Bihar is struggling to improve the lives of the poor even after 27 years of backward caste rule

The district hospital of Muzaffarpur, 100 km north of Patna, Bihar’s capital, is struggling with a shortage of doctors.

With 160 beds and an estimated inflow of 500-600 new patients each day, the hospital should have 48 full-time doctors and 52 nurses, said one of its administrators. What it has, instead, is 12 full-time doctors, 24 part-time doctors and 28 nurses. The Intensive Care Unit should have four doctors but has just one. The unit for newborn babies, which should have four pediatricians, is managing with just one.

Given such understaffing, the hospital doesn’t meet the district’s healthcare needs.

When Madina Begum, a resident of Ratnauli village, took a neighbour with a temperature of 104 degrees Fahrenheit to the hospital, she said, “All the doctors did was give her a bottle of saline. Nothing else. No medicine.” The woman’s companions had to put wet clothes on her all night to cool the fever down.

That is the story across Bihar. Seventy years after Independence, the state’s healthcare infrastructure continues to be grossly inadequate. Seventeen of the 38 districts in the state have no more than three government doctors for every 100,000 people. One district, Siwan, has just one doctor for 100,000 people. The highest, Sheikhpura, has eight doctors per 100,000 – or one for every 12,500 people. To put that in perspective, the WHO-prescribed level is 1:1,000.

In the same way, while the Right To Education law mandates student-teacher ratios at 30:1 in primary schools and 35:1 in upper primary, the ratio in Bihar districts hovers between 43:1 and 96:1. As a result, learning outcomes are poor in the state.

All of which echoes what we saw — in relatively greater detail — in the state’s remarkably inadequate response to both arsenic contamination of groundwater and the rising incidence of dengue. Embedded in all this is a paradox. In the last 12 years under chief minister Nitish Kumar, as the article says, Bihar has notched up large improvements in law and order, road connectivity and electricity supply. But its performance on issues crucial for the poor – like health, education and land redistribution – remains weak.

Which is odd. In the last 27 years, the state has been ruled by backward caste leaders, who rose to power by appealing to the poor. Given that, why is Bihar’s track record on crucial issues that most affect the poor so underwhelming?

Out today is the first of a three-part answer to that question.



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I am an Indian journalist with interests in energy, environment, climate and India’s ongoing slide into right-wing authoritarianism. My book, Despite the State, an examination of pervasive state failure and democratic decay in India, was published by Westland Publications, India, in January 2021. My work has won the Bala Kailasam Memorial Award; the Ramnath Goenka Excellence in Journalism Award; and five Shriram Awards for Excellence in Financial Journalism. Write to me at despitethestate@protonmail.com.

Reviews

…une plongée dans les failles béantes de la démocratie indienne, un compte rendu implacable du dysfonctionnement des Etats fédérés, minés par la corruption, le clientélisme, le culte de la personnalité des élus et le capitalisme de connivence. (…a dive into the gaping holes in Indian democracy, a relentless account of the dysfunction of the federated states, undermined by corruption, clientelism, the cult of the personality of elected officials and crony capitalism).” Le Monde

…a critical enquiry into why representative government in India is flagging.Biblio

…strives for an understanding of the factors that enable governments and political parties to function in a way that is seemingly hostile to the interests of the very public they have been elected to serve, a gross anomaly in an electoral democracy.” Scroll.in

M. Rajshekhar’s deeply researched book… holds a mirror to Indian democracy, and finds several cracks.The Hindu

…excels at connecting the local to the national.Open

…refreshingly new writing on the play between India’s dysfunctional democracy and its development challenges…Seminar

A patient mapping and thorough analysis of the Indian system’s horrific flaws…” Business Standard (Image here)

33 മാസം, 6 സംസ്ഥാനങ്ങൾ, 120 റിപ്പോർട്ടുകൾ: ജനാധിപത്യം തേടി മഹത്തായ ഇന്ത്യൻ യാത്ര… (33 months, 6 states, 120 reports: Great Indian journey in search of democracy…)” Malayala Manorama

Hindustan ki maujooda siyasi wa maaashi soorat e hal.” QindeelOnline

What emerges is the image of a state that is extractive, dominant, casteist and clientelist.Tribune

…reporting at its best. The picture that emerges is of a democracy that has been hijacked by vested interests, interested only in power and pelf.Moneycontrol.com

Book lists

Ten best non-fiction books of the year“, The Hindu.

Twenty-One Notable Books From 2021“, The Wire.

What has South Asia been reading: 2021 edition“, Himal Southasian

Interviews

Journalism is a social enterprise…,” Booksfirst.in.

Democratic decay at state level: Journalist M Rajshekhar on book ‘Despite the State’,” The News Minute.

Covid-19 en Inde : “des décès de masse” dont un “État obscurantiste est responsable,” Asialyst.

Allusions/Mentions

JP to BJP: The Unanswered Questions“.
Mahtab Alam’s review of “JP to BJP: Bihar After Lalu and Nitish”.

Urban History of Atmospheric Modernity in Colonial India“. Mohammad Sajjad’s review of “Dust and Smoke: Air Pollution and Colonial Urbanism, India, c1860-c1940”.

Westland closure: Titles that are selling fast and a few personal recommendations,” by Chetana Divya Vasudev, Moneycontrol. (Because this happened too. In February, a year after DtS was released, Amazon decided to shutter Westland, which published the book. The announcement saw folks rushing to buy copies of Westland books before stocks run out.)

Time to change tack on counterinsurgency” by TK Arun, The Federal.

All Things Policy: The Challenges of Governing States” by Suman Joshi and Sarthak Pradhan, Takshashila Institute (podcast).

The Future of Entertainment“, Kaveree Bamzai in Open.

On What India’s Watching“, Prathyush Parasuraman on Substack.

The puppeteers around us“, Karthik Venkatesh in Deccan Herald.

Will TN election manifestos continue ‘populist’ welfare schemes?“, Anna Isaac for The News Minute.

Why wages-for-housework won’t help women“, V Geetha in Indian Express.

The poor state of the Indian state“, Arun Maira in The Hindu.

Book discussions

26 December, 2021: Rangashankara, Bangalore, a discussion with Dhanya Rajendran.

16 November: Rachna Books, Gangtok, a discussion with Pema Wangchuk.

29 August: Books In The Time of Chaos, with Ujwal Kumar.

21 May: Hyderabad Lit Fest with Kaveree Bamzai and Aniruddha Bahal.

28 March: Paalam Books, Salem, Tamil Nadu.

19 March: The News Minute, “Citizens, the State, and the idea of India

6 March: Pen@Prithvi, with Suhit Kelkar

20 February: A discussion between scholars Usha Ramanathan, Tridip Suhrud, MS Sriram and me to formally launch Despite the State.

6 February: DogEars Bookshop, Margoa.

5 February: The Polis Project, Dispatches with Suchitra Vijayan.

30 January: Founding Fuel, “Systems Thinking, State Capacity and Grassroots Development“.

25 January: Miranda House Literary Society