India's Progress Towards Achieving the Targets Set in the Millennium Development Goals

The Millennium declaration signed by leaders of 189 countries and the Millennium Development Goals (MDGs) adopted in 2000 by all the Member States of the United Nations have become a universal framework for development and a means for developing countries and their partners to work together [1]. This blueprint agreed upon by all the countries has eight goals—which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education and gender equality by the target date of 2015—and has galvanized an unprecedented effort to meet the needs of all [2]. The MDGs are interlinked and have set measurable time-bound goals on commitments in the development agenda [3]. The status report on Millennium goals for India published in 2005 evaluates the progress made so far from the base year 1990 and also highlights the strategies developed for the attainment of the MDGs in 2005 [3]. Table 1 shows the values of the MDG indicators and progress of India from 1990 onwards [3]. Table 2 and Fig. 1 summarize the changes in the demographic profile in India in the new millennium. Population pyramid. Source: Population projections for India and states 2001–2026, revised December 2006, India-2001: Office of the Registrar General and Census Commissioner, India. Values of the MDG indicators of India for 1990 onwards Values of the MDG indicators of India for 1990 onwards Demographic changes from 2000 through 2016 in India Source: Population projections for India and states 2001–26, revised December 2006, Office of the Registrar General and Census Commissioner, India [2]. Demographic changes from 2000 through 2016 in India Source: Population projections for India and states 2001–26, revised December 2006, Office of the Registrar General and Census Commissioner, India [2]. India's tenth five-year plan (2002–2007) had taken note of the MDGs and included targets that are higher than the ones aimed in the MDGs during the plan period [3]. The unprecedented economic growth in India holds promise for the initial MDG targets to be met early [4]. The targets for the tenth five-year plan and beyond include the following: Reduction of the poverty ratio, i.e. the percentage of population living below the poverty line, by 5 percentage points by 2007 and by 15 percentage points by 2012 (the poverty line is defined based on per capita per month amount needed to ensure set calorie intake per capita per diem). Providing gainful and high quality employment, at least for the number entering the labour force. All children to be put in school by 2003, all children to complete 5 years of schooling by 2007, reduction in gender gaps in literacy and wage rates by at least 50% by 2007, reduction in the decadal rate of population growth between 2001 and 2011 to 16.2%. Increase in literacy rates to 75% within 2002–07, reduction of infant mortality rate to 45/1000 live births by 2007 and to 28/1000 by 2012. Reduction of maternal mortality rate (MMR) to 2/1000 live births by 2007 and to 1/1000 by 2012. Increase in forest and tree cover to 25% by 2007 and 33% by 2012. All villages to have sustained access to potable drinking water, cleaning of all major polluted rivers by 2007 and other notified stretches by 2012 [5]. The HIV/AIDS targets [5] include: An 80% coverage of high-risk groups through targeted interventions A 90% coverage of schools and colleges through education programmes An 80% awareness among the general population in rural areas Reducing transmission through blood to less than 1% Establishing at least one voluntary counselling and testing centre (VCTC) in every district Scaling up of prevention of parent-to-child transmission (PPTCT) activities up to the district level Achieving zero level increase of HIV/AIDS prevalence by 2007. The Malaria targets [5] include: The rate of increase in the prevalence of non-communicable diseases is also taken into account. Table 3 gives an account of the communicable and non-communicable diseases in India during this period. Annual blood examination rate over 10% Annual parasite incidence 1.3 or less A 25% reduction in morbidity and mortality due to malaria by 2007 and 50% by 2010 as per the National Health Policy (NHP 2002). Non communicable and communicable diseases in India Source: NCD in South-East Asia region-A profile. WHO, New Delhi 2002 and National Institute of Health and Family Welfare. National Health Programmes on Noncommunicable Diseases. New Delhi. 2003 [3] (aAd hoc prevalence data). Non communicable and communicable diseases in India Source: NCD in South-East Asia region-A profile. WHO, New Delhi 2002 and National Institute of Health and Family Welfare. National Health Programmes on Noncommunicable Diseases. New Delhi. 2003 [3] (aAd hoc prevalence data). The country report for India states that some of the indicators could have been better presented in a manner different from the ones specified under the MGD [3]. Non-availability of some of the sufficiently reliable data was the reason for dropping some of the indicators such as proportion of population below poverty, $1 per day, proportion of population below minimum level of dietary energy consumption, ratio of school attendance of orphans compared to attendance of non-orphans aged 10–14 years, MMR, proportion of population with access to secure tenure, unemployment rate of young people aged 15–24 years and proportion of population with access to affordable essential drugs on a sustainable basis [3]. India is moving in the direction of achieving the MDGs by 2015 despite the size and complexities of the nation [3]. The high economic growth, together with carefully designed and targeted pro-poor policies that are crucial for attaining the MDGs, effective decentralization, efficient delivery of services and respect for human rights, rule of law and accountability have the potential to channel the MDGs into good governance [6]. The information technology (IT) revolution is yet another boon for India with respect to employment and economic development. Progress in computer education and IT is far enriching the economy, employment prospects and social status. India's efforts at alleviation of hunger go back to the 1970s when the ration shops system was introduced under the Civil Supplies Corporation, for distribution of grains, lentils and fuel at subsidized price to the poor. The units of supply are based on the number of members in the family that is recorded in the ration cards, which is a valid record of citizenship. The ration cards are divided into two categories: above poverty line and below poverty line (BPL). The supply of food grains and fuel comes from the Central Government. Each state has the onus of appointing ration dealers for distributing the supply through ‘fair price’ shops called ration shops. The interim order of the Supreme Court of India [7] insisted that the access of BPL families to supplies at the set price at ration shops be improved and that individuals without means of support, including elderly, widows and disabled, be granted ration cards for free food. The State Governments were also ordered to implement the ‘mid-day meal scheme’ in schools to supply half the amount of energy and one-third proteins as per the recommended dietary allowance. Significant progress in implementing this scheme has been reported [8]. There are plans for recasting and expanding the Integrated Child Development Services (ICDS) Scheme to make it more effective in attaining the MDG targets. This is perhaps the largest scheme in the world with maximum number of beneficiaries, implemented in India in the late 1970s. The ICDS caters to the growth, development, immunization, medical aids, heath education and informal education needs of children under 5 years of age and pregnant and lactating mothers. Food supplementation is the key attraction of this programme, ensuring 300 kcal of energy and 15 g protein/child/day for 300 working days. This supplementary nutrition is being extended as the ‘School Mid day Meal Programme’, ensuring one-third of energy and one-half of protein requirements of the children. Programmes like the ‘Integrated management of neonatal and childhood illnesses’ (IMNCI), with added newborn services, the ‘Reproductive and child health’ (RCH) services and the ‘National rural health mission’ (NRHM) are paving the way to success in India. The Self-Employed Women's Association (SEWA) is a trade union registered in 1972 to represent low-income women workers in India's vast informal sector. It has regularly assisted its members, with marginal incomes from small farms or making of handicrafts, to spread the risk of income losses from droughts and cyclones through insurance and microfinance measures [9]. Now with the help of Panchayati Raj or local self-government, women employment schemes such as ‘Kudumbasree’ and ‘Mahilamandals’ are operating in full swing, contributing to economic progress in the families and communities and progress in environmental health. Day-to-day activities for maintaining a hygienic environment and waste disposal are entrusted to these organizations. Certain states like Kerala and Tamil Nadu have set good examples in this respect. India also has a dual centre–state sales tax system, with power given to states to set rates, in order to strengthen inter-governmental fiscal relations and to enlarge the tax base [10]. India still faces challenges, such as the joblessness and increasing income inequality, and the spread of communicable diseases and high incidence of HIV/AIDS concomitant to increasing migration of labour and international trade and also alarming increase in non-communicable diseases. Thus, the next generation of reforms need to focus on fostering a knowledge-based economy to maintain consistently high economic growth as average skill levels continue to improve [11]. Inclusive public policies should focus on balanced development by region and investments in health, education and infrastructure for future development, especially in backward areas and communities and ethnic groups [11]. There is a need for bridging the gap between the country's health policy and the health care needs of the poor to achieve the MDGs set for 2015. India accounts for 21% of global under five mortality (U5MR), although the U5MR has declined by 34% between 1990 and 2006 [12]. With a U5MR of 76 per 1000 live births, India occupies the 49th position in 2008. This decline occurred from 115th position in 1990. The ranking of India has come down slightly from 52 in 2006 and 54 in 2007, which reflects the rapid pace of decline in ranking in certain other countries compared with the slower pace in India. The state of the worlds children (SOWC) 2008 has ear marked India as one of the 60 ‘priority countries’ that need to scale up cost-effective strategies and community level integration of essential services for mothers, newborns and children and sustainable improvements in health care delivery system to achieve the MDGs. The most important point is that the world will not achieve the MDGs without India achieving it. The world is half way to the targets set for achieving the MDGs by 2015. The SOWC 2008 by UNICEF and the World Health Report (WHR) have audited the current situation and have given the correct interim advice to the ‘off track countries’ illustrating successful case studies to practise [12,13]. There is optimism that with frequent monitoring, involvement of new International health partnerships and initiatives like IMNCI, ICDS and National rural health mission (NRHM), India can also achieve selective reasonable goals by 2005. India's growth in the economic sector is encouraging. But the recent higher inflation rates and the hike in the oil prices are set backs to a large oil importing country like India. Communicable and non-communicable disease epidemics, natural disasters, communal riots, armed conflicts and frequent political swings are further hurdles that India has to account for in the future.