Why India fails to deliver health and education: 

Why India fails to deliver health and education

Context

  • The tragic death of scores of children recently at the BRD Medical College hospital in Gorakhpur has reopened the discussion on India’s weak state capacity.

India’s failure

  • In the last 70 years, the Indian state has clearly failed at delivering quality education and public health to its citizens.
  • This raises a couple of troubling questions:

1) Why have democratic institutions not been able to generate sufficient pressure upon successive governments to deliver better health and education services?

2) Why has high economic growth in the last quarter-century not created an improvement in government provision of services?

The work of Monica Das Gupta

  • Democratic institutions in India have negatively affected the provision of public health because—as Das Gupta writes—“electorates typically prefer public funds to be used to provide private goods (such as medical care), rather than public goods (such as sanitary measures to protect the health of the population as a whole).”
  • The non-democratic regimes of East Asia were more successful in delivering quality public health services.
  • Gupta blames “elite capture” which helps divert public funds meant for primary healthcare towards provision of tertiary medical services.
  • It should be noted that there is not much evidence to link higher economic growth to better institutions. The causality is better established in the other direction.
  • However, there is some evidence that higher economic growth may actually lead to degradation in governance quality.
  • The key here is the distinction between “thick accountability” and “thin accountability.”
  • For an organization, thin accountability is based on measures of objective performance and is judicable.
  • On the other hand, thick accountability comprises justification of organizational actions to internal culture and external stakeholders.
  • Setting the curriculum for schools is, therefore, something states with a weak capacity will be able to deliver much better than ensuring teaching standards.
  • In healthcare, similarly, tertiary healthcare service is easier than making doctors deliver in primary healthcare centres.
  • Both weak electoral demand and weak state capacity are reinforcing the same consequence, which, in healthcare for instance, is prioritization of tertiary medical services over primary healthcare.
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