Attaining the Millennium Development Goals in India: How Likely

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Attaining the Millennium Development Goals in
IndiaHow Likely What Will It Take?
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Millennium Development Goals (MDGs)

• As you all know, the MDGs are a set of numerical
  and time-bound targets to measure achievements in
  human and social development.

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Five MDGs analyzed in this Report

• Child and infant mortality reduction
• Reduction in child malnutrition
• Universal primary enrollment
• Elimination of gender disparity in school
  enrollment
• Reduction of hunger-poverty (calorie deficiency)

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Limitations of much of the MDG discussion so far

• Analysis has been at a highly aggregate level
  typically the level of the country. This is
  meaningless in a large and heterogeneous country
  like India.
• The likelihood of attaining the MDGs hasnt been
  usefully linked to the factors that influence MD
  indicators. This is necessary to address the
  question what will it take to attain the MDGs?

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MDG Attainment in the Poor States of India

• The poorest states in India (e.g., Uttar Pradesh,
  Bihar, Rajasthan, Orissa, and Madhya Pradesh)
• are among the most populous in the country, and
• have among the worst MD indicators.
• Owing to more rapid population growth, these
  states will account for an even larger share of
  Indias population in 2015.
• Therefore, Indias attainment of MDGs will
  largely depend on the performance of these states.

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Tremendous spatial variation in levels of
changes in MD indicators

• There are very large inter-state and intra-state
  variations in all MD indicators in India. For
  instance, the IMR for the country is 66 infant
  deaths per 1,000 live births. But it varies from
  a figure of 11 in Kerala to 90 in Orissa.
• Intra-state variations in infant mortality and in
  primary school enrollment rates are even greater,
  as seen in the following map.

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Infant Mortality Rate, 1997-99
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Net primary enrollment rates also vary a great
deal across regions
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And there is a great deal intrastate variation in
IMR decline as well, with some regions showing
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as in changes in net primary enrollments.
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Geographic Concentration of MD indicators

• The wide disparity in MD indicators results in
  the geographical distribution of these indicators
  being heavily concentrated.
• This indicates the need for targeting MDG-related
  interventions to poorly-performing states,
  districts, and perhaps even villages (if these
  could be identified).

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Case of infant mortality

• Four states
• Uttar Pradesh
• Madhya Pradesh
• Bihar
• Rajasthan
• Account for more than 50 of infant mortality in
  India
• Four more states account for another 21, or a
  cumulative 72

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51
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• Infant deaths are even more concentrated at the
  district and the village levels.

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Only one-fifth of the districts and villages in
the country account for one-half of all infant
deaths
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and more than half of all underweight children
are found in only a quarter of all villages and
districts in the country.
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Out-of-school children are even more
concentrated. Nearly three-quarters of all
out-of-school children in the country are found
in a mere 20 of villages (and 50 of districts).
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Identification of villages with poor MD indicators

• Unfortunately, currently-available data cannot
  allow identification of specific villages that
  account for most of the infant deaths,
  underweight children, or out-of-school children
  in the country, because most sample surveys are
  not large or representative enough at the village
  level.
• But new, emerging methodologies are available to
  do this.

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Most Deprived Regions in India

• But we can identify the most-deprived regions in
  the country.
• There are two regions in the country that are the
  most deprived in terms of all the 5 MDG
  indicators we have analyzed (Southwestern M.P.
  and Southern Rajasthan).
• There are another 6 regions that are most
  deprived in terms of 4 of the 5 indicators we
  have analyzed.

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MDG attainment

• Clearly, attaining the MDGs will require action
  in the poorest states, districts and villages.
• How can it be done? What will it take?

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Estimation of household, behavioral models of MD
indicators

• Using household survey data from various sources,
  we have attempted to quantify the factors
  associated with the reduction of infant
  mortality, child malnutrition, schooling
  enrollment, gender disparity, and hunger-poverty.
• These models are used to project changes in MD
  indicators in the poor states by 2015 under
  certain intervention scenarios.

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• We have considered
• General Interventions
• Economic growth
• Expanded adult male and female schooling
• Increased access to water sanitation
• Improved electricity coverage
• Increased access to pucca roads

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• Sectoral Interventions
• Increased government spending on health and
  family welfare, nutrition, and elementary
  education
• Various sector-specific interventions, such as
• More professionally-assisted deliveries
• Antenatal care coverage and tetanus toxoid
  immunization for pregnant women
• Increased number of primary schools per child
  aged 6-11
• Reduction in the pupil-teacher ratio
• Greater irrigation coverage
• Increased foodgrain production per capita.

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Results of the Simulations

• Large improvements in all the MD indicators are
  possible with concerted action in many areas.
• Both general and sector-specific interventions
  will be important in attaining the MDGs.

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Infant mortality could decline by 50 if the poor
states were to be brought up to the level of the
non-poor states
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• Any single intervention wont go very far in
  attaining the MDGs.
• What is needed is a package of interventions.

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The child underweight rate could decline by 40
if the poor states were to be brought up to the
level of the non-poor states
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The net primary enrollment rate in the poor
states could increase from 50 to 69 if the poor
states were to be brought up to the level of the
non-poor states
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Trajectory of Selected MD Indicators to 2015

• We have also made some assumptions about how the
  various policy interventions might change over
  time, and
• then traced out the path of the MD indicators to
  2015.

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Assumptions about policy interventions to 2015
Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015
Intervention Starting value Assumed change per year Ending value in 2015
Population with no access to toilets () 76.5 -2 points 42.5
Population coverage of regular electricity supply 27.7 1 point 44.7
villages having access to pucca roads 59.5 1 point 76.5
Consumption expenditure per capita 422 3 698
Adult male schooling years 4.5 0.25 8.5
Adult female schooling years 2.0 0.3 6.8
Government expenditure on health and family welfare per capita 95 4 185
Government expenditure on nutrition programs (ICDS) per child 0-6 years 51 4 98
Government expenditure on elementary education per child 6-14 years 955 4 1,789
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Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015 Assumptions about various interventions to reduce the infant mortality rate in the poor states, 1998-99 to 2015
Intervention Starting value Assumed change per year Ending value in 2015
Coverage of antenatal care 55.5 1 point 72.5
of pregnant women obtaining tetanus toxoid immunization 70 1 points 87
of professionally-attended deliveries 32.3 1.5 points 57.8
Crime against women (number of female kidnappings and rapes per 100,000 population) 1.65 -0.05 0.85
Crime against women (number of female kidnappings and rapes per 100,000 population) 1.65 -0.05 0.85
Number of primary schools per 1,000 children aged 6-11 years 5.1 .2 8.3
Pupil-teacher ratio in primary schools 91 -1 75
Share of secondary education in total government expenditure on education 36 1 52
of area irrigated 29.2 1 point 45.2
Food grain production per capita in districts 186 2 255
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The simulations suggest that attaining the infant
mortality MDG in the poor states will be
challenging but not impossible with a package of
interventions
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Likewise, it would be possible to reach the child
malnutrition MDG in the poor states with a
package of interventions
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but attaining the 100 net primary enrollment
goal by 2015 will be problematic in the poor
states
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Likewise, it will be very difficult for the poor
states to attain the 100 primary completion goal
by 2015
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• Note that increasing the net primary enrollment
  rate to 100 (the MD goal) is different from
  getting all children aged 6-11 in school.
• The simulations suggest that getting all children
  aged 6-11 in school is attainable with the same
  set of interventions discussed earlier.

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Other MDGs

• What about
• Gender disparity in schooling, and
• Hunger poverty?

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Complete elimination of the gender disparity in
primary and secondary school enrollment also
appears difficult in the poor states.
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But elimination of hunger-poverty in the poor
states is very likely with a package of
interventions, especially since hunger-poverty
appears to be very responsive to economic growth.
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Summing Up

• Meeting the MDGs will be challenging, especially
  for the poor states in India.
• A number of interventions, including
• economic growth
• improved infrastructure (especially water and
  sanitation, electricity, and road access)
• expansion of female schooling, and
• scaling up of public spending on the social
  sectors
• will be needed in order to attain the MDGs.

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• Also important will be a number of sectoral
  interventions, such as
• improved access to antenatal care
• Immunization
• nutritional supplementation
• home-based neonatal services
• increasing the density of schools
• lowering the pupil-teacher ratio
• raising agricultural production.
• Targeting interventions, public spending, and
  economic growth opportunities to the poor states
  and, within those, to the poor districts and
  villages will be critical.

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• Finally, the importance of
• systematically monitoring MD outcomes at
  disaggregated levels and
• evaluating the impact of public programs
• cannot be overemphasized.
• Currently, there is no system for monitoring
  progress toward attainment of the MDGs at the
  sub-national level.

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• In addition, most public interventions, such as
  the Integrated Child Development Services and the
  District Primary Education Program, have not been
  subjected to rigorous, independent evaluation.
• In order to choose the right set of interventions
  with which to attain the MDGs, it is critical to
  know which programs have been successful in
  improving MD indicators and which have not.

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Caveats

• Estimations and simulations subject to usual
  problems of measurement error, estimation bias,
  etc.
• Therefore, projections are indicative and should
  be used in rough-order planning.

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• Simulations focus on quantitative variables and
  not on qualitative variables, such as governance.
  Does not mean that governance is not important,
  just that it is difficult to take that into
  account in the simulations.
• The simulations assume business as usual. Any
  improvements in governance will result in
  speedier attainment of MDGs.