Opinion Sectors apart

So if I want to take a guess on how much time it would take to get at least middle-class India a reasonable level of healthcare,the answer would be at least another two decades. But if the same poser is about education,the answer from most analysts would be five years.

The wide difference has got created through the presence of private investment and a state policy that has actively encouraged education versus a system where just about everything is in a shambles,including even the now-scrapped Medical Council of India,the regulator for doctors.

Anywhere one goes in India,in schools or the smallest villages,exciting tales are pouring out about how people are battling adversity to reach education to their children and,at a lesser intensity,for themselves vocational education. In recent months,policy wonks in HRD have been telling stories of back-to-back visits by foreign education companies to check the “latest score” on policy issues.

To take a check on the health sector,one does not even need to venture out of Delhi. The city has three types of government hospitals,some run by the Centre,some by the state government and some by the municipal corporation. This means,a very senior Delhi government health official explained,a very laudable scheme of setting up health workers in poor neighbourhoods of Delhi has run up against this class difference. The workers under the Asha scheme cannot take their patients to a Central government-run hospital,even if it is nearer,but has to locate a state government hospital instead.

Yet the widely varying trajectories of the two sectors just should not have happened. The government started putting serious money in education and health at about the same time. The Sarva Shiksha Abhiyan and the National Rural Health Mission were started in quick succession,in 2003 and 2006.

Policy mavens,however,compounded the asymmetry through a key mistake in what they wanted to target. They ended up trying to maximise government investment in healthcare. So the most prominent piece of statistic in the sector is trying to raise public expenditure to measure how well healthcare has reached out. In 2007,public expenditure on health as a percentage of GDP was less than 1 per cent. The government plans to reach 6 per cent — the percentage of public health spend in OECD countries. But since India’s GDP is growing at least 8 per cent annually,the amount of incremental government spend on healthcare will have to be at least 20 per cent more each year to reach close to those benchmarks. This is a very tough call. The increase in plan allocation for the health ministry was just about 14 per cent from Rs 19,534 crore to Rs 22,300 crore for 2010-11.

As a result,while the HRD ministry has veered away to concentrate more on making policy for the sector,the health ministry is both running the hospitals and setting policy goals for it. Over-dependence on government spend has also created an environment of graft. The World Bank stopped funding schemes in the health sector for some time,a first for India,because of this reason.

This is why we have ended up developing the typical Third World medical support shanty towns around the few really good hospitals in the country. Vellore in Tamil Nadu receives a daily train that runs probably the craziest schedule anywhere in the world but which makes perfect sense to the people of West Bengal,Assam,Bihar and Orissa rushing to the Christian Medical College for treatment as the state-run hospitals have simply collapsed. That train touches every major town in these states and takes all of three days to reach Vellore. In West Bengal,the promoters of a private sector medical enterprise have made its sales pitch — as good as Vellore. In New Delhi,the huge numbers of people who sleep just inside the AIIMS gate every night have a similar tale to tell.

As the Gates visit shows,the two sectors are now becoming a study in contrast where investments are concerned. And that is the singular difference. To ensure that a decent percentage of Indians get better life chances,government money is just not enough. To bring in a credible amount of investment,the government has to however set up rules and create policies that make the plans interesting. FDI in health has been permitted for a long time. But the government has received scarce interest from investors,primarily because it writes in requirements for real-estate acquisition but has little to say on how many doctors and nurses a foreign-run hospital should employ.

Kapil Sibal’s team has done that in the education sector. It has decided,for instance,that since little money will flow into the primary education sector,except in the urban areas,the government will have to run those. But to make private investment attractive in higher education,the rules of the game have to be set out. The bill moved by him in Parliament to allow foreign universities to set up shop in India is one of the most visible signs of those rules.

More important,the minister has taken ownership for the changes in the education sector like his demand to make investment in the sector qualify for priority sector lending.

Across Rajpath,Ghulam Nabi Azad has to create a similar buzz. The demand for health is about as pervasive as that for education,probably higher. But unless we get the right combination,only evangelists would come visiting.

The writer is Executive Editor (News),‘The Financial Express’

subhomoy.bhattacharjee@expressindia.com