Malnutrition and Sanitation in India

This is an edited version of Rohini Nilekani and Pavan Srinath’s discussion on malnutrition and sanitation in India. This conversation took place on the sidelines of the Takshashila-Hudson conference, “Shaping India’s New Growth Agenda: Implications for the World” in Bangalore on August 1-2, 2014.

Over the last two decades India has made a lot of progress in the area of sanitation, and this is due to several factors including greater public policy changes. Now that the nation’s attention is focused on sanitation, it’s become clear to us how sanitation is crucially linked to public health.

For young children and vulnerable populations, lack of access to clean water and sanitation has multiple long-term implications. Our public policy must aggressively drive institutional reforms around the issue of sanitation. Through the work that we’ve been doing at our foundation, Arghyam, we know that behavioural choices can affect a significant amount of change. The government has a program where people who need toilets will be given financial incentives to install them. But I think we will need to do more than that, in terms of making sure that everybody uses clean toilets and reduces open defecation.

There is good public policy, but we also need to plug some of the gaps. We need a lot more philanthropic capital to come in, perhaps through a sanitation fund, so we can work with the government on this issue. If we want to see lower malnutrition and child mortality rates, we need to work on sanitation aggressively, as well as women’s safety. The demand for sanitation has been building up because of the pressure on land and urbanisation, and we only have another 10 years to address this so it is time to get our act together.

Financing toilets for the poor is certainly an issue, and there’s a need for money upfront to build those toilets with access to water. But I think we need to work around that, perhaps by encouraging banks to give out loans, etc. The financial aspect of it is a problem right now because of corruption and bureaucratic delays in getting that money to the people who need it. However, the bigger obstacle is cultural behaviour that we need to change. People need to internalise the idea that every single person in a household, including women, children, and the elderly, must have access to safe and clean sanitation. There’s a lot the government can do to spread more awareness, and I think more research is required. Civil society actors also have a big role to play in this.

We know that clean water and safe sanitation would go much further in terms of the prevention of malnutrition than any other solution. But we must also have a framework of rights for people to have equitable access to food. In India, we must focus on implementation, whether it’s about food policy, toilets, or education outcomes. We need to focus on getting the right incentive structures from the executive, along with the political class which is listening to people’s demands. We all seem to have some broad consensus on the ‘what’, so now we need to focus on the ‘how’. We have to build up the quality of demand, and that is where civil society comes in. When the quality of demand is built up, the supply system has to respond. We can’t have 600 million young restless people and not respond to their demands. And we are seeing some of those breakthroughs now, in the areas of water and sanitation. The next decade is a critical one, so we need to work together to demand and implement these changes.

We need to create physical and virtual libraries everywhere

The work of governments and ngos over the past two decades has certainly helped millions of children, all first-generation learners, get into school and take their first steps towards reading. However, for a vast majority, there is almost nothing joyful or interesting for them to practise their newfound skills on. The children of our elite classes have access to books from around the world, but kids learning in their own languages have precious little children’s literature to choose from.
The result is there for all to see, when survey after survey laments that one in two Class V children in India cannot read a passage fluently in any language.

Philanthropy in India Is Taking Its Own Route

A debate was going on about a government proposal to make it compulsory for companies to spend 2% of their net pro?ts on corporate social responsibility (CSR). Rohini Nilekani, philanthropist and chairperson of Arghyam, a foundation she set up with a private endowment to work on water and sanitation issues in India, says she has been “against the 2% rule from the beginning” because “I don’t think government should outsource its governance. And, secondly, making it mandatory is going to straightjacket [CSR] in a way that may not necessarily yield the best results. But now that it’s been done, we just have to make the best of it.”

Jaipur Literature Festival, 2013 | A Surrogate Life

This is an edited version of a conversation at the Jaipur Literature Festival, 2013, between Kishwar Desai, Jaishree Misra, and Rohini Nilekani, as part of the Rajasthan Patrika Series.

 

 

Often, I find myself wishing that the subject of my book, “Stillborn” was not as relevant as it is today. But when we look at the data, unfortunately things have gotten worse since I wrote my novel. At the time, I was a stay-at-home mother and I wasn’t able to do much journalism, but there is a writer in all of us and I felt like this is something I wanted to do. I happened to read an article in the papers that was reporting on people who were not scientists, but were giving women radioactive rotis to see what would happen to them. That story stayed with me, the plot developing from there as I researched more about it. But unlike the blood and gore thrillers that I was reading at the time, the story of Yati and Poorva that emerged was using the garb of the suspense novel to address something more serious. As a journalist and a writer, I felt like the story had to be told in this form. 

There have been hundreds of deaths in India due to clinical trials, and very few of them have gotten compensation from the government. This is because there are a lot of powerful agents between the people affected by this and the pharmaceutical sector, which allows them a level of impunity that is shocking. Some of the most recent anti-cancer vaccines were tried out on tribal women, who would not have access to even the most basic form of justice. It’s been 62 years since we have declared India to be a republic, but we still have a long way to go in terms of safeguarding the rights and lives of all our citizens. 

As Desai points out through her books as well, Indian women’s bodies are being exploited and experimented on in ways that may seem like science fiction, but are very real. The health sector is growing at a fast pace, while laws around surrogacy and drug trials have yet to catch up. The Drug Controller of India simply does not have enough resources. So while India has become one of the world’s most popular destinations for clinical trials, whether they are happening with the informed consent of the participants is questionable. Participants should be able to know the risks they are facing when they try out a medicine for a drug manufacturer but unfortunately people are not as transparent or upfront about these issues. 

With regard to the complicated issue of surrogacy in India where women from lower income families agree to act as surrogates for wealthy couples, often for very little money, discussions about commodification are difficult to tackle. In our culture, wet nurses were not unheard of, yet in a way that is also using a woman’s body and what it produces to nourish someone else’s child. The problem lies when there are complete strangers from around the world who are essentially renting Indian women’s wombs, and whether those women are informed and supported through that experience. So I appreciate Desai’s ability to look at this issue from different viewpoints in her novel. 

However, when we look at the drug trials and issues of medical malpractice, we have a more clear-cut situation. In my novel, I based the story on the facts — I wanted to show the Indian farming industry that was growing rapidly at the time, and facing international competition. The question was whether it would sink or swim, and whether it was going to do so by abiding international norms or trample over human rights for the sake of profits. That was the story I was interested in telling. It has been 10 years, but I’m hopeful that robust regulation will come in before long, because the world is watching us now. 

While it’s easy to talk about these issues, the more challenging task is to think about some of the solutions that we need to see happen in India. All of us read the newspapers nowadays and we get frustrated and angry about what is happening in the country. But what we have seen happening with the Nirbhaya case for example, is that we have now reached a tipping point where people are beginning to look outside of themselves. Middle class families are thinking about what is going on beyond their class, because it’s clear that it will impact all of us. I can see an increase in people’s empathy, which is crucial if we want to progress as a society. In terms of women’s empowerment, we are taking great strides. No other country in the world has elected one million women to local political power. Slowly but surely, that will result in real change. Women now have a voice on gram sabhas and gram panchayats, and local planning priorities reflect that, with more focus given to health care, education, and access to water. 

Data tells us that up to 60 million women have been a part of self-help groups, institutions of empowerment where women can discuss issues and come up with solutions. Together they make their voices heard through collective action. So we can see really positive changes happening in this space, ones that actively empower women and local communities. In addition to this, there are more women entering the workforce, who may not have had access to these jobs 10 years ago. Corporates are ensuring that their policies are progressive and work towards gender equity, because there’s a lot of public pressure for them to do so. It’s not easy, of course, and there are still many hurdles that women face. But things are changing for the better. 

We have to keep in mind that regulations and laws are not a silver bullet. Regulation often lags behind innovation, but it is not the only tool we can use to achieve societal change. We also need social and collective action, information and awareness, and empowerment of the people. Alongside empowering women, we have to engage with men and boys if we really want a more equitable society. More spaces need to be created in this country where men can express their hopes and fears without having to succumb to living up to stereotypes of masculinity. Without these avenues to express their feelings, the violent consequences have been well recorded. We have to start having those conversations if we want lasting change. 

Rohini Nilekani pours her wealth into getting books to India’s poorest children

When she found herself suddenly wealthy, the Indian philanthropist founded Pratham Books, a nonprofit publisher that uses innovative ways to put low-cost books in the hands of millions of kids.
“My mission is to put a book in every child’s hand,” says Rohini Nilekani That’s an ambitious goal anywhere, but especially in India, where there are more than 300 million children, most of whom can’t afford books, or even read.

Talk Time – Rohini Nilekani in conversation with tanmoy goswami – The Smart Manager

SMART SUMMARY: In 2008, United Airlines allegedly broke a $3500 custom made guitar belonging to Canadian musician Dave Carroll. Following many rounds of fruitless dialog, during which the company’s managers relentlessly cited ‘policy’ and refused to compensate the musician, Carroll made a music video called United Breaks Guitars that had amassed 10 million views on YouTube by February 2011. The impact: According to The Times, within four days of the video being posted, investors in the airline had lost $180m due to a fall in its stock price. The moral of the story: Managers need to talk meaningfully with their customers while they can…or face the music.

Charge of the compassionate brigade

Modern society is classified into different segments. First you have the state, as represented by elected officials and lawmakers, politicians, ministers, bureaucrats and other organs of the state. Then there are the commercial bodies — companies, chambers of commerce and other market players.
The third segment (there is a fourth, the underworld and the mafia, but let’s not talk about it) is civil society, comprising “the arena, outside of the family, the state, and the market where people associate to advance common interests,” a definition coined by Civicus, the World Alliance for Citizen Participation.