India: Fighting graft at the grassroots

Rohan, an emaciated nine-year-old, lies coughing in his father’s arms. "He has tuberculosis," the man tells me. "But I cannot afford the medications." Behind the pair stands Lakshmi, a slight young woman who cradles a pale, listless baby. Has her child had her vaccinations? "No," the mother says. "We began but they became too expensive." ...

Prakash Singh/AFP/Getty Images
Prakash Singh/AFP/Getty Images
Prakash Singh/AFP/Getty Images

Rohan, an emaciated nine-year-old, lies coughing in his father's arms. "He has tuberculosis," the man tells me. "But I cannot afford the medications." Behind the pair stands Lakshmi, a slight young woman who cradles a pale, listless baby. Has her child had her vaccinations? "No," the mother says. "We began but they became too expensive." Both families have waited hours in line for a two-minute appointment with a doctor at a free healthcare camp.

Over the past few years the Indian government has invested hundreds of millions of dollars to prevent such scenes from occurring. Tuberculosis medication and general vaccinations are both among the services that are supposed to be provided by officials on demand, at no cost. But these villagers in Mirzapur, Uttar Pradesh, know nothing about this policy. The reason: the ubiquitous, low-level corruption that stands between the poor and their access to healthcare. Local providers capitalize on widespread ignorance among villagers, illicitly charging for government resources and pocketing the profits. Those who are aware that they are being cheated often have nowhere to go with this knowledge and no choice but to pay the bribe.

Such daily graft rarely draws the same attention and headlines as the hunger strikes of anti-corruption champion Anna Hazare or the transformative tenure of Chief Minister Nitish Kumar in Bihar. Even as the Indian parliament dithers over anti-corruption legislation that would target high-ranking figures in business and government, grassroots efforts throughout the country are attempting to take on the petty bribery that probably exacts an even higher cost on the poor. To put this in perspective, Transparency International India estimated the average "Below Poverty Line" (BPL) household paid INR 550, or about 11 USD, in bribes in 2007. With 40 percent of BPL Indians earning less than 1.25 USD a day, this is a substantial portion of their very limited income.

Rohan, an emaciated nine-year-old, lies coughing in his father’s arms. "He has tuberculosis," the man tells me. "But I cannot afford the medications." Behind the pair stands Lakshmi, a slight young woman who cradles a pale, listless baby. Has her child had her vaccinations? "No," the mother says. "We began but they became too expensive." Both families have waited hours in line for a two-minute appointment with a doctor at a free healthcare camp.

Over the past few years the Indian government has invested hundreds of millions of dollars to prevent such scenes from occurring. Tuberculosis medication and general vaccinations are both among the services that are supposed to be provided by officials on demand, at no cost. But these villagers in Mirzapur, Uttar Pradesh, know nothing about this policy. The reason: the ubiquitous, low-level corruption that stands between the poor and their access to healthcare. Local providers capitalize on widespread ignorance among villagers, illicitly charging for government resources and pocketing the profits. Those who are aware that they are being cheated often have nowhere to go with this knowledge and no choice but to pay the bribe.

Such daily graft rarely draws the same attention and headlines as the hunger strikes of anti-corruption champion Anna Hazare or the transformative tenure of Chief Minister Nitish Kumar in Bihar. Even as the Indian parliament dithers over anti-corruption legislation that would target high-ranking figures in business and government, grassroots efforts throughout the country are attempting to take on the petty bribery that probably exacts an even higher cost on the poor. To put this in perspective, Transparency International India estimated the average "Below Poverty Line" (BPL) household paid INR 550, or about 11 USD, in bribes in 2007. With 40 percent of BPL Indians earning less than 1.25 USD a day, this is a substantial portion of their very limited income.

Aware of the graft-related obstacles facing their patients, medical residents of the Community Medicine department of Banaras Hindu University (BHU) decided to take action. Although they offer one-day health camps that are genuinely free (such as the one where I met Rohan and Lakshmi), the residents know that this is a temporary fix at best. So they designed an innovative patrol network to address the illegal charges that villagers face before receiving medicines and vaccinations. Each monitor is assigned to a specific village. Every week, they travel to their designated communities to observe medical clinics and immunization sessions held in front of the thatched-roof abodes of government-paid community health workers in an effort to enforce the proper provision of services.

Healthcare is merely one of many areas where Indians can expect "free government services" to come at a cost. James Rajasekaran, project director of the People’s Association for Rural Development (PARD), knows this all too well. His NGO was created to eradicate child labor from the slums in the southern city of Madurai in Tamil Nadu. Rajasekaran charts how corruption adds to the financial strain that often drives parents to send their children to nearby factories rather than school. Although separated from the villagers of Mirzapur by language, culture, and hundreds of miles, the slum dwellers of Madurai face problems with corruption that would ring familiar to Rohan and Lakshmi.

PARD now works to empower the poor to demand bribe-free government services. The effort began by employing inhabitants of the slums where PARD focuses its efforts: when the job involves approaching a house and asking residents to expose corrupt government officials, candid answers are more likely to come when it’s a neighbor who’s inquiring. Rajasekaran hopes to prove that such honesty regarding payment of bribes is neither dangerous nor futile. Recently, after learning that people looking to acquire a BPL card that gives them access to state-subsidized food and housing were forced to pay a 400-rupee bribe to a desk worker in a government office, he stationed a PARD employee at the office to ensure that 80 such cards were distributed without the payment of a bribe. Such demonstrations, he believes, will instill faith that, if people expose corrupt officials, they will be rewarded with an improvement in the situation rather than the inaction or threats many fear.

What the initiatives at BHU and PARD have in common is that they understand corruption as an everyday experience that has to be battled from the bottom up, at the grassroots. They don’t see corruption as a general problem to be debated in Delhi or countered by an outside "Anti-Corruption Movement" swooping in to save the day. It is a daily reality that has to be addressed if healthcare and other basic services are to be reliably delivered to the people of India.

Neither group holds the illusion that it might be able to cure corruption in Mirzapur or Madurai, let alone India. The residents at BHU hope that their monitoring will dissuade corrupt workers from charging patients — but they realize that parents will probably be forced to pay for polio vaccinations for their children as soon as the hospital workers drive away. Rajasekaran worries that many other non-profits allegedly serving the poor engage in corrupt practices with government officials. The BHU doctors and PARD are both striving to ensure that the poor are aware of government resources and to alter the behavior of corrupt government employees with the threat of public exposure. Yet their efforts are inherently limited by the slim chances of any of these crimes ever being brought to justice.

However, these grassroots advocates also understand that even the successful passage of national anti-corruption legislation will not, by itself, end the petty bribery facing the villagers of Mirzapur or the slum dwellers of Madurai. The only effective answer is likely to be the continued vigilance provided by groups like theirs. Local efforts and constant pressure, even more than legislation, are needed to change this culture of corruption.

Alli Hugi is a senior at Yale University studying Global Affairs and Political Science. She spent the last summer in India, where she was an intern at Transparency International India and conducted field research on anti-corruption efforts and healthcare initiatives. 

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