Putting shine into India Shining

Though education is not my field, while managing an NGO Regional Institute of Public Health, Chandigarh, I gained very useful experiences working with government agencies at the state, district Amritsar and block Bhikhiwind levels to ensure that all 6-14 year old girls got the benefit of elementary education.

In January 2004, through the Principal Secretary, Punjab School Education Department, I was provided a copy of the Framework for Implementation of Sarva Shiksha Abhiyan a programme for universal elementary education published by the Union HRD Ministry. A very well-written 63-page document. And let me share just one key paragraph from this which stresses community-based participatory planning:

8216;8216;The success of the Sarva Shiksha Abhiyan will depend on the quality of community-based planning. While the SSA is formulated on the premise that the community can plan, it also accepts the tremendous requirement for developing capacities in communities to do so. The heterogeneity of local communities in many regions often poses problems of unanimity8230;It is important to recognise a habitation, rather than a village as a unit of planning as most habitations have a higher degree of community solidarity. Similarly, in urban areas, a cluster of households in the same slum settlement has to be a unit of planning. The starting point8230;has to be the creation of a core group of persons, entrusted with implementing the Abhiyan.8217;8217;

To enable the school education system in the country to successfully implement the SSA, considerable operations research and creative efforts would be needed. The ground situation as perceived by K Venkatasubramanian, member, Planning Commission, is not encouraging. Talking to The Indian Express May 12, 2004, he recommended, for the higher educational institutions, peer monitoring by fellow experts instead of controls by the government. But for school education, public sector monitoring was emphasised and he went on to say that there are so many overlapping officials. 8216;8216;And these departmental people should be up to date.8217;8217; Obviously, what he was hinting at was that service managers were not sufficiently interested in identifying and solving day-to-day operational problems.

Because of my training in public health and experience, I have been able to observe over the last nearly 15 years the functioning of the health system in the country. Popularly perceived reasons for doing so poorly in promoting, protecting and restoring health of millions8212;in particular of poorer sections8212;are: 1 dwindling government budgetary allocations; 2 health ministries at the Centre and states not attracting political leaders of high calibre; 3 though health is by and large a state subject, too many health programmes are of vertical nature, sponsored and funded by the Union Government; and 4 not enough adequately trained public health professionals.

The Central Government8217;s announcement in April 2004 regarding the opening of six more institutions like AIIMS, New Delhi, in backward areas needs urgent reconsideration. Such hi-tech medical care, training and research institutions are very costly to build, equip and sustain. At the cost of one such institution, six university-based schools of public health can be built and kept functioning. And these could provide training to enough qualified personnel.

Herewith an important strategy mentioned in the Report of the Commission on Macroeconomics and Health, chaired by Harvard scholar Jeffery D Sachs India was represented at this commission by Isher Judge Ahluwalia and Manmohan Singh and submitted to the World Health Organisation on December 20, 2001:

8216;8216;We recommended that each country will need to define an overall programme of 8216;essential interventions8217; to be guaranteed universal coverage through public plus donor financing. We suggest four main criteria to choose these essential interventions: 1 they should be technically efficacious and can be delivered successfully; 2 the targeted diseases should impose a heavy burden on society; 3 social benefits should exceed costs of the interventions with benefits including life-years saved and spillovers such as fewer orphans or faster economic growth; and 4 the needs of poor should be stressed.8217;8217;

The United Progressive Alliance Government under the leadership of Dr Manmohan Singh is destined to make rapid progress in areas such as basic education, healthcare, environmental protection and basic social safety net. To facilitate this process and in view of the ground reality of pervasive corruption of all hues, eating into the governance of public services, it is suggested that a cabinet-level task force CTF of technocrats with distinguished service record8212;nor more than three or four8212;be notified. This would function from staff position and will have freedom to access and understand the role of all government departments, institutions and other non-governmental agencies with interest and responsibilities in the aforementioned areas.

The Central Government8217;s decision to form a National Commission on Macroeconomics and Health may need thoughtful reconsideraton. What the country needs at this juncture is not more reports but creative application of the knowledge and science at hand.

The writer is Adviser, Centre of Public Health, Punjab University and has earlier worked as programme director with WHO, South East Asia Regional Office