Health, education see strides but woes linger
Over the past fortnight, Prime Minister Narendra Modi unveiled dozens of healthcare and educational facilities, underscoring the political weight of these two welfare areas. The Centre shares duties on these subjects with states but the Modi government, on its part, has a mixed record in both areas. Tackling a rare pandemic and its cascading impacts, enacting key policies, yet not going the whole hog with systemic reforms: This summarizes the Centre’s 10-year report card on health and education.
First, the pandemic exposed chinks in public infrastructure in both areas. Yet, money ploughed into health and education remains range-bound, and their collective 2024-25 budget as a share of GDP is lower than pre-covid levels—even as the tax mop-up scales records.
Views about the pandemic response remain polarized. Much as the vaccination of a billion people is creditable, the loss of lives exposed administrative gaps. “In hindsight, covid management could have been better,” K. Sujatha Rao, a former Union health secretary, said. “While the introduction and scale-up of the vaccine was extremely creditworthy, human suffering could have been avoided or substantially reduced had policy been based on public health principles.”
Mampi Bose, a faculty member at Azim
Premji University, said that while covid19 laid bare the importance of health research, it had not led to higher budgets.
Education was badly hit, too, as school closures and economic distress cut short many children’s studies and led them to shift from private to government schools. Online classes caught the entire system unawares and the resulting learning losses could take years to undo.
AYUSHMAN BHAVA?
Ayushman Bharat has emerged as one of the Centre’s flagship health schemes aimed to give insurance cover to the poor. It has helped limit out-of-pocket spending in 63.3 million cases of hospitalization. The participation of government hospitals in the scheme has picked up, too, said Oommen Kurian, senior fellow at Observer Research Foundation. “Now more government hospitals than private ones are in the scheme, offering additional resources to the public health infrastructure,” he added.
But the insurance component has often failed to use allotted funds. The Comptroller and Auditor General has flagged delays in hospital empanelment and dead patients availing treatment. Experts also say funding for primary healthcare must remain a priority alongside. “More investment is needed in primary and preventive care and infrastructure for curative services,” Bose said.
However, Kurian pointed out that several other initiatives on issues around nutrition, housing, drinking water, indoor air pollution, and rural roads have had positive externalities on healthcare issues as well. Yet, focused funding remains a “binding weakness”, he said.
FIGHTING DISEASES
India’s non-communicable disease burden has surged due to fast food consumption, limited policy action and sedentary lifestyles. A 2023 health ministry-funded study estimated that 11.4% of Indians aged 20 and above were living with diabetes, and 28.6% were obese. The government has rolled out screening programmes and affordable cardiovascular and diabetes medicines, but regulations to tackle “high fat, salt and sugar” foods are weak. The food safety regulator’s proposal on star ratings to red-flag unhealthy packed foods is in cold storage.
Meanwhile, infant mortality and under-5 mortality were both down nearly 30%, and maternal deaths by 25% between 2014 and 2020, data shows. Some impressive outcomes were also seen in malaria control and immunization, Rao said. On the flip side, the Centre has missed its targets on major infectious diseases.
POLICY LEAP IN EDUCATION
The 2020 National Education Policy has been lauded for a focus on improving early-childhood learning through foundational skills. But it has also faced brickbats, such as experts saying that the exit options now available at various stages of college may encourage drop-outs. Besides, the cooperation of states will be vital for its success, but some Opposition parties-ruled states have voiced concerns and in some cases, have talked about pulling out from the policy.
More children are now in schools, especially at the secondary level, which had been a challenge earlier. The gross enrolment ratio for higher secondary has risen from 44.5% in FY14 to 57.6% in FY22. But with the spotlight increasingly on learning outcomes and employability, these successes won’t suffice. Reading and numeracy skills have not improved much, and a Wheebox survey showed just over 52% of young adults are job-market-ready. While the government has made strides, it has lagged in putting money where the mouth is in the form of adequate budget and calibrated reforms. nandita.venkatesan@livemint.com This is the fourth part of a series on top poll issues and the government’s 10-year report card. Previous parts covered welfare measures, the jobs conundrum, and farmer issues.