Neglected issues

Here is my feature with audio clips on healthcare and election manifestos in the British Medical  Journal


Socially awkward

The greatest political show on earth has begun. India is in election mode. But many of us are in the dark about what actually lies ahead when a new government takes over.

Sophia Loren famously said, “Sex appeal is 50 per cent of what you’ve got and 50 per cent of what people think you’ve got.” The same can be said for election manifestos and campaign sales pitches.

Their success with voters lies as much in what they reveal as what they conceal. The greatest political show on earth has begun. India is in election mode. But many of us are in the dark about what actually lies ahead when a new government takes over.
There are good ideas in each manifesto. But given their late release (the Bharatiya Janata Party unveiled its manifesto as late as April 7, the day the nine-phase polls kicked off), and the din of discussions about which party is likely to get how many seats and where, there has been little time to dissect how the competing visions of India stack up in many critical areas? The niggling problems are the frustrating lack of detail in how lofty goals will be achieved, and strategic silence on some key issues.
As a citizen, there are a few issues I would like to flag before whichever party or parties form the government.
Take women’s safety and security. There has been phenomenal mobilisation around women’s rights in the wake of the tragic Nirbhaya case. The rape law has been strengthened. Women’s safety has become a talking point in political circles. A quick look at the manifestos show that political parties realise this is a big electoral issue this time. So many promises have been made. Both the leading national parties — the Congress and the BJP — have promised that they will pass the Women’s Reservation Bill if voted to power. Then there are promises on specific areas. For example, the Congress promises to open One-Stop Crisis Centres for women in all hospitals to provide medical, legal, psycho-social aid in cases of rape and domestic violence. But once such centres are established, who will be in charge of maintaining them? Who will make sure that there are trained personnel in such centres? What is the redressal mechanism if things are found wanting? There are no answers yet.
The same is the case with the BJP’s promise of women-friendly police stations and increase in the number of women in police at all levels. Just more policewomen will not suffice. They need to be trained. The kind of training they receive is also a key issue.
Unless the public asks searching questions on the nitty-gritty of the delivery mechanisms, nothing much will come out of any of these measures.
Now, come to healthcare. Most people in this country have to pay for medical treatment out of their pockets. The prospect of a medical emergency in the family terrifies even middle class people. Health insurance does not cover all the costs. A huge chunk (almost 70 per cent) of what people spend on healthcare in this country goes towards the cost of medicines. Manifestos of two political parties — the Congress and the Aam Aadmi Party — have promised the “Right to Health”. What will this mean in practice? The Congress manifesto commits to increasing “health expenditure to three per cent of the gross domestic product and provide universal and quality healthcare for all Indians.” The BJP says it will radically reform the health system, initiate a new National Healthcare Policy (the last one dates back to 2002), reduce out of pocket expenditure on healthcare and bring in a National Health Assurance Mission with a mandate for universal healthcare.
Grand visions alone will not solve the problems. Unless there is continuous monitoring and supervision at the ground level, big outlays will not translate into big outcomes no matter how well-intentioned the schemes. When it comes to bringing down the price of medicines, there are many things that can be done, i.e. the Tamil Nadu Medical Services Corporation’s model of centralised tendering and purchase of drugs. Local contexts, however, have to be always kept in mind. Despite all the talk about slashing out of pocket expenses on healthcare, access to cheap drugs has not been a major talking point in the run-up to the elections. Curiously, one thorny but related issue which has not surfaced in the manifestos (barring that of the Communist Party of India-Marxist) is Intellectual Property Rights and the challenges facing India’s low-cost generic drug manufacturers. India’s use of flexibilities in connection with intellectual property (IP) is being stoutly challenged by a section of the United States industry. Last week, a Reuters report noted that the United States was waiting for the outcome of elections in India to tackle complaints over Intellectual Property Rights from US businesses upset about Indian companies that produce cheap, generic versions of medicines. So far India has stuck to the argument that its laws and policies are its sovereign function. Interestingly, even as Washington critiques New Delhi for “ineffective” Intellectual Property Rights (IPR) regime, two of America’s major defence and civil aviation firms, Honeywell and Boeing, have come out strongly in support of India’s IPR regulations. Given the high stakes, the new government in Delhi will have to carefully weigh the overall costs and benefits of the position it takes, and the public needs to be kept clued in on the trade-offs.
The third item in this shortlist being flagged is education. The United Progressive Alliance brought in the Right of Children to Free and Compulsory Education Act (RTE) in 2009. But despite levying a tax to fund education and bringing forth a law to ensure access to education for all children between the ages of six and 14, learning outcomes have not improved. Surveys such as the Annual Status of Education Report (ASER), prepared by the NGO Pratham Education Foundation, show that while enrollment levels have made significant strides with 97 per cent of children now in schools as compared to 93 per cent in 2005, there are severe problems in the quality of what children are learning in key areas — reading, writing and arithmetic.
The UPA’s critics have used this to slam the rights-based approach. But was the UPA’s fatal flaw really its welfarist legislation or was it corruption and poor implementation on the ground?
The public is a lot more alert today. After the honeymoon is over, the new government in Delhi will also be subjected to the same intense scrutiny as the outgoing one. At the end, it will boil down to just one issue. It is the implementation, stupid.

The writer focuses on development issues in India and emerging economies.
She can be reached at


My  latest  column in The Asian Age

War’s begun, where’s the plan?

While soundbites and slogans are aplenty, absence of any urgency in bringing out poll manifestoes on the part of major political parties has left us with little time to reflect on the specifics of the vision of each party on critical issues.

If elections come, can war imagery be far behind? With barely two weeks to go before India’s 16th Lok Sabha polls kick off, battle cries rent the air.

To be in combat mode, you don’t have to necessarily plunge into the heat and dust of the battleground. A quick skim of the headlines, an hour or two in front of the TV, or on Twitter if you prefer, would do as well.
The battle for the 80 Lok Sabha seats in Uttar Pradesh is set to be fought in the skies, we are told, as all major political parties have lined up helicopters and small aircrafts to criss-cross the sprawling state. Seats are turning into battlefields. Unless one has been living under a rock, one would not have missed hearing that Varanasi will be the mother of all battles in the coming elections with Aam Aadmi Party leader Arvind Kejriwal pitting himself against Bharatiya Janata Party’s prime ministerial nominee Narendra Modi from this holy city. Nor for that matter the un-hushed whispers about Barmer and a soldier possibly turning renegade in his final battle.
Battleground paraphernalia include slogans, jingles, posters, banners, SMS, street theatre, even ink and eggs. All this, of course, makes for a colourful mix of politics and spectacle which gives elections in the world’s largest democracy its famous carnival-like atmosphere.
Campaigning is in full swing. But on the eve of a general elections widely touted as the most critical since 1977, should not one be also asking some fundamental questions? Where are the details in the competing visions on the basis of which one is expected to make an informed choice? Where are the specifics of how the respective visions are to be funded? If aspiring prime ministers can dress up in presidential garb, should we, the voters, not also demand US-style presidential debates between the various contenders?
The debate on election manifestoes is yet to start because till the third week of March, only a handful of political parties had come out with theirs.
On Wednesday, the Congress Party released its poll manifesto (Your Voice, Our Pledge) in an eagerly awaited ceremony attended by Prime Minister Manmohan Singh, Sonia Gandhi, Rahul Gandhi and the party’s top brass. The party has offered a 15-point agenda for socio-economic and political transformation including a charter of rights such as the Right to Health. The BJP and the AAP would also release their manifestoes by the end of the month says the political grapevine. That gives voters in Delhi, for example, just a few days to chew on their contents, to ask tough questions and to demand answers from candidates. In this nine-phase elections, voters in 122 Lok Sabha seats which go to polls in 13 states on April 17 will also have barely a month to digest the contents of the manifestoes and interrogate their candidates.
This brings one to the critical question many have been asking. Do election manifestoes matter?
Or do all manifestoes read alike, the difference lying only in cover pages showing the names and election symbols of the respective parties, as the late Chaudhary Devi Lal, the Jat supremo, former chief minister of Haryana and briefly deputy Prime Minister of India famously quipped.
It is tempting to be cynical.
India in poll mode means high decibel election coverage on television about which politician is defecting to which party, who is being nominated or not nominated to which seat, who is sulking and why. Every evening, television offers a choice of shouting matches in different languages.
Much of the discussion so far has been on the Modi wave, Mr Gandhi’s dilemma, the AAP challenge and regional aspirations. We are asked to choose between different Messiahs. But none has offered a fine print of the rescue narrative nor a realistic assessment of how existing bottlenecks can be tackled and the resources needed to accomplish the task.
Perhaps, there is an element of truth in the sceptic’s observation that Indian voters choose leaders and leave it to them to decide the priorities of governance. But a good many of us are frustrated that while soundbites and slogans are aplenty, absence of any urgency in bringing out poll manifestoes on the part of major political parties has left us with little time to reflect on the specifics of the vision of each party on critical issues such as rejuvenation of the economy, investments in the social sector, in education and health, women’s security and safety etc.
Those involved in the drafting of the poll manifestoes have a different take. This time, political manifestoes are being used as a key tool for gauging the public mood. Political parties are also mindful of how manifestoes will be used against them in the post-elections phase. A member of BJP’s manifesto team told this writer that “manifestoes are important because there is much more media and public scrutiny today. One has to be very careful what one puts in it because one year down the line, newspapers and TV channels will come up with a report card — you promised this but you delivered something else…”
No doubt, today, manifesto making is as much about formulating a party’s agenda for governance as a strategic tool of interaction with key segments of the voting public.
The AAP popularised he idea of “crowd-sourcing” manifestoes. Many national political parties have followed their example. All this is good even it is making the process of manifesto-making matter more than the outcome.
But there is no getting away from the nitty-gritty of making an informed choice. For the first time, the Election Commission of India has brought manifestoes within the ambit of the model code of conduct. “In the interest of transparency, level-playing field and credibility of promises, it is expected that manifestoes also reflect the rationale for promises and broadly indicate the ways and means to meet the financial requirements for it. Trust of voters should be sought only on those promises which are possible to be fulfilled,” the EC order said.
This means that grandiose promises would need to be accompanied by a blueprint of the delivery mechanism.
Voters should not allow themselves to be shortchanged. There is still time to raise concerns which normally get buried in the sound and fury of the election season, and to ask those who seek our votes not only what they are against, but what they are for, and how they propose to fund their vision.

The writer focuses on development issues in India and emerging economies.
She can be reached at




Other columns touching on issues reverberating in India as it gears up for the 2014 general elections


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