Published on 13.03.2024
A recent study by the Centre for Socio-economic & Environmental Studies (CSES) calls for major changes in the state’s extreme poverty eradication programmes. The study was conducted by CSES researchers Athul S.G., Dr.N.Ajith Kumar, Dr.Parvathy Sunaina, Nagarajan R Durai and Bibin Thambi.
As per the Niti Ayog index of multidimensional poverty, only 0.55 per cent of the population in the state is multi-dimensionally poor. The corresponding proportion at the national level is 14.96 per cent. Given the success of reducing overall poverty levels, Kerala focussed on alleviating extreme poverty through tailor made solutions. At present, there are two state government schemes to address the issue of extreme poverty; Agathi rahitha keralam or Destitute Free Kerala (DFK) launched by Kudumbashree covering 1.5 lakh families and the Extreme Poverty Eradication Programme (EPEP) covering more than 60000 households.
The study is primarily based on extensive field work in three Grama Panchayats which were chosen to capture geographical diversity and ensure representation of different marginalised groups. They are: Panamaram in North Kerala with a significant presence of tribal population; Alappad in South Kerala with a sizable fisher population; Asamannoor, a peri-urban area located in Central Kerala.
Key Findings and Recommendations:
Living in Extreme Poverty: Extreme poor grapple with material deprivation, intensifying health concerns, and limited access to basic necessities, education, and employment. Spatial and environmental challenges pose additional obstacles. They have minimal assets and resources. The major assets owned by the extreme poor include land and house. But 12 per cent of the extreme poor households did not have any land. More than a quarter of them do not have house. Only 8 per cent of the members of the extreme poor households have post higher secondary education. One-fourth have no formal schooling. Only about half of the households has at least one member who is employed. Half of them work on daily wage and one-third participate in MGNREGS work. Only one-tenth is in regular employment. It is significant to note that two in five members of the sample households are unable to work due to old age, illness, disability, or caregiving responsibilities.
Address People at Risk of Falling into Extreme Poverty: The state government’s initiatives for eradicating extreme poverty are laudable. However, it is important to recognise that both extreme poverty and vulnerability are dynamic in nature and are often intertwined. One may fall into extreme poverty and experience different dimensions of vulnerability due to a single shock or multiple shocks and continued stress. The present programmes for eradication of extreme poverty, both EPEP and DFK, targets only those identified as extreme poor. It is important to focus on early identification of people at risk of falling into extreme poverty and address their issues. This calls for a new component in the programme to eradicate extreme poverty targeting such households.
Early Identification and Support: The study recognizes the dynamic and intertwined nature of extreme poverty and vulnerability. Delays in identification can lead to increased complexity in addressing the issue. The solution includes the committees at the ward level for extreme poverty eradication constituted under the Extreme Poverty Eradication Programme to conduct annual visits to existing extreme poor households, assessing their status and needs. Micro plans could be adjusted periodically based on these assessments, and the status of extreme poor households could be integrated into the agenda of local community meetings (grama sabha/ward sabha).
Integration and continuity of Programs: The study suggests the integration of the ongoing Destitute-free Kerala (DFK) program and Extreme Poverty Eradication Program (EPEP) into a single program. An assessment of beneficiary households of DFK should be initiated, and households continuing in extreme poverty shall be included in the common program. The EPEP is planned to be completed in 2026. The study points out that the complexity of issues necessitates continuation of the program even after 2026 focusing on strategies to prevent the households from relapsing into extreme poverty and to prevent new households from slipping into it.
Provision of Shock Absorbers: Nearly one-third of the extreme poor households were pushed into extreme poverty because of a major shock, the most important being the death of an earning member followed by accidents or health emergencies leading to permanent disability or bedridden situation. The impact of this shock is more severe if the deceased/disabled is the sole earning member. Such a single shock can push a household into extreme poverty unless timely support is received. Early identification of such situations can be done only at the neighbourhood level (ward). It is important to ensure immediate support including financial assistance. For this, a distress relief fund shall be initiated at the local body level to address such emergency situations which can push households into extreme poverty with the support of state government and the community.
Review Selection Mechanism: Revise the selection mechanism for extreme poor households, considering the immediate impact of life-altering events such as the death or permanent disability of the sole earning member. The study recommends immediate inclusion of households experiencing such shocks in the list of extreme poor without waiting for the regular annual or biannual revision. The study also highlights the inadequacy of a uniform approach or standard criteria for identifying extreme poor households and suggests revising the selection mechanism and inclusion criteria based on the practical experience gained from implementing EPEP and DFK initiatives.
Ex-ante Strategies: The study reveals that households in extreme poverty rely on ex-post strategies that help recover from shocks and regain stability, such as relying on informal social protection mechanisms, borrowing money, delaying health care, and prioritizing needs. However, they lack sufficient assets and social capital for ex-ante measures that build resilience and prevent the likelihood of falling into extreme poverty. Given these limitations, the study advocates for a long-term strategy in extreme poverty eradication that prioritizes ex-ante components. This includes increasing livelihood opportunities, diversifying income sources, improving educational outcomes for children in these households, and addressing spatial vulnerability.
Integration of Formal and Informal Social Protection: While recognizing the critical role of informal support for extreme poor households, the study highlights its limitations, including limited by size and of social networks, cultural exclusions, and the resources available within the community. The study suggests combining formal social protection mechanisms with informal systems to address these challenges to create a sustainable safety net for individuals in extreme poverty.
Social Security Pension: Social security pension is the most important social protection mechanism available for extreme poor households. Large majority of these households have at least one member receiving social security pension. It is the main source of income for nearly half of the households. This was possible because of the extensive and laudable social security pension system prevalent in the state. Though some of the assistance is partially covered by the centrally sponsored scheme of NSAP, lion’s share of the pension amount is met by the state government. For instance, the central share in old age pension is just 13 per cent in the case of those aged below 80 years. The central government provides even this assistance only for 15 % of the current beneficiaries of old age pension. Of the 52 lakh beneficiaries of social security pension in Kerala, the central government’s share is received only for 8 lakh beneficiaries (15%). While this has helped the extreme poor households, it is important that the state ensure regular payment of pension to the extreme poor. To facilitate this, a separate category may be created in the database.
Income Generation and Employment: The study reveals that extreme poor households face low and irregular income flows due to limited livelihood opportunities, mobility constraints, and caregiving responsibilities. The study recommends:
- Supporting the skill development of the extreme poor through collaboration with programs like Deen Dayal Upadhyaya Grameen Kaushalya Yojana (DDU-GKY), Kerala Academy for Skill Excellence, and Kudumbashree.
- Assist caregivers in undertaking income-earning activities within their homes.
- Create opportunities for elderly members of extreme poor households to engage in less strenuous work, providing additional income and a sense of purpose. Such initiatives can be linked with Kudumbashree or local elderly forums, with seed funding from local government funds.
- Prioritize extreme poor households under MGNREGA.
Healthcare for the extreme poor: The study found that only 40 percent of the extreme poor in the sample are covered by any health insurance scheme. All of them are covered by the Karunya Arogya Suraksha Padhathi. Half of the households that did not have insurance were elderly-only households which may be due to the lack of information and or capability to get enrolled. Universal health insurance coverage for the poor is essential not only for lifting people out of extreme poverty but also for keeping others out of extreme poverty. Often, the cost for medical care involved in a major accident or chronic illness can push people into extreme poverty as they end up selling even productive assets to pay medical bills. Therefore, the state government shall prioritize universal health insurance coverage for the poor as it is one of the most effective interventions in extreme poverty reduction. The ASHAs shall be entrusted with the responsibility of enrolling all poor households (not just extreme poor) in Karunya Arogya Suraksha Padhathi.
Focus on Mental Health: One-fourth of the extreme poor households have a member with mental illness. This high proportion is mainly due to the inclusion of mental illness as a criteria for identifying extreme poor households. The challenges include the inadequacy of healthcare and the stigma associated with acknowledging mental health issues, leading to delayed care-seeking and worsening conditions. The study also highlights the gap in addressing mental health issues within existing programs like DFK and the new EPEP, emphasizing on the importance of incorporating measures to address mental health concerns within the healthcare components of these programs. To address this, the study recommends
- Linking suspected cases of mental health issues with Aswasam, a depression screening and management program implemented through Family Health Centers (FHCs). This involves screening, diagnosis, and providing referral and treatment support, including the provision of medicines.
- Exploring the possibility of engaging retired medical professionals, particularly at the block level, to address mental health issues within extreme poor households.
- Provide institutional care to mentally ill individuals, especially those living alone.
Support for Caregivers: The study emphasizes the need to support caregivers in the family, predominantly women, who face stress and limited employment opportunities. Recommendations include providing training in care practices and offering counselling services to alleviate their challenges. Specifically, the study suggests the inclusion of caregivers in the Aswasakiranam program by the Kerala Social Security Mission, focusing on those caring for bedridden members in extreme poor households.
Door delivery of essentials and other services: With high incidence of old age and disability in the extreme poor households, access to essential provisions and services are limited. The delivery of medicines, food kits, and other necessities can be facilitated through a system involving the informal support network, which includes family, kinship, and community members as well as the support of local government and the Kudumbashree. Identifying the existing support system and linking it to service delivery can enhance outcomes, provide emotional support, alleviate loneliness, and gain insights into the well-being of households.
The study also highlights the barriers extreme poor households face in accessing services due to challenges in transportation, such as in procuring ration or health care especially during emergencies. To address this issue, the study recommends creating a list of autorickshaw drivers at the local body or ward level who are willing to provide transportation services to extreme poor households. The cost of autorickshaw services could be subsidized by the Panchayat for extreme poor households.
Food Security: Public distribution system is the primary source of food grains for large majority (90%) of the extreme poor households. The small group of extreme poor who are not depending on PDS do so because of their inability to cook food, absence of ration cards and restricted mobility/disability. A positive feature of DFK programme is the home delivery of food kits especially to the elderly, persons with disabilities and those with chronic illness. But some of the households reported that they are not getting it regularly.
It is found that 15% of surveyed households lack the ability to cook due to the absence of an able-bodied member. Some of them now depend on the relatives or neighbours for food. However, such support can be erratic. Therefore, the LGs should supplement such efforts to ensure that there is no break in the provision. A combination of options suitable can be tried. First option could be to entrust the Kudumbashree NHG or a neighbouring household to provide food to such households without interruption. The provisions from PDS and the food kits supplied under DFK could be routed to these NHGs/households. To meet the expenses for any additional materials to be purchased and the cost of labour, a fixed amount shall be provided from LG funds or by mobilising funds from the community.
Additional Nutritional Support: The well appreciated provision of food kits under the DFK program shall be extended to households covered by EPEP. Similar to the provision of Amrutham Nutri mix powder to children in anganwadis, a suitable nutritional product may be included in the food kits for the elderly and bedridden members of extreme poor households.
Make Kudumbashree more Inclusive: Being outside Kudumbashree, the state’s poverty eradication programme can be a major disadvantage to the extreme poor as it is the main avenue for social participation, main source of credit and an important source of information on government schemes. Most of the anti-poverty programmes are implemented by Kudumbashree. But, about half of the extreme poor households are not part of Kudumbashree network. This includes 18 per cent of the extreme poor households with only male members. Being the state’s poverty eradication programme, systematic exclusion of extreme poor households having only male members is not justifiable. Many such households have elderly or persons with disability. Being outside Kudumbashree is disadvantageous to all households, including men only households, as it is the state’s poverty eradication programme. A mechanism to link such households with the state’s poverty eradication programme may be developed.
If households with women only are taken, two in five such households were not part of Kudumbashree due to old age and health issues, inability to pay thrift, NHG being inactive, or due to absence of vacancy in the NHG or conflict with other Kudumbashree members. Hence, the following recommendations are proposed. Kudumbashree shall design a mechanism to include those who are not able to pay thrift and facilitate portability of Kudumbashree membership on migration of the household.
Upward Mobility through Education: One of the ways in which the extreme poor can escape from the poverty trap is through education. While no fees is charged in government and aided schools, the non-fee private expenditure is substantial as one moves up the educational ladder. Once a household is recognised as extreme poor, the educational expenses of the children, including at the higher education level, shall be shared equally by the state and local governments. The local government can find its share through contributions from the community, corporates and NRIs. But finance is not the only problem. They also require support in their studies and for employment/self employment. For this, a mentorship programme shall be initiated with retired teachers, and educated youth as mentors to these children. The local clubs or libraries shall also be included in such initiatives with the support of LGs.
For further details: Athul SG (9971438349), Research Associate, CSES, Kochi