Although Nuh has a long way to go, signs of change suggest that the government’s development programme has had a positive impact.
Just about a two-hour drive from India’s capital city is the district Nuh, earlier known as Mewat. The district came into existence in 2005 by bringing together blocks from Gurugram (earlier Gurgaon) and Faridabad.
Home to around 11 lakh people as per the 2011 Census (70 per cent being Muslim), Nuh has historically been one of the most under-developed districts in the country.
As per the National Family Health Survey-4, the prevalence of anaemia in pregnant women in Nuh was 79 per cent compared to 55 per cent and 50 per cent for Haryana and India respectively.
Similarly, only 38 per cent of the deliveries in the district took place in institutional facilities, as against 81 per cent in Haryana and 79 per cent at the all-India level. The full immunisation rate for children between 12-23 months was also abysmal at 13 per cent, with Haryana and the rest of India faring much better at around 62 per cent.
Further, the district has been plagued with high levels of malnutrition among children and poor outcomes in other areas such as education.
In fact, when the government of India’s Aspirational Districts Programme was launched, Nuh was the lowest ranked aspirational district based on its composite score across 49 Key Performance Indicators.
As I was doing my homework prior to the visit, I noticed that most of the media stories highlighted crime and violence in the district while others referred to the area as India’s “bleeding district” given the high maternal mortality rates.
During my visit to the district, I interacted with officials at various levels. They confirmed a number of the challenges I had expected based on my previous research. The biggest hurdles to development seem to be certain deep-seated myths and misconceptions in the community, especially with respect to the status of women.
These, in turn, adversely impact initiatives in sectors like education, health and nutrition, among others. As highlighted by one of the field workers I spoke with, it is difficult to convince many of the local residents about the importance of contraception after the birth of one or two offspring given their belief that children are “god’s gift”.
Even where the basic infrastructure is largely in place, there is a persistent shortage of specialists like gynaecologists and paediatricians at the health facilities, for instance.
The overall picture is undoubtedly grim. However, despite the multiple obstacles, there are several areas in which the district has made remarkable progress over the last few years. For instance, the maternal mortality rate fell sharply from 153 in 2015-16 to 91 in November 2017.
Similarly, the full immunisation rate increased from 29.92 per cent in March 2018 to 68 per cent in August 2019 as captured by the Champions of Change dashboard under the government’s Aspirational Districts Programme.
A dramatic shift in this indicator over a relatively short period of time has been enabled by the adoption of a systematic approach which can be scaled up and replicated in other parts of the country as well.
A key element of this approach is the clear delineation of roles and responsibilities among all stakeholders including the village sarpanchs, field-level health and nutrition workers, self-help groups, teachers and non-governmental organisations (NGOs).
The other critical element is organising meetings and interactions with local influencers through awareness rallies, mothers’ meetings, door-to-door awareness campaigns as well as favourable announcements from the mosque by religious leaders for encouraging residents to get their children vaccinated.
Finally, the emphasis on data ensures that the district can keep a record of every family and child who has either missed a dose or refused immunisation.
This, in turn, allows the programme team to focus their efforts on such families by providing appropriate incentives to nudge their behaviour in the desired direction.
Human beings, after all, do not always behave like robots, rationally or without biases. Many a time, the choices they make are driven and limited by mental ability, attention and motivation.
Thus, it is noteworthy that this initiative is designed in a manner that it can influence “choice-making” by people.
By addressing the misconceptions about immunisation and portraying it as the “norm”, the initiative is able to nudge people to adopt a desirable behaviour without constraining their freedom to choose.
In general, people suffer from enormous inertia with respect to making choices and hence prefer to go with the default option.
Undoubtedly, there is a long way to go before Nuh can become one of the more developed districts in the country.
Education, especially that of girls and women, needs continued special emphasis. Local employment opportunities need to be boosted so that those who complete their education can take up meaningful jobs in the district thereby serving as role models for the rest of the community.
Engagement of community and religious leaders also needs to be sustained in order to address the mindset issues that often impede progress.
Most importantly perhaps, the best practices from the district need to be widely acknowledged and those responsible for implementing them suitably recognised and rewarded.
Given that districts like Nuh have traditionally been perceived as “punishment postings”, officials who seize the opportunity and invest their time and effort in catalysing positive change in the area must be suitably encouraged through timely promotions and incentives.
The overwhelming sense I came away with as I completed my visit to Nuh was that change is definitely possible. Strong governance mechanisms, concerted action and above all a positive mindset can go a long way in converting even the country’s most challenging districts into islands of hope and opportunity.
Disclaimer: Views expressed are personal.
Acknowledgement: With research inputs from Shashvat Singh, Programme Officer, United Nations.