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The lesson is that if India is determined, it can deliver. India is capable of success and achievements; but when it comes to governance, all this success is washed down the drain.
Take, for example, the condition of a few hundred families in a not-so-remote village in India's state of Uttar Pradesh -- the village of Lohta in Varanasi District. There is nothing special about this village except for the fact that most of the villagers are Muslims and make a living from the handloom weaving industry.
Owing to the decline of the industry, the weavers are finding it hard to cope. Several of them have left the industry while those who remain are finding it difficult to make a living from weaving.
During the past several years, many of these weavers have died from utter starvation or tuberculosis. TB infection among the weavers is at an alarmingly high rate in Lohta. Both children and adults are infected by the disease, and it is spreading. The demographic profile of Lohta is also not promising.
According to the 2001 census, the village had a population of 19,695. Males constituted 53 percent of the population and females 47 percent. Lohta has an average literacy rate of 50 percent, lower than the national average of 59.5 percent.
In Lohta, 22 percent of the population is under 6 years of age. The village lacks any functioning medical facilities. Sanitation conditions are so poor that if a healthy person lives in the village for about a week the person will be infected with some disease that will require immediate medical attention.
Many people have died in Lohta in the recent past from TB alone. These deaths are in addition to those who have died from malnutrition and hunger. Yet the state administration, as well as the central government in New Delhi, have done nothing to take care of the immediate requirements of the villagers, even to ensure them a safe living environment.
The administration cannot plead ignorance of these conditions. First of all, the district as well as the state administration have a responsibility to know what is taking place in Lohta. This responsibility has obviously not been discharged. In the past few months, the state and the district administration were repeatedly informed by non-profit organizations and through media reports that people have been dying in the village from starvation and tuberculosis. The administration has done nothing thus far.
Even though Lohta, one among several thousand villages in India, is facing such neglect, the information provided by the director general of health services under the Ministry of Health and Family Welfare speaks a different story. The directorate claims that as of March 31, 2006, its anti-tuberculosis program, the Directly Observed Treatment Short Course, has been implemented, covering 100 percent of the country. Yet dozens of villagers infected with TB now living in Lohta claim that they have not been provided with any treatment by the government authorities so far.
The villagers also reveal several other glaring facts concerning the inadequacy of the government facilities as well as the neglect of government health workers. For example, the public health center in Lohta remains closed almost every day of the year. Even if the center is open, there are hardly any medical services that a person can receive from the center, for the center lacks both medicine and personnel.
Ideally, a public health center must have a minimum of 127 types of medicine for emergency medical care. The center is also expected to have a medical doctor, enough nurses and other medical technicians to attend to the immediate medical needs of the ordinary people who avail themselves of the services of these centers. It is imperative that a government medical facility located in a place where tuberculosis is commonly reported has the basic facilities to treat TB patients. The public health center in Lohta fails to meet all these necessary medical requirements.
Most often a person suffering from TB who approaches the center is informed that the person is not suffering from tuberculosis. This diagnosis is made because if the person is identified as a TB patient the staff at the center will have to follow up the case, which involves visiting the patient every week at his or her residence.
The state government also plays into this scenario so that less money needs to be spent on the public health centers. The government saves as well on the cost of medicine that has to be spent on treatment. TB treatment also requires healthy living conditions of which the first prerequisite is nutritious food. This responsibility also requires the government to spend money on procuring food.
As of now, people in Lohta live without any expectation of receiving treatment for tuberculosis. For that matter, they do not receive any treatment through the public health service system. This shortcoming is not because the state or central government lacks the necessary infrastructure for health care. What is lacking is the will.
The name suggested by Tata for their new car, Nano, is inversely appropriate for the obligation of the Indian government to its citizens. The right to health is a fundamental right in India.
Though not expressly provided in the Constitution, the Supreme Court of India has interpreted Article 21 of the Indian Constitution, which guarantees the right to life, as requiring the state to uphold the right to health as well. However, guaranteeing a right and fulfilling it are two different things in India.
The Tata Company could deliver on its promise because, at the end of the day, the company is accountable to its shareholders, both in theory and in practice. For the government of India, accountability remains only in theory.
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(Bijo Francis is a human rights lawyer currently working with the Asian Legal Resource Center in Hong Kong. He is responsible for the South Asia desk at the center. Mr. Francis has practiced law for more than a decade and holds an advanced master's degree in human rights law.)
