Thursday, May 11, 2006

High modernism, captured April 23l 2006

We are so jaded with the India versus Bharat story that nothing surprises us anymore. Yet even a surfeited soul like me blinks with amazement at this incongruity. When people from abroad are beginning to come to India for high quality, low-cost medical care, there’s a 70 percent chance of being prescribed a harmful therapy in a government primary health centre in Delhi for a common ailment like diarrhoea. This is the finding of an extensive study by J. Das and J. Hammer. We had long known that two out of five doctors were absent in our primary health centres, but we didn’t know that doctors in these centres were less competent than in an African country like Tanzania. Hence, even the poor now depend on private solutions and India’s share of private spending in health is double that of so called “free-market USA”.

It is the same in education. While our famed Indian Institutes of Technology have become a global brand and are feted on CBS’ 60 Minutes, the poor in India are removing their kids from government primary schools and enrolling them in indifferent private schools, which are spreading in our slums and villages. It is the same dismal story with water. Private tube wells account for nearly all new irrigation capacity in India. In Delhi, with greater endowment of water than most cities in the world, citizens cope with irregular supplies by digging tube wells or buying water.

Charles Dickens began A Tale of Two Cities with: “It was the best of times, it was the worst of times…” He might have been describing India’s dualism. How does one explain the gap between the government’s boast about universal education, health and drinking water and the reality that even the poor are embracing private solutions? The answer lies in what James Scott, the political scientist, calls “bureaucratic high modernism”. When Nehru came to power we lived in an age when we had a touching faith in the state’s ability to solve peoples’ problems. So, we asked the state to do more and more. But we did not anticipate that politicians in India’s democracy would “capture” our bureaucracy and use the system to create jobs and rents for their friends and supporters. Hence, the state became riddled with perverse incentives with no accountability. When political supporters are rewarded with jobs of teachers and doctors then the state stops providing public services but private benefits for those who control it.

The old centralized bureaucratic state has declined in many countries. Alas, not here. Despite our failing schools we enact an education cess and throw away good money after bad. Governance could improve if we focused on outcomes—what children learn or if patients are cured. More autonomy to schools and health centres would also help. But real change will only come if we discard our faith in “bureaucratic high modernism” and admit that government’s job is to govern and not run schools and clinics. It is to ensure that high quality schools exist; it doesn’t have to teach in the classroom. Government may have to finance these schools, but the provider could be an NGO or a teacher who would compete with others. Government today spends Rs 4000 per child per year and it should give this as a scholarship to every Indian child, who could exchange it for an education at a school of his or her choice. Thus, Bharat and India would begin to converge.


Anonymous said...

India should have a voucher system for children to go to school. Rs. 4000 is a lot of money, and we could have a great public-private partnership system. But unions in the US have prevented this from happening. How can India ever implement such a system. It needs a visionary state leader to take the first step.

Medicine said...

In Delhi, with greater endowment of water than most cities in the world, citizens cope with irregular supplies by digging tube wells or buying water.