By Anurag Vaishnav & Shashank Chepurwar
When there is talk about India it is often about the country’s development, but what does development mean? Amartya Sen defines development as freedom and freedom depends on economic capacity. In order to develop economic capacity, the government’s role must be to focus on the quality education and universal healthcare.
India’s performance in both these areas remains abysmally poor even after 70 years of independence. Overall expenditure on health and education combined remains at a mere five percent of GDP. This year’s budget allocated Rs 1.38 lakh crore to health, education and social protection. Although this represents a 13 percent increase from the previous budget, if the government is really to stand by the words enshrined in the preamble to the Constitution, “To govern to all citizens, Justice—Economic, Political and Social”, then a pivotal step would be a radical overhaul in the government’s spending on health and education. This increase in spending has to go along with structural and legislative reforms.
The situation with healthcare
According to the Global Burden of Disease Study published in the medical journal The Lancet, India stands at 154th position among 195 countries on the healthcare index, behind our neighbours Sri Lanka, Bangladesh, Bhutan and Nepal. Over six million people died of non-communicable diseases (NCDs) in India in 2016. With 1.7 million new cases of Tuberculosis in 2016, India continues to be the largest contributor to the global burden of the disease. India also had the largest number of children dying before the age of 5 at 0.9 million in 2016. Moreover, India stands at a poor 127th rank among 188 countries in terms of achieving the UN’s health-related Sustainable Development Goals.
However, the situation is not deteriorating everywhere. Healthcare access and quality have improved. Life expectancy has gone up. In 1980, only 85 out of every 100 children born would live to age five. Today, that number is 96. Things are certainly improving, but mere survival is not enough. We must ensure that our children live healthy, educated lives and ensure that they are achieving their full potential, for themselves and the nation. There is an urgent need to take steps to address these issues.
Firstly, we need to address the shortage of doctors, especially in rural areas. India’s primary health system is struggling with a below-par national physician-patient ratio—0.76 per 1,000 population, which is amongst the lowest in the world—due to a paucity of MBBS-trained primary-care physicians coupled with the unwillingness of existing MBBS-trained physicians to serve in remote areas.
Three areas to focus on
A three-year diploma for rural medical-care providers, along the lines of the Licentiate Medical Practitioners, was experimented in Chhattisgarh in 2001. Evidence from countries like Mozambique and Thailand shows that such training can be a safe, effective and economical way to provide life-saving healthcare when doctors are unavailable. The National Medical Commission Bill 2017 seeks a bridge course which would allow alternative-medicine practitioners to prescribe modern drugs. Also, the Cabinet Committee on Economic Affairs (CCEA) approved setting up 24 new medical colleges in underserved areas.
Secondly, the Union Ministry of Health and Family Welfare’s Rural Health Statistics 2016 Report states that more than 40 percent of PHCs do not have ambulances to transport the critically ill to the community and tertiary-care facilities. The government also needs to focus on the rapid improvement in the condition of the Public Health Centres.
Thirdly, significant improvements in maternal and childcare are necessary. Countries that make early investments in their children are more likely to have a workforce that will support economic growth over decades. South Korea and Japan are the best examples of this prudential move. Here, the focus needs to include vaccination, proper nutrition for mother and child, clean water and sanitation, and protection from vector-borne infectious diseases, including malaria and dengue.
Hopes for development in healthcare
Recently, the Centre announced a National Health Protection Scheme in the Annual Budget, which is being compared to Obama’s Medicare program. However, health protection might not necessarily translate into healthcare unless infrastructural and other issues—such as the lack of doctors and poor facilities at PHCs—are addressed first.
The number of children born in India each year is greater than those born in any country at any point in human history. If we give them the right start with vaccines, early nutrition and a childhood free of diseases, we will have the opportunity to create a nation that will race ahead in economic productivity and realise its potential for growth that reaches all Indians.
The situation with education
Post-independence, India has highlighted its ever-improving literacy rates, even though this has little relation with the strength of the country’s education system. While India defines literacy as the ability to read and write your own name in one of the 22 official languages, China defines literacy as the ability to recognize more than 1500 Chinese characters for a farmer or 2000 characters for an office worker or urban resident. The OECD’s Programme for International Student Assessment (PISA) takes a more holistic approach in its definition of literacy. Reading literacy is defined in PISA as the ability to understand, use and reflect on written texts in order to achieve one’s goals, to develop one’s knowledge and potential, and to participate effectively in society.
Successive studies, including the Annual Status of Education Report(ASER), have established the fact that a majority of Indian students have educational attainment much lower than what is expected. The proportion of class VIII students who can correctly do a 3-digit by 1-digit division problem was 68.4 percent in 2010, which declined to 44.2 percent in 2014 and had further fallen to 43.3 percent in 2016. To improve this situation, crucial steps will have to be undertaken.
Three areas to focus on
Firstly, Right to Education(RTE) Act needs to be properly enforced. There are clauses in the Act which have enormous potential but have gone largely unnoticed. RTE prescribes a Pupil-Teacher Ratio (PTR) of 30:1 at Primary level, but according to the Unified District Information System for Education (U-DISE) data for 2015-16, one-third of the schools in the country did not have the requisite number of teachers. In Bihar, only about one-sixth of the schools were PTR compliant. Also, there has been a total neglect of the 14-18 age group among whom dropping out has remained high. According to ASER 2017 data, 14 percent or a total of 125 million young Indians in this category are not enrolled as RTE is only for 6-14 years of age. Hence, it is essential to extend RTE to 18 years of age.
Guaranteed inclusion will empower those in the 14-18 age group who have not enrolled anywhere, and help them acquire finishing education that is vital to their participation in the workforce. India can look into the large-scale vocational education system on the lines of the dual German model which aims for classroom instruction plus apprentice training which would help to raise the productivity of both individuals and the economy.
Secondly, the poor state of teacher training remains a challenge. The vast majority of teachers—more than 90 percent in some states—fail to qualify in the Central Teacher Eligibility Test. To improve quality of teaching, the District Institute of Education and Training (DIET) needs to play a greater role. Specialists also need to be engaged by state governments to ensure that the teaching methodology remains effective, innovative, activity-based and creativity-oriented.
Thirdly, ASER data suggests that there are discrete differences among states in the learning outcomes of children. Using data technology to integrate national best practices could help reduce disparity among the states. The Government of India has taken steps in this regard by organising regional conferences on best practices and to discuss ASER findings and other issues. India needs a vision of cooperative federalism in order to develop a prosperous education sector.
The future in education
The increasing privatisation of education, in particular, is something which needs to be checked. Most people from poor economic backgrounds want their children to get private education because there is a strong perception that government schools do not deliver quality education. The privatisation of basic rights like healthcare and education could prove to be counterproductive as it depletes household savings, which is the main driver of a nation’s economy. Today, India stands on a steady path of increasing GDP. It is about time that the government realises the potential of education and healthcare as catalytic drivers of the nation’s development. India can boost its development through strengthening its institutions and building the capacity of the country’s 1.3 billion individuals to realise their high hopes.
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