Tuesday, Sep 27, 2022

India at 75 looking at 100: Equitable access should be the goal

Gagandeep Kang writes: To create the foundation for the next century, we need to invest in education and health in the next 25 years — not just for the elite, but for all.

Gagandeep Kang writes: A World Bank report from the early 2000s made the case for education of women as the major driver of change in the health status of societies. (Illustration by C R Sasikumar)

India at 100 to me is an equitable country, built on firm access to high-quality education and healthcare.

I could add gender parity, employment opportunities for all, reduced or no corruption — both small and large-scale — removing caste barriers, vibrant agriculture and animal husbandry and industries focused on quality. All these contribute to equity in several ways. But these are areas best left to other experts.

Education and health are foundational to every society. Examples of India’s capabilities in these areas are easy to find. Indian education produces global CEOs and Indian private healthcare systems have been providing services to medical tourists from many parts of the world. But these are exceptions and not the rule. Moreover, equity has no place in such outliers.

Foundational education must begin at an early stage at home, and then in schools, before we get to institutions of higher learning. Education that allows all children to achieve their full cognitive potential starts with parents understanding the importance of verbal engagement and sensorimotor stimulation and moves to schools that have trained, competent and engaged teachers. In both nuclear and non-nuclear families, socioeconomic status determines the amount and quality of the interactions children have in their early life — this translates to significant developmental advantages depending on the household into which a child is born. The school environment can mitigate socioeconomic deprivation to an extent. For that to happen, schools have to be functional. The functionality of schools comes not from buildings and administrative structures, but the quality and commitment of teachers. The transformational power of education for children who come from deprived environments can only operate at scale if schools and teachers know what is possible and do all they can to become agents of change. Such change cannot be effected overnight or through mandates and government orders. Whether it is in learning from tribal cultures or adapting reasoning exercises to the environment, school education and assessment cannot rely entirely on a one-size-fits-all approach of a standardised curriculum and limited assessment of knowledge and competencies.

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The counterarguments — India is a large country, standardisation is needed across states, the government lacks resources, and the timelines for change are too long — cannot be ignored. But these arguments ignore the foundational role of schooling in not just societal development, but equity, gender parity and a host of other consequential shifts.

Parallel to improving the schooling system, we must strengthen vocational training centres — Industrial Training Institutes, for instance — that provide skills necessary for employment, while also reducing the number of degrees that do not serve as a gateway to professional development or knowledge acquisition. India has had and will have stars in several fields — historians, mathematicians, doctors, engineers, business leaders and managers — and they will continue to emerge following the principle of the creamy layer rising to the top, but the goal of equity requires us to create and maintain opportunities at all levels of our educational system. Wherever possible, we must ensure that finances are not a barrier to education.

A World Bank report from the early 2000s made the case for education of women as the major driver of change in the health status of societies. Reduced fertility, safer births and better health of children and increased social status are causally linked to the education of women, but healthcare must move beyond maternal and child health packages and programmes to treat diseases that we today control far more effectively compared to a few decades ago. Enabling people to increase control over, and improve their health, preventing life-threatening diseases and improving palliative care for patients of such diseases should acquire importance.


The UN’s Sustainable Development Goals for 2030 are unlikely to be addressed in full measure by 2047 if we do not address health, health emergencies and catastrophic health expenditures. Although only Goal 3 of the SDGs directly focuses on good health and well-being, the other goals are also linked to health. For example, Goals 1 and 2 — no poverty and zero hunger — cannot be attained if issues related to health are not addressed.

To realise the dream of becoming an equitable nation in health by 2047, we must reflect on how best to make primary healthcare truly functional, especially when it comes to preventing illness and high out-of-pocket expenses on health. Treating a bulk of illnesses does not require hospitals. We need to place healthcare providers close to patients by creating proper and functional physical and digital infrastructure. We also need to create the right and rapid referral pathways, so that delays in care do not result in unnecessary burden on individuals and their families. For this, we need the right people with the right resources at the right places. Appropriate processes must also be in place. In other words, the architecture of health should place individuals and their needs at the centre and ensure that these needs are met without large payments being required at the point of care. This form of healthcare cannot be addressed without governance systems to regulate the private sector and to ensure that no part of the country is a health “desert”. To support this architecture, we need trained and motivated personnel and inexpensive drugs and vaccines for which India is well-known. We have islands of excellence in primary care and outstanding clinical services, but they are patchy and do not always provide sustained care. Equitable access requires that we deliver to all, and not just the privileged few. 2047 may seem distant, but to create the foundation for the next century, we need to invest in education and health in the next 25 years — not just for the elite, but for all. The returns on this investment will then keep accruing for generations to come.

The writer is Professor, Christian Medical College, Vellore. This article is part of an ongoing Ideas Page series that began on August 15

First published on: 24-08-2022 at 04:40:06 am
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