This report was published in The Federal on 18.05.2024
Multidimensional poverty has fallen drastically in state, but CSES study calls for special focus on mental health-related vulnerabilities in rural poor
Kunjammu, an 85-year-old cancer survivor, was forced out of her home in Idukki district eight years ago, and had to relocate to Kochi. Despite challenges, she makes ends meet by selling inexpensive plastic pens and seeking alms at traffic signals. At night, she finds refuge in a destitute home where she receives her daily meals.
Kunjammu has three sons and a daughter, but she is unaware of their whereabouts. She says her family abandoned her after she was diagnosed with cancer eight years ago, but she has successfully managed to cheat death.
Even though the Kerala government has made substantial progress in reducing the presence of beggars from the streets with the help of its poverty alleviation programme, more needs to be done to help impoverished people like Kunjammu and many who remain unidentified.
A recent study has called for significant changes in the state’s poverty alleviation programmes with a special focus on mental health-based vulnerabilities of the rural poor.
Least impoverished state
Data released by NITI Aayog on the Multidimensional Poverty Index (MPI) in 2021 shows Kerala as the least impoverished state in India.
Merely 0.7 per cent of the population falls under the category of multidimensional poverty, considering various factors like child and adolescent mortality, maternal health, education levels, housing conditions, access to sanitation, availability of clean drinking water, and electricity.
While poverty defines the lack of money, multidimensional poverty measures how people suffer from multiple disadvantages – poor health, malnutrition, lack of clean water or electricity, poor quality of work, low levels of education and so on.
The NITI Aayog report highlights Kerala’s Kottayam as the nation’s least impoverished district, boasting an absolute poverty rate of zero. These statistics underscore Kerala’s commendable efforts in alleviating poverty.
Poverty reduction
According to the NITI Aayog MPI, only 0.55 per cent of Kerala’s population falls into the category of multidimensional poverty, while at the national level, the corresponding figure is 14.96 per cent.
With overall poverty levels showing significant reduction, Kerala has directed its efforts towards addressing extreme poverty by implementing customised solutions.
In the past 15 to 20 years, the presence of beggars, mostly from the state, on the streets of Kerala, has also significantly decreased, with almost none of them visible now apart from the migrant population who are suspected to have fallen prey to the ‘begging mafia’ operated by criminal gangs.
State govt schemes
Kerala’s Local Self Government Department has identified 64,006 households, with 103,099 members, which meet the criteria for extreme poverty.
At present, there are two state government schemes to address the issue of extreme poverty – the Agathi Rahitha Keralam (Destitute Free Kerala, or DFK), launched under Kudumbashree (the poverty eradication and women empowerment programme implemented by the State Poverty Eradication Mission) covering 1.5 lakh families, and the Extreme Poverty Eradication Programme (EPEP), covering these 64,006 households.
However, a study conducted by the Centre for Socio-economic and Environmental Studies (CSES) has called for major changes in the state’s extreme poverty eradication programmes. One of the significant aspects of the study is its focus on the mental health-based vulnerability of the rural poor.
The CSES is an independent, non-profit NGO promoting policy and action oriented research, consultancy and training programmes, according to its website.
Mental illness issues
Charity workers from Thrissur recalled an incident in which a family of three, consisting of an elderly couple and their intellectually disabled son, in a tribal hamlet on the Kerala-Tamil Nadu border, were starving for days until they were rescued. While both the parents fell sick, the son was unable to grasp the severity of the situation, leaving the family in dire poverty for days until caregivers located them.
“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 criterion for identifying extreme poor households,” reads the report.
“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, emphasising on the importance of incorporating measures to address mental health concerns within the healthcare components of these programs,” it adds.
The study was conducted by CSES researchers Athul SG., Dr N Ajith Kumar, Dr Parvathy Sunaina, Nagarajan R Durai and Bibin Thambi.
Early identification is key
While the state government’s initiatives for eradicating extreme poverty are laudable, the study says 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, target 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.
“The study is primarily based on extensive field work in three gram panchayats which were chosen to capture geographical diversity and ensure representation of different marginalised groups. These are – Panamaram in North Kerala which has a significant presence of tribal population; Alappad in South Kerala which has a sizable fishermen population; and Asamannoor, a peri-urban area located in central Kerala,” Athul SG, one of the researchers who conducted the study, told The.
Merger of programmes
The study suggests the integration of DFK and EPEP into a single programme. An assessment of beneficiary households of DFK should be initiated, and households continuing in extreme poverty should be included in the common programme, it says.
EPEP is planned to be completed in 2026. The study points out that the complexity of issues necessitates the continuation of the programme even after 2026, focusing on strategies to prevent households from relapsing into extreme poverty and to prevent new households from slipping into it.
“This research wasn’t aimed at assessing or evaluating the said government schemes; rather, we explored the vulnerabilities of the subjects and whether the government overlooked any aspects,” said Ajith Kumar of CSES.
Focus on caregivers
“As far as cases like Kunjamma are concerned, if she had been residing in her own village or town, the EPEP would have identified her,” said Ajith Kumar. “Identifying individuals becomes challenging when they relocate, particularly to large urban areas.”
“As researchers, we haven’t delved into the issue of inclusion or exclusion, but rather focused on certain criterion to identify the impoverished people. People who have mental health were found one of the most vulnerable groups. As a practical solution, we suggest involving retired healthcare professionals to provide home-based care for this vulnerable group,” he added.
The study also emphasises the need to support caregivers in the family, predominantly women, who face stress and limited employment opportunities.
Key recommendations
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 (‘Ray of Relief’) programme by the Kerala Social Security Mission, focusing on those caring for bedridden members in extreme poor households.