Author: cprindia

BY THE ACCOUNTABILITY INITIATIVE AT CPR
SANITATION SOCIAL SECTOR SCHEMES BUREAUCRACY

The Swachh Bharat Mission (Gramin) marked its third anniversary this year. With only two more years to go to meet targets, what are we seeing as priorities for the Mission? Have they changed?

Devashish: Let us state upfront that there are in fact two ways of discerning priorities. The first is what the officially stated government priority is – available through the programme norms and guidelines. But there is also the priority that gets translated on the ground – what has been carried forth by implementers based on their own capacity and understanding. There is often a significant gap between the two. The recently released, updated implementation guidelines indicate that the priorities of the mission are witnessing a forceful reorientation towards the initial ideal of a community-led, sustainable movement. These revisions also seem to address several of the concerns raised by media and civil society and signal the right intentions.

More specifically, the guidelines include detailed instructions on the monitoring and verification protocol, as well as administrative capacity issues like manpower and trainings. They are also more focussed on the sustainability of the ODF (Open Defecation Free) status beyond mission activities , such as, what is being called ODF ++; issues related to toilet technology; and the need for greater attention to behaviour change with interpersonal communication as a means of bridging the access usage gap.

These are not new focal areas but a more explicit statement of principles the mission has always espoused. That they are reinforced three years into the five-year mission period suggests that the Centre sees the gaps in the programme, and is urging mid-term course correction. However, in the context of the current push to meet targets within a specified deadline, unless we find ways to strengthen implementation, there is a danger that these guidelines and principles will dissipate as they travel along the bureaucratic channels to the ground.

The government has consistently maintained that the objective of the mission is not only construction but behaviour change. With seven states already declared ODF and others striving for the status, do we have data available on toilet usage?

Devashish: This is the biggest gap in the existing monitoring framework of the sanitation sector. As we mentioned last year, collecting usage data is complicated, and quantitative data in this regard is often unreliable. At present the NSSO (National Sample Survey Office at the Ministry of Statistics and Programme Implementation) is an important source of toilet usage numbers. However, their approach to capturing it is fraught with problems.

For example, the wording of the question itself is a concern. It asks whether ‘members are using latrine’. This comes across at once as leading and accusatory and is likely to bias the respondent into answering in the affirmative. Further, no attempt is made to talk to other members of the household and verify what the respondent answers on their behalf. As RICE institute also notes, how you ask the question, whom you ask, how many times you ask, all have implications on the answer. There are also seasonal variations – usage tends to change during the rainy seasons, for example. We ourselves faced this problem in our survey when we got different answers to the question – where do you normally go versus where did you go today!

Avani: The other, more current source of tracking usage is the Swachh Survekshan, conducted annually by the Quality Council of India on behalf of the central government. Here too, however, the same shortcomings can be noted. Their approach is even more curtailed and they only ask the respondent ‘does any member (of the household) defecate in the open sometimes?’

The implications of this approach are evident from numerous stories on the gaps between access and usage. The concern that ODF Panchayats are not truly ODF has been flagged by AI and others previously. Recognising this, the guidelines have laid out a detailed monitoring and verification process and need for continued engagement with ODF Panchayats and villages after declaration, rewards for Panchayats that perform well, and other measures to ensure that official declarations do not become an end in themselves. Moreover, this time the guidelines focus on the use of independent qualitative studies in order to ascertain the status of usage. This is definitely a positive step. More focus needs to be given to collecting regular, independent data through different methods on tracking usage and compliance to policy.

Then, what can be said of the status of toilets that have already been built?

Devashish: Aside from everything else, it is very clear is that toilet construction is happening on a massive scale. While the latest Swachh Survekshan found that 90% of toilets are being used regularly, other independent estimates tend to be more conservative. One also often finds ground reportage based on anecdotal evidence claiming that many toilets are unusable and employed for storage and other purposes. The truth is likely somewhere in between. Of the millions of toilets being constructed, many are likely being used and many are probably not. While one may argue about where this proportion lies, it is safe to say that the ODF states are not truly free of open defecation. It would be more accurate to say that they are relatively freer of open defecation than before.

Avani: While this sounds positive – it is also a cause for worry. We have seen this already happen in the push for school toilets and specifically girls’ toilets. A few years ago the government had launched a Swachh Vidyalaya campaign. All focus and attention was on meeting the target of 100% toilet construction in all schools in the country. On Independence Day 2015, one was greeted by a congratulatory message on the completion of the target of constructing over 4.15 lakh toilets in 2.61 lakh schools. Consequently, the focus shifted away from school toilets towards individual household toilets. However, a look at the data suggests a large number of schools still not having access to a functional, usable toilet. According to ASER 2016 (Annual Status of Education Report), more than 30% of schools did not have a functional and usable toilet. A recent survey we conducted in a district in Rajasthan in nine Panchayats also found a significant lack of usable toilets in public facilities.

The Swachh Bharat Mission has been critiqued for placing emphasis on toilet construction while not being able to adequately render other policy aspects such as awareness raising for toilet use. What is your understanding of the situation?

Devashish: ODF is possible only if each and every person uses a toilet, each and every day. However, given the difficulty in capturing and tracking usage, the current ODF declaration process equates construction and usage, implicitly presuming that all those who construct toilets also use them. Not only is this not a valid assumption, it necessitates that ODF declarations be based on the only available quantitative measure, namely SBM construction targets, which are outdated and an inexact estimate of the actual toilet needs. For example, if a Panchayat had a mandated target of a 100 toilets, they declare themselves ODF as soon as a 100 toilets are constructed. That this Panchayat might in fact need 150 toilets, or that only 50 of these constructed toilets are actually used, are not always considerations. There are several instances of Panchayats being hurriedly declared ODF, often in a matter of weeks, under top down pressure.

Avani: Just to add, it’s important to remember that ODF is a process not an end in itself. However, while the goalpost may have changed from toilet construction to ODF, the problem is that this message has not fully been translated to the ‘implementers’ on the ground. And that is where I even question the SBM Dashboard. We all know the saying that what gets measured gets done, and for anyone who has seen the MIS (Management Information System) dashboard – the thing that stands out is a ticker counting the number of toilets constructed. Ironically, the Ministry’s own SBM idea book states that ‘[The SBM] approach necessitates adoption of the right processes, an understanding of actual outcomes and ability to resist a target driven approach.’ I would much rather the SBM-Dashboard instead showcased actual success stories – of the champions and ideas and innovations that different administrators have used. There are plenty of those and those should be highlighted and celebrated, not just the toilets constructed. In the absence of that, the main focus which is meant to be on catalysing a community-led social reform movement will be at odds with the adopted approach of targets and strict timelines that are imposed in the current ‘mission mode’ of functioning. Mass reform to overturn an engrained social norm is unlikely to take place in this timeframe, and the beleaguered frontline bureaucrats are clearly aware of this. They have no resort therefore but to focus on hard numbers and enforced target completions because that is the only approach which will achieve what is being asked of them.

What are the challenges that you foresee for the Swachh Bharat Mission in the coming years?

Devashish and Avani: As the name indicates, Swachh Bharat is a mission mode programme, which in government parlance means that it is a high intensity, limited duration scheme meant to achieve a specific purpose, namely, ending the practice of defecating in the open.

It must also be recognised that this approach is inevitable not just in the sanitation space but across every major government programme in the current governance environment. The work of Profs. Pritchett et al. of Harvard University on government capability and success of large development programmes helps shed light on some of our systemic problems. They posit that a system with weak institutional capability (they characterise India’s institutions as being moderately capable) when pressed to reach unachievable goals, will find solace in ‘mimicry of form without substance’. In effect, top down, large scale, target driven programmes which do not account for local realities and ask ‘too much of too little, too soon’ will inevitably devolve into chasing nominal success indicators, focussing on tangible outputs rather than outcomes. The much lauded political will driving SBM, coupled with existing weak institutional capability, is leading to ‘premature loadbearing’, a breakdown of the intentions, and inability to escape this capability trap. Simply put, our systems are not robust enough to meet the objectives, and adding top-down pressure is counterproductive to say the least.

Swachh Bharat is not a typical scheme – and for measuring its success it can’t be treated as one either. Again quoting from the Ministry’s own Idea book, it states that SBM implementation requires a lot of ‘unlearning’. For administrators, the schematic implementation usually requires a blue print which needs to be followed often in a top down manner. There are checklists, reports, money, and beneficiaries. Swachh Bharat instead is a Jan Andolan – a movement that needs to be built through shared understanding and collective action. There are no beneficiaries but owners, no ‘right process’ but complete flexibility based on the ground situation. These are subtle changes in language between saying this is our target and let’s do anything and everything to achieve it versus if we want to become a country that practices safe sanitation to improve public health, what is the enabling environment needed for it.

Consequently, there are many challenges that are now emerging, some requiring immediate attention while others needing sustained efforts.

The first of these challenges is to ensure the veracity of the granted ODF status. It is important to ensure that the 2,73,315 villages declared ODF so far, and the others to come, are truly free of open defecation. This is essential because in a mission mode programme, the likelihood of continuing efforts towards an objective that has already been (even nominally) met is limited. Visits to ODF Panchayats make it evident that work does indeed stop cold as soon as the declaration is made.

Second, is a question of sustaining the ODF status once achieved. As we mentioned, freedom from open defecation must be seen as a process rather than a one-time outcome. Given the ultimate objective of reducing the morbidity burden of sanitation related diseases, it must be ensured that not only are ODF villages truly ODF but that they remain so.

Third, a significant challenge is that of ensuring consistent and sufficient water supply. Not only is lack of water found to be a barrier to toilet usage and maintenance, the implications on additional labour for women charged with carrying water are also a concern.

Finally, it is important to remember that Solid Liquid Waste and Faecal Sludge Management (FSM) are integral aspects of safe sanitation. While the SBM-Gramin guidelines speak about a twin pit toilet, which does not require emptying out of faecal sludge matter – for most households who can afford to build a toilet – the chosen method is a septic tank or a single pit toilet. The implications of this may not be visible today but it is a public health crisis in the making and thus must be addressed today.

In the absence of FSM services, there are only two possible outcomes of the exponential growth in toilets. The toilets will fill up in a few years and be rendered defunct, or our traditional FSM mechanism, namely manual scavenging, will be resorted to. Not only will this perpetuate an exploitative social system, but it will also give rise to a public health emergency. This might sound alarmist but this waste will, in the absence of alternatives, be disposed in open land or water sources, as it is today. Instead of disperse accumulation of faecal sludge over a period, we will find it being released in a concentrated form, reversing all the gains that the preceding years have seen.

There is no doubt that a true and complete Swachh Bharat is a challenge for a country like India. But for Swachh Bharat to succeed, we need to highlight its successes and but equally importantly discuss the constraints to ensure course correction. It is only then that we will be able to meet our goal.

FULL VIDEO OF TALK
URBAN GOVERNANCE URBAN ECONOMY

Watch the full video of the workshop (above), where Chinmay Tumbe speaks about his paper examining the nature of urbanisation and urban growth in India since the late 19th century, against the backdrop of the unfolding demographic transition.

Through this talk, Tumbe seeks to address various factors that affect India’s relatively slow pace of urbanisation, such as the inter-city variation in population growth rates, and the paradox of faster urban growth in the North combined with slower urbanisation in the South.

The question and answer session that followed can be accessed here. More information about the talk can be found on the event page.

INTRODUCTORY DISCUSSION OF THE CPR-TCPD (TRIVEDI CENTRE FOR POLITICAL DATA, ASHOKA UNIVERSITY) DIALOGUES ON INDIAN POLITICS
ELECTION STUDIES POLITICS

Watch the full video (above) of a short data-driven presentation by Neelanjan Sircar unpacking the results of the Karnataka elections, followed by a panel discussion between Sreenivasan Jain, Manisha Priyam and Sugata Srinivasaraju.

Bringing together experts from academia and media, the event analyses the electoral performance of the BJP (Bhartiya Janata Party), Congress (Indian National Congress) and JD(S) (Janata Dal-Secular) in Karnataka, and the relevance of the election outcome for the 2019 Lok Sabha election.

Neelanjan Sircar is a Senior Fellow at CPR.

Sreenivasan Jain is Managing Editor at NDTV.

Manisha Priyam is Associate Professor at the National University of Educational Planning and Administration (NUEPA).

Sugata Srinivasaraju is Co-Founder and Editorial Director at The State.

The question and answer session that followed can be accessed here.

The presentation from the event can be accessed here.

About the CPR-TCPD Dialogues

This was the first event in the CPR-TCPD Dialogues on Indian Politics series, launched in a partnership between Centre for Policy Research and Trivedi Centre for Political Data (TPCD) at Ashoka University. This is a monthly event that brings together academicians, policy and political practitioners, and civil society actors to grapple with important social and political issues in India. It provides a forum for intellectually rigorous, non-partisan commentary to strengthen public discourse on politics in India. In these polarised times, debates on politics in India have tended to be increasingly noisy, blurring the lines between critical engagement and partisan endorsement. This dialogue series is an effort to carve out a space for critical, nuanced engagement to understand the changing dynamics of Indian political parties, the impact of new and emerging social movements and the use of new instruments of mobilization in our polity.

India’s vaccination drive began in January 2021. The recent rise in daily COVID-19 cases and deaths however, has been worrying. What led to the second surge in the country? How has the vaccination drive fared so far? Is India’s vaccination strategy the correct one? As certain states account for majority of the cases, how should the government alter its approach to contain the spread of the virus? Partha Mukhopadhyay, Senior Fellow at CPR, who has been closely tracking the pandemic, sheds light in this interview.

What according to you are the reasons for India’s second surge? A few months ago, we witnessed a steady decline in new cases. What has happened?
The short answer is: we don’t know. The other answer is: it had to happen. The surprise in India was that cases were going down steadily since mid-September, even as behaviour was becoming less and less CoVID-appropriate. It had to happen sometime and it happened in early to mid-February.

If the nature of CoVID infections is heterogeneous, i.e., (i) a few people mix with a lot of people and most people mix with few people and (ii) a few infected people infect a lot of people and lot of infected people do not infect others (or very few), then, it is the case that these kinds of localised spurts in infections can happen as part of the evolution of the pandemic. This is one of the results that we showed in our paper. So, from that perspective, this is not unusual.

There can be other, more deterministic, explanations, such as a variant, infective strain such as the B.1.1.7 variant that appears to dominate samples from Punjab or super-spreader events like election gatherings. Not enough information is being released about variants and genomic sequencing to answer this question, but it is odd that the Maharashtra surge started away from the major metros of the Golden Triangle (Nashik, Pune, Mumbai) in the smaller towns of Vidarbha, which is less likely to have imported variants. These areas were holding Gram Panchayat elections and celebrations took place in late January, but this also sounds a little over-determined since a lot of gatherings have been taking place around the country. A number of cases in Maharashtra were also reported from school hostels, after re-opening.

There is no particular evidence that testing in some states were low relative to other states, though it did decline for all states. Nor are there striking differences in mobility across states. But, wherever it started, it is now clear that the spread is much wider, as seen in Figure 1. In panel A, it is seen that the positivity (people testing positive as a share of people tested) in February 10 – March 10 of 2021 is much less than that over the period November 10, 2020 – February 10, 2021, except for Maharashtra, which had already started rising by this time. However, when we look at March 10-25, compared to the Feb – March period, in panel B, we see a striking increase in positivity in many states, indicating the spread of the second surge.

It is perhaps useful here to address the issue of sero-positivity surveys and herd immunity. Some commentators attributed the decline that occurred over September to January, to growing herd immunity, pointing to the high level of sero-positivity found in many surveys. However, these surveys seem to be at odds with the current experience, for example, one of the worst hit cities at the moment is Pune, which also had some of the highest sero-positivity numbers reported. It is the same for Bangalore and, also to some extent for Mumbai. It is possible that the current cases are concentrated in particular social classes and age-groups, while the sero-positivity were in other social classes, e.g., slum residents, but this is not something we know without more information.

Even if this sero-positivity hypothesis is accurate, an unexplained part of the hypothesis was the large number of unreported infections – indicating that these were most likely asymptomatic or very mildly symptomatic, also explaining why there was such limited reporting and relatively little pressure on hospitals. In this surge too, a very high proportion of asymptomatic cases is being reported, well over 80% in Mumbai. There has been no explanation for why Indian cases should be so asymptomatic. It is not that infected persons are much younger, though the share of 50+ is about 7% lower.

Another pattern that seems to be repeated from the early days of the pandemic is that a large number of the deaths, while fewer, are happening relatively soon after coming to hospital, implying that they are reporting late or the progression of the disease is suddenly taking a very bad turn for the worse.

India started its vaccination drive in January 2021. How do you think it has fared so far?
We took our time. We first started vaccinating healthcare workers (HCW) in mid-January, then added frontline workers (FLW) in early February and did not open up to the broader population until March. This may have allowed our core vaccination application – CoWIN – to stabilise and be tested on HCWs and FLWs, so as to iron out any glitches before it was rolled out to the general population. We also expanded the range of places that were allowed to vaccinate, including private hospitals and clinics, for a relatively small fee.

On the positive side, apart from a few starting glitches, we seem to not have had the kind of chaos seen in the United States in terms of arranging appointments for vaccination (people who were unable to engage with the web or the app were able to walk in to vaccination centres where they were assisted to enrol and get vaccinated). On the negative side, we seem to be vaccinating below capacity (actual vaccinations well below peak vaccinations, no vaccinations on Sunday, etc.) and possibly focusing more on the urban and peri-urban areas.

Also, we are only using two vaccines, Covishield and Covaxin (about 10% of the vaccines administered). We may have been able to expand capacity if we had allowed import of other vaccines like Pfizer-BioNTech and Moderna, which may not have been usable in many areas but which could have expanded supply in larger cities and private hospitals. We could have also imported other, less expensive, vaccines proposed to be manufactured in India, such as Sputnik V, which could be administered more widely (though with trained vaccination personnel because of the need to reconstitute, like Pfizer-BioNTech). But, we may have been prevented from doing so due to supply limitations.

The final concern that I have is that there is almost no outreach, no exhortation to get vaccinated, none of the saturation do gaz ki doori, mask hai zaroori that we saw for non-pharmaceutical interventions during the pandemic. There is also no concerned effort to bring vaccination centres closer to the people, though this is happening at a local level in some places, e.g., vaccination camps in community centres, apartment complexes, etc.

We were fortunate to begin the vaccination drive at a time when CoVID cases were dipping. On 1st April, we opened up the drive to all individuals above 45, amidst a second surge. Do you think we should have inoculated as many people as possible earlier, while cases were low, to avoid this situation? Is this a missed opportunity of sorts?
Yes, we could have vaccinated over 100 million people by now, if we had been able to advance the vaccination process by a month, starting the general population in February instead of March, if the app and web platform was operational and the supplies in place. Broadly speaking our most vulnerable are the persons over 60 who account for over half our deaths and those between 45 and 59 who account for another one-third. Among these, the most exposed are those living in urban areas. There are about 40 million people in urban areas above 60 years of age and another 60 million between 45 and 59. So, by now, we could have given all of these people at least one dose of the vaccine, if they had chosen to come forward to be vaccinated.

Since we do not know the rural / urban mix of people vaccinated (even roughly, estimated, for example, by the location of the vaccination centre), we cannot estimate how many people in the target population chose to get vaccinated and how many did not, because of vaccine hesitancy (they do not want to be vaccinated) or vaccine inaccessibility (they would like to be vaccinated but the centre is inaccessible). This is a major shortcoming.

Already, from the data on both the continuing uptake of first doses among HCW and FLW, which should have been completed by February and the share of eligible HCW and FLW who have come back for their second dose, we can see that a significant minority may not be enthusiastic about vaccination.

India’s vaccination strategy has so far been to vaccinate the vulnerable age groups. However given that we see increased mobility (to workplaces, socialising etc.) in younger age groups, would it be fair to assume that they act as super spreaders? In such a scenario, shouldn’t the vaccination strategy target this age group to avoid the spread of the infection between them and from them to older, more vulnerable groups?
Actually, the assumption that younger people infect other people more does not have any empirical support – it is not that it is false, just that there is no evidence for it either way. Indonesia is trying out such a strategy of vaccinating the younger population first (including allowing the private sector to import vaccines and vaccinate its workers), but there are two critical differences to be noted, of vulnerability and feasibility.

As noted earlier, about 85% of the deaths are of people more than 45 years old. This is therefore, the more vulnerable population (in advanced countries, the share of deaths in the 45-59 age group is much lower; less than 5% in Europe, compared to more than 30% in India).
The age group of 45 to 59 comprise 14% of the urban population and that of 60+ comprise another 9%, whereas the 18 to 44 age group makes up 46% of the population, i.e., more five times the number of 60+ people. So, starting with this group is much more feasible.
The vaccination drive has been fairly centralised, with the government exercising strict control. Given certain states like Maharashtra account for the majority of the cases in the country, do you think different states need a different vaccination strategy?
States should definitely have discretion as to where they locate the vaccination centres, etc. and it is my understanding that they do have that flexibility. However, it is more difficult to start vaccinating certain groups in certain locations, earlier, e.g., 30 year olds in Maharashtra compared to other states. It should definitely be possible to do so, in a consultative manner with other states indicating that stopping the surge in Maharashtra is to the benefit of all states, but it is not clear whether that degree of trust and maturity in the federal system has been nurtured by the Union government, and I am not pointing just to this government.

If we had this level of trust and co-operation, we could have definitely prioritised one geography over another. There is some disagreement over which geography should be prioritised, whether it should be the one experiencing a surge, that I would advocate or the one that is vulnerable but not yet infected, e.g., Bihar, but that is a different debate.

This would also help us in deciding when we should expand deeper into rural areas, beyond the urban and urban periphery. Implementing a two-dose vaccination programme in such areas is administratively complex, especially since people are difficult to reach for their second dose, due to shared phones, etc. In such a situation, it may be better to wait for a single-dose vaccine like the Janssen (Johnson and Johnson) vaccine, which will also be manufactured in India, especially since much of rural India has not been touched by the pandemic (though it can be argued that it leaves them more vulnerable).

FULL VIDEO OF DISCUSSION
INTERNATIONAL POLITICS

Watch the full video (above) of the discussion between Ambassador Shyam Saran, Srinath Raghavan and Zorawar Daulet Singh, where they analyse the complicated relationship between India and China.

As the dust settles from the last year’s Doklam Standoff between India and China, relationship between the two neighbours has entered a state of flux. Even as domestic political priorities have come to the fore in both countries, India and China are discovering new spots of friction and struggling to evolve a sustainable framework of cooperation.

Against the backdrop of the latest diplomatic efforts by both sides to put the relationship on an even keel, Centre for Policy Research’s (CPR) in-house experts on Chinese and Indian foreign policy consider the geopolitics, strategy and economics underpinning this new conjuncture in India-China relations and its implications for the two countries, for Asia and beyond.

Ambassador Shyam Saran is a senior fellow at CPR, a former foreign secretary and has served as the Prime Minister’s Special Envoy for Nuclear Affairs and Climate Change, as well as chairman of the National Security Advisory Board.

Srinath Raghavan is a senior fellow at CPR. He is also a senior research fellow at the India Institute at King’s College, London.

Zorawar Daulet Singh is an author and foreign affairs analyst. He is a Fellow at the CPR. He is also an Adjunct Fellow with the Institute of Chinese Studies and a Visiting Fellow at the Forum for Strategic Initiative.

The question and answer session that followed can be accessed here.