The economic liberalization during the last couple of decades led to impressive economic growth and poverty reduction in many developing countries. This period has also witnessed worsening of income inequality and widening of spatial disparity (World Development Report (2009); Kanbur and Venables (2005); Kim (2008)). There is considerable worry among policy makers about the extent to which this rise in spatial inequality is due to increasing disparity in opportunities in terms of provision of basic infrastructure and services. The recent growth and poverty reduction experience places Bangladesh as an exception to this trend of increasing spatial inequality. Bangladesh made significant strides in poverty reduction between 2000 and 2010 with incidence of poverty falling from 48.9 percent to 31.5 percent. During the same period, the incidence of poverty declined more than proportionately in traditionally poorer regions, reducing welfare gaps across regions. There is also no evidence of significant change in overall inequality over the same period. What made spatial disparity in Bangladesh to decline while its economic growth accelerated substantially? What were the sources of decline in spatial disparity in welfare?
In the policy discussions related to hunger, malnutrition, poverty and wellbeing, calorie intake is often the focus. Increasingly, however, micronutrient malnutrition appears to be a critical problem in many developing countries. Women and children are most vulnerable to micronutrient malnutrition due to their elevated micronutrient requirements for reproduction and growth. According to some estimates, nearly three billion people (including 56% of the pregnant and 44% of the nonpregnant women) suffer from iron deficiency anemia (IDA), and one-third of the world's population suffer from zinc deficiency. Twenty percent of the maternal deaths in Africa and Asia are due to IDA. One in every three preschool-aged children in the developing countries is malnourished. Undernutrition, coupled with infectious diseases, accounts for an estimated 3.5 million deaths annually. At levels of malnutrition found in South Asia, approximately 5% of GNP is lost each year due to debilitating effects of iron, vitamin A, and iodine deficiencies alone.
“People want to work, not fight,” said Nadir Ali, a male shopkeeper in Kabul, Afghanistan, in one of the discussion groups of the Moving out of Poverty: Rising from the Ashes of Conflict report. For many, like Nadir, work is a crucial part of their existence. However, in many parts of the world conflicts and violence prevent citizens from working as they destroy communities, institutions, infrastructure and human capital. Not surprisingly, they represent a major challenge to job creation, as highlighted by the 2011 World Development Report (WDR) and the forthcoming 2013 WDR.
South Asia has experienced high levels of conflict over the past decade. More than 58,000 people were killed in armed conflict worldwide in 2009; at least a third of them were in South Asia.1 Ongoing conflicts in the region include the conflicts in Afghanistan and Pakistan, insurgent movements in India’s northeastern regions, and the violent activities of left-leaning groups in the eastern and central parts of India. Nepal and Sri Lanka are recovering from long-lasting civil wars. In a recent paper prepared for South Asia’s first regional flagship report "More and Better Jobs," we examine the key challenges to job creation in conflict-affected environments, using household and firm level surveys from South Asian countries.
The role of the Indian government in helping foster the success of India’s IT industry is a point I disagree with Kalpana Kochhar about. Kalpana, World Bank regional Chief Economist for South Asia, posted a comment disagreeing with my views on the subject on ‘Africa Can Reduce Poverty’. Following is my counterpoint to her:
India experienced sustained economic growth for more than two decades following the economic liberalization in 1991. While economic growth reduced poverty significantly, it was also associated with an increase in inequality. Jean Dreze and Amartya Sen (2011) argue that Indian economic reform has been “unprecedented success” in terms of economic growth, but an “extraordinary failure” when it comes to improvements in the living standard of general population and social indicators. The contrasting news reports on billion dollar house (Mukesh Ambani’s house at Mumbai) and farmers’ suicides have brought the issue of income inequality to the spotlight for many people. Does the increase in inequality in post-reform India reflect deep-seated inequality of opportunity or efficient incentive structure in a market oriented economy?
Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.
In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.
More than health insurance for the poor
In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.
a) “Actors”, and their rights and responsibilities
Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.
India’s health system faces some major challenges. In some respects, the hill India’s health system has to climb is steeper than that facing other developing countries. The good news is that the innovation that India is famous for in other sectors, as well as in health technology, is now starting to make itself felt in the health system. Not only may these ideas benefit India’s poor; they may also provide food for thought for other countries.
In this post, we sketch out the challenges facing India’s health system. In the next two, we outline two innovative approaches—one government, one private—in the state of Andhra Pradesh.
For the last two years, there has been a mystery about the evidence supporting the past favorable assessments of the scope for reducing poverty using microfinance instruments such as the famous Grameen Bank (GB). The chances for many poor people to benefit from access to this form of credit rest, in part, on solving that mystery.
To understand the mystery we need to go back to an influential paper by Mark Pitt and Shahidur Khandker (PK), published in the 1998 volume of the Journal of Political Economy. PK documented research supported by the World Bank—research that came to provide the most cited scholarly evidence yet to support the view that microcredit helps reduce poverty.
South Asia presents a depressing paradox. It is among the fastest growing regions in the world. But it is also home to the largest concentration of people living in poverty. While South Asia is at a far more advanced stage of development than Sub-Saharan Africa, it has many more poor people than Sub-Saharan Africa.
Figure 1: Number of Poor People has increased in South Asia
Source: World Development Indicators, World Bank 2009.