Fair on Education, Bad on Health

The answer is: fair on education and bad on health. In other words, at least on the basis of the health and education figures available from the HDR, it is difficult to conclude that MP under Digvijay Singh has fared any better than the other BIMARU states.

The figures on literacy, the comparison here is drawn with the other BIMARU states, are illustrative of what has been managed in terms of education as much as the figures in infant mortality reflect its failure on the health front. The report highlights the initiatives carried out in the state, such as the educational guarantee scheme (EGS) for schools and the padhna-badhna adult literacy scheme.

Under the EGS, the state guarantees the provision of a school if no such facility exists within a kilometre, within 90 days of such a request by a community with at least 40 children or 25 in case of STs. The community chooses a teacher and provides space while the state trains the teacher and provides infrastructure. According to Gopalakrishnan, such schemes are helping the state to soon achieve its goal of universal elementary education.

But critics such as retired bureaucrat M N Buch say: ‘‘I think the HDR is a great effort if we think of it as a piece of fiction. Literacy levels in this state have risen no faster than in Rajasthan. And what do literacy levels measure: the ability to sign your name. The report touts attainments in education but doesn’t mention that scant attention has been paid to the 80,000 or so schools that have run into the ground. A hierarchy has been created with three categories of ‘shiksha karmis’ and the going rate for their appointments in this corrupt state are well known. These, then, are the teachers in this system, people who have paid their way through and have been hired by a committee at the zila panchayat level comprising mainly of illiterates.’’

Gopalakrishnan, however, feels that ‘‘as far as quality issues are concerned, we have to first ensure access and then we can talk quality. No one doubts that the focus on human development is the best strategy for us to shed the tag of a BIMARU state.’’

But even he does not contradict what the report lays bare about the government’s failure on the health front. ‘‘No one says we have done well on health. But for the first time, population figures have tipped the right way.’’

The report speaks for itself. ‘‘State of infant and child mortality would perhaps be the best assessment of the state of basic health care, quality and reach of health delivery …’’

Well, the infant mortality rate (IMR) in MP is the highest in the BIMARU states and the NFHS data shows that Rajasthan and MP have been the worst performers on this front. Goplakrishnan prefers to cite data from another government survey, the Sample Registration Survey, to show that NFHS data indicating no decline in MP is incorrect. However, the SRS data too shows that infant mortality rate in MP is the highest in the four BIMARU states. Moreover, the report indicates that malnutrition deaths reported from MP last year seem to be just the symptom of a deeper malaise. According to the report, about half the children in MP are malnourished and one-fourth are severely malnourished. And when the focus shifts to tribal children, the conclusions are ‘‘three-fourths of tribal children are underweight and stunted…. What is more worrisome is the very high proportion of severely underweight tribal children, at about 2 per cent…’’

The report itself indicates the source of the problem. ‘‘Financial allocations in the health sector have shown a trend of decline or stagnation over the years, as per the state budget allocations. Taken at constant prices, there has actually been a decline in per capita costs.’’ And this has happened in the Digvijay years. ‘‘Per capita expenditure of the Government Health expenditure was Rs 21.18 at 1980-81 prices in 1990-91, and has gone down over the years to Rs 16.32per capita in 1996-97.’’ It goes on to state, ‘‘One indicator of the weak and inadequate state of public health services in MP is the fact that in a state with such a low per capita income, the vast majority of people are constrained to access medical care from the less affordable private sector.’’

Gopalakrishnan points to the fifth pay commission as the major culprit in taking away money from treatment to salaries. ‘‘But it remains true that we have to move away from the national policy grid on health and design our own strategies. We need to carry decentralisation into health,’’ he says.

Digvijay’s own foreword states that the HDR is ‘‘an instrument to share our concerns on our failures’’ and goes on to admit that ‘‘in the area of health we need to strengthen our efforts.’’ If the HDR, fiction or not, manages to finally focus the state’s attention to the abysmal state of healthcare, perhaps, it would have served its purpose.