On India’s education and healthcare: Mind, body & growth

News: Ensuring top quality and a proper delivery of public goods like education and healthcare is one area where successive governments have underperformed in India.

The article highlights the current situation, reasons for underperformance and measures to address the issues.

What is the situation wrt education and healthcare in India?

– Education: ASER reported in 2019 that only about half the students in Standard III could read at Standard I levels.

– Healthcare: The rate of malnutrition amongst India’s children stays stubbornly over 30%, which is higher than in Ghana or Kenya.

Why India has not been able to deliver on education, health and other public goods?

Lack of responsibility: One of the reasons is that no particular person can be held responsible for local level health or education infrastructure. For instance: No one can be held responsible for a local primary health centre (PHC) that is frequently out of medicines, or for a local government school where the teacher is perpetually absent.

Local elections fought on populist matters: The aggrieved locals or their panchayat representatives often have little ability to reach the state capital to air their grievances about poor condition of local level infra. So local elections are rarely about improving delivery of public goods. Instead, campaigns are based on populist giveaways such as loan waivers or free rations that have broad appeal across the state, job reservations based on caste, region, or other subgroup identities etc.

What measures need to be taken?

Pushing the demand side: The supply side of service delivery in health and education is improving, but at too slow a pace. The demand side needs to be mobilised. Instead of centralising administration, we need to decentralise, while empowering beneficiaries.

Empowering the local govt: Some power to reward or punish providers needs to be handed to local government. Even better would be to set up school boards and health boards, staffed primarily by user households, which should be the primary input to the local govt’s decisions.

Removal of arbitrary laws that any administration – local, state, or national – has to harass critics. These laws cause fears against protesting a bad service delivery.

Private service providers: Private providers can offer people more choice. Instead of viewing them with suspicion, regulating them lightly and effectively, is a much better alternative.

Enhance transparency: Transparency can lead to more informed choice. Parents should know their local school’s test performance and its teachers’ qualifications. There is however no need to insist that every teacher have a B. Ed.

The eventual aim should be to allow state and private providers to compete on a level playing field. If the poor household chooses private alternatives, the government should aid them through school vouchers and health insurance. For instance: Ayushman Bharat.

The regulatory side of the state should be independent of the side providing the service, so that regulations do not inhibit competition to state providers.

Rethinking spending priorities: Consider sums being given under Production-Linked Incentives schemes – it will cost $10 billion or more in subsidies to convince a big industrialist to build one semi-modern chip factory, a highly capital-intensive (not labour-intensive) enterprise. That sum could fund 50 top-notch universities churning out 50,000 fantastic scientists and engineers a year or 1,000 schools with state-ofthe-art laboratories, libraries and gyms.

Source: This post is based on the article “On India’s education and healthcare: Mind, body & growth” published in The Times of India on 24th Mar 22.