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On a Recent Trip to Tamil Nadu…

Charukesi Ramadurai's picture

Five years ago, M. Revathy was a single mother abandoned by her husband, living in the small town of Tirunellikaval in Tamil Nadu. She is high school educated but was unable to find any employment except in a loom in her town. She was paid a pittance there and had the status of a bonded laborer. Today, she has her own loom at home and sells her saris at a good price to the wholesale market. She has a smile on her face as she says proudly that she sends her three sons to school and supports them and her father on her income.

Revathy was one of the women identified under the Tamil Nadu Empowerment and Poverty Reduction Project, 75% funded ($274 million) by the World Bank a few years ago. This project called Pudhu Vaazhvu (meaning New Life) has given a livelihood, and hope for thousands of women, unemployed youth and the differently abled in the state and has also been recognized by the World Bank as one of the best such projects in the world.

Being from the state, I was always aware that Tamil Nadu has always been one of the top Indian states in several development indices but till recently, I had never had the opportunity to see any the development projects firsthand. The focus on healthcare, especially in the rural areas is particularly heartening: providing access to remote areas in the form of once a fortnight mobile medical clinics and free ambulance services – 436 of them at present - for emergencies.

The mobile medical vans treat patients for basic ailments like fever, gastric ulcers, skin infections, respiratory infections and so on. The doctor watches out for and treats conditions like sickle cell anemia and malnutrition, highly prevalent among tribal women. For instance, Dr. Rajarajan whom I met in Kottayur village – 30 kilometers from the nearest town – travels to 3 or 4 villages and sees over a hundred patients a day.

These doctors, along with trained auxiliary nurse midwifes also conduct regular antenatal checks on pregnant women and counsel them on the benefits of having their delivery in hospitals instead of at home as they are used to. And there have been specialized CEmONCs (Comprehensive Emergency Obstetrics and Neonatal Centers) set up, leading to a significant decrease in both maternal mortality ratio and infant mortality rates.

There is a lot more work being done in government hospitals, including computerization of all records and placement of trained tribal counselors in many of the large ones. Beneficiaries correctly identified, resources well spent and a long-term vision – what is not to like?

Comments

Submitted by Varadan Atur on
Short but a nice story offering hope to many. Glad to see women being helped by the WB in such a bold way. Women are the center of families and hope for its upliftment too, especially in India. Thank you for sharing this developmental success story. Best wishes. Varadan Atur

Submitted by Nachiket Mor on
Dear Ms. Ramadurai, I work in the two areas of financial inclusion and rural healthcare and my constant effort has been to try and find sustainable longer-term answers to address the challenges in these two areas. I personally feel that the efforts like the one you describe while very worthy of appreciation and entirely appropriate at an individual or a small NGO level, are not consistent with finding longer term answers. In fact I worry that they actually end up delaying the search for durable solutions which involve either the government stepping up to the plate and doing much more or market forces being creatively engaged. In healthcare, for example, the depth of penetration and breadth of services needed are both entirely within the grasp of a prosperous state like Tamil Nadu but that need systematic investments in what happens at the sub-centre level at a scale that is multiples of what is currently happening and a great deal of innovation. My own expectation of a large and deeply reflective institution like the World Bank would be help move that process forward. Efforts of the kind that you describe, in my view, do just the opposite. At best they offer short-term palliatives and draw attention away from what is truly needed on the ground but at worst, as has happened in the financial inclusion journey in Andhra Pradesh, they help create an environment that is deeply hostile to change and to the development of longer term systematic solutions. Sincerely, Nachiket Mor

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