Social protection in Tamil Nadu: Covid-19 highlights need for universal coverage

multidimensional poverty
Malnutrition, lack of access to education major challenges in India's fight against multidimensional poverty.

The COVID-19 pandemic and measures undertaken to arrest its spread have thrown into sharp relief the importance of social protection. Extreme shocks such as the pandemic can undermine not only existing systems of protection, but can also have long-term implications for meeting Sustainable Development Goals. Disruptions in access to education, healthcare and livelihoods are superimposed on the pre-existing vulnerabilities. In this context, we highlight the possible impacts of COVID-19 on social protection in Tamil Nadu, a state known for its relatively well-developed social protection system from a life-cycle perspective. We then indicate possible interventions to address the impacts. To begin with, we highlight the nature of pre-existing interventions across different stages of the life cycle and how they may have been impacted by the pandemic.

Prenatal and early childhood

During pregnancy, the state provides universal health services, but maternity benefits are targeted and conditional. The Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS) introduced in 1987 comprise cash and in-kind transfers to pregnant women who belong to below poverty line (BPL) households and meet conditions like antenatal care, institutional delivery and child vaccination. Consequently, institutional delivery was near universal (99%) in the state in National Family Health Survey 4 in 2015-16, and full antenatal care coverage of mothers increased from 27.5% in 2005-06 to 45% in 2015-16. The strain on public health facilities that the pandemic poses can clearly undermine such support.

Girl children face higher risk of being eliminated by female infanticide and sex selective abortion, which could worsen after economic shocks due to COVID-19. Tamil Nadu introduced the Cradle Baby Scheme in 1996 and Chief Minister’s Girl Child Protection Scheme (CMGCPS) in 2001-02 to address the problem of sex selective abortion. While there was improvement in child sex ratio between 2001 and 2011, child sex ratios have worsened in some districts such as Ariyalur (897), Cuddalore (896), Dharmapuri (913), Namakkal (914) and Perambalur (913). Pandemic induced livelihood shocks may reinforce such practices. For children in the age-group 0-6 years, the central government scheme, Integrated Child Development Scheme (ICDS) aims at improving the nutritional and health status of through Anganwadi centres (AWCs).

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In Tamil Nadu, data from NFHS 4 shows that 58.5% of children between 0-71 months received supplementary food, 46% received vaccinations, 56.4% received health check-up from AWCs in 2015-16. Further, 58.5% of children in the age group 0-59 months were weighed at AWCs and 50.4% of children between 36-71 months received preschool education through AWCs. In 2018-19, nearly 13.8 lakh children attended PSE in AWCs, nearly 29 lakh children received supplementary nutrition and 37.9 lakh children availed vaccination, weight monitoring and health check-ups at AWCs. Due to the pandemic, most of these services have been disrupted.

School age

One of Tamil Nadu’s best known social protection schemes for school children, is its mid-day meals programme that started in 1982, which promotes school enrolment, attendance and nutrition. This has been supplemented by both cash and in-kind incentives that include laptops to children in higher secondary schools and sanitary napkins to adolescent girl children to prevent drop-outs.

Closure of schools due to the pandemic implies that nearly 131 lakh children’s education and access to mid-day meals will be affected apart from services for children with special needs (CWSN). Though online education has recently started, access to internet is not widespread. The NSS 75th round on education reveals that only 18.1% of households had a computer and 19.6% of households had internet facility in Tamil Nadu. The digital divide combined with livelihood shocks among parents could push children into the workforce.

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Working age

The predominance of informal employment at the all-India level is reflected in the state as well. Information from Periodic Labour Force Survey in 2018-19, shows that among the employed in Tamil Nadu, the share of casual workers was 31.5%, of regular employees was 34.6% and self-employed was 33.9%. This pattern does reinforce the need for a stronger social protection net, as nearly all those employed as casual labour did not have a written contract and are mostly not eligible for any social security benefit. Even among regular employees, 46.7% did not have any social security benefits in Tamil Nadu. The state had constituted Labour Welfare Board for unorganised sector workers quite early on, which has a protective focus. The aim is to protect against employment injury, death, disability, maternity and old age. The state has 17 schemes under the Unorganised Workers’ Welfare Board aimed at the informal workforce in the state, apart from other welfare boards for workers in other sectors. These boards covered 3,38,047 beneficiaries in 2016-17.

As a result of the lockdown during the pandemic, workers were not allowed to go to their place of work except those who were employed in the health sector and essential services. Even when the lockdown is being lifted in a staggered manner, several sectors remain closed, as those are high risk categories. Data from Centre for Monitoring Indian Economy shows that monthly unemployment rate in 2020 in Tamil Nadu witnessed a sharp rise from 6.4% in March to 49.3% in April, followed by a decline to 33% in May. Fall in consumption due to collapse of demand has also affected the self-employed adversely. Rough estimates suggest that only around 5% of workers in the unorganised sector are registered under such welfare boards. Hence, many would not have received cash benefits provided through welfare boards to tide over the shock.

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Old age

Tamil Nadu (10.4%) is the second most aged state after Kerala in 2011. The old age pension scheme for below-the-poverty line (BPL) elderly is an unconditional cash transfer, which currently stands at Rs 1000 per month. Yet, a large share of the 75 lakh elderly population are not covered under social security pensions. As per COVID-19 guidelines issued by Government of India, the elderly population are supposed to remain at home. If the elderly cannot work, they will experience severe deprivations, as they lose income from their labour. Their children who would have been out-of-work during the lockdown too would not be in a position to support them, exposing them to abuse.

Health and sanitation

Tamil Nadu has one of the better performing public health systems in the country. Consultations and medicines are provided free-of-cost at the point of delivery and diagnostics are charged at highly subsidised rates. However, the public health system faced human resource shortages in the public health system even before the pandemic, which can disrupt routine functioning of public health services like child vaccination during the pandemic. Even earlier, child vaccination has shown a decline from 80.9% to 69.7% between 2005-06 and 2015-16. Besides, given the chances of outbreaks like dengue, chikungunya, H1N1 annually, these shortages will expose the population to lack of healthcare and expenditure shocks arising from use of private health services.

Data from National Statistical Office report on Drinking Water, Sanitation, Hygiene and Housing Condition in India, 2018 reveals that while only 15.9% of households in the state had piped water supplied into the dwelling, 34.5% had to depend on public taps for access to drinking water. This shows that without universal provision of piped water supply into houses it would be difficult to adhere to COVID-19 physical distancing norms, as people have to collect water from common sources. Further, hand wash hygiene is sub optimal in the state. Declining revenues because of disruptions in economic activity will also adversely impact investments in sanitation and public health.

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Food security: Universal and non-cash transfers

While there are suggestions at the all-India level for cash transfers to replace provision of food, events such as the pandemic that disrupt supplies highlight the importance of making food available to the vulnerable. Tamil Nadu has one of the best performing Public Distribution System (PDS) in the country. According to Jean Drèze & Reetika Khera, TN’s universal PDS, has contributed to reduction of the poverty gap index by 61.3% in 2011-12. As very few in the informal economy could afford to be without work during lockdown, universal PDS in the state is likely to have protected them against food insecurity.

We now turn to identifying possible areas for intervention. Before going into specific life cycle stages, we would like to highlight a few systemic features that require attention. In India, bulk of the expenditure and interventions are being undertaken by state governments. Shortfalls in revenue or transfers from the union government clearly have repercussions. Further, conditions for borrowing implemented by the union government are likely to erode autonomy to innovate in response to regional conditions. Negotiations on these are therefore critical to ensure a responsive social protection system.

From disaster relief to disaster protection

At present ‘natural’ disasters like floods, cyclones and pandemics are seen as one off external shocks livelihoods of the vulnerable. But given the fact that such shocks and extreme climate events are recurring, mitigation measures can no longer conceive of such events as rare. For example, the state has witnessed two major floods, three cyclones and a major drought in the five years preceding the pandemic. It therefore calls for better disaster management systems that emphasize preventive measures. The effects of such shocks on livelihoods are also shaped by urban and agrarian ecologies and quality of growth. Social protection can therefore no longer be imagined independent of the process of development itself.

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Finally, the shock reiterates the need for a universalist approach to social protection as opposed to targeting, as targeting does not address the possibility of those likely to fall into poverty on account of livelihood shocks. In terms of specific life cycle stages, we suggest the following.

Maternity benefits: For the duration of the pandemic the state could consider relaxing the conditions associated with MRMBS and instead transfer the entire cash and in-kind benefit to beneficiaries as soon as pregnancy is detected.

Girl child protection: As there is a high risk of sex selective abortion of females during COVID-19, the CMGCPS scheme has to be expanded in districts with poor sex ratios by focussing on blocks which perform poorly on Gender Inequality Index.

Access to education and nutrition: Data from NFHS 4 shows that 94.7% of households in the state own a television. If the state has to adopt online teaching, perhaps classes for upper primary and secondary school students can be provided through this medium to address the digital divide. Online classes must be tailored for CWSN. The local governments can be entrusted with provision of midday meal rations along with stationery, sanitary pads and soaps to children enrolled in schools and AWCs during the course of the pandemic.

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Labour welfare and income security: In the short run, there is a clear need to take efforts to enrol more workers including intra-state and inter-state migrants in the welfare boards and also to disseminate information among members on the benefits of being a registered member. The immediate actionable solution is to expand coverage to at least one-third and gradually include a larger share once the state’s revenue improves. In rural areas, the government should expand access to MGNREGS and provide work based on demand.

Expand access to social security pensions: Although adult children continue to provide bulk of the economic support, it is clear that the state has to step up efforts to include larger sections of the elderly and widows under the ambit of social protection.

Public health and sanitation: Data from Rural Health Statistics in 2018-19 showed significant shortfall of key human resources in the public health system in the state before the pandemic. The immediate task is to fill the shortfall of doctors, specialist doctors, radiographers, ANMs and pharmacists. Urgent attention has to be paid to ensure that households get access to piped water supply into their homes and to encourage behaviour change regarding hand wash.

(Dr Gayathri Balagopal is an independent researcher based in Chennai. Professor M Vijayabaskar is faculty, Madras Institute of Development Studies. This paper is a short version of MIDS Occasional Policy Paper 12, Covid-19 Series published in July 2020. The authors acknowledge funding support from UNICEF.)