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.
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 of—a 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?
Amena Begum resides in a village in the Habiganj district in Bangladesh and is a mother to three young children. Last year Amena spent US$100 to construct a toilet to ensure her three children were hygienically protected from feces.
Even though her family members have adapted to using the toilet, exposure to fecal contamination can occur anywhere. For example, while playing outside, a child may accidentally ingest soil with animal feces, or the child could be exposed when he or she eats food off of dishes washed with pond water.
It is also not uncommon for families without toilets to throw feces into a nearby bush, which remains exposed in their living area. These actions can lead to the contraction of hazardous, lethal diseases and create a traumatizing effect on the lives of many children, not to mention the unfavorable impact on the environment.
A new study on early childhood diarrhea in rural Bangladesh found that despite high on-site latrine access, frequent fecal contamination was present along all environmental pathways investigated. Human fecal markers on children’s hands and in soil, and rotavirus in stored water, soil and on hands had been detected. Animal (particularly ruminant) fecal markers were highly prevalent in water, soil and on hands.
Poverty maps are a useful tool to visualize and compare poverty rates across geographic areas, and learn about how poverty is distributed within a country, which is often times masked in national or aggregated statistics. For instance, the national poverty rate in Bangladesh in 2010 was 31.5 percent, which is the latest year for which a household survey was collected by the government to produce official poverty numbers.
However, a look at zila (district) and upazila (sub-district) level poverty rates suggests that poverty levels differ quite substantially across the different areas of the country with large pockets of poverty concentrated in the north and south-west part of the country. For example, some of the zilas in the north belonging to the Rangpur and Dhaka divisions are among the poorest in the country with poverty rates well above 50 percent while some of the zilas in the south-east belonging to the Chittagong division have poverty rates well below 20 percent.
While country level poverty maps are generally widely available, accessing the underlying information is not always easy or is unavailable in a user-friendly format. Moreover, there is not a straightforward way to link these disaggregated poverty statistics with other socio-economic indicators and even if one attempts to do, it might take a substantial amount of time to put together all this information.
Specifically, poverty maps are often times disseminated in the form of printed reports, which do not allow users to directly access the data in a digitized format or link it to other socio-economic statistics. Lowering barriers to access poverty statistics and facilitating the linking of these indicators to other non-monetary living standards statistics is important to facilitate the use of poverty statistics, make them more relevant for policy and program planning, and promote more evidence-based policymaking.
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.
Erwadi is known for its 550-year-old Badusha Nayagam Dargah—“Erwadi Dargah,” one of the biggest shrines in India. Every day, numerous devotees of different faiths visit the shrine from surrounding villages, states, and countries. Among these visitors is a large number of people who suffer from mental illness and have come to pray for a cure. Some of them see the Dargah as their first and only hope—guided by the magico-religious belief that illness is caused by the possession of evil spirits or the performance of wicked magic—while others have turned to the shrine as a last resort after receiving ineffective treatment.
When I visited Erwadi Dargah in 2013 and met with a team working on a local program called District Mental Health Project (DMHP), an important partner of the World Bank-supported Tamil Nadu Mental Health Project, they expressed an urgent need to help the devotees affected by mental illness. Their subsequent discussions with representatives of the shrine revealed a lack of information on potential treatment options and strong resistance to medical interventions among the devotees. At that time, the team knew of a similar circumstance in another part of India—the state of Gujarat—so they invited the representatives of Erwadi’s religious community to learn from peers in Gujarat about complementing religious rituals with medical treatment.
And thus started a unique experiment called “Dawa-Dua,” or prayer-treatment.
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Over 80 percent of Pakistanis consistently report that their economic wellbeing has either deteriorated or remained the same. Only 20 percent, disproportionately concentrated in the very top of the distribution, feel that they are better off and similarly small numbers believe that economic conditions have improved for their locality. If we took a poll today, it is possible that many of you would say that extreme poverty has risen rather than fallen.
But in fact, the national data tells a completely different story! According to the national poverty line set in 2001, Moreover, these gains were not concentrated among those close to the poverty line. Even the poorest 5 percent of the population saw an improvement in living standards.
The southern state of Tamil Nadu, for instance, has one million people living mental disorders—about 3-5 cases per village. Meanwhile, the country faces a severe shortage of psychiatrists and psychiatrist nurses, and clinical care is scarce in rural India. Due to deep social stigma related to mental illness, such serious issues are largely invisible at the community level.
That’s why, in 2012, we launched a comprehensive social and clinical care program with the government of Tamil Nadu to inform and educate local communities on mental health issues, as well as to encourage families and people affected by mental illness to seek treatment. Working with leading local health practitioners, we based the campaign on a core message that was simple, powerful, and resonated with the community:
There is a lot for Bangladesh to celebrate in the latest World Bank research on global poverty and inequality.
The new report, entitled “Poverty and Shared Prosperity 2016: Taking on Inequality”, uses revised data to give a more accurate estimate of how many poor people live in Bangladesh. What the report shows is that 18.5 percent of the population was poor in 2010 compared with 44.2 percent in 1991.
This is a major achievement that will receive global recognition on October 17 when the World Bank Group marks End Poverty Day with the Bangladesh people at an event in Dhaka.
This achievement means that . It means that Bangladesh beat the deadline by an impressive five years in achieving Millennium Development Goal number 1, an internationally recognized target to cut extreme poverty rates by half by 2015.
It is worth remembering how far Bangladesh has come.