What ails us? Poor health, bad education

Three recent cheers from two powerful voices made those in power in India vainglorious. But one jeer, amidst this applause, dampened the entire hype.

US President Donald Trump acclaimed India in his UN General Assembly speech on September 25 for lifting millions of people out of poverty. Earlier, the ‘Bill & Melinda Gates Foundation’s Goalkeepers: The Stories Behind the Data, 2018’, said India had played a key role in lifting a billion persons in the world out of poverty through its investment in ‘human capital’, meaning health and education.

But the study of the Institute of Health Metrics and Evaluation (IHME), punctured the claims, ranking India at a lowly 158 among 195 countries, on the human capital index -- one notch below Sudan’s 157. India’s poor quality of education and high prevalence of certain diseases were the culprits in halting its progress, it said.

Thus, it is time for introspection, not celebration. The government should review the state of its health and education sectors to correct course.

Health spending in India — of the Centre and states put together — has been hovering around 1.3% of GDP, against the global average of 6%. The National Health Policy 2017 proposes to increase it to 2.5% by 2025, which means it doesn’t have plans to raise the spending even in the distant future to reach the international average — not even to 3% of GDP by 2022 as recommended in 2011 by the High-Level Expert Group on Universal Health Coverage.

The poor government spending results in people themselves meeting 70% of the healthcare expenditure. Result: 7% of those above the poverty line are pushed below that line every year. Despite governments’ boasting of several health schemes, as high as 86% of rural population and 82% of urban population are outside these schemes.

Unfortunately, people do not get quality medical service even to the extent of the money they spend and fall victims to the unethical practices of the healthcare sector. The list of the acts of misfeasance, malfeasance and nonfeasance, committed with great impunity by people in the medical profession, is endless. Unscrupulous hospitals focus more on the paying capacity of the patients than on their medical needs.

Rich, or insured persons, are overtreated while the poor and uninsured get no treatment or are undertreated. There are instances of hospitals treating the corpses, hiding the fact of a patient’s death for several days, just to fleece money from their families.

PMJAY no panacea

Prime Minister Narendra Modi launched the Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat (PMJAY-AB) in September. This scheme aims to cover 100 million families whose names feature in the socio-economic caste census of 2011. It gives a Rs 5 lakh annual healthcare cover per family.

There are doubts over the efficacy of this programme. Five states — Telangana, Odisha, Delhi, Kerala and Punjab — are not willing to implement it, questioning its feasibility, and contending that their schemes are superior to it. Other flaws apart, the scheme is not a universal healthcare scheme as it excludes a large number of the so called ‘non-poor’, but who are sure to become poor under the healthcare cost burden.

Similar to health, the country’s education spend and outcomes are depressing. In 2012-13, education expenditure was 3.1% of GDP, the Economic Survey 2017-18 notes. It fell in 2014-15 to 2.8% and registered a further drop to 2.4% in 2015-16. The subsequent slight rise to 2.6% since 2016-17 is not an enviable achievement; it is nowhere near the 6% of GDP target accepted way back in 1966 on the recommendation of the Kothari Commission report.

The poor outcomes of this expenditure are all too evident. The Annual Status of Education Report (ASER), 2017, says: “About 25% of students in the age group 14-18 still cannot read basic text fluently in their own language; more than half struggle with division (3 digit by 1 digit) problems”.

The environment in schools is not conducive to learning. There could be several outside-the- school reasons for pushing the students out of school; but one reason within the school: many teachers are found not only to be incompetent but were cruel to the students.

‘Child protection: A handbook for teachers,’ a government publication, says, “many street and working children have pointed out corporal punishment at school as one of the reasons for running away from school and from their families” and adds “almost all schools inflict corporal punishment on students” and “in the name of discipline, children are known to have had their bones and teeth broken, their hair pulled out and forced into acts of humiliation.”

All this suggests not only that the government spending is low, but its governance poor. Indeed, the deficit in governance is more than the deficit in spending. The government should accept that the development of health and education sectors is its primary responsibility, which it cannot delegate to the private sector, which works with purely commercial motives.