THE WRAP
Vouchers for social security
India may have done miracles with its growth rate but its social indicators are woefully poor ………Swaminathan S Anklesaria Aiyar
INDIA may have become a miracle economy in terms of economic growth, but remains a tragedy economy in terms of social indicators. Its ranking in the Human Development Index is a pathetic 128, way behind China (81st) or even Indonesia(107th). Indian life expectancy may have improved since independence, but remains a laggard at 63.7 years, against 72.5 years in China and 69.7 in Indonesia. Indian literacy is barely 65%, lower than in many parts of Africa. Infant and maternal mortality is shockingly high relative to GDP.
The problem cannot be solved simply by throwing money at it.The quality of government service delivery is so poor that more money means more waste. Teachers in government school are absent half the time, and half of those present are not teaching. Sarva Shiksha Abhiyan has succeeded in increasing school enrolments, but this means little if children emerge functionally illiterate from school. In a 2007 survey by Pratham, over one-third of children tested could not read a simple paragraph. In upper primary classes, 22% of children in government schools and 17% in private schools could not read a class II text. Half the children in most states could not do simple division.
As for public health, 40% of doctors and onethird of nurses are typically absent. And fully, half their prescribed remedies are wrong and harmful. This is partly because the doctors spend on average barely one minute per patient.
Lousy service delivery afflicts every other social sector, from nutrition and drinking water provision to maternal mortality and safety nets.
We need revolutionary changes in service delivery
We need revolutionary changes in service delivery
Even remote villages have an adequate supply of shops providing cigarettes and tea. But there is no adequate supply of educational and health, which are more important. Why? Because the sellers of tea and cigarettes are accountable to the consumers they serve, and their income depends on satisfactory service provision. But government educational and
health services are provided by salaried, unsackable staff who are not accountable to those they serve. They are accountable only to their bureaucratic superiors and state capitals, where powerful trade unions ensure there is no penalty for non-performance. We need new laws and institutions to ensure accountability to consumers. In education, two obvious remedies are needed. In cities and large villages, vouchers to poor families for education, plus easy licensing of new schools, will empower parents. They will be able to send kids to schools of their choice, and schools with poor services will suffer. Improved accountability to consumers will automatically improve service delivery, even in government schools.
However, for practical school choice you need two or three schools within easy reach. In remote rural areas, the population may be too thin to support more than one school in a radius of 10 km. In such circumstances vouchers which need competing schools will not work. In such areas, panchayats must be empowered to discipline errant teachers and health staff. In China, local governments directly hire and fire such workers. In India, this may not be feasible: qualified teachers and doctors may simply refuse to apply for jobs with panchayats in remote areas. However, panchayats should be empowered to withhold the salaries of absent staff. That will instill accountability.
Vouchers for poor household are needed for health no less than education. Many studies show that the illness or deaths of breadwinners often start a vicious cycle that drives families into poverty. Health vouchers will empower those most in need.
Catastrophic health insurance can help those needing surgery. Only a small proportion of sick people need surgery, but that can save lives of breadwinners. The Karnataka government has pioneered a scheme to provide surgical coverage to people paying just Rs 7.50 per month.
This needs replication widely
This needs replication widely
Education is a means to improved income. But high school education does not create sufficient skills for a decent job. We need vocational training on a massive scale, to raise the skills and employability of people. Industries across the board are complaining that rapid economic growth has created a shortage of every kind of skill. Even the construction industry is facing a labour shortage, and the historical classification of construction workers as unskilled is now proving false. Modern technology also requires new skills in all industries.
The government should offer grants and instruction subsidies to industry associations in every state to set up training institutions for every branch of work, manual as well as nonmanual. The government must also permit foreign universities to come in easily, and help expand higher education.
Foodgrains sold through the public distribution system should be fortified with iron, Vitamin D and iodine. This will help reduce chronic anaemia (which ails even the top 20% of households) and other mass ailments. So many things are wrong today that it is impossible to list all the reforms needed in the social sector. But the suggestions made here can be a good starting point.