Possible Reforms in Education & Primary Healthcare sectors of India

We cannot make India perfect. It is already perfect. All we need to do is to sift out the burdening clouds which obliterate the inherent brilliance. A country should not live like a man who does not exist but as a marionette held from falling over by life-support drugs and devices. I ask all countrymen : What will happen if the government removes all police-forces, all CAPFs and paramilitary forces ? Are we moral and restrained enough to still keep helping one another and not slit each other’s throats? Will secluded streets in dark nights be safe for everyone to tread on alone? I believe it won’t. Poverty seems to be an obvious cause. Empty stomachs divorce themselves from reason and regress one to animality. However one can see the anxiety which even the rich common citizens of developed countries experience today. The gun violence, hate crimes, xenophobia, racism, opioid epidemic and so on are some of the shameful social ills in such countries which inspite of their strong police are just feebly reined in. Still in the Indian context, there are logical ways to analyse and tackle poverty which I shall mildly touch upon. But indigence is merely a child of ignorance and illiteracy, although partly engendered by the same. Therefore it is imperative to deal with the issue of education with utmost primacy : a task I hope to partially fulfill in this exposition.

Education is a lifelong process which starts at the cradle and ends in the grave. The brain of a child is highly active in the first few years of his life. According to the National Institute on Deafness and Other Communication Disorders (NIDCD) of the US, the first three years of life is the most intensive period for acquiring speech and language skills. Hence any public policy should specially attend to this vital quarter in terms of providing rich exposure as well as ensuring good health for the child.

But does the Indian government do enough to ensure proper development of the foetus? The Janani Suraksha Yojana (JSY) was launched in 2005 to provide cash incentives to mothers and ASHAs for institutional deliveries. Since 2011, it is being supplemented by the mostly ineffectual JSSK scheme. It saw more than a tenfold increase of upto 10 million mothers in the number of beneficiaries. However according to a review conducted by NHIRC, only 15% of the JSY institutions were decently equipped. The cost-free transport, stay, medicines and care are, needless to say, in a pathetic condition, especially in district hospitals and rural health institutions run by the state governments. There is a serious paucity of doctors and professional staff in such rural areas, apart from limited and poorly maintained infrastructure. If qualified doctors serving in the villages keep suffering from apathetic stunting policies of the state health ministry, they would be fools not to venture for private practice in the cities. As a result, local quacks have been filling the voids so much so that according to the IMA, about 45% of the roughly 1.5 lakh people practising medicine in the country have no formal training. The recent NMC Bill,2017 proposes to legitimize AYUSH practitioners to practise modern allopathic medicine on par with MBBS doctors after completing just a six-month bridge course. This has serious downsides especially risking the rural poor to substandard medical treatment. Overall, there are concerning flaws in the maternity healthcare sector. The result is that India leads the world in the number of stillbirths with nearly 20 stillbirths per 1,000 livebirths and about 640,000 newborns dying in 2016 prematurely by the time of delivery or within the first week of their lives due to infections and other complications (and practically, not all are reported). Then there are cases of the mother dying in the childbearing and delivery process. Despite improvements, nearly 50,000 women die each year in India from pregnancy-related issues. The very image of thousands of motherless children growing through their childhood is appalling. It negatively impacts their education and future role in the society in a big way.

After a child successfully clears the perinatal phase, the next few months are very crucial for him. WHO recommends exclusive breastfeeding for the first six months of life and supplemented breastfeeding thereafter for two years or more. India targets a 69% rate of exclusive breastfeeding by 2025. Infact infections, pneumonia and diarrhoea which account for a major share in neonatal, infant and child mortality can be fairly vanquished with proper breastfeeding, vaccination, other nutritional inputs and early childhood care measures. Mission Indradhanush launched in 2014 is a massive programme to immunize children under 2 years of age. The Maternity Benefit Act,2017 which extended the duration of paid maternity leave to 26 weeks, combined with the Pradhan Mantri Matru Vandana Yojana providing partial cash compensation for wage loss to pregnant women and lactating mothers, are vital steps taken by the government to ensure proper nurturing of the infant in this phase. However critics blame the 2017 Maternity Benefit Act of leaving out the unorganized sector women workers and placing too much unshared burden on the employers in the organised sector which might affect the recruitment of young female employees in smaller private enterprises.

As the child grows up, a dedicated education plan should be pursued for him. In the period up to the age of six years, the brain grows to 90% of its adult size. The events experienced by the child during this time create a powerful impression on his perception, intelligence and behaviour for the rest of his life. Even when applying Jerome Bruner’s brilliant ‘spiral curriculum’ model of learning, the foundation for future reinforcement of learned concepts as well as analogy-making skills are established by the child in this very phase of his education.

Presently, India only has an Early Childhood Care and Education (ECCE) policy for the 0-6 years age group, but no legislation. The Right to Education (RTE) Act, which provides for free and compulsory education to all children from 6 to 14 years of age, also lays down that necessary arrangement be made by the State governments to provide free pre-school education for children between 3-6 years of age. In rural areas, some local schools have partnered with Anganwadi centres to comply with this clause. However progress on this front has not been up to the mark. A recent committee constituted by The Central Advisory Board of Education (CABE) has recommended including pre-school and secondary school within the ambit of the RTE Act. This is a much needed reform. The RTE Act, 2009 was hailed as the most radical initiative in the education sector after the Sarva Shiksha Abhiyan (SSA) (launched in 2000-01), particularly because it gave a legal backing to the magnificent objectives of the SSA and an expression to the stoutly enforceable Article 21A of the Indian Constitution. But citing and explicating all the vital provisions of this law is beyond the scope of this analysis. So I leave the interested reader to dig into it further. I only want to state that in the current state of affairs, most of the schools are always violating a few provisions of this Act : it is the ignorance and unwillingness of the civil society that keeps these schools going without facing much penalties. Also, the recent draft National Policy on Education, 2016 submitted by the TSR Subramanian Committee had made many multi-dimensional recommendations which must be taken up for legislation.

The government has also merged the SSA, Rashtriya Madhyamik Shiksha Abhiyan (RMSA) and Teachers’ Education (TE) scheme into a single Samagra Shiksha Abhiyan for all students from classes 1 to 12, in a move to eliminate duplication of effort and resources and to holistically implement the Education goal (Sustainable Development Goals-4) of United Nations Development Programme (UNDP).

This is a commendable step. Similarly, Rashtriya Uchchatar Shiksha Abhiyan (RUSA), the Higher Education Financing Agency (HEFA) and the grants function of Ministry of Human Resource Development should be combined into one for all higher education funding. Lesser the number of hops to commission a policy on ground, better the governance.

Let me now plunge into what I consider the most utilitarian part of any analysis : namely the possible solutions and the way forward. In this case, I propose a unified model for primary healthcare and education in the country. India is a unique combination of certain relevant attributes : democracy, size, diversity, a large but a mostly undisciplined, unaware and poor population, a rich and proud ancient culture and heritage and above all, a huge potential to someday be the leading nation in the world. Such an alloy of traits calls for a special setup. My model is centred around the notion of Public-Private Partnership (PPP). Various PPP models are being used indispensably in the highway infrastructure projects of the government. Education is also a very large scale industry in India and equally deserves the PPP prototype. For the establishment and operation of hospitals, schools and universities, the government should provide land, resolve the involved resettlement issues, provide tax rebates and funds to the private partner to subsidise the tuition fees (or patient fees in case of hospitals) of all the students equally, set up all the norms, guidelines and curriculum as well as enforce strict monitoring, follow-up and penalising measures. The private partner in any such PPP organisation should completely undertake building new institutes and revamping the existing ones, operating and maintaining them, collecting and appropriating the tuition fees (or patient fees in case of hospitals) as well as undertaking regional CSR activities.

Let me describe the school model; the hospital and university model will be similar. There should be a single design, size and scale for all schools throughout the country. The private partners may differ in each school but the appearance and operations of all schools should be utterly indistinguishable from each other because of strict adherence to defined common high standards. Such a technique is employed in most modern companies following TQM and TPM benchmarks in their various units and offices throughout the country. Moreover each district in the country should have one such school in the district headquarters. As per requirement, many additional such school(s) may be opened in other block(s) of the district. This school project should get priority in all schemes of the government. For example, the Swachh Bharat Mission should be first implemented in all these schools by providing toilets, waste disposal, etc and then be applied to other avenues of society. Similarly ensuring proper drainage, perfect roads leading to the school, necessary tree cover in the area, etc should be given priority for the school project first. This entire blueprint should be followed for universities and hospitals alike. All government and private schools and universities, religious and minority educational institutions should be fused into this one PPP type. This will bring in a powerful uniformity of top-notch educational standards for all upto the remotest districts of the country. Health should be included in the concurrent list if common standards are to be introduced at such a large scale.

I am personally not in favour of the current scheme of reservation in education. I would prefer a combination of affirmative action in ensuring equality of resources and the equality of capability as envisioned by Amartya Sen. Positive discrimination to ensure equality of welfare has some bothering demerits. But in today’s higher education, the major disparity at the entry level in colleges is not due to the difference in the category of students but rather due to variation in the quality of their past education brought forward from their higher secondary schooling, especially in their command over English language. This disparity is not tackleable with the present system of reservation and is difficult to overcome by any remedial coaching. This state of affairs calls for all schooling to be mandatorily done with English as the first language and with provision to study other Indian languages as an addition. Sanskrit as an ancient unifying language should be a compulsory subject in the school. Moreover the students should be exposed to spiritually strengthening education with Yoga, meditation and moral science as a mandatory part of the curriculum right from pre-school till the end of university. In today’s society of nuclear families and busy life, schools are the only social structures to deeply enroot a firm foundation of value systems in the students. The no-detention policy of the RTE Act may be scrapped in practice once such schools are operational, since by then the blame on poor faculty or facilities will have become outdated.

The next focus area should be academia-industry partnerships. All universities teaching technical courses have laboratories and research groups. The same are also present in the R&D divisions of big industries, albeit more advanced and aimed towards commercialization. There should be maximum possible overlap between the two : in other words, a number of industries should partner with a university to open a common R&D centre in a common campus. Under this design, the industries should specially train the final year students of the university they wish to absorb to seamlessly transition to the company without any need for additional trainings. This will remarkably increase the employability of the pass-outs on one hand and reduce the extra resource expenditure on comprehensive paid trainings by the industry. Thus the gradual industrialization of the syllabus of technical courses will also set in. Inspiration on this front should be drawn from the IIST-ISRO relation and the expected collaboration of the recently inaugurated NRTU,Vadodara and Indian Railways. Medical colleges usually have an attached hospital and so the transition is relatively easier for them already. The changeover from school to college should also be made smoothly. For that, the syllabus, nature and difficulty-level for the twelfth standard board exam should match that of the college entrance competitive examinations like JEE-MAIN, NEET-UG, etc so much so that bodies like CBSE feel it unnecessary to conduct separate exams rather than evaluating based on board exam marks. This will make school studies more appealing and meaningful to the students as well as reduce the stress to appear for multiple exams . It will also drastically plummet the very need for out-of-school coaching institutes.

Lastly, education should be digitised. Under the proposed model, there shall be a massive hike in the enrolment ratio at all levels of education and that of higher education which is presently at a dismal 25% roughly will also be much improved. There is a palpable paucity of quality faculty, especially in universities. In pursuance with the objectives of the larger approach wherein all students throughout the country be exposed to equally good teaching as well as overall cost of education remain bounded, there should be teaching through video conferencing in technology based classrooms with real-time student-teacher interaction. This will relax the pupil-teacher ratio (PTR) requirement as well. For example, the RMSA framework stipulates a PTR of 30:1 at the secondary level. With the digital approach, it may easily increase threefold or more.

Outside the family, the Doctor and the Teacher are the two principal entities for any child throughout his growing and learning years. Their jobs require proper qualifications and a strenuous dedication. Thus in order to keep them going, especially in the rural and remote regions, it is necessary to increase their compensation, provide them facilities and a congenial atmosphere to learn and deliver. It is therefore imperative for the government to devise policies in the best interests of the teacher, doctor and the society at large.

• Raman Butta

(An excerpt of this article is also published by ORF here)