NGOs, Government and Private Sector in Health

NGOs are private organisations, but their nature makes them somewhat different from what one generally refers to as the private sector. Firstly, organisations operating as NGOs are registered either as 'trusts' or 'societies'. As a consequence, they are not supposed to make profit, unlike the private sector. Secondly, NGOs are involved in the 'development sector'; that is, running programmes such as health, nutrition, family planning, education, water supply and sanitation, urban renewal, housing, research, training and documentation, agriculture related development programmes (IRDP etc) and employment programmes (FFW etc), among others. These constitute what one might call service-NGOs. Another category of groups included under the banner of NGOs are activist groups who are involved in conscientisation and struggle oriented activities, but they may also undertake some services. Organisations that are usually only production-oriented are normally not included under the NGO umbrella. However, some service NGOs may undertake production activities such as agriculture, household industry, etc. And there are also funding agencies which are referred to as NGOs. Thirdly, NGOs are invariably depen­dent on external sources of financing for their activities (including most activist groups). And finally, a large number of NGOs, especially in rural areas, ru n programmes of the government on a contractual basis because of their (NGOs) supposed dedication and flexibility. This is a more recent phenomena (Fifth Plan onwards)—the government, for instance, gives its own health centre or IRDP project to be run by an NGO because the government believes that its own structure is inefficient, bureaucratic and incapable of reaching the beneficiaries. In 1953 the government set up the Central Social Welfare Board, to provide grant-in-aid to NGOs. Further, in its own development programmes, the government sought the expertise and co­operation of well-known NGOs. This was more so necessary when CDP was evaluated at the end of the First Five Year Plan by the Planning Commission: Most of the time was spent in solving procedural/administrative wrangles making implementation of programmes inefficient, inadequate and wrongly directed (GOI, 1958). The government could not ignore the social services sector and the private sector was unwilling to invest in social infrastructure. The private sector, for its ow n expansio and profitability, pushed the government into investing vast public resources in building infrastructures and heavy industry that was essential for economic growth, but more so to facilitate the growth of private capital. As a consequence, the social sectors like health and education were totally neglected— health sector was mainly operated by private practitioners and a large number of hospitals run by NGOs, and the education sector was mainly run by NGOs (missions, public trusts and societies). The NGOs in these early years were largely concentrated i n urba areas, but many were now gradually spreading their tentacles into the countryside, the leaders being Gandhian and Christian missionaries. In the health sector the government, though i principle ha d accepte the Bhore committee recommendation, was still undecisive—even today, the physical targets recommended by the Bhore committee are far from realisation. The anti-malaria and anti-smallpox campaigns were undertaken at the behest and with support of international agencies. It was not until the mid-sixties (Third Plan) that the health infrastructure for rural India got serious attention from the govern­ment. This too for two reasons—the resurgence of malaria and the govern­ment's decision to give family planning programmes a big boost through the camp approach. This was also the time when the green revolution in India began and the country­side had suddenly come into focus (from the perspective of mainstream economics). The corporate sector showed increased interest in rural India for here was an opportunity to capture rural markets not only with the new agricultural technology but also (due to increased commerciali­sation of agriculture) with other goods and services. The corporate sector, however, was unwilling to go on its own into the rural areas. It wanted crutches from the government and the latter obliged by starting massive agricultural development programmes such as IADP and later SFDA. In these programmes the inputs for modern agriculture (equipment, fertilisers, high yielding variety seeds, pesticides, etc) were provided by the corporate sector through the government agencies to the farmers. The government paid the corporate sector for goods and service s an d marke the amount a loan and subsidies to the farmers. Thus, the corporate sector's profits were assured. To facilitate the government's loan programmes the corporate houses set-up NGOs who would act as middlemen between the peasantry and the govern­ment (using the same logic—government is inefficient and private sector is dedicated and effective). Thi s wa a new kind of association for the Indian corporate sector with its periphery .(earlier they only looked for raw materials and cheap labour in the periphery) and it promised assured returns because of the involvement and parti­cipation of the government at two levels-one as a monopoly buyer of agri-products and the other as a concession giver, in the form of tax-expenditure (with weighted deductions) and tax-holidays for venturing into agri-business and moving into the countryside (of details see Duggal, 1985). These NGOs, floated and/or supported by the corporate sector, invariably used medical programmes or drought relief as entry points. Though their interest was in promoting 'new agriculture' and expro­priating surplus, they also added social services such as medical, education, vocational training programmes, etc, to their activities, both for legal purposes (because they were registered as 'trusts' or 'societies') as well as to show that they were socially responsible! However, their approach was significantly different from Economic and Political Weekly March 26, 1988