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In India, eliminating tuberculosis isn't just a health issue — it's an economic one

Jorge Coarasa's picture



On February 1st, India’s finance minister presented the Union Budget for 2017-2018, and announced the government’s plan to eliminate tuberculosis (TB) by 2025. This is a welcome move. While ridding people of the burden of any disease is a worthy goal by itself, TB elimination provides perhaps one of the strongest cases for public intervention from an economic point of view.

All communicable diseases present what economists call externalities: infectious people can infect other people who in turn infect others and so on. In fact, economist Phillip Musgrove used TB in particular to illustrate this: “no victim of tuberculosis is likely to ignore the disease, so there is no problem of people undervaluing the private benefits of treatment. Rather, the cost of treatment--and the fact that they may feel better even though the disease has not been cured-- may lead people to abandon treatment prematurely, with bad consequences not only for themselves but for others. The rest of society therefore has an interest in treating those with tuberculosis, and assuming at least part of the cost.” Reducing TB incidence could generate benefits of $33 per dollar spent, prompting The Economist to put TB among their list of ‘no-brainers’. According to the Stop TB Partnership, ending TB globally could yield US$ 1.2 trillion overall economic return on investment.

Women can play a greater role in realizing South Asia’s potential

Annette Dixon's picture
Mumbai Train
The suburban train system in Mumbai is used by millions of women and men everyday, who rely on safe transport to access education and job opportunities. 

Last week, I took a journey on Mumbai’s suburban train system, which carries a staggering 8 million women and men, equivalent to the entire population of Switzerland, every day to where they live, work, and spend time with family and friends. Although stretched, the system has reduced mobility constraints and increased independence for millions of women who rely on safe transport to access education and job opportunities; contributing to the city’s dynamism and growth. There are similarly inspiring examples from all countries in South Asia.

As we mark International Women’s Day, we celebrate the progress made in improving women’s inclusion and empowerment, while seeking to better address continuing challenges, which are estimated to cost South Asian economies $888 billion, through devising and implementing solutions that will bridge remaining gaps.

Much to be proud of­a lot more remains to be done

South Asian countries have seen encouraging increases in greater access and gender parity in education. At the same time, the region has achieved substantial decreases in maternal and child mortality. Countries have made great strides in healthcare access through training more female healthcare workers while providing affordable care for mothers and children. The region also boasts many inspiring female leaders and role models, as well as the countless individuals positively contributing to their communities and societies against difficult odds. 

However, much more needs to be done in order to nurture all women and men to realize their potential. As South Asian countries become more prosperous, their growth trajectory will be less assured if hundreds of millions of women remain excluded from education and employment opportunities. South Asian countries will need to substantially expand their workforce in order to meet their economic growth goals and, at the same time, adequately support their increasingly large populations. Studies show that only around 1 out of 4 women in South Asia participate in the labor force, about half of what is typical in middle-income countries in other regions. Too many women face restrictions in decision-making, mobility, public safety; and far too many experience gender-based violence—the most egregious cases making headlines around the world. What can help bridge these gaps?

The ABCs of digital jobs in South Asia

Anna O'Donnell's picture
How Can South Asia’s Youth Plug into Digital Jobs of the Future?

Over the past several years, innovations in information and communication technologies have fundamentally changed the nature of work.

This has created new opportunities in digital employment for workers and employers in South Asia and beyond.

So what are the pathways to this new employment?

During a recent Facebook live chat on digital jobs, we explored three themes related to the digital jobs of the future. First, we discussed where the digital jobs of the future are. Second, we discussed how South Asia is uniquely positioned to benefit from the growth of these jobs. And finally, we discussed how to get started in the digital economy by finding relevant training and learning opportunities.

Here’s an overview of our discussion in five points:
 
1. What are digital jobs?

Digital jobs fall into two categories: jobs within the IT or digital industries, and what are termed digital society jobs. Digital industry jobs include those such as computer programmer, mobile app developer, graphic designer and other jobs where information and communication technologies are the core tool to perform the job functions. However, technology is also changing what we call digital society jobs, where technology is maybe not core to the job functions, but makes more you more efficient and productive, and improves access to markets and networks.

2. What is driving the emergence of these new digital jobs?

The rapid rise in connectivity that is linking more and more people to the internet is changing employment. Today, many jobs can be performed through computers, with workers telecommuting from almost anywhere in the world. Many business processes are being broken down into task based work, and which can be farmed out to people with the skills to do them, anywhere the world. Some of these tasks need higher-level skills, and can pay well – especially compared with many developing countries’ wage levels. But there are also simpler tasks that many more people, even those with limited skills, can do. This mix creates the opportunity to include more people in the global digital economy, while also creating pathways towards better paying and higher quality work for those who perform well and pick up in-demand skills.

How protein deficiencies impact the health of communities in India

Parvati Singh's picture
Soybean farmers discuss best practices that can leverage improvement of food and nutrition security in Madhya Pradesh.

The state of Madhya Pradesh in India is largely vegetarian with limited consumption of eggs and meat. 

While these dietary preferences are commonplace in other Indian states, Madhya Pradesh is facing a protein deficiency epidemic which threatens the long term health of its population.

How did it get there?

In 2015 I spent five weeks in rural and tribal areas of Madhya Pradesh evaluating the World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP II), with the support of the South Asia Food and Nutrition Security Initiative (SAFANSI)

Across the 8 districts I visited, families shared how they had improved their agricultural productivity, started backyard kitchen gardening, and supplemented their income through dairy and poultry farming, collective procurement and small scale enterprises.

As I examined local village level health records, Anganwadi Center (AWC) registers, Auxiliary Nurse and Midwife (ANM) registers and Primary Health Center (PHC) documents, I noticed a reduction in severe malnutrition and severe anemia among pregnant women and under 5-year-old children.

However, this decrease did not extend to moderate or mild malnutrition and anemia.

Voices of Youth: Restoring my belief in One South Asia

Nishant Khanal's picture
 7 people, people smiling, people standing and outdoor
Students from Nepal are in their national dress and preparing for their cultural show at the 13th South Asia Economics Students' Meet (SAESM) held in Kathmandu, Nepal last week. SAESM brought together top economic undergraduates to share research, learn from one another, experience a neighboring country, and make friends. 

Last November, when the SAARC summit that was supposed to be held in Pakistan was canceled, I thought regional cooperation in South Asia would lose its momentum. Tensions between members not only postponed the SAARC Summit, but also hampered the South Asian Economics Students (SAESM) meet. SAESM was scheduled to be held in India in December where I was supposed to be a participant. I started believing in news, media and opinion pieces that said ‘there’s no future for South Asian integration as there is so much mistrust in the region.

After a concerted effort from the economics professors from across South Asia with the support of the World Bank, the 13th SAESM of economics students (selected based on top paper submissions) was successfully held in Kathmandu last week. The meet brings together students to share their research, learn from one another, participate in academic competition, and make friends from across the region. Despite regional dynamics, SAESM has never missed any year since its inception in 2004, and it may well be unique in that respect in South Asia.

Involving communities to achieve sustainable development

Annette Dixon's picture
Discussing community priorities
Former refugee Jeyaranjini discusses community initiatives with her local project officer in northern Sri Lanka.
Photo Credit: Joe Qian/World Bank

Jeyaranjini lives near Kilinochchi in Northern Sri Lanka with her husband and daughter. They have been rebuilding their lives through the North East Local Services Improvement Project (NELSIP), which uses a Community Driven Development (CDD) approach to tailor projects based on community needs in this conflict affected region. 

The project has helped build 611 km of roads, 23 km of storm drains, 400 community public spaces such as markets, parks, and playgrounds, as well providing improved access to water and electricity across Sri Lanka.

“Each community member used to be alone, but now we learn, exchange ideas, and make decisions together,” she said.

South Asia has a strong tradition of local participation

Let me offer a couple of other examples: Nepal’s Self Governance Act in 1999 decentralized services delivery to villages and districts. In Afghanistan, Community Development Councils (CDCs) receive funds, in which they then manage to support their villages.

In post-disaster contexts, CDD has shown to be fast, flexible and effective at re-establishing basic services. In fragile or conflict-affected states (FCS), the approach has also helped rebuild trust within communities, and between communities and governments.

Projects incorporating CDD approaches give control over planning and investments to community groups, and aim to empower communities to deliver services to the poor and vulnerable.

CDD principles can contribute to the realization of the 17 Sustainable Development Goals (SDGs), a roadmap for the international development community to  promote sustainable economic, social, and environmental development by 2030.

Currently, the World Bank has 41 active CDD projects worth $6.1 billion in South Asia, including 21 projects in India worth $4.2 billion.

Women Masons in Tamil Nadu: Lessons from a unique experiment

Varalakshmi Vemuru's picture
Not long ago, fifty three year old Parvati Amma was told that she was too old to train as a mason. But that didn’t deter this feisty lady. She took the rejection as a challenge and went on to ace the class.

Parvati Amma comes from Pulkattai village in the southern Indian state of Tamil Nadu where the Tamil Nadu Empowerment and Poverty Reduction Project (TNEPRP) has conducted a unique experiment.  In an effort to raise the very low levels of women’s participation in India’s labor force, it is helping rural women break into jobs that are traditionally held by men, where they could increase their earnings significantly.

In this part of Madurai district, most of the men folk are successful masons. The women worked as helpers, merely passing tools to the men as they laid brick over brick to build houses and office blocks. Being unskilled, the women earned half the men’s wages.

Even though Tamil Nadu is one of the most urbanized states in India with high literacy rates, new buildings are proceeding apace amidst the state’s booming construction industry, attracting over a million migrant workers - more than a tenth of whom work as unskilled labor. There is, however, a paucity of trained masons.

The challenge for the women was to take on age-old social and cultural barriers and enter into this exclusive male preserve. Masonry has never been seen as a woman’s job in India, much less in this conservative rural area. For a start, the women wear sarees that constrain them from climbing onto scaffolding to build the higher storeys. Masons are also required to travel long distances for work, and staying away from their families is not something the women could easily do. Apart from mobility constraints and worksites that are not women-friendly; domestic responsibilities, burden of child and elderly care, and a conservative societal outlook, are all challenges.

Nonetheless, the women of Madurai’s Pulkattai village were not to be daunted. They saw this as an opportunity to prove their worth and double their wages in the bargain.
 TNEPRP)
Women Masons in training (Photo Credit: TNEPRP

Supported by a visionary panchayat president and an expert mason from the village who had confidence in the women’s capability - Parvati Amma and 25 other women joined the masonry training offered by the project. 

In India, small interventions bring big changes for gender equality

R. Kyle Peters's picture
Young girls iin a  school in India
Young girls in a school in India. Credit: World Bank


I was in India a few weeks ago and had the chance to visit some rural schools in Uttar Pradesh. When I was there, I met a group of adolescent girls who could potentially help close the country’s gender gap.
 
These girls board at school, where they get nutritious meals and are able to focus on their studies. The program purposefully targets 11 to 13-year-old girls from poor households who cannot afford to send their daughters to school. Some girls are also at risk of being married off early.
 
By keeping the girls in school at this critical juncture, they have a chance at a better life.
 
Parents told me that many of the girls at this boarding school were underweight and malnourished when they arrived. As they studied and ate and slept well, they slowly gained weight and got taller. As their knowledge grew, so did they.
 
But how many of these girls will go on to fulfil their true potential and add to their family’s income by joining the job market?

For the differently abled by a differently abled – an inspiration from Tamil Nadu, India

Varalakshmi Vemuru's picture
Mr. Kannan, a differently abled social entrepreneur
Mr. Kannan, a differently abled social
entrepreneur. (Photo: Varalakshmi Vemuru)
During my recent mission visit to Sivagangai District in Tamil Nadu, India, I met with Mr. Kannan, a social entrepreneur. I was visiting communities to understand the latest efforts under the Tamil Nadu Empowerment and Poverty Reduction Project (TNEPRP) to support the differently abled with economic activities following their identification and mobilization. For six months now, Mr. Kannan is running a Community Skills School (CSS), an innovative approach to skills enhancement, in the Kalaikulam Village. At the school, which provides self-identified and motivated trainees with skills to repair home appliances, Mr. Kannan has already trained 70 differently abled men and three women. Among the trainees is his wife, who is differently abled herself, but is of huge support to Mr. Kannan in running the CSS and in working with women. He has an agreement with TNEPRP to train a total of 180 differently abled, including a planned group of 30 women.


He has an agreement with TNEPRP to train a total of 180 differently abled, including a planned group of 30 women. Run on a guild program model, the CSS ensures that upon completion of a one-month program on skills enhancement, the trainees can become self-employed or work in small enterprises repairing home appliances in their own and neighboring villages. The rapid urbanization of rural Tamil Nadu offers plenty of such opportunities.

Mr. Kannan designed the key aspect of the curriculum—which goes beyond technical training—based on his own life experiences. During our conversation, I found out that Mr. Kannan is differently abled himself—he was afflicted with polio at the age of three and has lost the use of both his lower limbs. As a result, Mr. Kannan needed a wheelchair to get around. Nevertheless, he was not deterred and continued his education to receive a diploma in mechanical engineering from a local Polytechnic. He ended up at Samsung’s service center in Chennai, the state capital, where he spent four years acquiring skills in home appliance repair. 
 

Minimizing the risks caused by geohazards in South Asia

Yuka Makino's picture
 A man watches a piece of land fall into a river September 22, 2014 in the Kalashuna village in Gaibandha district of Bangladesh. In the past month Kalashuna village has had 600 homes washed away due to river erosion. In August severe flooding displaced hundreds of thousands of people and led to rapid and severe river erosion which continues to wipe away hundreds of homes each week.
A man watches a piece of land fall into a river September 22, 2014 in the Kalashuna village in Gaibandha district of Bangladesh. Credit: Allison Joyce. 2014 Getty Images
Geological hazards – or geohazards, natural or human-induced disruptions of the earth surface that may trigger landslides, sinkholes, or earthquakes, present serious threats to communities, cost extensive damage to infrastructure and can bring traffic and services to a standstill.
 
Most geohazards are linked to climate activity such as rainfall and thawing of ice or snow. In many places, recent climatic changes have increased the intensity of rainfall and raised mean temperature, increasing hydrological hazards, such as debris or earth flows, erosion, and floods.
 
South Asia is particularly vulnerable to geohazards. A study completed in 2012 found that from 1970 to 2000, the number of geohazards quadrupled in the region, resulting in damages of over $25 billion in 2008-2012 alone.
 
This week, the World Bank Group and its partners will gather at a first-of-its-kind South-to-South learning workshop to devise practical solutions to help South Asia become more resilient to landslide and geo-hazard risks.
 

 

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