The real C-word in healthcare

The Asian Age & Deccan Chronicle

The real C-word in healthcare

http://www.asianage.com/columnists/real-c-word-healthcare-133

 

3 July 2014

What is the most relevant ‘C’ word in India’s healthcare system today? Is it condoms, crudity in sex education or corruption? For most people in this billion-plus country, it is corruption.

If there is one thing that gets everyone in this country raging even more in the mid-summer heat, it is talk about sex and sexuality. No surprises then that health minister Harsh Vardhan’s recent statements about sex education and condoms have stirred the pot.

The minister says he is against “crudity” in sex education programmes. He also thinks that “condoms promise safe sex, but the safest sex is through faithfulness to one’s partner”.
We have been down this road before. The debate on what is, or is not, “crudity”, and condoms versus fidelity will continue till the cows come home. Sensibilities vary massively. But while we are on the topic, will the good doctor explain what he considers “crude” in sex education?
Lost in the cacophony is the larger question. What is the most relevant “C” word in India’s healthcare system today? Is it condoms, crudity in sex education or corruption? For most people in this billion-plus country, it is corruption.
Out-of-pocket healthcare expenses in India are among the highest in the world. A medical emergency is a catastrophe plunging families into deep debt, even impoverishment. The situation is exacerbated by the widespread corruption that permeates both public and private sector. In 2010-11, the deaths of three medical officials in Uttar Pradesh sounded the alarm on the organised looting of government funds that crippled the flagship National Rural Health Mission in the state, which has some of the worst health indicators. Last month, the All-India Institute of Medical Sciences (AIIMS) suspended 14 of its staffers and fined 50 others for corruption and absenteeism. The employees whose services were terminated included clerks and housekeepers. But graft is not confined to the lower levels. Private sector hospitals in the country are notorious for prescribing unnecessary tests from private laboratories.
A recent article in the prestigious British Medical Journal, titled “Corruption ruins the doctor-patient relationship in India”, has triggered a frisson by drawing public attention to the ghoulish underbelly of India’s healthcare system, honourable exceptions notwithstanding. In the article, David Berger, a district medical officer in Australia, who worked as a volunteer physician in a charitable hospital in the Himalayas, offers a first-person account of how the system works at the ground level: “I saw one patient with no apparent structural heart disease and uncomplicated essential hypertension who had been followed up by a city cardiologist with an echocardiogram every three months, a totally unnecessary investigation. A senior doctor in another hospital a couple of hours away was renowned for using ultrasonography as a profligate, revenue earning procedure, charging desperately poor people `1,000 each time. Everyone who works in healthcare in India knows this kind of thing is widespread.”
Berger’s observations have created ripples across the public health community the world over but it does not come as a surprise to anyone who has a nodding acquaintance with how the system works in this country.
Writing in the Indian Journal of Medical Ethics last year, Subrata Chattopadhyay, head of the department of physiology at the College of Medicine and JNM Hospital, West Bengal University of Health Sciences, listed the forms of corruption in healthcare and medicine. This could include but were by no means limited to bribes and kickbacks paid by individuals and firms.
The reasons are many — to procure government contracts, leases or licences for the construction of healthcare facilities, for the supply of medicines, goods and services, as well as to ensure the terms of their contracts. There is also a racket to rig the bidding process, manipulate and falsify records, and modify evidence to give the appearance of it being in compliance with the norms of regulatory agencies. There are even cases of “speeding up” the permission to carry out legal activities, such as obtaining institutional affiliation, company registration or construction permits. There are cases of influencing or changing legal outcomes to avoid punishment. The long list includes outright theft and embezzlement.
Mr Chattopadhyay says public assets and instruments in government hospitals may also be intentionally damaged so as to make them unavailable to patients, with the ultimate aim of ordering the services from private clinics in return for commission. Then there are the ever-familiar informal payments even where healthcare services are supposedly free.
Corruption is also prevalent in clinical research. In some private hospitals, physicians have contractual obligations to admit a fixed number of patients to allotted beds and prescribe a number of laboratory investigations (even if unnecessary) to generate revenue.
All this has far-reaching consequences on patient care, clinical research and medical education. So where do we go from here? T. Sundararaman, adjunct professor (public health) at Jawaharlal Nehru University and National Convenor of the People’s Health Movement, points out that most countries which have a functional healthcare system have checks and balances to deal with kickbacks and referrals. Even the United States, where healthcare facilities are largely owned and operated by the private sector, has the federal Anti-Kickback Statute and the Stark Law.
The Stark Law prohibits a physician from referring Medicare and Medicaid patients for designated health services if the physician (or an immediate family member) has a financial relationship with the entity to which the patient is referred, unless an exception is met.
It is not that India has not tried. The Clinical Establishments (Registration and Regulation) Act, 2010, was enacted to register and regulate all clinical establishments in the country with a view to prescribing the minimum standards of facilities and services provided by them. But as of now, the law is not applicable throughout India. Only a handful of states have rolled it out.
The Modi government was swept to power on an anti-corruption wave. It has promised to significantly reduce out-of-pocket expenses on healthcare for the common man, a new national health policy and better regulation of medical education, as well as the pharmaceutical market. It would be impossible to operationalise this grand vision without tackling the most crucial “C” word — corruption.
As a doctor and a seasoned politician who pioneered many health interventions in Delhi, Dr Vardhan surely knows the challenges ahead. Will he make a serious attempt to cleanse the stable?

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

Fear and sexual violence in aspirational India: Lessons from Badaun

]http://www.asianage.com/columnists/shackled-fear-143

 

Amid all the talk about unleashing animal spirits, better roads, bridges, flyovers, highways and so on, one persistent worry cannot be wished away. Even if the spirit soars and the economy surges, what happens to that slice of young, aspirational India at the bottom of the social structure which is currently cowering in fear?

Many are afraid to step out of their homes; many are dropping out of school. How do they get a bigger slice of the pie if they are effectively denied mobility?
That this is not alarmism is borne out by last week’s savagery in Badaun, Uttar Pradesh, and a string of similar incidents in the state over the past few days. The two cousins, aged 14 and 15, who were abducted, gangraped and left hanging from a mango tree in Katra Sadatganj village of Badaun district also had aspirations. They were smashed. “She was always studying and working. That’s what she liked best. She wanted to be a doctor,” the father of one of the girls told a reporter.
The victims did not have a toilet at home, like 665 million out of India’s 1.2 billion people, and were forced to step out in the dead of night. Clearly, toilets for all are vital. But alongside access to sanitation, we must stress the importance of access to basic justice. This is not a given for everyone in this country. The father of one of the girls sought police help to find them, but for hours the policemen on duty refused to investigate or even register the complaint. The suspects are from the politically powerful Yadav community to which the chief minister belongs. Now under intense pressure, the Uttar Pradesh government is talking about fast-track justice. Arrests have been made and bureaucrats transferred. But what happens once public attention fades and the media is on to the next story, the next atrocity? Who guarantees the safety of the families under the scanner and of the villagers who are being brazenly threatened?
As mother of a teenage daughter, my initial feelings were of revulsion and outrage. Then came anger. This has happened before, many times. There have been marches, protests, debates and new legislation. Delhi had its Nirbhaya moment. Today, the focus is on Badaun and Uttar Pradesh. And yet the culture of impunity continues. Asked about her wish for the future, my 15-year-old says “a safe city”, without blinking.
How will the aspirational India story take off if young girls do not feel safe in many parts of the country? Why does much of the political class not see this as a serious problem?
Law and order is a state subject and Uttar Pradesh is justifiably in the dock for the brazen callousness of the administration. Chief minister Akhilesh Yadav wondered aloud why journalists were so bothered about Badaun when their own personal safety was not compromised. His father Mulayam Singh Yadav told a recent election rally that he opposed death penalty for rapists. “Boys will be boys… They make mistakes,” he said. Since Katra Sadatganj jumped to headlines, many similar horror stories have been reported, including another gangrape at Azamgarh, the constituency of Mulayam Singh Yadav.
Clearly, what happened in Katra Sadatganj is not an isolated instance. It is only the latest illustration of the violent sexual assault and murder of young girls from the poorest and most marginalised communities. Dalit women have been targeted in Maharashtra, Haryana, Rajasthan and many other states.
Women and child development minister Maneka Gandhi has promised to set up Rape Crisis Centres. That is good, but a lot more needs to be done to avert such crises. What will the Centre do to prevent such violence? What are Prime Minister Narendra Modi’s thoughts on the matter?
There is a shared anxiety among women across India. But those at the bottom are the most insecure. Dalit women and girls face the triple burden of gender, class and caste. Several dalit activists I spoke to over the past week were unequivocal in their views.
“This is revenge violence. A war is being fought over the bodies of dalit women. Every time dalits have tried to inch forward a little, we have seen the backlash. There is acute fear of dalit aspiration. Violence strikes when there is dalit mobility,” says Asha Kowtal, the general secretary of the All-India Dalit Mahila Adhikar Manch.
Khalid Chaudhry, who oversees NGO ActionAid’s interventions in Uttar Pradesh and Uttarakhand, argues that though the victims were from the Shakya community — not included in the list of Scheduled Castes in Uttar Pradesh, their lives were as harsh as that of the dalits with whom they lived cheek by jowl.
With 11.9 million children (ages 6-13) not in school, India has a mammoth challenge ahead. “The situation is exacerbated by the violent and sexual attacks on girls. One of the immediate impacts of savagery such as the one in Badaun is further restrictions on mobility. When something like what happened in Badaun takes place, there is further pressure on girls to drop out and stay at home,” says Mr Chaudhry.
Thirty-five-year-old Smita Devi from Bhagana village in Haryana’s Hisar district, now camping in Delhi, tells me that dalit girls in her village do not want to go to school and want to move to the town where they think they will be safer, especially since four young girls from the community were abducted and raped by five men from the Jat community. The story grabbed headlines earlier this year. The victims were dumped near Bhatinda railway station in Punjab after the crime. As in Badaun, the families of the victims say they have had enormous problems getting justice. At the heart of the conflict in Haryana is the struggle over land. Dominant castes are trying to grab land owned and used by poor dalits.
Middle-class girls won’t be asked to drop out of school but many forego opportunities because they don’t feel safe to move around.
What should be done?
The Central Bureau of Investigation is likely to probe the savagery at Badaun. It is important to make sure that the correct provisions of the concerned laws are applied so that the case is not weakened and those being pressured know their legal rights. It is equally important to follow up as the case wends its way through the tortuous layers of the Indian justice system. It is vital to keep talking about Badaun and similar incidents so that the Centre and various state governments work together to protect India’s women and girls. That will truly respect the spirit of aspirational India.

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

Does it really matter if the victims of Badaun were Dalit or from the weakest sections of what we call “Other Backward Castes”

There is some confusion whether the teenaged girls in Badaun were Dalits or the lowest among Other Backward Castes. I have got conflicting responses from people. When I wrote this column, the overwhelming view was that they were Dalits. I think the core issue does not change. It is the extreme and socially tolerated oppression of the weakest by those with muscle power, clout, political patronage. 

Death comes easy

My  thoughts on the abduction, gang-rape and hanging of the two teenaged girls in Badaun. Also posting an English version for those who don’t follow Hindi.

http://www.amarujala.com/news/samachar/reflections/columns/patralekha-chatterjee-article-8/

 

 

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What is a greater crisis? When buffaloes of a state minister go missing from a farmhouse or when two teenage girls from a Dalit family do not return home after going to the field to relieve themselves in the middle of the night, and a distraught father pleads for help? Most readers would recall the swiftness with which the Rampur police swung into action when seven buffaloes of Azam Khan, Samajwadi Party leader and minister in the Uttar Pradesh government, were reportedly stolen from his farmhouse earlier this year. Contrast this with the slow response of the police in Badaun where a gruesome crime took place last week.

The story has sent shock waves through the nation. In a grim replay of a familiar pattern, two Dalit girls, cousins aged 14 and 15, were abducted, gang-raped and subsequently found hanging from a tree in Katra village in Badaun, UP. The teenagers may have been saved had the police acted on time. There was no toilet at home; the girls had stepped out to relieve themselves. The father of one of the girls sought police help to find them, but for hours the policemen on duty refused to investigate or even register the complaint. The next morning, the girls were found hanging from a mango tree near their houses. Autopsies indicate that both had been gang-raped and strangled.

Under pressure to act, UP’s Samajwadi Party government finally arrested five men, including two policemen. There is also talk of a “fast track” court. But the problem is the entire system, under which a policeman’s promotion depends on how few cases he registers, quite apart from the caste-based protection alleged against one of the arrested policemen.

While talking about the gruesome murder at Badaun, one must not miss the larger picture. This is not an isolated case. It is only the latest reminder of the utter vulnerability of Dalits, especially its women and girls, in India’s highly patriarchal and caste-based society even today. Despite constitutional guarantees and legislation, Dalit women continue to bear the triple burden of caste, class, and gender. The greater worry is that the political class in much of India does not see this as a serious problem. Akhilesh Yadav, the Uttar Pradesh Chief Minister ,wonders why journalists are so bothered about this case when their own personal safety is not compromised. Mulayam Singh, the Samajwadi Party supremo and father of the chief minister, told a recent election rally that he opposed the death penalty for rapists. “Boys will be boys… They make mistakes,” he said.

This week, Uttar Pradesh is in the dock, with reports of another gang-rape in Mulayam Singh Yadav’s own constituency Azamgarh, and the mother of a rape victim being beaten up by the father of a rape accused in the Yadav family’s pocket borough of Etawah. But the problem of atrocities against Dalits and the weakest in our society is not confined to the state.

What should be done?
Searching questions need to be asked all the time. As Namrata Daniel of All India Dalit Mahila Adhikar Manch puts it, there is a need to focus on details. “At core, the struggle is about access to justice. The police are reluctant to register a First Information Report (FIR). In the cases when they do register a FIR, there is a reluctance to use the Scheduled Castes/ Scheduled Tribes (Prevention of Atrocities) Act approved in 1989 which has stringent provisions.”

Victims of atrocity under this act are entitled to compensation and benefits of several other provisions.The compensation varies between Rs.20,000 and 2 lakh. But as Daniel points out, getting the compensation is a big challenge. And without it, victims are often unable to sustain themselves and fight long, tortuous legal battles.

Lenin Raghuvanshi, a Dalit rights activist working with the People’s Vigilance Committee on Human Rights (PVCHR), says the government should appoint a state nodal officer and district nodal officer in conflict-prone districts to register cases which police are not heeding. Police reforms, he says, should be the top priority.

What can the rest of us do? The most important thing to realise is that such crimes are due to a culture of impunity. Those at the bottom of the socio-economic ladder like the Dalits are often too scared or too powerless to protest. After initial outrage, the rest of us are too busy to care. Violence against women becomes “invisible” as public attention shifts elsewhere. This must not be allowed to happen this time. We must keep talking about Badaun and all those places where atrocities have happened and keep up the pressure

What can India’s new government learn from Asia’s tiger economies?

Boost human capital

The bald fact is that a country that simply has many young people will not automatically gain from the potential economic benefits of the demographic dividend

The suspense is over. A Narendra Modi-led Bharatiya Janata Party has swept back to power in New Delhi with the biggest mandate any party has won in three decades.

Of the 814.59 million registered to vote in the just-concluded general election, close to 100 million were first-time voters. Millions of these young Indians voted for 63-year-old Mr Modi because they believe that he has the magic wand to economic prosperity. These youngsters are now impatiently awaiting an India where there are jobs for everyone and where all their hopes and aspirations are fulfilled.
What will Mr Modi do to tackle the myriad challenges confronting this diverse nation of 1.25 billion people running in multiple speeds? Clearly, the economy will be on top of the new government’s agenda. In the coming days, a slew of measures would seek to bolster a business-friendly image, to instil confidence in foreign investors and to reign in inflation.
The buzz among the commentariat is about India’s swing to the Right. Indeed, thorough his election campaign, Mr Modi himself has talked a lot about “minimum government, maximum governance”. There is much talk about India’s demographic dividend.
But is India in a position to reap the potential benefits of a demographic dividend? What can India learn from Asia’s successful market economies?
During the election campaign, the BJP emphasised the need for a trajectory that would yield benefits from the demographic dividend of a youthful population. If manifesto-speak is to be taken seriously, a BJP government would “take up skill development on a mission mode, at an unprecedented scale”. The BJP’s manifesto also spoke of transforming employment exchanges into career centres and starting industrial training institutes for women.
All this is good. But can skill development on a mass scale be meaningful if millions remain without basic and quality education? Amid all the heady talk of a new era, few want to hear the stark truth — India is home to the world’s largest population of illiterate adults. India’s literacy rate has growth from 12 per cent at the time of Independence to 74.04 per cent in 2011, but this is way below the global average literacy rate of 84 per cent. Disconcertingly, there is also a huge gender disparity in India’s literacy rate: 82.14 per cent of India’s males are literate. The corresponding figure for women is 65.46 per cent. India’s low female literacy rate has adversely impacted the country in many ways including in its efforts to stabilise its population. The magnitude of the challenges ahead can be understood if we also recognise that national statistics don’t tell the full story and there are big differences between states.
The bald fact is that a country that simply has many young people will not automatically gain from the potential economic benefits of the demographic dividend

India can take a leaf out of the successful market economies of Asia. Each and every country that has become an economic power in the region has invested in boosting the human capital of its people. Take Japan, a country with which Mr Modi has had excellent relations. As has been pointed out by scholars, soon after the Meiji Restoration in 1868, there was a concerted effort to make Japan into a modern society. One of the radical challenges was universal elementary education for boys and girls. The aim was to make Japan into a fully literate society within a few decades. In successive years, Japan improved its living standards and labour productivity through investments in education and healthcare.
Or turn to East Asia. The region’s market economies realised that public investments in healthcare and education were crucial for the creation of a healthy, productive workforce and improvements in overall economic output.
What about China? Can India ever overtake China? It may seem like an impossible dream at this point, but nothing is impossible as the Modi story itself has proved. Alongside measures to boost India’s business-friendly image and ramping up infrastructure, the Modi government also needs to look at what China has done to provide essential public services to its people. Both countries suffer from huge disparities but China has shown much greater political will to expand general education and secure healthcare for its people. India has some of the best schools and institutions of higher education, but the education that is available for the vast majority is of low quality. This has to change if India wants to take on China. If India wants to compete with China as a manufacturing power, it must work hard at producing a better-educated and healthier labour force at all levels of society.
The bottomline: human capital is just as important as infrastructure and business-friendly policies when it comes to a country’s competitive edge. The late Gary Becker, Nobel laureate and world-renowned American economist once summed up the critical role of human capital thus. “Human capital,” he said, “refers to the skills, education, health and training of individuals. It is capital because these skills or education are an integral part of us that is long-lasting, in the way a machine, plant, or factory lasts. If you look at Korea, for example, all the coal is in North, not South Korea. Prior to the Korean War, the north was the richer part of Korea. Today North Korea is an economic disaster while South Korea is a very prosperous, democratic nation. South Korea prospered, I believe, mainly because it was able to utilise and promote the talents of its population effectively…”
Will India under Mr Modi be able to utilise the talents of its population? The jury is out.
Asia’s successful market economies show what is possible. Once these countries too wrestled with challenges that confront India. But political will and national resolve helped them reconfigure themselves as economic success stories where the vast majority had access to the basics.
Legislation alone will not do the trick. For example: India has a Right to Education but various evaluation reports tells us that for millions of children, the classroom is not offering education. Alongside the illiterates, we have a large number of semi-literates
The government alone cannot do every thing. But it needs to take the lead in critical areas like health and education. Historically that is the proven method.
There are no short cuts to development. Mr Modi has the mandate to do whatever he wishes to. It is a rare chance. Here is hoping he will live up to the promises he made and the promise that India’s youth bulge offers.

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

http://www.asianage.com/columnists/boost-human-capital-309

The future of welfare schemes in India

My  latest  column

 

The welfare story

DC | Patralekha Chatterjee | May 08, 2014, 01.05 am IS

 

In more tranquil times, one might have trilled “Que Sera Sera, whatever will be, will be.” But in frenzied, election-mode India, the words have changed. The impatient are demanding: What will be?

If you go strictly by the ill-tempered spats between various ideologues in public over the past few months, India’s future is teetering precariously between two trajectories — the growth economy and the welfare state. But is it?

As the parliamentary elections draw to a close, and one awaits a new government, this nagging question does not lend itself to easy answers. Fiscal hawks have been setting off alarm bells about the United Progressive Alliance’s social welfare policies for long. They argue that India, with its economic slowdown and crumbling business confidence, can ill-afford freebies, and that when a business-friendly government takes over, such “sops” should get short shrift.

But development experts point to the likelihood of a more complex picture.
If there is a Bharatiya Janata Party-led coalition government at the Centre, as is widely expected, economic growth and infrastructure development will be the top-line items of the administration. And flagship welfare schemes are unlikely to face the axe. In other words, Modinomics, post-elections, could turn out to be somewhat different from what many Modi supporters have been clamouring for.

“No government in Delhi will abandon welfare schemes in the near future,” says Prof. Alakh N. Sharma, director, Institute for Human Development, a Delhi-based think tank. Mr Sharma says existing welfare schemes will be reviewed and fine-tuned, not junked. There may be greater emphasis on direct cash transfer, possibly new approaches and initiatives. A review of welfare schemes has become necessary in light of changing circumstances no matter who forms the government. Mr Sharma says that even if the Congress-led UPA were to return to power, it would be compelled to revisit some of its landmark schemes like the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), the massive public works programme launched in 2005. In many states, more people are now educated, the labour market has changed and MGNREGA is not that relevant. But for backward districts in the country mired in pools of poverty, such a scheme still provides a life support system, Mr Sharma argues.

Some development analysts assert that the BJP has run with the economic growth narrative, pushing its welfare legacy in the background because of poll politics. Economic growth is where Gujarat and BJP’s prime ministerial nominee Modi scores. However, once elections are over, hard-headed pragmatism will settle in and a more calibrated policy atmosphere is likely to take root.

Another noted development expert, Dr Vinoj Abraham of the Thiruvananthapuram-based Centre for Development Studies, agrees that there is little chance of welfare schemes being tossed out by the new dispensation, especially in poor, backward regions of the country. There are just too many extremely poor people.

“Buyers, not sellers, drive growth. Welfare schemes offer minimum social protection. If people don’t have money, what will they buy? In the long haul, economic growth can lead to huge expansion of jobs and generate disposable incomes. But this will take many years. The crucial question is ‘what kind of economic growth will we get?’” asks Dr Abraham.

Dr Abraham and Mr Sharma both stress that there is no evidence to suggest that the people in this country are turning against welfare schemes. Voters, they say, are rejecting corruption, poor execution and the slowdown in governance, particularly during the last few years of UPA-2.

While travelling across southern India researching MGNREGA, Dr Abraham found that people wanted more, not less government initiatives in areas like education and food security. They also demanded that the loopholes be plugged so that the public benefits from public funds.
In an interview this week, Mr Modi himself gave an inkling of the nuanced shape of public policy if he and his party succeed in forming the government. On MGNREGA, viewed by many as the ultimate Budget-busting handout,  Mr Modi had this to say: “We are committed to the effective implementation of MGNREGA. However, there is a need to analyse the costs and benefits in a professional manner. Experts should be asked to find out the loopholes and plug them…”

Mr Modi pointed out two key gaps in the scheme, as he saw it: it did not create much durable community assets; it needed to be seen if part of the public funds allocated for MGNREGA could be used for rural housing, sanitation, skill generation to unemployed etc. That is hardly a toss-out into the dungeon.

Indeed, though the UPA’s “handouts” and welfarist vision have been savaged by many economists sympathetic to Mr Modi, the examples of BJP-ruled states show that the party itself has no illusions about the political and economic realities which underpin welfare measures in India. BJP leaders have picked up bits and pieces of the Congress package and run with them.

During last year’s Assembly elections in BJP-ruled Madhya Pradesh, media reports noted that local health officials admitted that the National Rural Health Mission (NRHM), a UPA flagship programme focusing on maternal and child health, was the main source feeding many health schemes in the state. But the Shivraj Singh Chouhan government was able to communicate its ownership of the idea of promotion of institutional delivery.

In Chhattisgarh, another BJP-ruled state, the state government has been openly welfarist. The state government started the Saraswati Bicycle Supply Scheme back in 2004 to slash the dropout rate among high school-going girls. Though the state government can be faulted on many scores, doling out free bicycles did help push female attendance. Chhattisgarh was also smart enough to derive political mileage from its own version of the public distribution scheme when the UPA was under attack for its ambitious food security legislation. Even noted development economist Jean Dreze, no lover of the BJP, has publicly lauded Chhattisgarh’s political decision to prioritise food security.

So what is the future of welfare policies? It is not as good as many diehard welfarists may want. But neither is welfare likely to become a cuss word any time soon in India.

The Congress, now on the backfoot, had a welfare story to tell. It did not. What muddied the narrative? Corruption and implementation glitches. Not the principle underlying the social protection policies.