It has been found that, improvement in social infrastructure, such as education and health, can sustain the service-led growth that depends mainly on the availability of skilled and productive human power (Dash and Sahoo, 2014). Social infrastructure, such as education, health, and housing, is essential to promote better utilization of physical infrastructure and human resources, thereby leading to higher economic growth and improving quality of life (Hall and Jones 1999; De and Ghosh, 2003). For example, Hall and Jones (1999) argue that international differences in levels of output-per-worker are determined by differences in human capital, physical and social infrastructure. Further, Wagstaff (2002) noted that up to 1.7% of annual economic growth in East Asia between 1965 and 1990 (about half the total GDP increase for the period) has been attributed to massive improvements in public health and education. Against this backdrop, there have been concerted efforts in recent years to improve both physical and social infrastructure facilities in India. To assess the impact of Government’s effort, in the next two subsections we will discuss various indicators pertaining to health and education and then we will try to point out the shortcoming and suggest various policy changes that can bring about a change in the two sectors
1.1 Health
At the turn of the century India’s Life Expectancy is lagged behind the average for high income, BRCS and East Asian countries as well as for China. India’s healthcare infrastructure has not kept pace with the economy’s growth. The physical infrastructure is woefully inadequate to meet today’s healthcare demands, much less tomorrows. While India has several centers of excellence in healthcare delivery, these facilities are limited in their ability to drive healthcare standards because of the poor condition of the infrastructure in the vast majority of the country. This is reflected in the numbers of Physicians as well as hospital beds, which were 0.65 and 0.9 respectively in the year 2011. These numbers are at least three times smaller than China and East Asia. The main reason cited behind these formidable challenges faced by health care system in India is public spending on medical, public health, and family welfare in India which is much below what is required. Between 1996-97 and 2005-06, total government spending on health was stagnant at about 1 percent of GDP, and the public expenditure elasticity with respect to GDP was at 0.94, lower than the average for low-income countries (1.16) for the same period (Tandon and Cashin, 2010). Despite efforts to increase public spending after 2005-06 including the adoption of NRHM, under which spending on health care is expected to increase to 2-3 percent of GDP the expenditure, increased only marginally to 1.2 percent of GDP in 2011. This has resulted in poor quality of preventative care and poor health status of the population. The inadequate level of public health provision has forced the population to seek private health providers resulting in high Out of Pocket spending. Out of Pocket spending in India is over four times higher than the public spending on health care.
Drinking water supply and sanitation in India continue to be inadequate, despite longstanding efforts by the various levels of government and communities at improving coverage. The level of investment in water and sanitation, albeit low by international standards, has increased during the 2000s. Access has also increased significantly. For example, at national level in 1990 sanitation coverage was estimated at 17% and reached 25% in 2000 and 35% in 2011. Also, the share of Indians with access to improved sources of water has increased significantly from 72% in 1990 to 81% in 2000 to 91.6 in 2011. At the same time, local government institutions in charge of operating and maintaining the infrastructure are seen as weak and lack the financial resources to carry out their functions. In addition, only two Indian cities have continuous water supply and an estimated 69% of Indians still lack access to improved sanitation facilities.
Moving to water source and sanitation facilities at the disaggregated level we find that in rural areas, where 72% of India’s population lives, the respective shares are 89% for water and only 35% for sanitation for the year 2011. In urban areas, 96% had access to an improved water source and 59% to improved sanitation. Though, access has improved substantially yet it falls short of the facilities available at the international level.
1.2 Education
India has a large school going population. To accommodate this school going population, it requires a strong educational infrastructure in order to keep pace with the developing economy and provide it with quality manpower. Education can accelerate economic growth and investment is a key indicator to expand and improve quality of education.
The education sector in India is experiencing rapid expansion and change. Governments (both Central and State) have implemented new initiatives and increased spending to encourage greater enrolment and attendance at the school level. Both Central and state governments have continued to accord a high priority to expanding the supply of education and increasing participation, especially at the primary level. The universalization of elementary education, defined in India as grades one to eight, was given a renewed impetus in April 2010 when the Right of Children to Free and Compulsory Education (RTE) Act came into force. In the light of these initiatives we take a look at Education sector characteristics measured by enrollment, literacy rate, pupil teacher ratio public spending etc to take a stock of current situation in India in comparison with International achievement.
In higher education they are seeking to implement wide-ranging changes to the regulatory framework. At the same time the rising affluence and aspirations of households is spurring strong demand for education at all levels and the traditional dominance of the public sector as a provider of education is receding. The dual challenge now is to build on the considerable progress made in lifting participation and, equally importantly, improve the quality of education outcomes. To meet these objectives reform momentum needs to be maintained and broadened. This is especially so given the pace of development in the Indian economy, the changing needs of households and businesses, and the considerable lags between changes in education policies and outcomes.
First we look at the gap in adult literacy rates among India, China and East Asia has stayed nearly the same since last 10 years, however, it has narrowed among youth. While all the countries groups and China’s overall literacy rate in 2011 was around 100 percent, India came out way behind them at 63 percent. The divide in case of youth was much smaller with India being at 81 per cent. In addition to literacy rate, average years of schooling is another commonly used indicator to measure education attainment. Average years of schooling obtained by Indians were half or less than half when compared to other group of countries in the data set.
As a fraction of its GDP, public education expenditure in India has been higher than that of China during the last two decades. Expenditure per student in primary, secondary and tertiary sector for the year 2011 was 7, 14 and 70 percent of GDP per capita for India while that of China was 6, 11 and 90. The expenditure on students in tertiary sector is higher in India than that of high income, BRCS and East Asian countries. But the same number for primary and secondary education is not even comparable.
Enrolment rates have significantly improved in elementary education; the Gross Enrolment Ratio grew from 94 percent in 2001 to 112 percent in 2011. Though this number look quite large and is in comparison with all the other group of countries yet the transition has been very slow. For example the gross primary enrollment rate in China had exceeded 100 since 1985 and India reached that figure only in 2000.
The secondary enrollment rate was about 45 percent for India in 2000, and has been increasing ever since and now it is around 63.2. The tertiary enrollment rate has increased from 9 percent to 18 percent over the matter of a decade. Nevertheless, by international standards enrolment at the secondary and tertiary level remains low, particularly the latter. Much less than 104 and 68 of high income economies for 2011 which we target to achieve.
Teaching staff constitutes a vital aspect of education. Pupil teacher ratio (PTR) is one of the critical indicators of education. It may provide insight to measure the quality of education. The data reveals that the PTR is quite low at primary and middle level figuring 30.2 and 25.3 respectively about twice when compared to China and other group of countries and needs improvement. Thus it is imperative to improve PTR to enhance quality of education and to make human resource globally competitive.
Growth in private institutions has been significant during the Eleventh Plan period, with 98 private state universities, 13 private deemed universities, 6,335 private colleges, and 2,321 private diploma institutions being set up during this period. In 2012, 28.3% of all elementary students i.e. those in the age group 6 -14 years who are enrolled in schools, attended private schools, in comparison to 18.7% in 2006. Most institutions of secondary and higher education are driven by the private sector; private institutions make up 60% of all secondary schools in 2010-11, and 63% of all higher education institutes with 52% of the share of students in 2010. The privatization of education sector is adding to the weight of overburdened middle and lower income families.
However, in spite of the significant progress made during the past few years, India’s education sector is still plagued with several challenges, e.g., its relatively low GER, inequitable access to higher education by community, gender and geography, and lack of high-quality research and education institutions, resulting in sub-optimal outcomes. The quality of learning across all levels of the education system is abysmally low. All surveys unanimously point to one direction “extremely poor learning outcomes across-the-board”. Urban schools are not significantly better than rural schools and the vast majority of private schools are not much better than government schools. About half of the primary school students are three classes below the levels they ought to be in reading and even more in arithmetic. These appalling outcomes continue or are even exacerbated at the secondary and higher levels. High school children do not have basic conceptual understanding. Students entering the workforce have very low employability. Clearly, raising the quality of education is the biggest challenge in our educational system. Keeping this in mind we will now look at some of the problems infested in education and health sector of India and what are the possible solutions to tackle them.
1.3 Roadblocks in Health and Education
Both large survey-based studies as well as case studies have repeatedly shown that education and health services in India are characterized by (i) inadequate and inferior infrastructure; (ii) poor public service delivery; (iii) lack of quality choices for consumers; and (iv) lack of access especially for the poor due to a high dependence on relatively expensive privately provided services. In this subsection we will discuss some of the challenges faced by health and education sector and how they undermine the impact expected.
Health – Key Challenges
- Adverse Impact of User Fees & Privatization of Health Services
- Focus on Women is missing
- Public Expenditure on Health: insufficient, inefficient
Education – Key Challenges
- Investment In Public Education still Limited
- School learning and higher education quality remain low
- Quality Education Has Not Reached the Most Marginalized
- Right to Education- still not Free
1.4 Overcoming the Challenges
However, central and state governments have, since independence, been devoting substantial funds and public effort towards provision of education and healthcare. Somehow the efforts have not yielded the desired results. The aspects of policy failure could be categorized as follows:
1. Attention to the challenges posed by the rapidly increasing population has been inadequate.
2. Delivery mechanisms are poorly designed.
3. Implementation of policies and schemes is poor.
4. Appropriate institutional mechanisms to bridge need gaps are absent.
5. Democratic institutions do not appear to be adequately answerable for the failure of the public delivery system.
Listed below are some of the points which can help the country as a whole in overcoming the challenges faced in both education and health sector
- Improvement in Infrastructure and Institutions
- Increase in Education & Health Public Expenditure
- Free not User Fee
- Planning Around the Poorest
- Uniform Quality of Service
- Increased focus on disparities on the basis of caste, religion and gender
Data Source: World Development Indicators, 2012