This week's links on how most people believe they won't catch the infection, Modi's PM-CARES may be diverting funds from those who need it most, why it is so difficult to do business in India, the impact of the pandemic on India's fisheries, and a great open-access resource if you like working with evidence.
New survey data: The National Council of Applied Economic Research (NCAER) has released the results of a rapid response survey (DCVTS-3) conducted in the Delhi NCR region. The survey was conducted at a crucial moment when restrictions were coming off but infections were accelerating rapidly, and the healthcare infrastructure was coming under historically unprecedented stress. Key findings below:
Who went out and how: In the week prior to the survey, 73% of Delhi NCR residents went outside (mainly workplaces, fewer women than men). Signalling a failure in shielding the most vulnerable, the survey found that 61% of those aged 60 or above went out. (Not hard to believe if you – like me – have already been driven up the wall convincing them to please stay in!). Less than a third (32%) of those who went out, took all the three key precautions widely recognised as necessary: washing hands with soap, wearing a mask, and maintaining a distance of 3 feet or more.
More than 65% of those surveyed either didn’t know whether they had a risk of infection or not, or didn’t think there was a risk at all.
Policy implication: If this isn’t argument for more, more, and more investments in awareness building and public information campaigns, I don’t know what is.
What happened to the economy: Agriculture is found to be the least impacted with 97% of those engaged in the sector being able to continue cultivation though with less hired labour, and challenges of transport and selling. Caveat: most of the farm sample comes from better off districts like Western UP, Haryana and Bharatpur. Small businesses and casual labour faced the most arduous challenges. Only 8% of the small businesses could continue normal operations in April and May. 63% were either totally closed down or suspended and nearly 40% could not pay any salaries. More than 70% of casual labour found no work in May and June. There were some improvements in June but there is still a long way to go.
Policy implication: MSME support to industry, and tackling logistical challenges in agriculture.
Did the welfare announcements work: Many pro-poor safety net schemes were announced but their implementation was not without exclusion, mainly of the urban poor. While 88% of the rural residents had ration card, only 70% of the urban residents did and this made it difficult for them to access subsidised foodgrains. Urban poor also received lower cash transfers. Policy implication: Universal ration cards, focus on urban poor.
If you want to know more, the detailed presentation is here. There is also a video, and a news piece. Read also this on how at least 140,000 rural households have completed 100 days of work under the MGNREGA (India's rural employment guarantee act) and will no longer be eligible for further benefits under the scheme (that provides for jobs up to 100 days in a year). Another 700,000 households have completed 80 days and are on the verge of running out of work as well. While this is not a big proportion of the poor in India, those undertaking work under the scheme are the country's poorest and most vulnerable.
What’s happening to other health indicators?: Covid-19 isn’t just a health emergency in itself, but because of the pressures it has created on health systems, and the lockdowns that have been imposed to control it, the pandemic is creating a whole new set of health emergencies and causing a reversal of progress on many health indicators. To understand this better, I recommend this new policy paper by Lydia Regan and Y-Ling Chi of the Centre for Global Development. It does two main things:
provides an overview of what previous outbreaks and economic crises tell us about indirect health effects of such a pandemic, and
presents a framework to understand and articulate these through 4 distinct but interrelated lenses: economic, environmental, health systems, and social/behavioural.
The study also links to many interesting India-specific analyses and evidence including impacts of the lockdown on substance abuse disorders, reductions in blood donations, decline in reporting of TB cases. For instance, see this for the impact of the lockdown on family planning services in India. Injectable contraception doses given decreased by 36%, IUD insertion dropped by 21%, and distribution of the combined oral pill and condoms dropped by 15% and 23% respectively. The number of abortions performed fell by 28%. FRHS India reports that even in the best case scenario, 24.55 million couples will not be able to access contraceptives in 2020.
In the likely scenario, nearly 26 million couples will not be able to access contraceptives in 2020, resulting in an additional 2.38 million unintended pregnancies, 679,864 live births, 1.45 million abortions (including 834,042 unsafe abortions), and 1,743 maternal deaths.
See this for the factors behind the disrupted supply and access to these services.
See also here on the impact of the lockdown on those with kidney diseases. Based on a survey of 19 major hospitals (8 in public and 11 in private sector), the survey finds the total number of dialysis patients in these centers came down, 28% of patients missed one or more dialysis sessions, many others missed required emergency dialysis sessions, or stopped reporting for dialysis, and 9 patients were confirmed to have died. Outpatient attendance came down by 92%, and inpatient service reduced by 61%. Tele-consultations were started but accessed by only a small number of patients.
Patients in the public sector hospitals were most affected as a large number of these were converted into COVID care centres. In some instances, dialysis units were shut down, and patients were forced to seek care in other facilities, which in most cases were already full.
The CGDev experts have also built an online, frequently updated, open-access inventory of accounts of indirect health effects of COVID-19 here. If you work on health, and like to use evidence, this is NERD GOLD.
PM may Care but others do too: Read this very good piece on CSR funding during the pandemic - where it’s going, who it’s from, and who gets it. The central and eastern parts of India together receive less than 10% of CSR funds. Putting this in the context of funding announced for the PM-CARES fund, the piece finds that those who have traditionally been key CSR contributors in these regions have already committed funds elsewhere. So development work in these chronically under-funded regions can be expected to receive even less than usual. More broadly too, PM-CARES appears to have funneled away a large amount of capital away from the non-profits. While I am all for supporting state-backed interventions and the need for the government to lead the response, concerns around PM-CARES' transparency and accountability and the importance of community-led, decentralised interventions - make me think that is a cause for worry.
While historically the PM National Relief Fund has received INR 200 crore annually though CSR contributions, PM-CARES has managed to garner more than 25 times this amount in a much shorter time frame.
How Easy is it to Do Business in India?: An analysis by the consulting firm Team Lease has found that India has a problem of “Regulatory Cholesterol”. For businesses to stay in business, they have to trudge through 1,536 Acts, 69,233 compliances and 6,618 regulatory filings across both the Central and State governments. The regulations operate through more than 1,000 government acts, and there are more than 2,500 changes in compliances every year.
Little wonder that India remains a country with predominantly informal, unregistered enterprises.
I haven’t found the actual report yet but a note with more detail is here, along with a call for Rationalisation, Simplification and Digitisation.
Mint has a piece here with summary findings and this neat graphic capturing State-wise differences.
It's the politics stupid!: See this Ideas for India piece on the political economy of why the Make in India campaign has found limited success. It argues that:
de facto deals (between businesses and corrupt politicians) rather than de jure rules characterise the business-state relationship in Indian states (you don't need to follow the regulations, you just need to make a deal with the politican),
deals are made faster in states with weak governance (so better governance doesn't mean a business will get its licenses faster), and
faster deals often go to the less-productive firms (they out bid their more productive competitors in deal-making) - so faster deals do not necessarily mean more growth.
The authors conclude by saying that "as long as the business environment in India is characterised by these types of deals, ... ‘Make in India’ programme is unlikely to succeed."
I don't find the findings surprising, but I am not sure I agree with their conclusion*. I lean firmly towards the school of Yuen Yuen Ang (Michigan) and Mushtaq Khan (SOAS) who have often argued that it is not corruption or deal-making per se that is bad for growth. One way to fix this might be to ensure that decision making politicians to have a stake in the firms' growth - i.e. they are able to stay on in power until the firms mature and reap profits. Difficult though given the multiparty nature of India's democracy and state politics with frequent changes in government.
*Edited to add: Grateful to Sabyasachi Kar (co-author of the study) for reaching out to clarify that the study does not claim that all deals are bad and agree that deals that enable productive investment are useful. They do however find that deals that we see in the Indian context are the unproductive kind. I am happy to report that I am inclined to agree with this. The full study is here. (18/07/2020)
Cod you pay attention here and not leave it to salmon else?: A comprehensive piece here on India's fisheries and aquaculture sector. A direct source of livelihoods for more than 20 million people and a major export earner, this sector is an important source of food production, nutritional security, employment, and income in India. Covid-19 has unsurprisingly wreaked havoc here.
A sudden and protracted lockdown, closure of seafood processing plants, disrupted supply chains, lack of consumer demand, fears of infection and the absence of a migrant workforce that (like most of India’s productive sectors) is a large part of the labour force - are some reason swhy.
Fisheries and aquaculture also have direct implications for poverty and women. Over 600,000 of the 818,000 traditional fishing families in the country fall below the poverty line, and have limited access to a social security net. About a third of those employed are women. See this for more numbers, and also if you want to know what “The Andhra-Gujarat Nexus” is. Watch here Fishing Palk Bay - a cool documentary on the traditional fishing practices of the south eastern coast of India and the impact of mechanised fishing.
Guess who was best prepared: In 2019 the Global Health Security Index had assessed countries on a number of factors to score them on their levels of preparedness in preventing and handling a disease outbreak. The United States was named the country that was best prepared for a pandemic, with the strongest measures in place and a score of 83.5 out of 100. The UK came second with 77.9, followed by the Netherlands with 75.6.
I have 3 observations here: (1) some of the differences between expected performance and actual numbers may be explained by the absence of testing in poorer countries (so real numbers could differ widely from reported cases there), (2) this is still a developing situation. If things have gone so poorly in the better prepared countries, what do the others have in store for them? And (3) you shouldn’t trust every map and index that comes your way.