and easing access to information and decision-making processes. Investing in extending these technologies to rural areas, in particular targeting young people – who are generally more adaptable to their use – has allowed them to keep themselves up-to-date with market information and new opportunities.

In sum, there is an abundance of remunerative employment opportunities for the youth in rural areas that could dispel the mirage through imaginative government policies.

Excerpt:

By Raghav Gaiha and Vani S. Kulkarni
NEW DELHI and PHILADELPHIA, Oct 31 2017 (IPS)

Undernutrition is widespread and a key reason for poor child health in many developing countries. In Sub-Saharan Africa, around 40 percent of children under the age of five suffer from stunted growth, that is, severely reduced height-for-age relative to their growth potential. Stunting is a result of periods of undernutrition in early childhood, and it has been found to have a series of adverse long-term effects in those who survive childhood. It is negatively associated with mental development, human capital accumulation, adult health, and with economic productivity and income levels in adulthood.

Raghav Gaiha

The central premise is that agricultural development has enormous potential to make significant contribution in reducing malnutrition and the associated ill health. With its close links to both the immediate causes of undernutrition (diets, feeding practices, and health) and its underlying determinants (such as income, education, access to WASH – water, sanitation and hygiene- and health services, and gender equity), the agriculture sector can play a strong role in improving nutrition outcomes.

Women are vitally important agents, both in their roles as producers and as custodians of household welfare. Their importance, moreover, is generally greater in the lowest-income settings and among households with high dependency ratios—in which a large proportion of household members are nonearning and often nutritionally vulnerable dependents.

The resources and income flows that women control often have positive impacts on household health and nutrition. In some countries, women tend to lack access to economic opportunities outside the domestic sphere to which traditional customs often confine them, especially in rural areas. They are also very often severely constrained by time and the multiple—often simultaneous—roles they play as producers and caregivers. Agricultural programmes and policies that empower and enable women and that involve them in decisions and activities throughout the life of the programme achieve greater nutritional impacts.

Vani S. Kulkarni

In Kenya, new varieties of sweet potatoes rich in beta-carotene were introduced to women farmers with an end goal of improving vitamin A intake of young children, thereby preventing vitamin A deficiency. There was a significant increase in the intake of vitamin A-rich foods, among children whose mothers received both the production-focused intervention of planting materials and access to agricultural extension services, and the consumption-focused intervention of nutrition education and training in food processing and preparation. By contrast, there was a decrease in vitamin A intake among children whose mothers received only the production-focused inputs. This example suggests that: (a) women’s farm production offers an entry point for interventions that can improve nutrition; and (b) interventions that increase women’s agricultural productivity and increase their health and nutrition knowledge may yield more benefits than ones that target only productivity or only knowledge.

In Ethiopia, a women-focused goat development project was expanded to include interventions to promote vitamin A intake, nutrition and health education, training in gardening and food preparation, and distribution of vegetable seeds. Goat owning households consumed all produced milk; 87% by the adults as hoja; children in the participating households had slightly more diversified diets; they were also more likely to consume milk more than 4 times a day. As substitutions occur between foods, in the absence of anthropometric indicators, nothing definitive could be inferred about improvements in child nutrition.

Women’s employment in agriculture has positive impacts on nutrition in the household when women have decision-making power over resource allocation. In Uganda, for example, evidence from randomized controlled trials showed positive impacts from biofortified crops, including orange-fleshed sweet potato, on vitamin A status among women and children. Ownership of livestock was associated with better household food security in Kampala. However, there were mixed impacts on the links between women’s empowerment, intrahousehold decision-making, and better nutrition outcomes.

Failure to understand cultural norms and the gender dynamics within the household can result in unanticipated outcomes. In the Gambia, for example, a project geared to increasing women’s rice production was so successful that the land it was grown on was reclassified internally within the household. This resulted in output from that land being sold by men as opposed to women. Women therefore lost their original income stream, but remained committed to increased labour.

Vegetables and legumes are often regarded as women’s crops. Recognizing this, a project in Togo was successful because it promoted the introduction of soybeans as a legume rather than as a cash crop. Promotion as a cash crop would have resulted in the crop switching to male control. Interventions promoting the production of animal source foods also assessed their impact on maternal income or women’s control over income. The results were quite mixed. For example, an intervention involving intensified dairy farming in Kenya showed that an important share of the additional income was controlled by women, whereas in Ethiopia men’s incomes benefited significantly more from intensified dairying than did women’s. Whether women’s income is likely to increase depends on the livestock or aquaculture production system, the nature of the intervention, and cultural beliefs and practices relating to gender. Even if the intervention is targeted to women’s livestock and aquaculture activities, women lose control over the income generated by those activities.

In conclusion, it is arguable that there are improved impacts on nutrition if agricultural interventions are targeted to women and when specific work is done around women’s empowerment (for example, through behaviour change communication), mediated through women’s time use, women’s own health and nutrition status, and women’s access to and control over resources as well as intrahousehold decision-making power. That this may be dismissed out of hand is not unlikely either, given the persistence of male dominance.

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By Vani S. Kulkarni
PHILADELPHIA, May 22 2017 (IPS)

The discourse must move beyond a top-down approach to listen to the people and formulate best insurance practices

Much ink has been spilled in documenting the inadequacy of budgetary allocations for public health insurance, specifically for the Rashtriya Swasthya Bima Yojana (RSBY), the world’s largest publicly-funded health insurance (PFHI) scheme. Though the 2017-18 budget allocation has marginally increased from last year’s revised estimates, it has declined relative to last year’s budgeted amount by about ₹500 crore. However, higher budgetary allocation can only constitute a small part of the solution to the scheme’s mixed, if not lacklustre, performance.

Vani S. Kulkarni

Increase in hospitalisation
True, there has been a substantial increase in hospitalisation rates. However, it is unclear if it has enabled people to access the genuinely needed, and hitherto unaffordable, inpatient care. Often, doctors and hospitals have colluded in performing unnecessary surgical procedures on patients to claim insurance money. For instance, hospitals have claimed reimbursements worth millions of rupees for conducting hysterectomies on thousands of unsuspecting, poor women. Indeed, in the absence of regulations and standards, perverse incentives are created for empanelled hospitals to conduct surgeries. It is thus not surprising that there is no robust evidence of an improvement in health outcomes.

Evidence on the financial protection front is conflicting as well. One study revealed that poorer households in districts exposed to the RSBY and other PFHIs recorded an increase in out-of-pocket (OOP) expenditures for hospital care, and a corresponding rise in incidence of catastrophic expenditure. There is near-consensus that the RSBY has resulted in higher OOP expenditures. Though it is a cashless scheme, many users are exploited by unscrupulous hospital staff.

So, what is the solution? There is a need to bring the ‘public’ back into the discourse on public health to highlight its present culture. The conversation needs to move beyond a top-down approach specifying budget allocation and administrative and technical efficiency. It needs to involve listening to the real public to deliberate on various health practices and policies.

My ethnographic study of the RSBY in Kalaburagi and Mysuru districts between 2014 and 2016 brought to light that a top-down approach on allocation and coverage was important but, by itself, did not translate to expected outcomes. What mattered more was the existing culture of health insurance — how it was perceived, practised and experienced in the everyday, local worlds of the enrolled households. Though they valued aspects like the money available and the number of illnesses covered, they were more deeply affected by how other actors — doctors, local officials, neighbours and even relatives — related to health insurance.

Card not accepted
The disillusionment of Savitri, one of the beneficiaries, after obtaining the plastic card said it all: “If public officials only give us the card without telling us how to use it, the card is just plastic material. Sometimes information is also not correct, making us feel that the card is of no real value if we do not know how to use it.” Further, many hospitals refused to acknowledge the card’s value. Shivakumar’s observation summed it well: “We went to the hospital with the card. Not only could it not be used but also the doctors did not even acknowledge us as patients… We just brought the card home and tossed it to the shelf.” Many bemoaned the absence of public debate on health issues and the RSBY card. Deva’s pithy response was illustrative: “If it is not talked about and debated, we can only think that there is no big value that we should pay attention to.”

Households clearly separated the economic value from social ones. A section saw health insurance as a bad omen, one that announced arrival of illness. Ramesh Kumar, among those in his neighbourhood who refused to enrol, explained: “This card is not a solution for illness, it is a cause of it. You see, when you people knock on our doors to give us the card, it feels like an illness is knocking on our doors. The farther away we are from the card, the further we are from health problems.”

Overall, while the discourse on a greater allocation to RSBY and enhancement of cost-effectiveness are important, a shift of emphasis is needed, bringing the ‘public’ back into the sphere of public health.

The oped first appeared in The Hindu.

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getty images/ istock photo

By Vani S. Kulkarni and Raghav Gaiha
PHILADELPHIA AND NEW DELHI, Apr 14 2017 (IPS)

Implementation of the Mental Healthcare Act will require a restructuring of health-care services
The Mental Healthcare Bill, 2016, which was passed in the Lok Sabha on March 27, 2017, has been hailed as a momentous reform. According to the Bill, every person will have the right to access mental health care operated or funded by the government; good quality and affordable health care; equality of treatment and protection from inhuman practices; access to legal services; and right to complain against coercion and cruelty. The Bill also empowers a mentally ill person to choose a treatment and her/his nominated representative, decriminalises attempted suicide, prohibits the use of electroconvulsive therapy (ECT) to mentally ill adults without the use of muscle relaxants and anaesthesia, and contains provisions for care, treatment and rehabilitation for those who have experienced severe stress and attempted suicide. While these are laudable and ambitious objectives as they address major concerns of mental health care, there have been some critiques drawing attention to the lack of funds, trained personnel, and insufficient emphasis on community care. The ground reality, however, suggests that these objectives are not just overambitious but an overkill.

Poor infrastructure, low funds
The Global Burden of Disease Study shows that in 2013, 50% of all disease burden in India was caused by non-communicable diseases, while mental disorders accounted for about 6% of the total disease burden. A third of this is due to depression, which also significantly contributes to suicide and ischaemic heart disease. Worse, suicide is a leading cause of death in people in India aged 15-29.

Vani S. Kulkarni

At the macro level, the proposed health expenditure of 1.2% of GDP in the Budget for 2017-18 is among the lowest in the world. In real terms, public health expenditure has consistently declined since 2013-14. Of the total health budget, a mere 1-2% is spent on mental health.

But this is a small part of the explanation of the inadequacy and abysmal quality of mental health services in India. Underlying this deplorable state of affairs is a pervasive perception that those with mental illnesses are pathological or even criminal; hence they do not deserve the type of rehabilitation given to those with physical ailments. Besides, the treatment gap (the difference between those suffering from mental illnesses and those seeking medical/psychiatric care) is widened because of the social stigma attached to such illnesses. In fact, many poor people hide their illnesses and endanger their lives. Others argue that it is not so much stigma but ignorance and lack of knowledge, myths, and supernatural beliefs that impede treatment. Women typically face larger treatment gaps as they are vulnerable to violence, sexual abuse and inhuman treatment.

Raghav Gaiha

Often, all women and girls were admitted without their consent and, as the team left, they cried out in despair, “send me home” or “take me home”. Unable to cope with mentally ill relatives, families often abandon them in mental hospitals and elsewhere. In one case, a woman who was declared “fit for discharge” in the 1990s was still in the institution as of August 2013 because of lack of alternative resettlement options for her.

Some women were not even informed that ECT was being administered. Psychiatric nurses admitted that ECT was administered not just on violent and suicidal patients but also on new admissions who tend to be unmanageable.

Women and girls with psychosocial or intellectual disabilities in institutions are often subject to not just physical and verbal abuse but also sexual violence. Some women went to a hospital for three months and returned one month pregnant. Not a single FIR was filed.

Government hospitals refuse to admit “mentally ill” persons in the ICU on the grounds that this facility could be put to better use. A woman suffering from breast cancer for two-three years was denied treatment and subsequently died.

Shift to community-based care
An emphatic case could be made for shifting from institutional care to community-based care for people suffering from mental disorders. A study published in The Lancet Psychiatry, 2017 offers corroborative evidence from VISHRAM (the Vidharbha Stress and Health Programme), which is a community-based mental health initiative. The reduction in the treatment gap was due to increased supply of mental health services through front-line workers and their collaborative linkage with the physicians and psychiatrists in the facilities, as well as increased demand for mental health services due to improved mental health literacy. The substantial reduction in the median cost of care resulted from availability of general as well as specialist services in the village itself.

Whether legislation such as the Mental Healthcare Bill help overcome supply and demand barriers seems highly unlikely, as the root causes lie in pervasive negative attitudes, massive neglect of mental health care, rampant abuse and unchecked inhuman practices, and weak redressal and enforcement mechanisms. The Bill seeks to address major lacunae in mental health care and is thus an important step forward. However, its implementation will require substantially larger public resources and, more importantly, restructuring of mental healthcare services with a key role for the community in their provision, rapid expansion of mental health literacy, effective monitoring and enforcement of the objectives envisioned in it. With limited awareness of these challenges, and with a slight risk of exaggeration, the Bill is an overkill.

This opinion editorial was first published in The Hindu

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By Raghav Gaiha and Vani S. Kulkarni
NEW DELHI AND PHILADELPHIA, May 17 2016 (IPS)

Imminent demise of small farmers is predicted as they are not competitive in a context of transforming agrifood markets. Most important is the transformation of the “post–farm gate” segments of the supply chains.

Raghav Gaiha

Agrifood markets have been transforming because of growing affluence, urbanisation and large inflows of FDI induced by liberalised investment policies. A few salient features include replacement of local and fragmented food value chains by geographically much longer chains. Traditional village traders/brokers/processors have declined while small and medium firms have proliferated with eventual domination of large domestic firms and multinationals (Reardon and Timmer, 2014). For example, rice mills have declined rapidly. Instead small but especially medium and large scale mills have emerged located in towns. A comprehensive Asian Development Bank report on Food Security in Asia (2013) draws attention to some contrasts between Bangladesh and India in rice supply chains. The role of the village trader, for example, has shrunk, controlling only 7% of farms and sales in Bangladesh, and 38% of farms and 18% of sales in India.

Vani S. Kulkarni

A large share of food undergoes processing. Grain milled rice is made into bread or polished rice, for example. The rapid growth of food processing is driven by women’s participation in the labour force and dietary shifts, promoted in part by modern retail. The retail segment has transformed rapidly in the last decade. Many governments had public sector cum cooperative retail ventures (e.g. India, Vietnam, and China). These were dismantled with structural adjustment and liberalisation. The supermarket “revolution” has been a catalyst. Supermarket chains seldom buy fresh produce directly from farmers. Instead, they tend to buy from wholesale markets or from specialised wholesalers who in turn buy from preferred suppliers.

In the downstream, dietary changes have been significant. Domestic consumption of high-value crops such as fruits and vegetables rose by 200 % during 1980-2005, while consumption of cereals stagnated. High value food exports –including fruits and vegetables, meat and milk products, and fish and seafood products-from developing countries increased by more than 300% during 1980-2005, and now constitute more than 40 % of total developing country agrifood exports (World Bank, 2008). The growth in high value agricultural exports has been much faster than the growth in traditional exports such as coffee, cocoa and tea, which decreased in overall importance.

The shift towards high value agriculture and concomitant “restructuring” or modernisation of supply chains are associated with (i) increasing number and stringency of food standards for quality and safety; (ii) consolidation of supply chains; and (iii) a shift from spot market transactions in traditional wholesale markets to increasing levels of vertical coordination of supply chains.

Overall, the supply chain is lengthening geographically and “shortening” inter-mediationally (or, “simply fewer hands in the chain”). The former implies that food markets are integrating across zones/states in a country; it also implies “de-seasonalisation” of the market. A case in point is the potato market in India, China and Bangladesh.

Although there is considerable pessimism about small farmers’ ability to participate in high value food chains because of their small scale of production, failure to comply with stringent quality standards and unreliability of supply, recent evidence is mixed. The main arguments that transaction costs and investment constraints are a serious consideration in these chains and that processing and retailing companies express a strong preference for working with relatively fewer, larger and modern suppliers are not rejected. But the evidence also shows that many more small farmers participate in such chains than predicted by these arguments.

In India, small farmers play an important role as suppliers in growing modern supply chains. In China, production in the rapidly growing vegetable chains (and in several other commodities) is exclusively based on small farmer production. Poland, Romania and CIS do not show any evidence of “exclusion” of small farmers. Studies of high value export vegetable chains in Africa find in some cases that production is fully organised in small farms or fully in large farms or mixed in small and large farms (Swinnen et al. 2010).

Small farmers are indeed excluded in some supply chains and in some countries, but this is far from a general pattern, and, in fact, small and poor farms are included in supply chains to a much greater extent than expected on arguments based on transaction costs and capacity constraints.

Several reasons underlie this view. (i) Buyers often have no choice where small farmers supply a large share of supply and occupy a large fraction of land. In parts of East Asia and China, with a high population pressure on land, sourcing is often from small farms. (ii) It is often not the case that companies contract with large farms simply because of lower transaction costs. In fact, many companies prefer not to depend on large farms because contract enforcement is harder. (iii) In some cases, small farms have substantive cost advantages. This is particularly the case in labour-intensive, high maintenance, production activities with relatively small economies of scale, such as dairy or vegetable production.

Empirical evidence reveals that small farmers engage in high value contract production because of guaranteed sales and prices, and access to inputs, and not so much for direct profit and income benefits.

Vertical coordination is widespread in high value chains, often as an institutional response to problems of local market imperfection. But vertical coordination varies from integrated (large) farms managed by food companies to extensive contracting arrangements with small farmers. Contract farming improves access to credit, technology and quality inputs for poor, small farmers hitherto faced with binding liquidity and information constraints. But reneging of buy back arrangements on specious poor quality standards is frequent due to weak enforcement mechanisms (a case in point is India).

Evidence on impact of these value chains on small farmers is patchy and inconclusive.

Available evidence suggests that where the smallholders are only partially participating as suppliers, the poorest rural households may benefit from inclusion through the labour market than small farmer participation. In other words, whether small farmers are included in these chains or not, is unlikely to be a good indicator of the welfare effects. On the other hand, the shift of suppliers from traditional to modern markets causes price effects. These price effects and their welfare implications depend on scale economies in modern versus traditional production systems, trade, relative demand and production elasticities (or how responsive is production to price changes), and on the factor intensity of high value commodities. In poor countries, where modern supply chains increase demand for labour- intensive commodities, the spill over effects are likely to be positive.

The transaction costs faced by private actors when transacting with a large number of farmers could be reduced by investing in intermediary institutions (e.g. producer groups). Intermediary institutions reduce the number of transactions and the cost of exchange between farmers and processors or input suppliers. Whether small coverage of producer groups undermines this argument is beside the point as what is emphasised is that the potential of such groups is considerable. Besides, as argued by a World Bank report, Enabling the Business of Agriculture 2016, clear and accessible laws foster a business environment that benefits all market players-especially farmers including vulnerable female farmers and smallholders, consumers and large investors.

In conclusion, the imminent demise of small farmers is exaggerated, if not mistaken altogether.

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