Opinion: An article by Rajiv Kumar shows that there is still confusion about Niti Aayog’s role

The column by the new Niti Aayog vice-chairman in Dainik Jagran also shows that he has flip-flopped on important policies.

On Monday, shortly after Rajiv Kumar was appointed Niti Aayog vice-chairman, the economist wrote a column in Dainik Jagran in which he described his vision of a swadeshi patriot-technocrat.

In the article, Kumar lamented the “Anglo-American” influence on Indian policy making. He gave examples of former Reserve Bank of India chairman Raghuram Rajan and his own predecessor at Niti-Aayog, Arvind Panagariya, claiming that these kinds of people had several failings. They do not understand the Indian ground realities and are not committed enough, so tend to run away from responsibilities before their tenures end. Besides, he claimed, the policies they frame spring from their ideological baggage rather than any real need.

While Kumar’s decision to advocate an insular idea that has little relevance in today’s world is worrying, that seems to be the smallest of the problems. Worryingly, his column reflects his willingness to alter his opinions to suit the prevailing ideological climate. More alarming, it indicates that both the government and Kumar are yet to define the role Niti Aayog ought to play as a premier government think-tank.

A change of mind

These early signals of Kumar’s intellectual flexibility are a cause for concern, considering that he is going to head an institution meant to provide intellectual rigour to policy making.

In the Dainik Jagran piece, he strongly opposes the privatisation of the health sector, primary education and other basic services. He says leaving these functions to the private sector will increase inequality and lead to looting by some at the cost of public welfare. He described this as the Reagan-Thatcher-International Monetary Fund model.

However, only the week before, he seemed to have held a completely different view. In an article in Swarajya magazine, he wrote: “An innovative approach would be to hand over the management of primary health centres and even district hospitals to private providers on the basis of a carefully drawn contract that is strictly monitored and enforced. The central government could design such a model contract for adoption by the states.”

This is exactly what the Niti Aayog had prescribed under Panagariya. But this push for privatisation of health care had drawn loud condemnation from the Swadeshi Jagran Manch, an organisation that Rajiv Kumar now seeks to align with.

Anglo-American admiration

That isn’t the only instance of Kumar reversing his position. As journalist Sunit Arora recollected on his blog, Kumar had in 2013 advised India to seek help from the International Monetary Fund during the economic trough that year. This is quite in contrast to his newly-adopted criticism of the World Bank, the International Monetary Fund and other Anglo-American’ influences.

In April 2015, too, he flipped from commending Prime Minister Narendra Modi for trying to amend the land laws through central fiat and then, a few months later in August 2015, went on to congratulate him for backing off and leaving it to the states as a federal concern . One can only hope that in coming days he will either show greater cohesion of thought or explain the reasoning behind his change of views. Else, he will strengthen the impression that his intellectual elasticity is a result of political expediency.

What is Niti Aayog?

The article raised questions about more than just Kumar’s intellectual positions. The article creates doubts over the future of Niti Aayog as government’s premier think tank. Rajiv Kumar’s own earlier thoughts on this might be useful for Prime Minister Narendra Modi to mull over.

In 2015 Kumar wrote, “As one foreign observer quipped, Professor Arvind Panagariya could hardly be expected to give up his University of Columbia professorship for anything short of regular and intensive interaction with the PM and his senior officials.”

In the same article he explained how that anecdote reflected the uncertain role of Niti Aayog:

“My fear is that, given the lack of statutory authority and the absence of well-defined rules of business, it [Niti Aayog] could continue to be perceived as a fifth wheel by both state government and central government agencies. Its role in government policy formulation would then be restricted to the personal access that the vice-chairman and two full- time members enjoy with the PM and his Cabinet colleagues... I am left wondering at the rational and strategic approach that has underpinned the design and mandate of the Niti Aayog.”

Kumar has repeatedly thought aloud about the confusion over the role of Niti Aayog. He has written several articles imagining various roles for the institution. In January 2015, Kumar, while discussing the nature of the new organisation, lamented that Prime Minister Narendra Modi has taken small incremental steps that add up to a good beginning. But he added: “These [steps] need to be broadcast much better to remove the perception that his government is suffering from hubris”. In the same article he notes, “One could, therefore, justifiably argue that this government, with its record of delivery, new initiatives and reliance on civil servants did not really require an independent body comprising primarily of professionals and domain experts.” He also suggests that taking over administrative roles from other ministries may not be a good idea for the think tank.

Even to function as a useful think-tank that can shape public policy, the Aayog requires clarity about its space in the government and not just a broad brush-strokes of ideas as guidance. For example, it would be valuable to consider if Niti Aayog is an agency that details and coordinates implementation of the ideas emanating principally from the executive across ministries, agencies and states – such as Skill India? Or it could work as a think-tank at arm’s length to provide the government with out-of-the-box ideas? The latter format allows the government some latitude to adopt ideas that work within the party-in-power’s political-economic goals and disown others as that of the think-tank.

Clear brief essential

Once this role is clear, the government needs to draw clear brief for staffing the institution. It is not just about the top rung. Other layers of the staff have a great deal to do with the deep drill and fleshing out of policy prescriptions that brings ground reality to bear upon big ideas. They are assisted by a host of non-government institutions, besides government officials at the Centre and in the states. Potential technocrats can come in all flavours after all and from all corners of life. Their intellectual moorings should not be dismissed as ideological baggage but valued for providing different perspectives and approaches.

The Bharatiya Janata Party-led government did well to dissolve the Planning Commission and the command-and-control ideology it represented, shortly after coming to power in 2014. But it will take a lot more to shape an alternative institution, which unlike its predecessor, does not draw powers only from personal proximity of its top rung to the prime minister and one that does not act as the government’s advertising agency.

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Removing the layers of complexity that weigh down mental health in rural India

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Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.