Opinion

Good governance calls for gumption

Nilanjan Banik | Updated on December 25, 2013

In healthcare, the Government has a lot of catching up to do.   -  The Hindu

Raise the bar on quality of services, rather than pouring pots of money into schemes



The recent elections have emphasised that government intervention without focusing on good governance does not work. It was the ability to usher in a host of programmes focussing on overall development that helped the UPA continue at the Centre since 2004. During the pre-UPA phase, the focus was on growth without too much of a policy focus on the social sector. And this led to a political backlash against the NDA’s ‘India Shining’ campaign.

A popular perception explaining the ouster of the NDA during 2004 was its inability to check the rise in income inequality, and the perception that it has failed to focus on development. The UPA was quick to spot this and began several market interventions targeting overall development. However, intervention sans governance has resulted in inflation, something voters detested.

Results of government intervention education and health — two important pillars of development — show they have not been effective. Although there has been an increase in, say, the number of schools and hospitals, students going to school, proportion of tribal women giving birth in government hospitalsthe general perception on quality healthcare and education remains negative.

Some hard lessons

Take education. Sarva Shiksha Abhiyan has been successful in terms of raising the literacy and gross enrolment ratios. The UN’s Public Report on Basic Education in India shows social disparities in school enrolment have considerably narrowed. The gap between boys and girls has virtually disappeared at the primary level. Nearly three-fourths of all primary schools have drinking water facilities. Toilets have been built in over 60 per cent of all schools.

But these achievements do not tell us about the quality of education. In 2012, India for the first time participated in world-wide tests of reading and arithmetical ability among school children. India competed desperately with Kyrgyzstan for the last two places. It came second last among the 73 countries that participated in OECD’s the Programme for International Student Assessment

In fact, the Annual Status of Education Report (ASER) 2013 conducted by the non-profit Pratham in Tamil Nadu shows the share of Class V student who could not solve basic division problems of Class II level increased from 58.6 per cent to an alarming 77.4 per cent. A large number of teaching posts are still lying vacant in most states. Interestingly, if all these vacant positions are to be filled, then some State governments can go bankrupt.

The state of the health sector is even more interesting. Data from the National Sample Survey Organisation and the Ministry of Health and Family Welfare show that , on an average, 70 per cent of the people prefer to visit private hospitals. They think they can get better facilities there. One can blame increase in income, but two-third of the poor does not feel confident about government healthcare facilities. The trend is the worst in Bihar where 93.3 per cent of the people do not go to government healthcare units.

But there are a few exceptions. For instance, government healthcare system seems to function well for Sikkim, Mizoram, Himachal Pradesh, Arunachal Pradesh, Orissa and Tripura (91.8 per cent, 90.6 per cent, 82.7 per cent, 82.5 per cent, 76 per cent, and 80 per cent respectively).

There are three key reasons to the general apathy towards government hospitals. First, the perception that the government healthcare system does not function. On an average, 57.7 per cent people feel this way. Ideally, one would have expected a positive correlation between higher income state providing better healthcare facilities. But data show 41.4 per cent people do not prefer to visit government hospitals in West Bengal (a middle income state), against 42.6 per cent in Gujarat (a high-income state).

Second, people are forced to wait longer at these centres. On an average, 24.8 per cent people this is a problem. In Delhi, Kerala, Gujarat, Tamil Nadu and West Bengal, these numbers are 57.4 per cent, 34.2 per cent, 31.6 per cent, 32.3 per cent and 35.2 per cent, respectively.

The third reason is, on an average, only 10 per cent of people say availability of paramedics a reason for not visiting government hospitals. This is even less for West Bengal (4.3 per cent), Delhi (2.3 per cent), Tamil Nadu (3 per cent), Sikkim (4.7 per cent), Goa (4.4 per cent) and Maharastra (5.3 per cent). An important implication for this is that people care less about the availability of paramedics. What matters is the quality of services paramedics provide.

Ensure quality

The latest National Family Health Survey (NFHS) was published in 2006. It would be interesting to note that if this perception will change in its next round in 2014-15. A change in perception will say whether government healthcare interventions in the form of schemes such as the National Rural Health Mission and Janani Suraksha Yojana have been effective.

The bottom line: What matter most in education and health is the quality of services, and not merely building more schools and hospitals.

More government outlay in health and education without improving productivity will lead to inflation. On the contrary, a more effective healthcare and education system will enable people assimilate knowledge more efficiently, translating into higher productivity and growth.

(The author is a Consultant with CUTS International and Glocal University.)

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Published on December 25, 2013
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