Reimagining India: Unlocking the Potential of Asia’s Next Superpower (8 page)
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Authors: McKinsey,Company Inc.
That’s a bold claim. Let me offer some history to back it up. In 1988, when the number of new polio cases was approximately 350,000 a year and the disease was crippling children in 125 countries, the World Health Assembly—representing all the world’s countries—established the goal of eliminating polio worldwide. The Global Polio Eradication Initiative—which includes Rotary International, the World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention—was able to generate the political will and the funding for large-scale immunization campaigns. Progress came quickly. By 1994, the Americas were polio-free. Soon we saw the last case in China, the last case in the Pacific, the last case in Europe. By the year 2000, the number of polio cases had dropped by 99 percent. But the task of ending polio was not 99 percent done.
As the global map of polio shrank, and the remaining cases were concentrated in fewer countries, India was one of the last nations left. This
was no surprise. India’s urban centers are among the world’s most densely populated. Its rural communities are dispersed across a vast and often inaccessible terrain. The country suffers from poor sanitation. Its 1.2 billion citizens are highly mobile, and give birth to 27 million new Indians every year. These challenges prompted experts to predict that polio would be eliminated in every other country before it was eliminated in India.
But India surprised them all: The country has now been polio-free for more than two years. As I see it, India’s success offers a textbook script for winning some of the world’s most difficult battles, not only in public health, but in most every area of human welfare, from business to agriculture to education. And the key has been the participation of the humblest, most vulnerable elements of the Indian population.
To be successful, any campaign this big has to include three elements: a clear goal, a comprehensive plan, and precise measurements—so you can see what is working and what is not and improve the plan as you go. India’s polio program has benefited from all three. The goal is clear and ambitious: eliminate polio in India. The plan is massive and comprehensive, big enough to inspire the entire nation to action. The fact that India has fully funded its own antipolio plan is a ringing statement of Indian commitment and self-confidence. The measurements of vaccination coverage and the tracking of new cases allowed health officials to make midcourse corrections and refinements that proved decisive. In each of these three elements, India demonstrated its resilience, talent, and determination.
Above all, though, the campaign enlisted the support of the full sweep of Indian society, including health workers, ordinary citizens, and some of the poorest people in the most impoverished regions of the country. This program became their cause. It created a groundswell of enthusiasm and tapped the spirit of India.
The heart of the plan was a simple and inspiring mission: find the children.
To defeat polio, it’s essential to achieve up to 95 percent vaccination coverage in afflicted areas. There is no way to measure whether you’re meeting that mark unless you know how many children there are, where they are, and whether they’ve been vaccinated. That’s a daunting challenge in a nation where millions of the most vulnerable people live in poor and remote regions.
India responded to this challenge with an army of more than two million vaccinators, who canvassed every village, hamlet, and slum, paying particular attention to the most polio-afflicted areas marked by the worst poverty. Vaccinators took the best maps they had and made them better. They walked miles every day and worked late into the night to find every child.
They found children in the poorest areas of Uttar Pradesh. They found children in the remote Kosi River area of Bihar—an area with no electricity that is often flooded and unreachable by roads. They found the sons and daughters of migrant workers in bus stations and train stations, accompanying their families on their way to find work.
The thoroughness of India’s vaccinators was astonishing. When Melinda and I visited India in March 2011, two months after the last case of polio was identified, we traveled to a brick kiln where we met with workers who labored long hours at low wages and lived in mud huts. Despite their toil, these are some of India’s poorest people. We met a young mother, perhaps twenty-two years old, and asked if her children had been vaccinated. She ducked into the hut where she lived, retrieved a bag that held all her possessions, and rummaged around the bottom of it until she proudly produced an immunization card listing names of all her children and showing that each had received the polio vaccine—not just once, but several times. We were amazed. The vaccinators had not only reached this migrant woman and her children; they had done so often.
Wherever India’s vaccinators have gone, they’ve had help from local residents. In one Kolkata slum, a group of schoolchildren who call themselves the Daredevils have been relentless in their efforts to get every child vaccinated; their work is now featured in a film called
The Revolutionary
Optimists.
The Daredevils looked on the Internet for a map of their community and found that the area where they lived had been left blank. So the children decided to make a map. The community had never had house numbers, so the children assigned house numbers. Using donated cell phones that could connect to global positioning satellites, they created a digital map for their neighborhood, marking every house where children hadn’t been vaccinated. They used both high-tech and low-tech methods. The film shows the children going into the streets with their handmade megaphones, shouting: “Polio vaccinations at the club this Sunday! Please come and bring your children!”
The Daredevils helped double the vaccination rates in their community from 40 percent to 80 percent. They’re now taking aim at 100 percent.
The fight to end polio is not over, not even in India. Vaccinators have to continue their work, and the country needs to stay vigilant. If the world can maintain its funding and its commitment, we can eradicate polio globally within six years. That would be a tremendous accomplishment, but it will be only one of many benefits to come from India’s polio program. The effort to find and vaccinate every child has created the basis for a better public health system throughout the country.
In 2011, Melinda and I accompanied polio vaccinators as they went door to door in Bihar. When we met women who were pregnant, the vaccinators talked to them about the importance of receiving maternal and neonatal care, and urged them to visit the local clinic. They promised on their next visit to bring information about child health care and teach the women about breast-feeding. They reminded the women to be ready to get their newborns vaccinated for other diseases and made sure they knew the way to the clinic.
This is why the accomplishments of the vaccinators and the children and the scientists and the politicians will not end when polio ends. They will be applied to the next challenge. This is the legacy of polio in India. They have found the children. Now they can bring them and their families other vaccines, and clean water, and education, and advice on maternal and child health, and support for agriculture, and all the things that
people need to live healthy and productive lives. India has miles to go in this quest, by any measure, but it has shown it has the will and means to realize its full potential.
Years ago, on that day we were landing in Bangalore, I didn’t know nearly as much about India as I do now. I saw India’s obvious talent and energy, but, like my colleague, I missed its hidden strength—the rich, the powerful, and the poor working together toward a common goal. The antipolio campaign’s extraordinary push to find every child has awakened the power of India—not just for the children who were found but also for all those who worked find them and tell them, “Your life is important to us. We will protect you.”
The campaign showed India at its best—the relentless spirit, the idealism, the teamwork, the scientific power, the business acumen, the manufacturing skill, the political imagination, and the vast human resources that can deploy more than two million people and spark the imagination of a billion. Yes, India faces challenges in many areas that are well documented in the media. But in its fight against polio, India has shown the world that when its people set an ambitious goal, mobilize the country, and measure the impact, India’s promise is endless.
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The village of Jharki Bisalpur, deep inside a forest in Jharkhand, lies beyond three rivers. When the rains fall, the rivers swell, barricading the village from the outside world. Then Sheila Devi, the daughter of a farmer and a housewife, the first woman in her family to have a paying job, takes charge. She strides the length of the village in her mustard-yellow sari, urging residents to pen their cows, check their stores of grain, or cover the well. She devises a plan to send someone to the nearest town, five hours away on foot, to buy additional supplies. “This is the jungle,” she says, from under a voluminous black umbrella. “But even the wild animals had the sense to move elsewhere.”
Devi is the
sarpanch
, or village head, of Jharki Bisalpur, and she is an unusual choice of leader for this impoverished village. Still only in her thirties, she is making her first foray into local politics. Before becoming
sarpanch
, she worked for a nonprofit group. And yet women like her are no longer uncommon in rural India.
Devi’s status is part of a trend running counter to the misogyny and patriarchy embedded in Indian society. Those forces exploded into public consciousness following the December 2012 rape and murder of a twenty-three-year-old woman in Delhi and the massive demonstrations that ensued. The long-overdue focus on pervasive sexual harassment and
violence in India has spurred parliamentarians to toughen laws, while the police and judges—who have tended to treat rape casually, sometimes urging victims to marry their attackers—are scrambling to adopt more enlightened practices.
Whether those promises of change lead to fundamental improvement in Indian attitudes toward women remains to be seen. But as Devi’s case shows, progress is possible, even in the most remote and tradition-bound parts of the country. For that to happen, action and reform by public policy makers is necessary—though it is hardly sufficient, given the myriad economic, social, and political complexities besetting life in places such as Jharki Bisalpur.
Devi is one beneficiary of a 1993 constitutional amendment aimed at confronting sexual discrimination by mandating that a third of all seats in the
panchayat
—the governing institution created to foster grassroots democracy—be reserved for women. Such “reservations,” as this kind of quota is known, were the only way, supporters argue, for women to have a shot at leadership roles in local politics. Prior to this, social pressure kept village women in the home and, as a result, the
panchayats
were almost entirely male, with priorities that often excluded women’s and children’s issues such as day care and schooling.
The law may have required change, but the enthusiasm with which women grasped at the opportunity—with several candidates contesting each seat—showed readiness. According to the Ministry of Panchayati Raj, women comprise 1 million out of the 2.8 million elected members in the
panchayats
.
As
sarpanch
, Devi is less concerned with making a point than with doing her job. She is the only link between her voters and the state government—a vital link given the isolation and poverty of Jharki Bisalpur. Although Jharkhand is a mineral-rich state, and the forest was once mined for mica, it is no longer legal to do so. Still, with no other work available, every able-bodied man and boy, and women as well, dig for mica with
whatever implements they can afford—hammers, knives, or even just their fingers. Families that don’t have the manpower to dig deeply forage for mica debris. But at 3 rupees a kilogram, a family in Jharki Bisalpur often earns less than half the daily minimum wage of 120 rupees.