Doctor Devi Shetty is a cardiac surgeon who trained in Britain and could have practiced anywhere in the world. Instead, he set up the Narayana Hrudayalaya, a hospital in Bangalore, in the southern Indian state of Karnataka, where one can undergo an open heart operation for as little as Rs 65,000 ($1,300). Dr. Shetty and his team also use telemedicine to diagnose patients in rural areas. He is attempting the “Walmartisation” of health care in India. Dr. Shetty believes hospitals can offer cheap quality treatment and still be profitable if physicians are devoted, new technologies are used, and insurance packages are designed to serve the poor.

In the arid Kutch region of Gujarat, Abdul Karim, just 19, walks three kilometers from his village to a neighbouring one to coach dropouts from an inefficient school system. Abdul is one of a band of barefoot teachers who earn US$62 a month. They have been trying to help Kutchi children move on in life. Abdul himself only finished high school, but he realizes that Kutchis must learn to help themselves to emerge from their backwardness.

In Delhi, at the sprawling India Habitat Centre, the office of the Centre for Science and Environment (CSE) is bustling with activity. The NGO is all set to announce the results of tests on samples of Coca-Cola and Pepsi. A set of similar tests conducted three years ago yielded damning results. This time, too, CSE reports high pesticide residue levels. Television stations and newspapers show up to hear the results. The findings make headlines in no time and Coca-Cola and Pepsi sales decline.

Civil society in India is very diverse. Though 1.2 million NGOs exist, just half are officially registered with the government. More than 80 percent of NGOs are one-person outfits and two-thirds of NGOs are based in rural areas. They run on funds from the government and private donors in India and abroad. Those who fund NGOs generally dictate the organization’s field of work—whether it be a project on health, environment, education or livelihood.

Some non-profits regard themselves as peoples’ movements. A peoples’ movement is generally understood as collaboration between several grassroots organisations for a common cause such as the right to information, opposition to big dams, and community rights over forests. Examples are the Narmada Bachao Andolan “Save the River Narmada Campaign,” the Mazdoor Kisan Shakti Sangathan “Worker-Farmer Organisation,” and the National Forum for Forest Workers and Forest People (NFFWFP).

A charity hospital which treats those who cannot afford mainstream medical attention.

A new trend in Indian civil society is the rise of socially responsible businesses such as Dr. Devi Shetty’s hospital in Bangalore. These businesses are self-sustaining and fill a particular niche in the economy, such as providing affordable quality healthcare or financing of small enterprises through microcredit. These businesses tend to evolve out of NGOs. Many enterprises begin as non-profits, earn revenue, and then become viable small companies.

The role of Indian civil society is to step in where the government fails. It brings better services to communities and raises awareness on important issues. It lobbies for change and sensitizes lawmakers and people in government. Organizations like CSE have specialized in the tracking industry and in the evaluation the environmental record of companies.

“Rich India” and “Poor India”

NGOs are vital because they can speak for “Poor India” at a time when “Rich India” is getting rapidly richer. Economic reforms have helped companies do phenomenally well for themselves. The stock market is booming. The GDP growth rate is 8.5 percent and is expected to touch 10 percent. Indian industrialists are among the world’s wealthiest individuals. Salaries of the educated and professionally qualified are rising. Indians travel abroad more frequently, and now own more cars and television sets.

But this prosperity does not seem to be trickling down to lower economic classes. Studies show that poverty declined by merely 0.74 percent between 1993 (when reform processes began) and 2005. An estimated 22 percent of the population continues to live in poverty. The number of poor people has risen in some Indian states.

Further reform measures are likely to exacerbate, rather than ameliorate these disparities. For instance, real estate projects and plans for special economic zones (SEZs) will push people off the land with only cash in their hand. If history is any indicator, these displaced persons will quickly run out of money and will end up on the streets of cities. Big-ticket investments are needed, but they must finally be linked to the people on the bottom rungs of the economy. Even in China, with its huge SEZs, enormous inflows of foreign direct investment (FDI), and a dazzling rate of economic growth, President Hu Jintao was still concerned with the breakdown of social harmony. He declared at a recent meeting of the Communist Party that a range of social concerns, including the surging wealth gap, corruption, pollution, and access to education and medical care must be placed on par with economic growth.

The plan to create growth first and then equity later may work in the Chinese political system, but it will not be successful in India’s democracy. India needs a more inclusive model of development. The concern is that as disparities become starker, social unrest will grow. Already, one-third of the Indian landmass is under the control of various insurgents. The Indian government's writ does not run in such regions. The reason for this alienation with government control is a lack of social and economic justice.

With reforms, the government has loosened the controls it used to exercise on the economy. Private sector companies now do business more freely. Foreign investment has poured in. Most global brands are now available in India. Shopping malls, call centres and other such businesses provide many jobs to young people. But these reforms only benefit the affluent.

Almost all new jobs are in the service sector, which can only employ those with an education. Employment needs to be more inclusive. For that to occur, quality education must spread to people in villages. The national literacy rate is 65.38 percent and has steadily increased but much more needs to be done. Children may officially be going to school, but government schools are in bad shape. Teachers often do not show up.