India in Pursuit of Millennium Development

Goals: Were the Targets Really Feasible?

J. Prachitha
TRIOs Development Support (P) Ltd., New Delhi
Akshay Dhume
School of Business Management, SVKM’S NMIMS, Bangalore Campus,
Bangalore
S. Subramanian
IILM University, Gurugram, Haryana

Abstract

In recent years, the Indian National Health Mission (NHM) was introduced by
the Government of India as an umbrella of health programs to cover reproductive
and child health, adolescent health, and selected disease control programs. These
programs were given a mandate to accelerate the achievement of the health-related
Millennium Development Goals (MDGs) by 2015. Considerable progress toward
realizing the MDG objectives has been achieved, especially reductions in infant
and child mortality and improvement in measles vaccination coverage (MDG
Goal 4), as well as the reduction of maternal mortality and an increase in the
number of births attended by skilled personnel (MDG Goal 5). Nevertheless, an
overall appraisal of the status of the indicators in 2015 reveals that many of the
targets remained to be achieved. The analytical issue explored here is whether the
targets were too high to achieve or whether Indian health policies were flawed or
too long delayed. This article offers a state-wise analysis of the achievements in
health indicators relating to MDGs 4 and 5. The rate of achievement for two time
periods, pre-NHM and NHM until 2015, is analyzed here. Our key finding is that
most of the targets were indeed infeasible, but that lack of achievement could be
attributed to delays in planning; sometimes poor execution of the policies and
programs; and to the economic, social, and political disparities within the country.
Better organized and more innovative approaches at the state level could improve
the realization of vital MDG targets, providing improved public health for all.

Keywords: Health and development, health outcome achievements, National

Health Mission of India, health-related Millennium Development Goals, health
policy planning

Copyright © 2019 SAGE Publications www.sagepublications.com

(Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne)
Vol 35(1): 105–133. DOI: 10.1177/0169796X19826737
106 Journal of Developing Societies 35, 1 (2019): 105–133

Introduction

The Sustainable Development Goals (SDGs) adopted by the United

Nations General Assembly in September 2015 focused on placing the
world on a sustainable public health reform trajectory by the year 2030.
The SDGs set the global direction for 17 developmental goals. Deeply
aware of the positive relationship between health, economic development,
and growth, the SDGs have set a core health goal, goal 3, to “ensure
healthy lives and promote well-being for all at all ages,” calling upon
achieving Universal Health Care (UHC) by all the member countries.
Health constitutes an important element among the objectives and
targets of SDGs and in combination with multiple SDGs relating to
critical social determinants of health. The SDGs also set forth a plan for
preserving and augmenting the achievements for the 15-year Millennium
Development Goal (MDG) period.
Even before this initiative, the UN’s Millennium Summit of 2000
(UNMS 2000) had recognized the importance of health for economic
development, setting time-bound goals for nations to achieve. The
Millennium Declaration of 2000 deepened the commitment to achieving
goals 4, 5, and 6 (combating HIV/AIDs, malaria, and other leading killers).
A snapshot of the goals, targets, and indicators is provided in Table A1.
Substantial efforts were made, especially by developing countries,
toward achievement of the health-related MDGs. But while the intentions
of UNMS 2000 were noble, developing countries have found it difficult to
achieve the targets. A glimpse of the status of the MDG health indicators
of the BRICS nations (Brazil, Russia, India, China, and South Africa),
countries that were at similar mid-range stages of economic development,
can be seen in Table 1. While Brazil and China have achieved the targets

Table 1.
Achievement of MDG Health Indicators by BRICS Nations

IMR U-5MR MMR

MDG MDG MDG
Country 1990 Target 2015 1990 Target 2015 1990 Target 2015
Brazil 53 18 14 64 21 15 104 26 44
Russia 18 6 7 22 7 8 63 16 25
India 88 29 36 126 42 43 556 139 174
China 42 14 9 54 18 10 97 24 27
South Africa 45 15 36 57 19 44 108 27 138
Source: World Bank (www.data.worldbank.org).
 Prachitha et al.: India in Pursuit 107

set for infant mortality rates and under-five mortality rates, the other
three BRIC nations have not achieved these. None of the BRIC countries
have been able to realize the target set for lowering maternal mortality
rates. Thus, the extent of the achievement varies between countries,
regions, and goals because of the extent of commitment by key stakehold-
ers within the nations, as well as each nation’s actual stage of economic
development.
The shortfall in MDG achievement is more serious and regrettable for
developing and middle-income countries like India, but may in part be
explained by the wide intra-regional diversities in social, political, and
economic statuses. It is, therefore, imperative to reflect on the achieve-
ments with respect to health-related targets of the MDGs and use these
experiences to plan the pathway forward for realization of these important
goals. The present study is a sub-national analysis of the achievements of
health-related MDG targets by India and its states, seeking to demonstrate
that a wide and diversified array of factors have a significant impact on
achievement of these time-bound goals.
The article is organized as follows. The second section presents the
Indian context, specifying diversities in the social, political, and economic
statuses of the Indian states. The third section summarizes the initiatives
undertaken by the Indian policy makers in the health sector and discusses
the Indian health approaches in light of the MDGs. The fourth section
focuses on the methodology used to analyze feasibility of health-related
MDGs in the Indian states, while the fifth section assesses the results.
The sixth section concludes the article with a review of India’s experience
given the diverse nature of the country.

Multi-dimensional Diversities of India

Following independence in 1947, India was divided into state administra-

tive units, established based upon the language spoken by majority of
the population in each region. The Linguistic Survey of India undertaken
by George Abraham Grierson, started in 1894 and last for 30 years, found
that there were 179 languages and 544 dialects spoken in the Indian
subcontinent. Grierson may have overstated the case; the present-day
Constitution of India recognizes only 22 official languages in the nation.
Languages in India serve not only as a form of communication but also
as markers of regional identities. There are other areas of diversity,
for India is also a home to six principal religions or faith-based beliefs.
Unlike most of the Western world where religion is more a private affair

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that generally does not impact healthcare choices, the situation in India
is different. Each religious belief or faith can hold different approaches
to accessing healthcare, and most individuals resort to faith healing
rather than conventional or alternative medicine. Further, religious
beliefs can often forbid individuals from making use of some measures
that promote healthcare. For example, in certain communities usage of
contraceptive methods is prohibited, while in others abortion is banned.
The complexity of religious bearing on healthcare choices is further
deepened by the Indian caste system, where individuals from lower castes
are not given the right to basic healthcare system in certain parts of the
country. Finally, some communities in India have very different lifestyles,
and they do not wish the modern world to tamper with their beliefs
and practices.
Beyond these factors, India is a country riven by profound geographi-
cal regionalism, ranging from flat plains, inaccessible mountainous, dense
forests to marshy lowlands. The country experiences varied climatic
conditions which can lead to droughts in some areas, while floods and
landslides in others. Given this geographic context, providing healthcare
infrastructure is often difficult and costly. Moreover, even if the govern-
ment were to establish the facilities in all zones, obtaining skilled profes-
sionals who would be willing to work in these remote and challenging
regions is very difficult or in some cases just not possible. The differences
caused because of linguistic, religious, and geographical factors result
in grave social and economic disparities, having a measurably adverse
impact on the success of healthcare programs.
Added to this is the polity of India, which is also rather complex in
nature. India follows a parliamentarian system where the members of
the Parliament are elected by the citizens of the country through secret
ballot, whereas the prime minister or the members of the cabinet are
not elected by the people. An analogous structure is followed at the
state level, where members of the State Assembly are elected by resi-
dents of the respective states. It may also be noted that unlike the USA,
where the elections for practical purposes are between two political
parties (Democrats and Republicans), Indian elections witness a contest
among several national and regional parties. While the Indian National
Congress (INC) and Bharatiya Janata Party (BJP) dominate the scene at
the national level, regional parties are more important at the state level.
Thus, it is not unusual to have one political party in power at the center
and the opposing party in some of the states. The tussles between parties
 Prachitha et al.: India in Pursuit 109

can lead to either the center not providing adequate funds to the state or
the state not cooperating with the center for promoting any given pro-
gram, or both. In the recent years, parties have been forming coalitions,
but the dynamics and loyalties between parties are not stable from one
election to next. The changing political scenarios have an adverse impact
on the stability of the government and the chances that any policy can be
introduced and implemented successfully.
India, at present, has 29 states and 7 union territories (UTs) which are
as seen in the map of India provided in Table 2. The states of India are
rather diverse in their size, population as well as the resource (natural
and financial) endowments that they enjoy, which, in turn determine their
social and economic indices. Of the 29 states, 8 are small and have low
densities of population. Since data on health outcomes are not available
for these small states and the UTs (MoHFW & NITI Aayog, 2018), these
units were not considered for the analysis in the present study. Even among
the 21 larger states, 8 are termed in India as “empowered action group”
(EAG) states on account of their poor economic and social statuses.
Taking account of these factors, the present study considered 17 states
including (1) Andhra Pradesh, (2) Bihar, (3) Chhattisgarh, (4) Gujarat,
(5) Haryana, (6) Jharkhand, (7) Karnataka, (8) Kerala, (9) Madhya
Pradesh, (10) Maharashtra, (11) Odisha, (12) Punjab, (13) Rajasthan,
(14) Tamil Nadu, (15) Uttar Pradesh, (16) Uttaranchal, and (17) West
Bengal for analysis. These 17 states either belong to higher income groups
or have considerable potential for development.
A comparison between the 17 Indian states in terms of income, health
expenditure, and literacy levels for the last time period for which we
have comparable data, 2013–2014, is presented in Table 2. As can be
seen in the table, the per capita gross state domestic product in the states
of Maharashtra, Haryana, and Gujarat were higher and these states
enjoyed both higher literacy rates and higher per capita expenditures on
health. The states of Kerala, Uttaranchal, Tamil Nadu, Punjab, Andhra
Pradesh, and Karnataka had moderately higher income levels, and as a
result showed above average literacy levels as well as above average per
capita expenditures on health. The moderately lower income levels found
in states of West Bengal, Rajasthan, Chhattisgarh, Odisha, and Jharkhand
were reflected in their lower literacy levels and below average per capita
health expenditures. The states of Madhya Pradesh, Uttar Pradesh,
and Bihar were economically far less developed, with lower per capita
incomes, lower per capita health expenditures and lower levels of literacy.

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Table 2.
Classification of Indian States Based on Income, Health Expenditure and
Literacy Rate (2013–2014)

Real Per Capita

Real Per Capita Revenue Expenditure
State GSDP on Health Literacy Rate (%)**
Maharashtra 76,160 344 84.8
Haryana 74,337 325 79.4
Gujarat 70,906 320 82.6
Kerala 66,742 591 94.8
Uttaranchal 66,365 486 82.2
Tamil Nadu 63,721 405 82.5
Punjab 60,405 359 79
Andhra Pradesh 51,826 350 70
Karnataka 50,244 335 78.5
West Bengal 39,090 237 79.8
Rajasthan 35,275 301 69.2
Chhattisgarh 35,020 269 73
Odisha 31,464 209 76.9
Jharkhand 31,160 176 72.5
Madhya Pradesh 29,913 226 72.8
Uttar Pradesh 21,967 204 74.3
Bihar 15,557 96 69.9

Source: Central Statistical Organization; RBI State Finances: A Study of Budgets; Census of
India.
Notes: Green–High income; blue—moderately high income; yellow—moderately low income;
red—low income.
**Indicates 2013 values.
 Prachitha et al.: India in Pursuit 111

These economic and social characteristics showed a direct association

with the overall well-being of the people of these states.

Health in India and Reaching for the Millennium Goals

The Millennium Declaration of 2000 adopted by the member countries

of the United Nations, including India, set out 8 MDGs and 18 related
targets that aimed at reducing world poverty by 2015. For achieving
these targets, benchmark indicators that need to be improved were set
(see Table A1).
Health assumed a central place in the Millennium Development
agenda. Goals 4, 5, and 6 of the MDGs were related to health, of which
goals 4 and 5 set targets for prime health indicators. The reduction of
infant mortality and under-five mortality targets for 2015 were fixed at
two-thirds of the rate in 1990 and a reduction of maternal mortality by
three-quarters of that in 1990 (refer Table A1).
India’s healthcare system is fragmented, characterized by both public
and private providers and offering multiple systems of medical care. The
status of the health indicators in India during the start of the Millennium
period can only be termed just pathetic depicting extremely poor maternal
and child health indicators compared with other nations. The mater-
nal mortality ratio (MMR) of India was 327 per 100,000 live births in
1999–2001 (in Iceland and in Sweden it was 5 in year 2000), and the infant
mortality rate (IMR) in India was 68 per 1,000 live births in 1999–2000
(it was 3.2 in Iceland, and 3.4 in Sweden in year 2000), in large measure
because of India’s inability in assuring professional medical attention on
hand at the time of delivery (SRS, 2014). Given this context, the MDG
achievement targets for India were set at an IMR of 27 per 1,000 live
births, an under-five mortality rate (U-5MR) of 40 per 1,000 live births
and an MMR of 87 per 100,000 live births by the year 2015.
The Indian Constitution, in the Seventh Schedule (Article 246),
assigns the responsibility of providing healthcare to the state govern-
ments. The central government in India has control over only certain
components of health, including family welfare, population control, and
disease prevention. In spite of this, the national government has taken
several timely initiatives in the health sector, which were targeted on
achievement of specific goals, and these, in turn, were adopted by the
state governments.

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Policy Initiatives in the Health Sector Since UNMS 2000

To align with the targets of the Millennium Declaration, the Indian

government proposed various policy initiatives that were introduced
and implemented in the Indian heath sector by both the central and state
governments. The major policies and initiatives include: (a) National
Population Policy (NPP), 2000; (b) National Health Policy (NHP), 2002;
and (c) National Rural Health Mission (NRHM), 2005.

National Population Policy

Although the Indian population policy had been introduced in the year
2000 before the signing of the Millennium Declaration, this effort had
considerable relevance to the Millennium goals. The objectives of the
NPP were threefold: (a) the immediate objective of addressing the unmet
needs for basic reproductive and child healthcare; (b) the medium-term
objective of bringing down the total fertility rate (TFR) (the number of
children born per 1,000 women) to replacement levels by 2010; and (c) the
long-term objective of achieving a stable population by 2045.
The goals of the Indian NPP program that were set to be achieved
by 2010 included: (1) addressing the unmet supplies and infrastructure
needs for basic reproductive and child health services; (2) reducing IMR
to below 30 per 1000 live births; (3) reducing MMR to below 100 per
100,000 live births; (4) achieving universal immunization of children;
(5) delaying marriage of girls; (6) achieving 80 percent institutional
deliveries and 100 percent deliveries by trained personnel; (7) achieving
universal access to information and services for fertility regulation and
contraception; (8) achieving 100 percent registration of births, deaths,
marriage and pregnancy; (9) containing the spread of HIV/AIDS;
(10) preventing and controlling communicable diseases; (11) integrat-
ing Indian systems of medicine in the provisioning of reproductive and
child health services; (12) promoting the small family norm to achieve
replacement levels of TFR; and (13) convergence of related social sector
programs.

India’s National Health Policy

The NHP 2002 was developed after two decades of formulation of NHP
1983. This period had witnessed the emergence of the new and extremely
virulent communicable disease, HIV/AIDS; an increase in mortality from
 Prachitha et al.: India in Pursuit 113

“lifestyle” diseases like diabetes, cancer, and cardiovascular diseases; and

continuing high levels of nutrient deficiencies that can result in low birth-
weight infants who can suffer from reduced physical and mental growth.
However, the lack of financial resources and public health administrative
capacity available in India presented considerable hurdles in achieving
the goal of “health for all by 2000” of the NHP.
The NHP of 2002 attempted to set out a new policy framework for
accelerated achievement of the public health goals, taking into account
the continually evolving socioeconomic context of the nation. The main
objective of this policy initiative was to achieve a standard of good health
for the general population through (a) wider and more equitable access
to health services through a more decentralized public health system;
(b) increased public health investment by enhancing the central govern-
ment’s financial contributions; and (c) enhancing the level of donations
from the private sector. With this agenda, the NHP (2002) set many
time-bound goals, including the eradication of polio and leprosy by 2005;
zero level growth of HIV/AIDS by 2007; elimination of Kala Azar (leish-
maniasis); reduction of mortality from tuberculosis, malaria, and vector
and water-borne diseases by 2010; reduction of the IMR to 30 per 1,000
live births by 2010; reduction of the MMR to 100 per 100,000 live births
by 2010; as well as setting goals for 2010 to increase utilization of public
health facilities and raising overall public health expenditure.

The National Rural Health Mission

Adding to these efforts, the Indian government launched its NRHM in

2005 with the goal of providing effective healthcare to the rural popula-
tion throughout the country, offering a special focus on those states that
had weak public health infrastructure. The goal of the mission continues
to be the improvement of access and availability of quality healthcare to
all rural people, the poor, women, and children. The program seeks to
mainstream the Indian systems of medicine to facilitate much wider
health care coverage.
The plan of action of the NRHM included: (a) increasing public health
expenditures; (b) reducing regional imbalances in health infrastruc-
ture; (c) pooling resources; (d) integration of organizational structures;
(e) optimization of health human resources; (e) decentralization and
district management of health programs; (f) community participation
and ownership of assets; (g) recruitment of personnel into district health

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systems; and (h) upgrading community health centers (CHCs) into fully
functional hospitals meeting Indian public health standards in each part
of the country. The target goals of the NRHM were: (a) reduction of
the infant mortality and maternal mortality ratio; (b) universal access
to public health services including women’s health, child health, water,
sanitation, hygiene, immunization, and nutrition; (c) prevention and
control of communicable and non-communicable diseases, including
locally endemic diseases; (d) access to integrated comprehensive primary
healthcare; (e) population stabilization and overall demographic bal-
ance; (f) revitalization of local health traditions and alternative AYUSH
(Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy)
treatment approaches; and (g) promotion of healthy lifestyles. The health
mission was extended to the urban areas in 2013 with the creation of
India’s National Urban Health Mission (NUHM). Since then, NRHM
was renamed the National Health Mission (NHM), combining the NRHM
and NUHM initiatives.
The NRHM was rooted in the principle “More Money for Health, More
Health for the Money.” It was focused on strengthening primary health-
care in the country by adopting innovation in healthcare provisioning that
had proven to be effective. The five key approaches of NRHM included:

1. Communitized decentralized planning: NRHM advocated decen-

tralized planning by constituting local community organizations/
Panchayati Raj Institutions (PRIs) such as the village health sanita-
tion and nutrition committees (VHSNCs) in each local setting, and
starting hospital management committees, known as “Rogi Kalyan
Samiti” (RKS), or patient welfare committees, in hospitals at all
levels. Grants were made available to the PRIs, and additional
healthcare workers were assigned to provide service at the village
level. NRHM also employed Accredited Social Health Activists
(ASHAs) to provide healthcare at the doorsteps of homes in rural
areas, thus, providing links to the healthcare system.
2. Flexible financing: NRHM introduced new financing mechanisms
in the health sector by providing flexible untied grants to the facili-
ties at all levels and to the VHSNCs as a risk-pooling measure. At
the same time, more resources were made available for reforms
and innovation under NRHM. These reforms took into special
consideration the differential regional norms for human resource
remuneration, infrastructure etc. based on local customs and the
urgencies in the need for service.
 Prachitha et al.: India in Pursuit 115

3. Improved management through capacity building: NRHM aimed

at improved management at the district and block levels by consti-
tuting the local health offices, employing personnel with efficient
management skills. NGOs were involved in capacity building of
the staff. Health system resources centers were constituted at
the national and state levels as technical support agencies for the
national health authorities.
4. Monitoring progress: NRHM adopted the Indian Public Health
Standards (IPHS) for health facilities at various levels of operation.
It introduced robust monitoring and evaluation mechanisms using
heightened information technologies to improve service delivery
and strengthen monitoring activities. NRHM also undertook facility
surveys for identifying gaps and addressing them.
5. Innovation in human resource management: NRHM employed
strategic measures for managing the shortage of professional
healthcare providers. More nurses were employed based on the
local resident criteria and 24/7 emergency services were provided
by nurses and AYUSH doctors in primary health centers (PHCs).
Round the clock medical emergency services were made available
at CHCs as well. NRHM believed in multi-skilling and task-shifting
of staff, thus optimizing the services provided by the available
human resources. Mobile medical units were introduced to serve
hard-to-reach areas and performance-linked incentives were
introduced for staff.

NHM had specific areas of focus for which different programs were
developed and implemented. Among the focus areas, the foremost was the
Reproductive, Maternal, New-Born, Child Health and Adolescent Health
program (RMNCH+A). The RMNCH+A approach entailed a “contin-
uum of care” that addressed the various causes of mortality among women
and children. It offered free services in public health institutions to preg-
nant women right from the ante-natal care to delivery, including caesarean
sections and post-natal care. It provided free diagnostics, blood supplies,
medicines, food, transport from home to hospital, referral between health
facilities and drop back services (transporting the mother and child back
home after delivery or for the mother and any sick new-born). These
free-of-cost services were provided through two initiatives: the Janani
Suraksha Yojana (JSY, or Safe Motherhood Scheme) and the Janani
Sishu Suraksha Karyakram (JSSK, or Safe Mother and Child Scheme).

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Home-based new-born care (HBNC) advanced through visits by health-

care providers during the first 42 days of life, and facility-based new-born
care (FBNC) through special newborn care units (SNCU), neonatal
intensive care units (NICUs), new-born stabilization units, and new-born
care units in hospitals were measures undertaken to reduce neonatal
mortality. An exclusive program for adolescents, Rashtriya Kishor
Swasthya Karyakram (RKSK), targeted improving nutrition, promot-
ing sexual and reproductive health, and enhancing the mental health of
adolescents, was likewise introduced under the NHM. On the whole, the
RMNCH+A approach directly sought to take on the challenges of high
IMR, MMR, and the high fertility rate in the country.
Second, NHM gave attention toward prevention of major childhood
illnesses. It emphasized the universal immunization program, includ-
ing the DPT vaccine (diphtheria; pertussis or whooping cough; and
tetanus), measles shots, and BCG (anti-tuberculosis) vaccination which
also prevents childhood pneumonia. With the objective of promoting
breastfeeding (which helps protect infants against common childhood
illnesses like diarrhea and pneumonia), NHM promoted the infant and
young child feeding practices (IYCF) to improve the nutritional status
and health of children, helping thereby to reduce infant and under-
five mortality rates. The Integrated Management of Neonatal and
Childhood Illnesses (IMNCI) program under NHM provided training
to community health workers for early detection and management of
diarrhea and pneumonia. The mission introduced the vitamin A supple-
mentation program for children up to 5 years as a preventive measure
against diarrhea and pneumonia. For preventing deaths among children
with severe acute malnutrition (SAM), nutrition rehabilitation centers
were established.
The third focus area of NHM was the enhancement of the facility-
based delivery system. The mission sought to improve and strengthen
the infrastructure, equipment, human resources, medical supplies, qual-
ity assurance systems, and service provisioning at the facility level. The
facility strengthening plan was guided by the IPHS and the provisions
for beds, medicines, supplies, and human resources were made according
to the caseloads.
Fourth, the NHM focused on creating technology-based health
management information systems (HMIS) for monitoring progress and
improving service delivery. The data from HMIS was expected to help
in the planning process. Another technology-based innovation was the
 Prachitha et al.: India in Pursuit 117

mother and child tracking system (MCTS) that monitored every preg-
nant woman registered and assessed ante-natal and post-natal care and
immunization for every child from birth up to its first birthday.
Fifth, NHM focused on disease control and brought all the national
level communicable and non-communicable disease control programs
under its ambit. It included the existing programs like National Leprosy
Eradication Programme (NLEP), National Vector Borne Disease Control
Programme (NVBDCP) and the Revised National Tuberculosis Control
Programme (RNTCP). Apart from this, the NHM introduced programs
for control and prevention of lifestyle diseases like cancer, diabetes mel-
litus, cardiovascular diseases and also programs for blindness control and
elderly care.
Thus, the NHM provided an assortment of programs that included
both the existing and the new programs. This grouping of programs
was set on mission mode, with a sole mandate of improving the health
indicators in the country and accelerating the achievement of the health-
related MDG targets.

Improvements in Indian Health Indicators Since UNMS 2000

A closer look at the indicators relating to MDGs 4 and 5 highlights the

impact of the above discussed policy initiatives at the national level
(see Table 3). The U-5MR has improved from 109 in 1992–1993 to 50 in
2015 in India as a whole. The improvements in IMR and MMR were also
quite encouraging. The IMR fell from 79 in 1992–1993 to 37 in 2015. The
MMR improved from 327 in 1992–1993 to 167 in 2015. The proportion
of measles immunization reached 81.1 percent in 2015, rising from only
42.2 percent in India in 1992–1993. The proportion of births attended by
Table 3.
Achievement of MDG Health Indicators by India Against the MDG Targets

Value in MDG Target

Indicator 1992–1993 Value in 2015 for 2015
13 U5 mortality rate (U-5MR) 109 50 40
14 Infant mortality rate (IMR) 79 37 27
15 Proportion of 1-year-old children 42.2 81.1 100
immunized against measles
16 Maternal mortality ratio (MMR) 327 167* 87
17 Proportion of births attended by skilled 34.2 81.4 100
health personnel
Source: NFHS-1(1992–1993); NFHS-3 (2015–2016); SRS Bulletins for IMR.
Note: *Indicates value for the year 2011–2013.

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skilled personnel also improved from 34.2 percent to 81.4 percent during
this period for the nation as a whole.
In spite of considerable progress toward MDGs 4 and 5 being made,
an overall analysis of the status of the indicators in 2015 revealed
that many of the targets remained to be achieved (see Column 4 of
Table 3). This raises the question as to whether the targets were too high
to begin with or whether the policies were somehow flawed or too long
delayed. A state-by-state analysis of the indicators relating to MDGs 4
and 5 is a sounder approach for assessing the efforts of each of the states
toward the achievement of the targets.
There are studies available at various stages for the period 2000–2015
that have analyzed the progress in achievement of the health MDGs by
the Indian states. Overall, the World Health Organization (WHO) and
United Nations Children’s Fund (UNICEF) (2010) have concluded that
India as a whole was off-track in meeting MDG 4 and was pushed into
the “insufficient progress” category. Tracing the patterns of failures and
successes, the GoI (2010) study concluded that India was off-track with
respect to all the health-related MDG indicators.
A cross-country analysis by Lozano et al. (2011) indicated that nearly
all developing countries, not just India, will doubtless take many years
past 2015 to achieve the MDG 4 and 5 targets, with especially slow pro-
gress in meeting the maternal mortality reduction objective. Intriguingly,
however, in case of maternal deaths, the Lozano et al. study indicated a
better record of achievement for India compared with other countries, as
28.6 percent of the global decline in maternal deaths from 2005 to 2011
actually came from India.
Although the overall dismal performance by India could be attributed
to various factors like the low share of public expenditure on health,
inefficiencies in public spending, regional inequalities in providing health
services etc., one could expect measuring errors as well. The MDGs used
1990 as the base year for the health-related indicators to be achieved
in 2015 (refer Table A1). All the above studies that have looked at the
achievement of health MDGs by India and the states have taken 1990 as
the base. However, the NRHM introduced in 2005 had been the major
policy initiative in the health sector that has exclusively focused on acceler-
ating the achievements of health-related MDGs in the country. Therefore,
the rate of achievement with respect to the MDG health indicators would
surely be expected to be higher during the NHM phase, which is from
2005 to present, compared with the pre-NHM phase.
 Prachitha et al.: India in Pursuit 119

Taking this into account, the research for this article involved a policy
analysis by comparing the achievements by the Indian states in the pre-
NHM phase (1990–2005) and the NHM phase (2005–2015) and calculating
the projected path at the new NHM rate.

Achievement of the Health-Related MDGs

The state-wise analysis of the feasibility of health-related MDG targets

produced interesting results. The progress of the targets with respect to
goals 4 and 5 are presented in the sub-sections below.

Progress Toward MDG 4

Target 13: Reduction of U-5MR

The state-wise analysis revealed that five states—Karnataka, Kerala,

Tamil Nadu, Uttaranchal and West Bengal (all but one, West Bengal,
that fall in the moderately higher income grouping)—are on track, having
achieved the U-5MR target by 2015 (see Table 4). A comparison of the
compound annual growth rate (CAGR) between the pre-and post-NHM
periods shows that the rate of decline was lower in the second period
compared with the first in the states of Gujarat, Haryana, Tamil Nadu,
Uttar Pradesh and Uttaranchal (states, except Uttar Pradesh, in the high
to moderately high income groupings). However, had NHM started a few
years before, in 2002–2003, 11 of the 17 states would have achieved the
MDG target. Even then, states such as Uttar Pradesh, Madhya Pradesh
and Chhattisgarh (among the poorer states) would require substantially
longer time for achieving the target and therefore could be considered
weaker states where the U-5MR target would not have been feasible
with the prevailing initiatives. If the delay in planning is taken into
consideration, it is fair to conclude that the national target would have
been achieved by 2017.

Target 14: Reduction of the IMR

As regards the achievement of target for IMR, only Kerala and Tamil
Nadu (in the moderately higher income grouping) have achieved the goal.
Comparison of the CAGR between the pre-and post-NHM periods (pre-
and post-2005) showed that the rate of decline was higher in the second

Journal of Developing Societies 35, 1 (2019): 105–133

 Table 4.
Progress of Achievement of MDG Target 13: Reduction of U-5MR

Projected Year Projected Year of

of Achieving Achieving Target
CAGR CAGR MDG target Status Target at CAGR Had NHM Been
States 1990 2005 2015 (1990–2005) (2005–2015) for 2015 in 2015 2005–2015 Started in 2002
Andhra Pradesh 99 58 41 –0.035 –0.035 33 Off-track 2021 2017
Bihar 140 85 58 –0.033 –0.037 47 Off-track 2021 2017
Gujarat 118 61 43 –0.043 –0.034 39 Off-track 2018 2014 (achieved)
Haryana 114 52 41 –0.051 –0.023 38 Off-track 2018 2014 (achieved)
Karnataka 97 55 32 –0.037 –0.053 32 On-track Achieved
Kerala 37 16 7 –0.055 –0.079 12 On-track Achieved
Madhya Pradesh 140 94 65 –0.026 –0.036 47 Off-track 2024 2020
Maharashtra 77 47 29 –0.033 –0.047 26 Off-track 2017 2013 (achieved)
Odisha 143 91 49 –0.030 –0.060 48 Off-track 2016 2012 (achieved)
Punjab 72 52 33 –0.022 –0.044 24 Off-track 2022 2018
Rajasthan 107 85 51 –0.015 –0.050 36 Off-track 2016 2012 (achieved)
Tamil Nadu 106 36 27 –0.070 –0.028 35 On-track Achieved
Uttar Pradesh 154 96 78 –0.031 –0.021 51 Off-track 2035 2031
West Bengal 112 60 32 –0.041 –0.061 37 On-track Achieved
Chhattisgarh 142 90 64 –0.030 –0.034 47 Off-track 2024 2020
Jharkhand 137 93 54 –0.026 –0.053 46 Off-track 2018 2014 (achieved)
Uttaranchal 174 57 47 –0.072 –0.019 58 On-track Achieved
India 119 74 50 –0.031 –0.038 40 Off-track 2021 2017
Source: Authors’ own calculations using data from NFHS-1 (1992–1993) and NFHS-3 (2015–2016).
Note: 1990 values are projected using NFHS-1 data; CAGR—compound annual growth rate.
 Prachitha et al.: India in Pursuit 121

period compared with the first. Achievement of the target was delayed for
Karnataka, Maharashtra, Odisha, Punjab, Chhattisgarh, and Uttaranchal
(states in all income groupings except the lowest one) because of delayed
planning. These states could have achieved the target even before 2015
had the reform policies not been delayed. Nonetheless, the feasibility
of achieving the IMR target was dreary for the states Andhra Pradesh,
Bihar, Haryana, Rajasthan (from across the state income groupings), and
all India (see Table 5).

Target 15: Immunization Against Measles

As can be observed in Table 6, none of the states and India had achieved
the MDG target of immunization against measles. The CAGR in
the achievement of immunization for many states, including Bihar,
Haryana, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha,
Tamil Nadu, West Bengal, Jharkhand, and Uttaranchal, declined in the
post-NHM period. The growth rate was negative in the second period
for Maharashtra (a high-income state) and Tamil Nadu (a moderate-
income state). The measles immunization targets are infeasible for many
states, including Haryana, Gujarat, Karnataka, Kerala, Madhya Pradesh,
Maharashtra, and Uttaranchal and all India even when accounting for
the delays in planning.

Progress toward MDG 5

Target 16: Reduction of MMR

The record of India and the individual states in terms of the MMR targets
were miserable. Table 7 indicates that all the 17 states and all of India
were off-track in achievement of the target, a goal slowed because of
delayed planning. Even when accounted for this, the feasibility is limited
only to Maharashtra state possibly because of the outcomes from the
state initiatives during the post-2005 NHM phase. However, the targets
are infeasible for all other states and for India as a whole. The CAGR
for the NHM phase was higher for all states and all India as well (with
the exception of West Bengal). This indicates that the policy initiatives
(during the NHM phase) positively impacted the reduction of MMR
but that the targets were not feasible for the states and the country
as a whole.

Journal of Developing Societies 35, 1 (2019): 105–133

 Table 5.
Progress of Achievement of MDG Target 14: Reduction of IMR

Projected Year Projected Year of

of Achieving Achieving Target
CAGR CAGR MDG target Status Target at CAGR Had NHM Been
States 1990 2005 2015 (1990–2005) (2005–2015) for 2015 in 2015 2005–2015 Started in 2002
Andhra Pradesh 70 57 37 –0.014 –0.042 23 Off-track 2026 2022
Bihar 75 61 42 –0.014 –0.037 25 Off-track 2029 2025
Gujarat 72 54 33 –0.019 –0.048 24 Off-track 2021 2017
Haryana 69 60 36 –0.009 –0.050 23 Off-track 2024 2020
Karnataka 70 50 28 –0.022 –0.056 23 Off-track 2019 2015 (achieved)
Kerala 17 14 12 –0.013 –0.015 6 Off-track Achieved
Madhya Pradesh 111 76 50 –0.025 –0.041 37 Off-track 2022 2018
Maharashtra 58 36 21 –0.031 –0.052 19 Off-track 2017 2013 (achieved)
Odisha 122 75 46 –0.032 –0.048 41 Off-track 2018 2014 (achieved)
Punjab 61 44 23 –0.022 –0.063 20 Off-track 2017 2013 (achieved)
Rajasthan 84 68 43 –0.014 –0.045 28 Off-track 2024 2020
Tamil Nadu 59 37 19 –0.031 –0.064 20 On-track Achieved
Uttar Pradesh 99 73 46 –0.020 –0.045 33 Off-track 2022 2018
West Bengal 63 38 26 –0.033 –0.037 21 Off-track 2021 2017
Chhattisgarh 111 63 41 –0.037 –0.042 37 Off-track 2018 2014 (achieved)
Jharkhand 75 50 32 –0.027 –0.044 25 Off-track 2020 2016
Uttaranchal 99 42 34 –0.056 –0.021 33 Off-track 2016 2012 (achieved)
India 80 58 37 –0.021 –0.044 27 Off-track 2022 2018
Source: Authors’ own calculations using data from SRS Bulletins (various years).
Note: CAGR––Compound annual growth rate.
 Table 6.
Progress of Achievement of MDG Target 15: Immunization Against Measles

Projected Year Projected Year of

of Achieving Achieving Target
CAGR CAGR MDG target Status Target at CAGR Had NHM Been
States 1992–1993 2005 2015 (1990–2005) (2005–2015) for 2015 in 2015 2005–2015 Started in 2002
Andhra Pradesh 53.7 69.4 89.4 0.020 0.026 100 Off-track 2020 2016
Bihar 11.5 40.4 79.4 0.101 0.070 100 Off-track 2019 2015 (achieved)
Gujarat 55.9 65.7 75 0.013 0.013 100 Off-track 2037 2033
Haryana 60.9 75.5 79 0.017 0.005 100 Off-track Indefinite Indefinite
Karnataka 54.9 72.0 82.4 0.021 0.014 100 Off-track 2029 2025
Kerala 60.5 82.1 89.4 0.024 0.009 100 Off-track 2028 2024
Madhya Pradesh 37.0 61.4 79.6 0.040 0.026 100 Off-track 2024 2020
Maharashtra 70.2 84.7 82.8 0.015 –0.002 100 Off-track 2028 2024
Odisha 40.2 66.5 87.9 0.039 0.028 100 Off-track 2020 2016
Punjab 64.8 78.0 93.1 0.014 0.018 100 Off-track 2019 2015 (achieved)
Rajasthan 31.3 42.7 78.1 0.024 0.062 100 Off-track 2019 2015 (achieved)
Tamil Nadu 71.5 92.5 85.1 0.020 –0.008 100 Off-track 2023 2019
Uttar Pradesh 24.2 37.7 70.8 0.035 0.065 100 Off-track 2021 2017
West Bengal 42.5 74.7 92.8 0.044 0.022 100 Off-track 2019 2015 (achieved)
Chhattisgarh 36.9 62.5 93.9 0.041 0.042 100 Off-track 2017 2013 (achieved)
Jharkhand 11.1 47.6 82.6 0.118 0.057 100 Off-track 2019 2015 (achieved)
Uttaranchal 20.9 71.6 80.6 0.099 0.012 100 Off-track 2033 2029
India 42.2 58.8 81.1 0.026 0.033 100 Off-track 2022 2018
Source: Authors’ own calculations using data from NFHS-1 (1992–1993), NFHS-2 (2005–2006) and NFHS-3 (2015–2016).
Note: CAGR––Compound annual growth rate.
 Table 7.
Progress of Achievement of MDG Target 16: Maternal Mortality Ratio

Projected Year Projected Year of

of Achieving Achieving Target
CAGR CAGR MDG target Status Target at CAGR Had NHM Been
States 1990 2005 2015 (1990–2005) (2005–2015) for 2015 in 2015 2005–2015 Started in 2002
Andhra Pradesh 239 154 92 –0.029 –0.062 60 Off-track 2020 2016
Bihar 424 312 208 –0.020 –0.049 106 Off-track 2027 2023
Gujarat 213 160 112 –0.019 –0.044 53 Off-track 2030 2026
Haryana 174 186 127 0.005 –0.047 43 Off-track 2036 2032
Karnataka 280 213 133 –0.018 –0.057 70 Off-track 2024 2020
Kerala 165 95 61 –0.036 –0.054 41 Off-track 2020 2016
Madhya Pradesh 426 335 221 –0.016 –0.051 106 Off-track 2028 2024
Maharashtra 180 130 68 –0.021 –0.078 45 Off-track 2018 2014 (achieved)
Odisha 458 303 222 –0.027 –0.038 115 Off-track 2030 2026
Punjab 174 192 141 0.007 –0.038 43 Off-track 2044 2040
Rajasthan 531 388 244 –0.021 –0.056 133 Off-track 2024 2020
Tamil Nadu 184 111 79 –0.033 –0.042 46 Off-track 2026 2022
Uttar Pradesh 565 440 285 –0.017 –0.053 141 Off-track 2026 2022
West Bengal 241 141 113 –0.035 –0.027 60 Off-track 2036 2032
Chhattisgarh 426 335 221 –0.016 –0.051 106 Off-track 2028 2024
Jharkhand 424 312 208 –0.020 –0.049 106 Off-track 2027 2023
Uttaranchal 565 440 285 –0.017 –0.053 141 Off-track 2026 2022
India 347 254 167 –0.021 –0.051 87 Off-track 2026 2022
Source: Authors’ own calculations using data from MMR Bulletin, SRS 2004–2006 and 2011–2013 and NFHS-1 (1992–1993).
Note: 1990 values are projected using NFHS-1 data; CAGR––compound annual growth rate.
 Prachitha et al.: India in Pursuit 125

Target 17: Births Attended by Skilled Health Personnel

The MDG target of increasing the proportion of births attended by skilled

health personnel was achieved only by the states of Kerala and Tamil
Nadu (states in moderate-income bracket) because of increased state
efforts on raising the proportion of institutional deliveries. The CAGR
declined in the post-NHM period for the states of Andhra Pradesh,
Kerala, Tamil Nadu, and Uttaranchal (all states in the moderate-income
bracket). The delayed start of NHM programs was the main reason for
non-achievement of the target by the other states and India because once
the program began, good progress has been seen. The target is feasible
for all states except Uttaranchal (refer Table 8).

Discussion

The results presented in the previous section indicate that India has
not achieved any of the targets relating to MDGs 4 and 5. One potential
explanation for the shortfall may be found in the delay in planning and
implementing NHM programs that were designed to accelerate the pro-
gress toward the health-related MDGs. The NHM was introduced in 2005
and its impact on the outcome indicators was experienced only from the
year 2007 onwards. To understand whether policy delays have caused
India to fail to achieve the targets, the NHM period growth rate was
applied to years following 2002–2003. Had the projections thus obtained
been able to help India achieve the target rate, then it would become clear
that the shortfalls were squarely due to policy paralysis. On the other
hand, if this is not true, then this calls into question the practicability of
the targets set by the policy experts at the UNMS 2000.
Yet, even when the planning delays were taken into account, it
appeared that India’s chances of achieving the MDG targets were miser-
able. The target for births attended by skilled personnel was achievable
in the stipulated period at the national level. India would have achieved
the U-5MR target by 2017, IMR target by 2018, measles immunization
target by 2018 and MMR target by 2022.
A disaggregated analysis at the state-level indicated that among the
targets of MDG 4, 11 out of 17 states would have achieved the U-5MR
targets, whereas 8 out of 17 states would have achieved the IMR target and
6 out of 17 states would have achieved the measles immunization target.
Among the targets of MDG 5, none of the states except Maharashtra
would have achieved the MMR target and all the states except Uttaranchal

Journal of Developing Societies 35, 1 (2019): 105–133

 Table 8.
Progress of Achievement of MDG Target 17: Births Attended by Skilled Personnel

Projected Year Projected Year of

of Achieving Achieving Target
CAGR CAGR MDG target Status Target at CAGR Had NHM Been
States 1992–1993 2005 2015 (1990–2005) (2005–2015) for 2015 in 2015 2005–2015 Started in 2002
Andhra Pradesh 48.9 77.10 92.2 0.036 0.018 100 Off-track 2019 2015 (achieved)
Bihar 17.0 29.30 70 0.043 0.091 100 Off-track 2019 2015 (achieved)
Gujarat 43.4 63.00 87.3 0.029 0.033 100 Off-track 2019 2015 (achieved)
Haryana 31.5 48.90 84.7 0.034 0.056 100 Off-track 2018 2014 (achieved)
Karnataka 46.6 69.70 93.9 0.031 0.030 100 Off-track 2017 2013 (achieved)
Kerala 90.2 99.40 100 0.007 0.001 100 On-track Achieved
Madhya Pradesh 28.6 32.70 78.1 0.010 0.091 100 Off-track 2018 2014 (achieved)
Maharashtra 53.1 68.80 91.9 0.020 0.029 100 Off-track 2018 2014 (achieved)
Odisha 19.0 44.00 86.6 0.067 0.070 100 Off-track 2017 2013 (achieved)
Punjab 47.3 68.20 94.1 0.029 0.033 100 Off-track 2017 2013 (achieved)
Rajasthan 19.3 41.00 86.6 0.060 0.078 100 Off-track 2017 2013 (achieved)
Tamil Nadu 69.3 90.60 99.3 0.021 0.009 100 On-track Achieved
Uttar Pradesh 15.2 27.20 70.4 0.046 0.100 100 Off-track 2019 2015 (achieved)
West Bengal 33.9 47.60 81.6 0.026 0.055 100 Off-track 2019 2015 (achieved)
Chhattisgarh 25.3 41.60 78 0.039 0.065 100 Off-track 2019 2015 (achieved)
Jharkhand 15.4 27.80 69.6 0.047 0.096 100 Off-track 2019 2015 (achieved)
Uttaranchal 12.4 38.50 71.2 0.091 0.063 100 Off-track 2021 2017
India 33.0 46.60 81.4 0.027 0.057 100 Off-track 2019 2015 (achieved)
Source: Authors’ own calculations using data from NFHS-1 (1992–1993), NFHS-2 (2005–2006) and NFHS-3 (2015–2016).
Note: The 1992–1993 values for Bihar, Madhya Pradesh, Uttar Pradesh, Chhattisgarh, Jharkhand and Uttaranchal were not available and therefore were projected
using 1998–1999 values; CAGR––compound annual growth rate.
 Prachitha et al.: India in Pursuit 127

would have achieved the target for proportion of births attended by

skilled personnel.
To understand the limited success enjoyed by India in pursuing
MDGs, one therefore must consider the unique nature of Indian geo-
graphical, socioeconomic, and political diversities and its dynamics,
which are beyond the domain of the health sector. A general observa-
tion is that the states such as Maharashtra, Haryana, Gujarat, Kerala,
and Tamil Nadu are economically better off and have performed well
in terms of health target achievement. Added to this, Kerala and Tamil
Nadu had very high per capita revenue expenditures on health. Even
among the EAG states (the most socioeconomically challenged states),
Rajasthan, Odisha, and Jharkhand have performed better compared
with the other states in the group. In case of these states, the slowness
in achieving targets appears to be due to delayed start of the programs,
with the partial exception of the MMR target. Apart from this, the state
of West Bengal, although lower in economic performance, was likely
to achieve most of the targets had it not been for the delayed start of
NHM initiatives.
The states of Bihar, Uttar Pradesh, and Madhya Pradesh are economi-
cally far less advanced and remained well behind in terms of health target
achievement. Chhattisgarh also lagged in its health target achievement,
which could be attributed to its heavy forest cover and the implications
of the political unrest in the state. Other than the economic statuses of
these states, key social factors, especially the literacy rate, appeared
to be the major factors in determining the health performance. These
diversities in the Indian sub-continent suggest the need for multi-
level targets to be set depending on the resource constraints faced by
each region.
Another critical factor is the Indian political structure, one of a con-
tinual disconnect between the competing political exigencies and agendas
of the different ruling parties at the center and in the states, leading to
delays in transfer of required funds and in turn delays in achievement
of the targets. This context too often undermines the willingness of
state governments to take more responsibility and develop innovative
approaches that could function as catalysts for the rise of better health in
the country.
The socioeconomic, political, and geographical complexities discussed
above led inexorably to lags in policy making and implementation.
However, these complications also led to under-utilization or inefficient

Journal of Developing Societies 35, 1 (2019): 105–133

128 Journal of Developing Societies 35, 1 (2019): 105–133

utilization of resources. As indicated in a study by Prachitha and

Shanmugam (2014), the efficiency of the states in improving the health
outcomes was sorely lagging Given this waste and inefficiencies, there
is yet room for improving the health indicators without investing vast
new flows of additional financial resources. This study found that India
had an unused potential of 25 percent with respect to reduction of IMR
programs, and the unused potential with reduction of U-5MR was about
19 percent (Prachitha, 2012). Along with multi-level targets, necessary
attention on efficient utilization of the invested resources would have
assisted in fostering improved results.
In all, India has shown a great deal of progress in attainment of the
MDG health goals, at least since the 2005 initiatives. Therefore, the
policy experts who comment on the inability of the developing nations to
achieve the targets need to understand the varied degrees of complexities
that persist in the developing countries as seen in the case of India and
reconsider the notion of “one size fitting all.”

Appendix 1

This study has attempted a policy analysis by comparing the rates of

achievement of the MDG health indicators by 17 Indian states in the pre-
NHM phase (1990–2005) and the NHM phase (2005–2015). The CAGR
of the MDG health indicators, r, for the two periods were calculated for
each of the states and the national level and compared. The CAGR was
calculated using the formula:

r = (n X t /X 0 ) - 1(1)

where Xt is the value of the indicator at the end of the period, X0 is the
value of the indicator at the start of the period and n is the number of
years during the period.
Using the CAGRs of the health indicators during the NHM phase, the
study estimated the “projected path” beyond 2015 until the MDG target
is achieved. Projections for the indicators for s future years hence was
calculated using the following equation:

Xt+s = Xt (1 + r) s

where t is 2015 for this period and s is the number of the future year
beyond 2015 for which the values are predicted. The examination of the
 Prachitha et al.: India in Pursuit 129

proximity of the actual values and the target values in 2015 signifies if the
indicator is on-track. When the indicator is off-track, the year in which
the MDG target value would be achieved at the historical rate of growth
(projected path at NHM rate) was recorded.
NHM was introduced and implemented in the year 2005 and its impact
on the outcomes was observed from the year 2007. Therefore, the study
then attempts to examine the feasibility of achieving the MDG targets
by the Indian states and the nation as a whole provided NHM had been
implemented a few years before in 2002–2003. This would help to analyze
whether the delays in planning and execution of the policies/programs
impeded the achievement of targets by 2015.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or
publication of this article.

Appendix A

Table A1.
The Millennium Development Goals (MDGs)

Goals and Targets Indicators

Goal 1: Eradicate Extreme Poverty and Hunger
Target 1: Halve the population 1. Proportion of population below US$1 (PPP) per day
of people whose income is less 2. Poverty Gap Ratio (=incidence × depth of poverty)
than 1 dollar a day 3. Share of poorest quintile in national income or
consumption
Target 2: Halve the proportion 4. Prevalence of underweight children (under 5 years of
of population who suffer from age)
hunger 5. Proportion of population below minimum level of
dietary energy consumption
Goal 2: Achieve Universal Primary Education
Target 3: Ensure that all boys 6. Net enrolment ratio in primary education
and girls will complete a full 7. Proportion of pupils starting grade 1 who reach grade 5
course of primary schooling 8. Literacy rate of 15–24 years old
(Table A1 continued)

Journal of Developing Societies 35, 1 (2019): 105–133

130 Journal of Developing Societies 35, 1 (2019): 105–133
(Table A1 continued)
Goals and Targets
Goal 3: Promote Gender Equality and Empower Women
Target 4: Eliminate gender
disparity in primary and
secondary education
preferably by 2005 and to all
levels by 2015
Goal 4: Reduce Child Mortality
Target 5: Reduce by two-
thirds, between 1990 and 2015,
the under-five mortality
Goal 5: Improve Maternal Health
Target 6: Reduce by three-
quarters, between 1990 and
2015, the maternal mortality rate
Goal 6: Combat HIV/AIDS, Malaria, and Other Diseases
Target 7: Have halted by
2015, and begun to reverse the
spread of HIV/AIDS
Target 8: Have halted by
2015, and begun to reverse the
incidence of malaria and other
major diseases
Goal 7: Ensure Environmental Sustainability
Target 9: Integrate the
principles of sustainable
development into country
policies and programs
and reverse the loss of
environmental resources
Target 10: Halve, by 2015, the
proportion of people without
sustainable access to safe
drinking water
Target 11: By 2020, to
have achieved a significant
improvement in the lives of at
least 100 million slum dwellers
Indicators
9. Ratio of girls to boys in primary, secondary, and tertiary
education
10. Ratio of literate females to 15–24 years old males
11. Share of women in wage employment in the non-
agricultural sector
12. Proportion of seats held by women in national
parliament
13: Under-five mortality rate
14: Infant mortality rate
15: Proportion of 1-year-old children immunized against
measles.
16: Maternal mortality rate
17: Proportion of births attended by skilled health
personnel
18: HIV prevalence among young people aged 15–24 years
19: Condom use rate of contraceptive prevalence rate
20: Number of children orphaned by HIV/AIDS
21: Malaria prevalence and death rates
22: Proportion of population in malaria risk areas using
effective malaria prevention and treatment measures
23: Tuberculosis (TB) prevalence and death rates
24: Proportion of TB cases detected and successfully
treated under DOTS (Directly Observed Treatment Short
Course)
25. Proportion of land area covered by forest
26. Land area protected to maintain biological diversity
27. GDP per unit of energy use (proxy for energy
efficiency)
28. Carbon dioxide emissions (per capita) (plus two figures
for global atmospheric pollution: ozone depletion and the
accumulation of global warming gases)
29. Proportion of population with sustainable access to an
improved water source
30. Proportion of people with access to improved sanitation
31. Proportion of people with secure tenure
(rural/urban disaggregation of these indicators may be
relevant for monitoring improvement in the lives of slum
dwellers)
 Prachitha et al.: India in Pursuit 131
Goals and Targets
Goal 8: Develop a Global Partnership for Development
Target 12: develop further an
open, rule-based, predictable,
non-discriminatory trading and
financial system;
Includes a commitment
to good governance,
development and poverty
reduction both nationally and
internationally
Target 14: Address the special
needs of landlocked countries
and small developing states
Target 15: Deal
comprehensively with debt
problems of developing
countries through national
and international measures in
order to make debt sustainable
in the long term
Target 16: In cooperation with
developing countries, develop
and implement strategies for
decent and productive work
for youth
Target 17: In cooperation with
pharmaceutical companies,
provide access to affordable,
essential drugs in developing
countries
Target 18: In cooperation
with the private sector,
make available the benefits
of new technologies,
especially information and
communications
Source: United Nations Development Programme.
Journal of Developing Societies 35, 1 (2019): 105–133
Indicators
Some of the indicators listed below will be monitored
separately for LDCs, Africa, landlocked countries, and
small island developing countries.
Official Development Assistance
32. Net ODA as percentage of DAC donors’ GNI (targets
of 0.7% in total and 0.15% for LDCs)
33. Proportion of ODA to basic social services (basic
education, primary healthcare, nutrition, safe drinking
water, and sanitation)
34. Proportion of ODA that is untied
35. Proportion of ODA for environment in small island
developing states
36. Proportion of ODA for transport sector in landlocked
countries
Market Access
37. Proportion of exports (by value and excluding arms)
admitted free of duties and quotas
38. Average tariffs and quotas on agricultural products
and textiles and clothing
39. Domestic and export agricultural subsidies in OECD
countries
40. Proportion of ODA provided to help build trade capacity
Debt Sustainability
41. Proportion of official bilateral HIPC debt cancelled
42. Debt service as a percentage of exports of goods and
services
43. Proportion of ODA provided as debt relief
44. Number of countries reaching HIPC decision and
completion points
45.Unemployment rate of 15- to 24-year-olds
46. Proportion of population with access to affordable
essential drugs on a sustainable basis
47. Telephone lines per 1,000 people
48.Personal computers per 1,000 people
Other indicators TBD
132 Journal of Developing Societies 35, 1 (2019): 105–133

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J. Prachitha is Manager (Research) at TRIOs Development Support,

a company that offers technical and management support to socio-
economic and human development projects. She is a researcher by
profession with a doctorate in Development Economics. She has over
 Prachitha et al.: India in Pursuit 133

9 years of professional experience in areas of healthcare financing,

rural development, social issues and similar developmental themes.
Prachitha has expertise in developing research proposals, formulating
research designs, statistical and econometric analyses and socioeconomic
impact assessments. She has worked on research projects of varied top-
ics at reputed research institutions including Institute for Social and
Economic Change, Bangalore, Karnataka Health System Resource
Centre, Bangalore and Indian Institute of Technology (IIT-Madras),
Chennai. She also has research publications to her credit in reputed
national and international journals.

Akshay Dhume is an Associate Professor of Economics and Econometrics

at the School of Business Management, SVKM’S NMIMS, Bangalore
Campus. Dr Dhume has more than 10 years of experience teaching at the
undergraduate and graduate levels. He has been associated as consultant
with the study group for the High Level Committee on Balanced Regional
Issues in Maharashtra, which was appointed by the Governor of the state
of Maharashtra. He has served as resource specialist for Harvest Plus
for its project on the impact of Biofortifies Pearl Millet in Maharashtra.
Dr Dhume was formerly associated with the Gokhale Institute of Politics
and Economics, Pune, one of the premium institutes for higher education
and research in Economics in India, as well as with the Foundation for
Liberal and Management Education, Pune (now FLAME University),
a pioneering Liberal Education institution in India.

S. Subramanian is currently an Assistant Professor at IILM University,

Gurugram, Haryana. He obtained a doctorate in Economics from Institute
for Social and Economic Change, Bangalore and has worked extensively
on labour issues in the Indian agricultural industry. He is an empaneled
Agri and Allied Sector Expert with the Indo-European Chamber of
Commerce and Industry. He worked with the Bangalore Metro Rail
Limited and for other government programs. He has presented papers
on labour and development issues at numerous national and international
conferences.

Journal of Developing Societies 35, 1 (2019): 105–133