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A recent policy brief by Oxfam, “India Public Good or Private Wealth? The India Story”, insists that “universal health, education and other public services reduce the gap between rich and poor, and between women and men”, something that is not happening in India today.
Insisting that “a fairer taxation of the wealthiest can help pay for them”, the report states, “The per child unit cost in government-run Kendriya Vidyalaya schools for central government employees in transferable jobs is INR 27,000 per child compared to INR 3,000 per student in other Government schools across India.”
According to the report, “In tangible terms, it means that India spends INR 1,112 per person on public health per capita every year. This is less than the cost of a single consultation at the country’s top private hospitals or roughly the cost of a pizza at many hotels. That comes to INR 93 per month or INR 3 per day.”
While the literacy rate in Kerala, Mizoram and the UT of Lakshadweep is over 90%, it is just little above 60% in Bihar. The percentage of children and young people who were never enrolled in school (age group 5-29) in rural areas is double than that of urban areas (National Sample Survey Organizatoin).
In India, girls belonging to rich families (top 20%) get on an average nine years of education, while girls from poor families (bottom 20%) get none at all. This is not to deny that significant gains have been made since independence. The average longevity has increased dramatically and school enrolment rates have increased. However, India continues to underperform against its own constitutional commitments of creating a just and fair society where every citizen is equally valued.
Addressing these inequalities in achieving human potential requires a robust system of public provisioning of essential services. Yet, there are major gaps in public services in India. A large part of India has accepted the inevitability that public services, especially those targeted at the poor, are of poor quality. The reasons are manifold.
There is an acute shortage of health specialists in rural areas. In 2012, according to the World Bank, India had 0.7 doctors per thousand people. In contrast, the United Kingdom had 2.8 doctors per 1000 persons and China had 1.8 doctors per 1000 persons.
Barely 12.7% of India’s schools comply with the minimum norms laid down under the Right of Children to Free and Compulsory Education Act (RTE). There are huge differences between states; it ranges from 39% in Gujarat to less than 1% in Nagaland, Sikkim, Meghalaya, Tripura, and Lakshadweep. While almost all teachers in schools in Delhi, Gujarat, and Puducherry have the requisite academic qualifications, 70% of teachers in Meghalaya continue to lack the necessary qualifications. Where a child is born continues to determine a child’s destiny.
At the heart of this continued poor quality of provision is chronic under investment in public services. Despite India graduating to a lower-middle-income country and accounting for 1/5th of the global burden of disease burden, its public spending on health continues to hover around 1.3% of its GDP compared to the commitment made under the National Health Policy, 2017 to increase this to 2.5% of GDP by 2025.
Similarly, India’s spending on education has hovered at under 4%, despite successive governments’ electoral commitment to spending 6% of its GDP on education. This is not just a function of meeting an arbitrary figure. India continues to fail to spend what is necessary to realize the minimal norms laid down under the RTE Act. Thus, Bihar spends only 30% of what is required to implement the Act in totality i.e. getting all children into school, hiring the minimum numbers of teachers required, putting infrastructure in place, and placing a textbook in the hands of each learner.
Research points to a clear correlation between actual per pupil expenditure and learning outcomes. A functional school is an essential, if not adequate, condition for any sustainable improvement in India’s education system. While spending on education has to be equitable, the government itself often discriminates financially.
For example, the per child unit cost in government-run Kendriya Vidyalaya schools for central government employees in transferable jobs is INR 27,000 per child compared to INR 3,000 per student in other Government schools across India. The government needs to practice more equitable distribution and investment in children in the country and raise the per child expenditure in non-Kendriya Vidyalaya schools.
In tangible terms, it means that India spends INR 1,112 per person on public health per capita every year. This is less than the cost of a single consultation at the country’s top private hospitals or roughly the cost of a pizza at many hotels. That comes to INR 93 per month or INR 3 per day.
Indians, therefore, have no other choice but to spend out of pocket on health. As a result, 63 million people are pushed into poverty every year. A fifth of the ill in both rural and urban areas deny themselves treatment; 68% of patients in urban India and 57% in rural areas attributed “financial constraints” as the main reason to take treatment without any medical advice.
Insurance does not offer an alternative, not least given that most insurance schemes (including the new Ayushman Bharat) fail to cover outpatient costs that account for 68% of expenses.
Excerpts:
While a fair society should offer equal opportunities to all its children, it is often economic status or social identity that dictates its destiny. Forty-two percent of India’s tribal children are underweight, 1.5 times higher than non-tribal children. Children from poor families in India are three times more likely to die before their first birthday than children from rich families. A Dalit woman can expect to live almost 14.6 years less than one from a high-caste.While the literacy rate in Kerala, Mizoram and the UT of Lakshadweep is over 90%, it is just little above 60% in Bihar. The percentage of children and young people who were never enrolled in school (age group 5-29) in rural areas is double than that of urban areas (National Sample Survey Organizatoin).
In India, girls belonging to rich families (top 20%) get on an average nine years of education, while girls from poor families (bottom 20%) get none at all. This is not to deny that significant gains have been made since independence. The average longevity has increased dramatically and school enrolment rates have increased. However, India continues to underperform against its own constitutional commitments of creating a just and fair society where every citizen is equally valued.
Addressing these inequalities in achieving human potential requires a robust system of public provisioning of essential services. Yet, there are major gaps in public services in India. A large part of India has accepted the inevitability that public services, especially those targeted at the poor, are of poor quality. The reasons are manifold.
There is an acute shortage of health specialists in rural areas. In 2012, according to the World Bank, India had 0.7 doctors per thousand people. In contrast, the United Kingdom had 2.8 doctors per 1000 persons and China had 1.8 doctors per 1000 persons.
Barely 12.7% of India’s schools comply with the minimum norms laid down under the Right of Children to Free and Compulsory Education Act (RTE). There are huge differences between states; it ranges from 39% in Gujarat to less than 1% in Nagaland, Sikkim, Meghalaya, Tripura, and Lakshadweep. While almost all teachers in schools in Delhi, Gujarat, and Puducherry have the requisite academic qualifications, 70% of teachers in Meghalaya continue to lack the necessary qualifications. Where a child is born continues to determine a child’s destiny.
At the heart of this continued poor quality of provision is chronic under investment in public services. Despite India graduating to a lower-middle-income country and accounting for 1/5th of the global burden of disease burden, its public spending on health continues to hover around 1.3% of its GDP compared to the commitment made under the National Health Policy, 2017 to increase this to 2.5% of GDP by 2025.
Similarly, India’s spending on education has hovered at under 4%, despite successive governments’ electoral commitment to spending 6% of its GDP on education. This is not just a function of meeting an arbitrary figure. India continues to fail to spend what is necessary to realize the minimal norms laid down under the RTE Act. Thus, Bihar spends only 30% of what is required to implement the Act in totality i.e. getting all children into school, hiring the minimum numbers of teachers required, putting infrastructure in place, and placing a textbook in the hands of each learner.
Research points to a clear correlation between actual per pupil expenditure and learning outcomes. A functional school is an essential, if not adequate, condition for any sustainable improvement in India’s education system. While spending on education has to be equitable, the government itself often discriminates financially.
For example, the per child unit cost in government-run Kendriya Vidyalaya schools for central government employees in transferable jobs is INR 27,000 per child compared to INR 3,000 per student in other Government schools across India. The government needs to practice more equitable distribution and investment in children in the country and raise the per child expenditure in non-Kendriya Vidyalaya schools.
In tangible terms, it means that India spends INR 1,112 per person on public health per capita every year. This is less than the cost of a single consultation at the country’s top private hospitals or roughly the cost of a pizza at many hotels. That comes to INR 93 per month or INR 3 per day.
Indians, therefore, have no other choice but to spend out of pocket on health. As a result, 63 million people are pushed into poverty every year. A fifth of the ill in both rural and urban areas deny themselves treatment; 68% of patients in urban India and 57% in rural areas attributed “financial constraints” as the main reason to take treatment without any medical advice.
Insurance does not offer an alternative, not least given that most insurance schemes (including the new Ayushman Bharat) fail to cover outpatient costs that account for 68% of expenses.
Ironically while India attracts a large number of foreign patients for medical tourism on the plank of ‘world class services at low cost’, only 11% of its Sub Health Centres (SHC) and 16% of Primary Health Centres (PHC) meet the Indian Public Health Standards (IPHS).
India manages to simultaneously rank 5th on the Medical Tourism Index and 145th among 195 countries in terms of quality and accessibility of healthcare.
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