Link to India Growth Story – Progress, Myths, Looking Ahead – 4 of 5
So far, covered progress India has made in various vectors. While we are not there yet, there are still issues that require septic focus, good amount of road to cover, progress we have made so far itself is phenomenal something we need to be happy about. In this installment, I have given my take on what need to be our focus looking ahead.
Looking Ahead: Considering where India was in 1950, we have come a long way. Progress has been good. Picture is not BAD as it is made out to be. Yes, there are still issues and problems that needs to be addressed. Getting a real picture of the progress that has been made will help us to focus on key areas moving ahead rather than going with a negative feel. My take on key areas our government, irrespective of which party rules, below.
While 162 million people escaped Poverty (crossed US$2 per day per capita), from 2004 to 2011, India still has 269 million people below International Poverty Line (IPL), US$2 per day per capita, which is one in every 5 Indians. If we keep the bar at US$4 per day per capita, 750+ million Indians come under that net, poverty and Lower Middle Income Class Poverty Line. While we have good number of welfare programs, we lack delivery mechanisms and there is lack of transparency and accountability. States which have been doing good continue to do good and progress but backward states continue to fall behind, which means the gap widens. Along with budget increase and targeted welfare programs, delivery mechanism, transparency, and accountability need to be addressed. Distribution network need to be localized and empowered to make decisions based on their needs.
On Healthcare side, India’s investment is one of the lowest in the world. From 2000 to 2015, our % allocation of GDP for health has come down.
Healthcare spending per capita in US$:
Percentage allocation in GDP for healthcare:
Source: The World Bank: Health, Nutrition, Population: Health Financing
Out-of-pocket expenditure (% of current health expenditure), Out-of-pocket payments are spending on health directly out-of-pocket by households, India is really on the higher side at 65%, which means, there are not enough public health care facilities and/or health facilities are not accessible.
Source: The World Bank: Health, Nutrition, Population: Health Financing
Government hospitals reputation coming down, and mushrooming of private hospitals are direct reflection of lack of government spending on public healthcare system, and accountability. Private sector is filling the void of not having enough PHCs. Consulting costs are high, and with no transparency and accountability, many of these multi-specialty hospitals are nothing but glorified First-Aid centers. Private hospitals’ focus is more on high class facilities to cater to demands of upper/rich class. This will not meet the wider net coverage that is required. Health is a basic need and can’t be left to market forces. PHCs are the first level of defense and has to be owned, run, and monitored by government, and not a candidate for privatization. Government spending has to go up to have enough PHCs (based on population density, and access distance), followed by multi-specialty hospitals (again based on population density, and access distance), and then Specialty hospitals. Private hospitals can be in addition to Government health services and used as replacement. As an example, while one can understand choices of shared/private/deluxe/ wards, but options in cataract lenses and Angioplasty stents? How one is expected to decide when you are asked to choose between normal lenses Vs high quality ones for cataract or normal stents Vs high-quality stents for angioplasty? Choice in smartphones and TVs one can comprehend, but when it comes to health quality can’t be optional. When we hear high quality lens, normal lens implies low quality, isn’t it? In Summary, India needs to invest more in public healthcare, medical colleges, availability of general practitioners, increased PHCs to cover the population, and improve transparency & accountability. Private hospitals will not solve the problem for us, they can supplement but not the primary solution.
While Literacy rate has gone up, which is good, in reality, we may need to dial it down a little. Why? Literacy should not be measuring how many are getting out of school, we need to look in to next level of details, how many are actually able to read and write, ability to do decent math (required for daily life), and in case of higher studies, employability. We have mixed data in this area. While it is good to see high enrollment across schools (public and private), and good number of colleges including prestigious IITs, there is no transparent mechanism or data available yet to grade schools across district/zone wise on faculty quality, infrastructure, student to teacher ratio, upgrading of skillset/techniques for teachers. On the colleges front, only now HRD has started grading, FWIW it is a good start, but we need a neutral body. Education is one area we are regressing and need a jolt to the system. Till 12th grade, all schools need to be run by state governments, considering the federal structure and regional differences (language, and history). English medium is an economic must, and needs to be supported. Good to have common syllabus across core subjects (maths, science, English) across the country. Government spending has to be increased in education sector with focus on public schools, students to teacher ratio, infrastructure, and transparent grading of schools and colleges. For UG/PG, good to go with a workable model of public-private partnership rather than going 100% private. This will get the required funding while updating the curriculum to meet the changing trends and future needs. Like health, education is another area government has to own and not leave it to private sectors. Health and Education being basic needs, can’t be driven by profit motive in mind similar to corporate sector.
With respect to Employment, considering the growth in population, this needs a serious look by the government and planners. We need to move people out of agriculture. Most of the country’s workers (more than 50%) are in agriculture sector followed by unorganized sectors like construction. Low income groups, if I can make a guess (couldn’t find the data on this one), comes from these sectors, since in agriculture they would be unemployed for most of the year. First thing, we need to stop hypocritical glorification of farming and farmers. IMO, this is a trick by society (one of many tricks of society) to continue to keep a section of population in poverty / low income while others keep moving upwards. From the time agriculture started 8000 years ago, farmers have been always poor, period. We need to get out of this social myth first, else, we will never be able to address the issue. To move them out of agriculture (here I am referring to farmers who work on the land and not land owners) and in to other sectors where they can get in to better living, government needs to invest heavily on focused vocational training. Get in to public-private partnership to get a workable model that guarantees jobs post the training. Training can be customized based on region and job requirements. Bringing the % of agriculture workers to say 30% from current 60% itself will be a good target to work towards. Of course, this would need government and corporates to create that many jobs and automation of agriculture.
While Health Care, Education, and Employment, can continue the progress by increased government investment, fixing the issues, and public-private partnerships, there is one big social issue which is denial of access based on various discriminatory practices. No use having political democracy when there is no social democracy. This would need a separate write-up but in brief, even after 70 years of independence we are still a discriminating society. We have made some progress but with prevailing political climates there is more noise than constructive debates. Rather than talking openly with reason, issues are used as vote banks and to polarize the society. Without getting in to power, politics and polarizing factors, current reality is, as a society, we still deny access based on caste, religion, and gender, listing the big ones. This cuts across income groups. It has to start with acknowledgment of existence of discrimination to have constructive discussion, build awareness, and move ahead with social programs. Till then, claiming MERIT is meaningless with 50% of the eligible population being denied access (through various discriminations). Till we start practicing democracy with representation from every group in government and other institutions, this is not going to make forward progress. As an example, none of our political parties practice democracy. They are all run either by a family or a powerful leader and in both they don’t allow dissent within the party. Any dissenting voice is sidelined. Whenever we have a party in power with majority, they don’t practice parliamentary democracy, they bypass assembly and parliament. All parties behave like this. If they don’t support dissent and debate within the party, expecting them to practice democracy with the population is only a mirage. To restate, till we start practicing democracy with representation from every group in government and other institutions, this will not move. People need to stop voting for leaders, meaning who will be PM or CM. Start voting for a good candidate out of the running lot in your constituency without getting biased by caste, religion, party or leader who will be CM or PM. They need to figure out how to dissent, debate, and build consensus in a constructive way making our country a vibrant democracy without bypassing assemblies and parliament. Nothing radical in this. This is what democracy is.
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