This study examined pro-poor development initiatives in two Indian states that had, in the 1990s, been considered to have been responsive to poverty: Andhra Pradesh and Madhya Pradesh. Each state had a chief executive who, supported by a core group of political leaders and civil servants, devised and maintained a commitment to programmes and institutional reforms aimed at addressing the needs of poorer constituencies.
The purpose of the study was to assess those political and institutional factors that assisted in realising the promise of these innovations, as well as those factors that constrained the process of pro-poor change. This study consisted of four components: two studies on Madhya Pradesh (one on agriculture and one on health); and two in Andhra Pradesh (one on agriculture and one on health). The design of the study enabled the research team to draw conclusions on the basis of three axes of comparison:
- Between locations of differing types, but within the same state and implementing the same programme
- Between programmes in the same sector, but operating in two different states
- Between programmes in different sectors, whether within the same state or across states.
The two case study states are usually contrasted as one based on radical decentralisation (Madhya Pradesh), and one notably resistant to the decentralisation of powers to the constitutionally stipulated local government bodies (Andhra Pradesh). This perception is true, but some of the implications drawn from it are not:
- Madhya Pradesh’s record on decentralisation, especially the more recent emphasis on empowering village general assemblies, is not necessarily revitalising local political environments or creating space for pro-poor mobilisation
- While Andhra Pradesh’s government displayed no penchant for devolving power to Panchayati raj institutions – it is not necessarily suffocating pro-poor policy interventions.
These differences are attributable largely to the political incentives to investing in local pro-poor activities such as watershed development programmes, with District and State-level politicians in Andhra Pradesh perceiving electoral gains from channelling resources to the poor.
By and large, however, in the two states, participatory local watershed management projects tended to become resources through which the hold of certain powerful interests were consolidated within the case study villages. Of particular note is the ability of contractors who benefit from works contracts (especially in Madhya Pradesh where the violation of programme regulations in this respect is rife) to then gain direct control over political groupings, as opposed to simply courting favour with political leaders.
As the Andhra Pradesh case studies showed, this process can also be reversed, with politicians using the programmes to become contractors in their own right. This convergence of economic and political power makes it less possible for watershed programmes to create a conducive pro-poor political environment. When different dimensions of power are consolidated, there is less competition among rival elites to attract the support of poor people by distributing to them a greater share of programme benefits.
Health sector reforms were compared in the two states: a community health workers’ scheme in a remote tribal area of Andhra Pradesh, and a community hospital management scheme in the city of Indore in Madhya Pradesh.
The Community Health Worker (CHW) scheme is an appropriate means of extending the outreach of primary health services in remote and impoverished areas. But this case study showed, however, that the CHW scheme did not adequately reach the poor for a number of reasons attributable to power relations within the health system and at the local level:
- The public health system did not take ownership over the CHW program and in consequence there was no effective performance monitoring of these volunteers, and no means of coordinating their work to produce a coherent assault on the health problems afflicting tribals.
- The refusal of the public health system to take charge of the CHWs put them under the authority of local elites and created of their position another prebend that could be awarded within patronage systems. Caste, clan and gender politics determined the appointment and control of CHWs.
- Wherever local authorities were given control over a health system resource such as the CHW, this created conflict with the technical line ministry staff and discouraged their interest in working with people who they see to be appointed for political reasons, not merit.
- Patterns of use of health facilities are shaped in part by party political concerns, with some health facilities identified as a resource for particular support groups, to the exclusion of others.
In Madhya Pradesh the community hospital management scheme was effective in rehabilitating a crumbling facility, but because this became a local elite interest, it may have limited the extent to which needs of the poor were addressed. The community hospital management scheme worked because:
- It attempted to by-pass health professionals and their lobbies, yet at the same time, improved conditions for doctors and nurses in ways that created non-material incentives to do their work more effectively;
- It limited the control of the health ministry over hospitals by putting local administration in stronger control and by the stimulating interest in scrutinizing and monitoring expenditure patterns at the hospital;
- It created opportunities for local elite buy-in to hospital improvement by engaging elites in the management of public assets and giving them access to contracts for hospital supply, construction, and maintenance.