British Academy: The UK's National Academy for the Humanities and Social Sciences

Thursday 5 October 5 2006

ABSTRACT

Everyday politics in the social sector: Health providers and ailing villagers
Roger Jeffery and Patricia Jeffery (Edinburgh)

A major cause of India’s embarrassment on the world stage - especially when it is compared to China as an emerging giant - is the poor health status of its rural population, especially in the large north Indian states. For instance, maternal and child health indicators suggest improvements have at best plateaued. Most interpretations of the 'problem' focus on failures of the population (to get education, to access services in timely and appropriate ways) but some recent studies increasingly emphasise systemic failures. Even so, however, the political dimensions of the relationships between providers and villagers have not been given adequate attention. Whether by default (failing to invest in existing or new hospitals and clinics) or by design (as key workers - doctors and nurses - have established themselves in the private sector), the state has become less central to health care. But the transformations this has wrought remain unclear.

In this paper we analyse local perspectives on services and providers, and examine the political dimensions that contribute to the failures to deliver quality health care to India’s villages. We draw on fieldwork carried out over more than 20 years in rural Bijnor, in western Uttar Pradesh, to explore local demands on and constructions of the social state, and how they have changed during India’s economic liberalisation. We focus on reproductive and child health, and the changing roles of key intermediaries - untrained as well as government health workers to highlight the micro-politics of the local state and the emerging ambiguities of costly absences in curative services and coercive presences in family planning and Pulse polio campaigns.

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