Abstract
Developing countries can generate effective solutions for today’s global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed—this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.
Keywords:
Developed countries; Developing countries; Partnerships; Learning; International cooperation; Health care quality, Global health
Background
International cooperation is crucial for improving global health outcomes. One such form of cooperation occurs through international partnerships, which lead, stimulate, and facilitate action on health challenges through programming, advocacy, and technical support. Just as the preference for the term ‘global health’ has increased [1], so has the shift in philosophies and attitudes to partnership-building. Partners today increasingly seek mutuality of benefits, including two-way flow of energies, expertise, and knowledge to justify investment.
At the same time, more and more health leaders are turning their attention to developing countries to generate effective solutions for health [2-6]. One such leader is Lord Nigel Crisp, the former Chief Executive Officer of the U.K. National Health Service, who states, “rich countries can learn a great deal about health and health services from poorer ones…combining the learning from rich and poor countries can give us new insight on how to improve health” [2]. The private sector has already embraced the sensation—termed ‘reverse innovation’—and corporations are rapidly promoting the spread of developing country innovations worldwide [3].
African Partnerships for Patient Safety (APPS) is a WHO programme that has built patient safety partnerships between hospitals in Africa and Europe. Partnership strengthening is a core APPS programme objective [7] and building a business case for international cooperation (in particular, developed-developing country partnerships) is a critical component of this objective. This interest informed the main purpose of our research. In this paper, we relay existing information on health system benefits accrued by developed countries from partnering with developing countries, and then gauge whether developing country health system experiences could form the basis of future international cooperation.
Methods
Search strategy and selection criteria
Five MeSH search headings, “health care quality”, “access and evaluation”, “international cooperation”, “hospitals”, and “learning”, were combined and exploded with geographical qualifiers such as “Africa” OR “Asia” AND “Europe” OR “North America” to identify studies with full or partial information related to developed-developing country cooperation. Developed and developing countries were defined according to the 2008 World Bank classification [8]. English language articles between 1990 and 2010 were included and searches were carried out on PubMed, Google, and grey literature databases. Relevant articles were retrieved and their reference lists searched for additional articles. Abstracts were evaluated for their suitability to the research question. For each article included, the reviewer completed a data extraction form to summarize key details (i.e., author, year of publication, key points, and health/clinical benefits). Relevant articles were appraised for inclusion by one investigator (VD) and confirmed by a second investigator (SBS). Disagreement was resolved by consensus. The information searching and extraction process was iterative. The comprehensive search strategy and the appraisal questions are provided separately in Appendix 1/Additional File 1.
Additional file 1. Comprehensive search strategy employing MeSH terms and questions for critical appraisal. (DOC 59 kb)
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Our search yielded 227 articles, of which 18 were eligible for inclusion. Relevant articles and their bibliographies generated new leads, which were also evaluated for inclusion. A total of 65 articles were finally included in the review (see Figure 1 for more detail).
Figure 1. Flow chart for selection of articles.
Results
Benefits accrued by developed countries from partnering with developing countries were found to principally span the first three intangible, or ‘soft’, elements of the Partnership Evaluation Tool (PET), a model that identifies four categories of partnership benefits, namely ‘connections’, ‘learning’, ‘action’, and ‘impact’ [9]. These benefits predominantly influence health workforce education and training and include examples such as improved employee morale, heightened learning, better information sharing, personal and professional development, improved patient-provider relationships, and a greater awareness of the factors impacting health (see Figure 2 for more detail). We did not find clear evidence for the broader ‘impact’ of such benefits on developed country health systems, perhaps because soft benefits are difficult to measure and their effects hard to trace [10].
Figure 2. Benefits to individuals and organizations in developed countries.
Rather, our research overwhelmingly detected unique ways of responding to health challenges that support the concept of reverse innovation. Narrative summaries describing our main findings are provided below, arranged according to the six key components of a health system [11]. These accounts provide insights on how innovations (e.g., a new method, idea, product, policy, etc.) in developing countries can inform responses to contemporary health system challenges in developed countries (see Table 1).
Table 1. Summary of key system-wide benefits arranged by the six WHO building blocks of health systems
Service delivery
Many developing countries have developed mechanisms to reduce cultural, social, financial, or gender-related barriers to service delivery [12,13]. For example, family and community-based interventions in developing countries have been indispensable to the management and treatment of diseases like schizophrenia, through de-stigmatizing practices like therapeutic optimism, extended support networks, and more holistic appraisals of the disorder [14,15]. Where direct interaction between men and women is discouraged (e.g., rural communities), gender mainstreaming has allowed for the delivery of gender-specific care through the use of female workers [16]. An Iranian thalassaemia prevention programme demonstrates culture-sensitive ways of prevention in high-risk individuals by screening school children as part of their regular health check-ups [17]. Such strategies can be helpful in managing developed-country healthcare challenges in marginalized developed country populations. Indeed, this was the experience for Project Connect, a U.S.-based AIDS treatment program that found inspiration from a similar program in Zambia [18].
Multiple innovative and efficient models for depression care exist in China, Iran, and Tanzania, which integrate mental care into general medical settings through the use of ‘village health workers’ and ‘health houses’ where suitably trained health personnel serve general medical and psychiatric needs of the communities they represent [19]. Developing countries have also long addressed the use of alternative medicine through policy models where modern and traditional medicine are either integrated through medical education and practice, or practiced through parallel mechanisms within the national health system [20]. As Western governments grapple with medical pluralism, developing country models of integrated health can offer guidance on how to provide a care continuum that enhances social integration.
Developing countries can also offer learning opportunities to those seeking to maximise health service coverage, quality, and safety. For example, organisational innovation and management using discriminatory service provision, fixed price models, and efficient supply and delivery chains, has helped improve production efficiency in India [21]. In Ethiopia, quality of hospital care was improved through partnership-mentoring models, which provide new approaches for increasing management capacity and improving hospital management systems [22]. Similarly, task shifting, group interventions, and pricing/procurement strategies in multimodal stepped-care programmes in Chile have produced quality clinical outcomes at low cost [23].
Focused example: Chronic care models
When doctors running an AIDS clinic in the U.S. sought to increase patient follow-ups, they turned to an unusual place for help: Zambia. Project Connect, a program based in the University of Alabama is reducing patient no-show rates by taking a community and patient centred approach adapted from lessons in Zambia. The Wall Street Journal reports, “Patients were given appointments with doctors within five days of calling the clinic. Blood tests were taken during the first visit. A social worker did an interview, trying to identify and address any issues that might prevent patients from coming back. The no-show rate dropped from 31% in 2007 to 18% through June 2009.” Effective chronic care delivery is possible in resource scarce settings, and developing country models can offer opportunities for combined learning.
Medical tourism has resulted in the rapid development of major teaching hospitals abroad. The work of subsidiary organizations like Harvard Medical International and Johns Hopkins International demonstrates strategic, financial, research and marketing-related opportunities in emerging economies like India, China, Pakistan, Malaysia, Chile, Peru, and Mexico [24]. Several U.S. hospitals are also engaged in hospital and institutional partnerships in countries like Saudi Arabia, India, and Turkey to boost revenues at home [25]. Commercial partnerships can provide a channel to inform key service delivery challenges, including the training and retention of workers, maintenance of quality outcomes, and access to health care.
Health workforce
Developing countries are promoting novel approaches to dealing with the global shortage of professionally trained healthcare personnel by scaling-up modified service delivery models and introducing specialized worker education and training. For example, several developing countries are effectively and efficiently training mid-level workers to perform emergency interventions [26-29]. In Mozambique and Bangladesh, this approach has generated novel applications of task shifting that has improved health access [30,31]. In Ghana, pre-hospital trauma training of lay workers, such as commercial drivers, has led to a significant reduction in road traffic deaths [32]. In Nepal, the facilitation of professional relationships between traditional healers and government health workers is improving health service delivery [33]. Without doubt, human resource planning and development vary between developed and developing countries. However, as the developed country health workforce diversifies in remote and rural areas, workforce planners may benefit from utilizing developing country models for worker substitution, mobilization, recruitment, and retention.
Community health workers (CHWs) are often underutilized in developed countries and a key challenge remains in institutionalizing and mainstreaming community participation. Training programs involving CHWs and volunteer networks in countries like India [34], Peru [35], Haiti [35], and Brazil [36] have shown tremendous success in improving health outcomes for the chronically ill and dying. Pakistan’s Lady Health Workers is an accredited community-based programme that has improved both the quality of care and gender-based workforce participation [37]. These health-care workers are trusted members of society and play an important role in linking formal health systems to rural communities. Lessons from developing country experiences can help expand the knowledge base on community workforce policy, training, and education, as well as help raise the profile of community-based interventions.
Focused example: Community health workers
Pakistan’s Lady Health Worker Programme was established in 1994 to provide essential primary health services in rural and urban slums. Over 100 000 lady health workers have been deployed to date, reaching out to over 90 Million Pakistanis in all 135 districts of the country. The Programme is widely regarded as one of the best community-based programmes in the world. Melinda Gates writes about community-based interventions: “By empowering the community with knowledge about lifesaving methods such as skin-to-skin care and immediate breastfeeding, the project cut the mortality rate for newborns in half in only 16 months without introducing any new technology.” Community health workers can play a vital and effective role in a country’s regular health system by improving community self-sufficiency, fostering meaningful use of social systems, and improving health and well-being in neighbourhoods with complex needs. Developing countries have a rich history of both small and large CHW programmes that can offer a source of learning for developed countries wishing to employ such programmes in both rural communities as well as inner-city neighbourhoods.
Finally, clinical and public health training in developing countries can serve as a critical component of skills development and maintenance for developed-country practitioners who are at risk of losing knowledge due to differing patterns of disease burden [38]. Such training allows exposure to a range of diseases, organizations, and management styles, which are necessary to solve today’s global health challenges [39-41]. Partnership reports also describe developing country settings as optimal grounds to build training competencies in the areas of public health policy and administration [42,43]. Some developing country models of patient-centred care give a human face to pathology, priming healthcare workers for expressive relationship-centred care that improves doctor-patient relationships and satisfaction [44]. Finally, connected health models and hospital-to-hospital links such as teleradiology partnerships illustrate how the use of global staffing models can allow for shift flexibility, sub-speciality consultations, and reduced overhead costs [45]. Such links also allow opportunities for practitioner learning through continued professional development [46].
Health information
Health information technology (IT) and connected health programs are increasingly being leveraged to manage chronic illnesses, maintain health and wellness, improve adherence, engagement, and clinical outcomes in developed and developing countries alike. The rapid expansion of mobile health (or mhealth) in developing countries has created innovation hubs in countries like Kenya [47], Uganda [47,48], South Africa [47,48], Rwanda, [48], and India [48] where mhealth campaigns show high levels of popularity among physicians, and are transforming rural healthcare through improved data collection, disease surveillance, post-discharge surveillance, health promotion, diagnostic support, disaster response, and remote patient monitoring [47-49]. A Ghana-based network called mPedigree is an excellent example of how local IT innovation can protect the lives of people across continents [49]. While developed countries are more likely than developing countries to have a national mhealth policy or strategy, developed country organizational culture remains either unaccustomed to, or hesitant of, the advantages of mhealth [50]. Developing country experiences can promote concerted advocacy efforts on the benefits of mhealth in developed countries, especially for remote patient monitoring, emergency health management, medical adherence, and health education for disadvantaged communities [50].
Focused example: Health technology and medication safety
Counterfeit pharmaceuticals are being combated through health technology in Africa. mPedigree, an African social enterprise network, provides a mobile phone service which delivers services targeting counterfeit pharmaceuticals in Ghana and Nigeria (an example of very low-tech solution to very major problem). Users simply send a free text message with verification code to one of mPedigree’s partners in Europe for an instant response regarding their medications. mPedigree’s business interfaces also allow pharmaceutical companies to monitor presence of genuine and counterfeit drugs. The program is built on cloud-based technology, scalable infrastructure expandable to other regions. While counterfeit medicines are not nearly as serious in industrialized countries due to safety and quality mechanisms, innovative platforms such as mPedigree provide quick and effective user-based solutions to protect one’s health. Such technologies and business models can be scaled up through international cooperation to more effectively battle the global trade in counterfeit medicines, as well as tackle other medication safety issues such as remote support for aging populations.
Medical products, vaccines, and technologies
Despite constraints, developing countries produce efficient and effective substitute health products and treatments [3,51-54]. Resource frugality not only compels creativity but also provides the right settings to train employees to adapt, create, appreciate, and utilise health products [54-57]. Indeed, there are numerous cases of famous innovative health products being generated this way. For example, in Ecuador, a simple polymerase chain reaction-based assay was used to diagnose leishmaniasis[58]. In Bangladesh, homemade spacers became a cost-effective and quality-assured means to help manage asthma in children [59]. Oral rehydration therapy, a simple treatment developed in Bangladesh to treat diarrhoea using sugar and salt solutions, has now saved millions of lives across the world [60]. Perhaps equally renowned, Kangaroo Mother Care is another example of how simple interventions can be scientifically sound low-cost alternatives [61]. One U.K. doctor, faced with several cases of clubfoot in resource-restricted Malawi, made use of a method devised in the USA in the 1960s called the Ponseti treatment. This treatment, which involves manipulation and splinting, was found to be more simple and effective than surgery and is now popularly used in the USA and Europe [62]. Clearly not all developing country innovations can be adaptable to developed country scenarios. However, a shift of thinking through the reverse flow of knowledge can help bridge the large gap between developed and developing country health products to pave the way for future collaboration.
Focused example: Kangaroo Mother Care
In the 1970s, hospitals in Bogota, Colombia, did not have enough incubators to treat premature and low-birth weight infants. Rey and Martinez developed a conceptually simple and elegant intervention out of this scarcity, which relied on continuous skin-to-skin contact between mother and infant. Known as Kangaroo Mother Care (KMC or skin-to-skin care), this intervention quickly became an ideal model for homecare for low-birth-weight infants. Detailed recommendations for the application of KMC have been issued in both developing and developed countries. Enhanced practice of KMC (including continuous skin-to-skin contact) is necessary to reap the benefits of the intervention (e.g., emotional regulation, increased nursing rates and lactation, improved sense of parenting, breastfeeding support, and early discharge) in developed countries. Indeed, this innovation provides high quality care in high-income settings based on an intervention generated for low-income health systems.
Financing
Countries have a number of financing strategies at their disposal to advance their health systems. Comparing health-financing reforms between countries is therefore particularly challenging and depends on the ‘starting point’ of each country [63]. That being said, some developing countries have employed innovative financing strategies with a careful choice of well-aligned policy instruments. For example, to avoid direct payments and extend coverage to hard-to-reach groups, Mexico’s public insurance scheme relies on the contributions of the federal government, states, and individuals alike [64]. Similarly, in Colombia, tax-based insurance schemes target both the rich and poor, working hand-in-hand to provide the basic level of care by increasing coverage and service [11]. District health planning matched by targeted incremental budgetary increases have led to a substantial decline in infant mortality and improvement in adult health in Tanzania [65]. Thailand’s tax financed universal coverage reforms in 2001 also reduced supply-side subsidies in favour of a national pool of funds that would ensure inexpensive and easy physical access to services for all [66]. Finally, although debates around microfinancing continue, the Grameen Bank experience in Bangladesh has inspired many countries to pursue economic and social grassroots’ development [67]. It is expected that many developed countries will need to raise additional funds to meet future health demands, particularly due to population aging and the rising costs of new medicines and technologies [68]. Assessing experiences from low- and middle-income countries is not meant to yield strong conclusions about any one particular financing scheme but can help draw lessons for policy-makers who seek ideas on resource diversification.
Focused example: Microcredit
Born as a social experiment in Bangladesh, the Grameen Bank today serves more than 7 million poor families with loans, savings, insurance and other services. The bank is owned and operated by its clients and has been a model for microfinance institutions around the world. Health-related services have been packaged with these micro-finance initiatives across the world and can have direct positive impacts. Indeed, poverty alleviation is clearly linked with improving a key wider determinant of health. While micro-finance is not a panacea for health financing, the principals used and the experiences (both positive and negative) can inform local approaches to health solidarity.
Leadership and governance
A growing number of developing country success stories illustrate the progress of global health: polio eradication is closer than ever [69]; low-cost cataract treatments are restoring sight in India [69,70]; simple salt fluoridation has led to significant prevention of dental caries in Jamaica [69]; regional initiatives are succeeding in curbing Chagas disease in South America [69]; oral rehydration therapy has helped reduce infant diarrhoeal deaths worldwide [69]; tuberculosis prevalence is dramatically decreasing in China [69]; and prevention of HIV and sexually transmitted infections in Thailand has led to significantly fewer new cases of HIV [69,71]. Interventions like these would not have been possible without political and community vision and leadership [71-73], resourcefulness, and optimism [74]. Qualitative health-related action research on the Philippines health reform confirms the importance of local solutions to lead the way [75]. Indeed, for many of these successes, domestic health stewardship allowed effective oversight, performance monitoring, coalition building, system design, and accountability.
Focused example: Catalysing local system performance through leadership
Some leadership programs in developing countries are demonstrating links between transparency, governance, and health outcomes by improving health system capabilities. One such example is provided by the State of Ceará in Brazil, which mandates that public servants receive leadership training to apply for management positions. By weaving leadership development into all underlying talent management systems and processes, the State has been able to strengthen leadership and management of public sector employees. This has contributed to improved health system performances over time. For example, 25 municipalities in Ceará (out of 37) reduced infant mortality between 2000 and 2004—some by as much as 50%. Given that effective leaders and managers lie at the foundation of good governance, identifying key ingredients of successful leadership programmes remains in the interest of developed and developing countries alike. Taking stock of collaborative initiatives to reflect on strengths and weaknesses of such programmes is necessary to seize future opportunities for cross-fertilization of ideas focused on change.
Leadership development continues to be a top strategic priority for senior health leaders around the world, yet most health systems have underdeveloped leadership and management skills and a high rate of turnover in central positions [76]. Furthermore, there is little consensus on how to adequately monitor and evaluate health leadership and governance, including within developed countries [77]. However, as Donald Berwick (ex-administrator of the U.S. Center for Medicare and Medicaid Services) advocates, knowledge and understanding of developing country efforts can stimulate and inform health care debates in developed countries [6]. One such example is from the State of Ceará in Brazil, where innovative approaches in health leadership and management have played an important role in improving the health outcomes for Brazilians [78]. Future country cooperation can focus on knowledge exchange and the development of accepted best practices in these critical areas.
Discussion
The core purpose of our research was to harness health systems insights to build a business case for international cooperation between developed and developing countries with a focus on the partnership-based approach. To our knowledge, no previous efforts have attempted to review benefits that developing countries may provide to developed countries. Our research findings not only confirm the existence of such benefits, but also showcase the innovative power of these experiences.
Presently, evidence-based insights on the benefits from health partnerships consist largely of soft benefits being accrued by developed country partners. Further benefits arising from the phenomenon of reverse innovation are possible in the future if opportunities are created for combined learning across health systems. Stories that anchor developing country successes can offer preliminary insights on international cooperation, including through various partnerships, collaborations, and exchanges. This evidence is seen across every part of the WHO Health Systems Framework (see Table 2 for key areas).
Table 2. Ten areas of health care where developed countries have the most to learn from the developing world
There is no guarantee that knowledge and innovations from developing country experiences are necessarily appropriate for, or will transfer to, developed countries. Studying the diffusion of knowledge and innovations from developing to developed countries is a complex field outside the scope of this paper. Notwithstanding the numerous enablers and barriers to the diffusion process, the examples cited in our paper are meant to promote context-specific learning and collaboration that is reflective of the various social, economic, and political factors that influence health system development. pt?>The phenomenon of a combined developed-developing country learning process can potentially generate effective solutions for health. Health partners who appreciate the reverse flow of knowledge and expertise have their business cases made out for them: not only do partnerships have an important role to play in balancing the mutuality of benefits, but they can also enable a sustainable two-way flow between countries to promote truly global solutions to today’s health challenges.
Conclusions
A strong commitment to valuing different forms of knowledge is required to promote learning that challenges and rethinks traditional practice within global systems. Blending global knowledge with on-the-ground innovations from developing countries will undoubtedly transform future modes of international cooperation and any benefits accrued therefrom. However, our understanding of innovation diffusion processes between developing to developed countries is fragile, and the existing literature on this phenomenon limited. How can health innovations designed for a developing country setting be best made applicable to a developed country setting? What are the enablers and barriers to health innovation diffusion from developing to developed countries? How can largely unreported experiences by developing countries be synthesized for the global knowledge pool? An urgent next step in this complex inter-connected research agenda is to develop a standardized method for reporting the flow of health system benefits from developing to developed countries. This is perhaps the single most important component in planning for, and realizing, the full potential of international cooperation.

Impact of Globalisation on Developing Countries and India | | Impact of Globalisation on Developing Countries and India by Chandrasekaran Balakrishnan | | | | | | Chandrasekaran Balakrishnan for The 2004 Moffatt Prize in EconomicsIntroduction:Globalisation is the new buzzword that has come to dominate the world since the nineties of the last century with the end of the cold war and the break-up of the former Soviet Union and the global trend towards the rolling ball. The frontiers of the state with increased reliance on the market economy and renewed faith in the private capital and resources, a process of structural adjustment spurred by the studies and influences of the World Bank and other International organisations have started in many of the developing countries. Also Globalisation has brought in new opportunities to developing countries. Greater access to developed country markets and technology transfer hold out promise improved productivity and higher living standard. But globalisation has also thrown up new challenges like growing inequality across and within nations, volatility in financial market and environmental deteriorations. Another negative aspect of globalisation is that a great majority of developing countries remain removed from the process. Till the nineties the process of globalisation of the Indian economy was constrained by the barriers to trade and investment liberalisation of trade, investment and financial flows initiated in the nineties has progressively lowered the barriers to competition and hastened the pace of globalisationAdsRoubini Global Economicswww.roubini.comGet The Latest Economic Insights From Nouriel Roubini & RGE AnalystsFeng Shui HoroscopeAboutAstro.com/horoscopeLove, money, career, family ... discover your year 2013 for Free !Maak PDF- Download Gratisnl.nitroreader.comDe enige Gratis PDF Reader en Maker Lees, Maak en onderteken - Gratis!Definition:Globalised World - What does it mean?Does it mean the fast movement of people which results in greater interaction?Does it mean that because of IT revolution people can be in touch with each other in any part of the world?Does it mean trade and economy of each country is open in Non-Intrusive way so that all varieties are available to consumer of his choice?Does it mean that mankind has achieved emancipation to a level of where we can say it means a social, economic and political globalisation?Though the precise definition of globalisation is still unavailable a few definitions worth viewing, Stephen Gill: defines globalisation as the reduction of transaction cost of transborder movements of capital and goods thus of factors of production and goods. Guy Brainbant: says that the process of globalisation not only includes opening up of world trade, development of advanced means of communication, internationalisation of financial markets, growing importance of MNC's, population migrations and more generally increased mobility of persons, goods, capital, data and ideas but also infections, diseases and pollutionImpact on India:India opened up the economy in the early nineties following a major crisis that led by a foreign exchange crunch that dragged the economy close to defaulting on loans. The response was a slew of Domestic and external sector policy measures partly prompted by the immediate needs and partly by the demand of the multilateral organisations. The new policy regime radically pushed forward in favour of amore open and market oriented economy.Major measures initiated as a part of the liberalisation and globalisation strategy in the early nineties included scrapping of the industrial licensing regime, reduction in the number of areas reserved for the public sector, amendment of the monopolies and the restrictive trade practices act, start of the privatisation programme, reduction in tariff rates and change over to market determined exchange rates.Over the years there has been a steady liberalisation of the current account transactions, more and more sectors opened up for foreign direct investments and portfolio investments facilitating entry of foreign investors in telecom, roads, ports, airports, insurance and other major sectors.The Indian tariff rates reduced sharply over the decade from a weighted average of 72.5% in 1991-92 to 24.6 in 1996-97.Though tariff rates went up slowly in the late nineties it touched 35.1% in 2001-02. India is committed to reduced tariff rates. Peak tariff rates are to be reduced to be reduced to the minimum with a peak rate of 20%, in another 2 years most non-tariff barriers have been dismantled by march 2002, including almost all quantitative restrictions.India is Global:
The liberalisation of the domestic economy and the increasing integration of India with the global economy have helped step up GDP growth rates, which picked up from 5.6% in 1990-91 to a peak level of 77.8% in 1996-97. Growth rates have slowed down since the country has still bee able to achieve 5-6% growth rate in three of the last six years. Though growth rates has slumped to the lowest level 4.3% in 2002-03 mainly because of the worst droughts in two decades the growth rates are expected to go up close to 70% in 2003-04. A Global comparison shows that India is now the fastest growing just after China.This is major improvement given that India is growth rate in the 1970's was very low at 3% and GDP growth in countries like Brazil, Indonesia, Korea, and Mexico was more than twice that of India. Though India's average annual growth rate almost doubled in the eighties to 5.9% it was still lower than the growth rate in China, Korea and Indonesia. The pick up in GDP growth has helped improve India's global position. Consequently India's position in the global economy has improved from the 8th position in 1991 to 4th place in 2001. When GDP is calculated on a purchasing power parity basis.Globalisation and Poverty:Globalisation in the form of increased integration though trade and investment is an important reason why much progress has been made in reducing poverty and global inequality over recent decades. But it is not the only reason for this often unrecognised progress, good national polices , sound institutions and domestic political stability also matter.Despite this progress, poverty remains one of the most serious international challenges we face up to 1.2 billion of the developing world 4.8 billion people still live in extreme poverty.But the proportion of the world population living in poverty has been steadily declining and since 1980 the absolute number of poor people has stopped rising and appears to have fallen in recent years despite strong population growth in poor countries. If the proportion living in poverty had not fallen since 1987 alone a further 215million people would be living in extreme poverty today.India has to concentrate on five important areas or things to follow to achieve this goal. The areas like technological entrepreneurship, new business openings for small and medium enterprises, importance of quality management, new prospects in rural areas and privatisation of financial institutions. The manufacturing of technology and management of technology are two different significant areas in the country.There will be new prospects in rural India. The growth of Indian economy very much depends upon rural participation in the global race. After implementing the new economic policy the role of villages got its own significance because of its unique outlook and branding methods. For example food processing and packaging are the one of the area where new entrepreneurs can enter into a big way. It may be organised in a collective way with the help of co-operatives to meet the global demand.Understanding the current status of globalisation is necessary for setting course for future. For all nations to reap the full benefits of globalisation it is essential to create a level playing field. President Bush's recent proposal to eliminate all tariffs on all manufactured goods by 2015 will do it. In fact it may exacerbate the prevalent inequalities. According to this proposal, tariffs of 5% or less on all manufactured goods will be eliminated by 2005 and higher than 5% will be lowered to 8%. Starting 2010 the 8% tariffs will be lowered each year until they are eliminated by 2015.GDP Growth rate:The Indian economy is passing through a difficult phase caused by several unfavourable domestic and external developments; Domestic output and Demand conditions were adversely affected by poor performance in agriculture in the past two years. The global economy experienced an overall deceleration and recorded an output growth of 2.4% during the past year growth in real GDP in 2001-02 was 5.4% as per the Economic Survey in 2000-01. The performance in the first quarter of the financial year is5.8% and second quarter is 6.1%.Export and Import:India's Export and Import in the year 2001-02 was to the extent of 32,572 and 38,362 million respectively. Many Indian companies have started becoming respectable players in the International scene. Agriculture exports account for about 13 to 18% of total annual of annual export of the country. In 2000-01 Agricultural products valued at more than US $ 6million were exported from the country 23% of which was contributed by the marine products alone. Marine products in recent years have emerged as the single largest contributor to the total agricultural export from the country accounting for over one fifth of the total agricultural exports. Cereals (mostly basmati rice and non-basmati rice), oil seeds, tea and coffee are the other prominent products each of which accounts fro nearly 5 to 10% of the countries total agricultural exports.Where does Indian stand in terms of Global Integration?India clearly lags in globalisation. Number of countries have a clear lead among them China, large part of east and far east Asia and eastern Europe. Lets look at a few indicators how much we lag. Over the past decade FDI flows into India have averaged around 0.5% of GDP against 5% for China 5.5% for Brazil. Whereas FDI inflows into China now exceeds US $ 50 billion annually. It is only US $ 4billion in the case of India Consider global trade - India's share of world merchandise exports increased from .05% to .07% over the pat 20 years. Over the same period China's share has tripled to almost 4%. India's share of global trade is similar to that of the Philippines an economy 6 times smaller according to IMF estimates. India under trades by 70-80% given its size, proximity to markets and labour cost advantages. It is interesting to note the remark made last year by Mr. Bimal Jalan, Governor of RBI. Despite all the talk, we are now where ever close being globalised in terms of any commonly used indicator of globalisation. In fact we are one of the least globalised among the major countries - however we look at it. As Amartya Sen and many other have pointed out that India, as a geographical, politico-cultural entity has been interacting with the outside world throughout history and still continues to do so. It has to adapt, assimilate and contribute. This goes without saying even as we move into what is called a globalised world which is distinguished from previous eras from by faster travel and communication, greater trade linkages, denting of political and economic sovereignty and greater acceptance of democracy as a way of life.Consequences:The implications of globalisation for a national economy are many. Globalisation has intensified interdependence and competition between economies in the world market. This is reflected in Interdependence in regard to trading in goods and services and in movement of capital. As a result domestic economic developments are not determined entirely by domestic policies and market conditions. Rather, they are influenced by both domestic and international policies and economic conditions. It is thus clear that a globalising economy, while formulating and evaluating its domestic policy cannot afford to ignore the possible actions and reactions of policies and developments in the rest of the world. This constrained the policy option available to the government which implies loss of policy autonomy to some extent, in decision-making at the national level. |