Date: 31/01/2023

Relevance: GS-2: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Key Phrases: Core pillars in the budget exercise, Proliferation Of private healthcare, Governance Gaps, National Health Policy of 2017, Poor Medical Infrastructure, Lack of Insurance Culture, Huge Out-Of-Pocket Expenditure.

Why in News?

• Governance needs to be one of the core pillars in the budget exercise likely to be presented for the year 2023-24.
• This becomes especially significant in two critical areas of health and education where the government’s social contract with citizens is in danger of being hollowed out.

Status Of Healthcare Spending In India:

• The National Health Policy of 2017 set a target for government spending on healthcare at 5% of gross domestic product (GDP) by both the Centre and states to be achieved by 2025.
• In contrast, the budgetary outlay for healthcare has been range-bound between 1.2% and 1.4% in the period 2014-20 which increased to 1.8% in 2020-21, and 2.1% in 2021-22 during the covid pandemic.
• As per the preliminary indicators, healthcare expenditure is likely to be 1.3-1.4% of GDP in 2022-23.

Concerns Associated with the Health Sector:

• Governance Gaps:
  • Government spending on this vital part of the social sector has led to major flaws in this industry’s structure, leading to governance gaps.
• Poor medical infrastructure:
  • According to the public health research organization Center for Disease Dynamics and Economic Policy, India had 69,265 hospitals in 2019, which translates roughly to one hospital for every 20,350 Indians.
  • This leaves a wide gap between the demand and supply of healthcare capacity.
  • The problem gets compounded by the fact that there are only 25,778 public hospitals against 43,487 private ones.
• Proliferation Of private healthcare:
  • There are only 0.71 million beds in public hospitals against 1.18 million in the private sector out of the roughly 1.9 million hospital beds in India.
  • This points to growing inequality in access to healthcare. Various research studies have shown that the cost of treatment in private hospitals is in multiples of that in public hospitals.
  • Given that a large number of Indians reside in rural and semi-rural areas, it is clear that the number of public hospitals is inadequate.
• Lack of insurance culture and huge out-of-pocket expenditure:
  • Over 80% of India’s population is not covered by health insurance forcing the patients to pay for expensive treatment from their own pockets.
  • The government which must provide affordable healthcare to citizens has ceded this space and responsibility to private hospitals which must be availed by only those who can afford them.

Measures to Reform the Health Sector:

• The health sector is a shared space between the Centre and states, with the burden of expenditure split 25:75.
• The economic shock of the past four years decrees that the Centre increase its share, especially since better health indicators are unequivocally linked with higher productivity and economic growth.
• Meanwhile, till additional money is made available, the Centre can effectively contribute much more by creating a regulatory framework that lays down strict treatment guidelines and discourages price extortion by the private sector.
• It is also necessary to rationalize the complex legal framework in the sector by discarding unnecessary laws while enacting some vital ones which are currently missing.
• The Budget must boost infrastructure in Tier II and Tier III towns and address the shortage of healthcare professionals.
• The Budget can facilitate the Government and the private sector working in tandem to improve the quality of skilled healthcare professionals with a blueprint to identify healthcare professionals willing to work long-term in Tier 2/3 cities.

Status of Budgetary Allocations in the Education Sector:

• The combined Centre-state expenditure on education, as per Economic Survey 2021-22, has remained at 2.8% of GDP through 2014-20.
• Subsequently, in the wake of the pandemic, the bill increased to 3.1% for both 2020-21 and 2021-22.
• The expenditure ratio between the Centre and states works out to 23:77.
• In the current financial year, the combined spending is likely to end up between 2.8% and 3.1% of GDP which is far below the 6% of GDP promised in the 1968 education policy, which was reaffirmed in the 1986 policy and its 1992 review, and further revalidated as a worthwhile target in the 2020 National Education Policy.
• Moreover, as per a 2022 study by the ministry of education, close to 61% of the Centre’s spending is focused on elementary and secondary education.

Issues Faced by the Education Sector:

• Regulatory issues at Pre-primary and Tertiary levels:
  • Regulation in the sector has focused largely on higher education and elementary and secondary school stages.
  • Regulation for the two other stages—pre-primary and tertiary (10+2) levels is largely a grey area, leading to multiple unethical practices.
    • For example, many premier 10+2 institutions outsource their pedagogy especially in the science stream to coaching outfits and charge exorbitant fees. Thus, fulfilling the dual functions of providing students with a formal school certificate as well as preparation for competitive entrance exams.
  • Edtech and coaching classes are two other categories that require stricter regulation.
• Poor governance and lack of responsibility:
  • Another problem with the education sector is the absence of teachers in government schools which creates huge gaps in the accessibility of quality education.
  • Further, poor management in these schools is also another major problem as these school management committees are barely functional.
• Lack of infrastructure:
  • One of the major challenges faced by public schools is the lack of drinking water facilities, electricity, toilets, poor hygiene, etc.

Reducing Inequalities of Education:

• For a targeted approach to reducing regional inequality, the essence of federalism needs to be induced into education. Therefore, education policies need to strengthen the central, and provincial governments as well as local governments.
• This educational inequality is widespread, so civil society and NGOs must ensure their roles.
• Along with this, there is a need to bring innovative teachings in more and more languages. Prima facie will be a problem, but it will be beneficial in the long run.

Conclusion:

• Education and health sectors are public goods that have huge multiplier benefits for human capital and economic growth.
• The regulation of these sectors is not easy since it entails close coordination with states and their various institutions.
• It can be argued that perhaps a budget is not the ideal vehicle to accomplish the complex task of improving regulatory structures but a start has to be made and any time during the next 12-16 months seems like a good time to initiate.

Source: Live Mint

Mains Question:

Q. Discuss the issues faced by the health sector in India. Suggest measures to reform the sector. (150 words).