Saturday, July 12, 2008



By Kevin Anthony Stoda

I am writing from Manali in Himachal Pradesh, India. This is a land where many Bollywood films have had their dance scenes filmed. With the Himalayas, the fruit orchards, 50-meter tall trees, gardens and villages as their singing backdrops, there is little doubt that there is eye candy galore to film or view here.

As a matter of fact, one local TV station runs non-stop musicals set in the hills and villages in the immediate area.

This isn’t all kitsch either. There are some great showcases in some Bollywood films for local traditional clothing and lifestyle to be witnessed in observing over-and-over again such footage.

As a matter of fact, the connection between the rural traditions and modern India can be witnessed all around one here. (This was definitely not quite the case a decade ago before the advent of great internet and telecommunication networks coming to the Himalayan towns of northern India.)

At the same time, one can feel transported to a basic way of life not experienced in Europe for several centuries. Just five to fifteen minutes outside of the tourist centers in the region, you can be on your own in the trees or walking in hillside villages that have no motorized vehicles used on the farms, gardens, and orchards. This is the way life is in this part of India--up into the highland peaks reaching to more than 6000meters all the way to Nepal and Tibet.

In short, ideal alpine life meets tourism (crash commercialism) at the edges of India’s villages. However, India has many different faces, and the distinction between life in the rural areas and life in the cities here in this land (of one-billion-plus citizens) is as astounding in its contrasts and contradictions as can be found anywhere else on the planet earth.


Over a century ago, Gandhi began to tell the British and the Europeanized Indian citizenry of that era that India was really to be encountered in the towns and village of the subcontinent.

Interestingly, this situation remains to be a surprisingly accurate description for India in the third millennia.

Recently, on my short stopover in Mumbai (on my way north this excursion to India0, I met with one of the head managers of the HIV/AIDS project for the Society of Service to Voluntary Agencies (SOSVA) in India.
According to its own website, “SOSVA works with field NGOs to implement projects, ensure that funds are used effectively, monitor performance; and assure transparency. SOSVA is one of the main implementing partners of Family Health International (FHI) to initiate, guide and monitor interventions with marginalized groups in Mumbai and Thane as part of the HIV/AIDS prevention project of the Bill and Melinda Gates Foundation.”

In other words, SOSVA is an umbrella NGO. It tries to link the needs of rural and urban communities. It tries to trouble shoot and build bridges between caregivers and the needy throughout the state of Maharashetra. It fills in the gaps that the state and NGO networks have been unable to attend to over the past decades. It is also consistently working to get more and more local communities involved in their own empowerment.


HIV/AIDs has long ago made the crossover from being a cosmopolitan problem in India. It is a problem in rural communities, too. However, underdevelopment of the infrastructure (in rural areas of India over the last 60 years of Indian history) has made diseases, like HIV, TB/respiratory & dysentery-related illnesses all-to prevalent.

This is partially due to the Nehru-style centralized development practices implemented for far too many decades, i.e. this soviet-style centralization had left the local communities of India fairly underdeveloped by the end of the 20th Century.
These underdevelopments have occurred in the areas of health, education, and physical infrastructure, like roads & highway improvements and the creation of better train services and regional metro networks in states like Maharashetra, where Mumbai is located. The long-term centralization of India, i.e. after the British left in 1947, has hurt the local autonomy and growth of local political counterweights to demand better rural development.

For example, to this very day (i.e. July 2008), according to residents of local towns throughout Himachal Pradesh, townships receive “only enough funding” from the central governments to provide for “the bare maintenance of roadways—and this is a major tourist destination. They have little-to-no say in making intermediate and long-term plans.

That is, local communities cannot make long term development plans with centralized parties in the statehouse or in Delhi always controlling their purse strings. Local communities in India need to get permission to cut through red tape and create their own sources of income and development—without having to bow to the regional and national elite who control both the parties and the civil services in India.
According to the most recent Indian census, over 70% of the nations 1.1 billion people live in rural areas. There are over 638,000 villages in the land. (This is all in a territory in which makes up only 2.45% of the total world surface area. ) In short, 2.45% of the world’s land surface is holding 16.7 % of the total world population.

These facts are all part of the story of India in the 21st century.

On the other hand, India suffers already with the planet’s third largest number of HIV/AIDS--It will have 3 million or more cases by the end of this decade.

On the other hand, this bodes also some good news, because nearly 99% of the people in India do not have AIDS currently.

The bad news is that India has a large and growing population of under-educated peoples, including those from Kashmir and Jammu that have seen more violence than normal the past two decades. Further, many people are creating rumors about condoms and safe sex that are just not true—I reads such bizarre editorials in Goan newspapers just last month.

Likewise, historically in India most sex practices are not very up-to-date in the fight against aids in many part of the country. There are huge populations of sex workers.

Further, India has a high number of at risk persons, such as homosexuals, prison inmates, long-distance truckers, migrant workers (including refugees from neighboring lands, like Bangladesh), and street children.

NOTE: Many street children, of course, come from families who are migrating from rural areas to the city. However, I have seen children begging in the street in small villages as well.

As noted above, the centralized manner of development in India has often helped the larger cities in recent decades to develop. This growth has also been mirrored by the growth in the number of hospitals and hospital beds to be found in urban centers.

These structures and specialized clinics are lacking in many parts of many states these days.

When I was in Amritsar, Punjab, the city had just opened its own trauma clinic for the first time. Before this year, patients had to be taken to another state for such care.

Similarly, hospitals of all types are not distributed at all fairly in India, e.g. the state of Kerala has 2,053 hospitals while a state with 7 times its population, Utter Pradesh, has only has 735 hospitals.

This phenomena has partially been because the private hospitals (normally NGO or non-profit care giving institutions) have come from urban living dwellers’ inspirations—while rural areas, which are underdeveloped in terms of educational and economic infrastructure, have had to rely fully on the centralized states planning of the health care delivery in India.

To be sure, Indian health care has continued to have successes over each and every decade. For example, just in the last ten years infant mortality rate went down over 20 percent between 1994 and 2004. However, infant mortality rates in rural areas are over 35% higher than in urban centers.

Meanwhile, both malnutrition rates and the rising number of cases of drug-resistant TB are major concerns in India today.


The aforementioned NGO, named SOSVA, is an impressive group that works with health care NGOs and clinics throughout the states of Maharashetra and Haryana. SOSVA has also helped create its own regional pharmaceutical firm to keep the costs down for its 250 cooperating institutions.

Alas, India has nearly 30 other states and territories & horizontal and vertical integration of healthcare and educational programs is needed throughout the subcontinent. (India is by constitution a federal state and needs to act more like one.)

All the holes in health and educational programs need to be filled in during the coming decade. Local groups need to be banded together to work with (a) government agencies-, (b) other NGOs, and (c) even for-profit health care organizations more effectively in the future.

NOTE: This in no way implies that traditional medications, holistic treatment, and aruvedic-like techniques shouldn’t be fully integrated into patient therapies and in community health education settings.

The problem is in India that horizontal and regional health care developments have been hindered by the vertical history of India’s three-tiered medical care system, which simply centralized training and prowess while transporting patients and physicians to urban areas, i.e. when things got a little too complex for the ill-trained local health personnel to handle. There was little incentive for people to grow knowledge, know-how, and improve facilities locally and most effectively.


It might be good for India to decentralize rural development a bit more by creating a Council on Local Authorities and International Relations
, as Japan has done, to facilitate rural and international developmental relations in terms of economic, education, and technical exchanges. Such a program works not only in health care but across the economic and educational exchange spectrum to empower countries around Asia. It also empowers local communities to reach out to the world like never before.

If India’s 600,000-plus villages can learn to work with other Asian countries on Asian-solutions to the log-jam of local & regional underdevelopment--which has plagued India-- (rather than depending on the gifts of political party monopolies at center and regional levels), perhaps more substantial development can be achieved more quickly in India.

Such an increase in exchanges of people-to-people (in rural and local community development) and know-how among cultures and concerned volunteers around the globe cannot hurt India today.

This international development exchange suggestions means simply linking local communities across the globe directly to one another and bypassing a lot of the centralized politics and purse strings of misguided bureaucrats and party leadership—who are afraid of allowing local people to shape their own destiny (and afraid of giving local peoples the purse strings and educational tools to grow on their own.)

This CLAIR suggestion is just one of the many ways, like the need to create other regional SOSVA’s in India, which can further empower villages in India and can eventually change the world for the better.

The world wants to see India do better. You are the planet’s largest democracy in this millennium and we want you to succeed. But politically, socially, economically and educationally India needs to do better and think out of the box that 60 years of mediocre governance has brought you!



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