POORLY PERFORMING PUBLIC SERVICES

Implementation of the Right to Education Act and the National Rural Health Mission should lead to better outcomes but we see the reverse

There is something ironic about politicians making announcements about the Right to Education or the Right to Health when the only thing they can ensure is allocation of funds. Their control over the usage of these funds is somewhat weak; the overall quality of services is even weaker; their control over actual health or educational outcomes is the weakest.

Looking at education and health behaviours and outcomes using data from the India Human Development Survey (IHDS) of 2004-05 and 2011-12 paints a picture of striking dissonance between government programmes and experiences at the ground level. The period between 2004-05 and 2011-12 saw initiation of several new programmes. The Right to Education Act (RTE) was implemented in 2010; the National Rural Health Mission (NRHM) began in 2005; the Janani Suraksha Yojana (JSY) began in 2005, to be implemented alongside the NRHM. Substantial expenditure was incurred in each of these centrally-sponsored programmes. Below we look at changes in education and health to see how these programmes line up with outcomes.

Privatisation

The implementation of the RTE should, in theory, lead to higher enrolment in government schools and better educational outcomes. Ironically we see the reverse. Private school enrolment increased from 28 to 35 per cent between 2005 and 2012 for children of 6-14 years, even before poor students in private schools were reimbursed. At the same time, in keeping with the findings of various Annual Status of Education Report surveys, the IHDS also found a small decline in reading and writing skills among children of 8-11 years. While 54 per cent of children could read a simple paragraph in 2005, there was a modest decline to 52 per cent in 2012. A similar decline was observed for basic arithmetic skills like two digit subtraction, from 48 per cent to 45 per cent. For government schools the decline was higher — nearly 5 percentage points for both outcomes, but a shift from government to slightly better performing private schools limits the overall decline in skill levels.

This growing privatisation of education was matched by continued and slightly increased privatisation of health care. The NRHM is supposed to strengthen preventive and curative care, particularly in rural areas and in States with poor health infrastructure such as Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh. However, a very small proportion of the Indian population relies on public facilities. About 70 per cent of patients visit private providers — either as their first choice or once they are frustrated with public services.

Between 2005 and 2012, years when the NRHM was implemented, instead of increased usage of government services, we see a modest growth in the use of private services for minor illnesses such as cough, cold and fever (from 69 per cent to 73 per cent) as well as for treatment of major illnesses like diabetes, cancer and heart problems (from 67 per cent to 72 per cent). Ironically the greatest increase in the use of private services is in high-focus large States like U.P., Bihar, Rajasthan, M.P. and Orissa. Here the proportion of patients going to private providers increased by nearly 5 percentage points.

The disenchantment of parents and patients with government services is widespread. When asked in 2012 about their confidence in government and private schools and medical facilities, 53 per cent of the respondents expressed confidence in government schools compared to 72 per cent for private schools. Similar differences are observed for confidence in government doctors vis-à-vis private doctors. What explains this? There is no reason to believe that private doctors and teachers are more qualified than government doctors and teachers. Typically government recruitment standards are more stringent about training and qualifications while there is little control over the private sector. It is hard to imagine that anyone would prefer a self-styled private “doctor” in a distant village to an MBBS doctor in a Primary Health Centre (PHC). Yet, this is exactly what we see around us.

The reasons for these preferences are myriad. Parents and patients feel disrespected by government service providers and may find they get better service if they pay. For example, about 6 per cent of the patients see a government doctor or nurse in their private practice rather than in the government dispensary where the same services could be practically free. Government facilities are often irregular in their opening times and teacher and doctor absenteeism adds to the disenchantment. The classroom environment is often not friendly and supportive. The IHDS finds that children are scolded and physically punished in both government and private schools. Indeed, our qualitative interviews suggest that parents consider this to be a sign that the teachers care about students. But this scolding is not balanced by positive reinforcement in government schools. Only about 33 per cent parents of 8-11-year-olds in government schools claim that their children received any praise in the school in the prior month; this proportion is about 55 per cent for private schools.

These observations reflect our pessimism about the potential for improving government health and educational services, regardless of the “rights” that get enshrined in the Constitution. Any service delivery system that insists that a doctor live in a remote village is doomed to failure since doctors must also think of their children’s education. But instead of focussing mainly on village-based sub centres — which patients rarely seem to use — enhancing PHCs which are located in slightly larger and perhaps better connected towns may have a greater potential for improving the quality of services. Thoughtful organisation of services has a far greater potential for enhancing health and educational outcomes than ideologically influenced discussions of rights.

Some good news

The success of the JSY in increasing hospital deliveries is heartening. The years following the initiation of the JSY document a striking increase in hospital deliveries. This increase is greatest in large focus States. Here the hospital delivery rate has jumped from 25 per cent to 56 per cent between 2005 and 2012. Most of this improvement is in government hospitals — from 14 per cent to 40 per cent. This success may be due to the efforts made by medical personnel in response to cash incentives they receive, and the fact that hurdles to hospital delivery like transportation have received consideration in programme design. Although the quality of maternity care remains a concern, increasing utilisation certainly points to the success of the programme. This suggests that focussing on smarter organisation of public services that aligns with provider incentives, and enhances efficiency, offers potential.

SOURCE: SONALDE DESAI, HINDU

FOOD SECURITY IN THE TIME OF INFLATION

If the expansion of the Public Distribution System results in an increase in market prices, it may counterbalance the benefits of food subsidy

Passage of the National Food Security Act (NFSA) has put the Public Distribution System (PDS) at the core of the national mission to feed the hungry. The PDS, operated via “fair price” or ration shops, will distribute up to 5 kg of rice at Rs. 3 per kg., wheat at Rs. 2 per kg, or millet at Rs.1 per kg per person per month to 75 per cent of the rural population and 50 per cent of the urban population.

Will the PDS be able to handle this scale of distribution? Will availability of practically free grains overcome the potential inconvenience of buying from a single shop? Will this allocation meet all the households’ cereal needs? Some of the data from the India Human Development Survey (IHDS) conducted by the National Council of Applied Economic Research and the University of Maryland provides a guide to the recent past. About 42,000 households were surveyed in 2004-05, and once again in 2011-12, and provide an interesting description of how PDS has grown in importance for ensuring household food security in an era of rapid food price inflation.

PDS cards come in three flavours — Above Poverty Line (APL), Below Poverty Line (BPL) and the Antyodaya Anna Yojana for the poorest of the poor. Here we combine BPL and Antyodaya card holders. While the Central government decides on the proportion of a State’s population that is eligible for BPL status, States identify which particular households should get which card using their own criteria.

Substantial efforts were made between 2006 and 2012 to improve targeting of BPL cards and expand the number of Antyodaya cardholders.

Did retargeting of PDS work? Comparing access to BPL cards across different income categories (using 2012 constant prices) paints a picture of the glass both half full and half empty. In 2005, 44 per cent rural and 31 per cent individuals with monthly incomes of Rs. 300 or below had a BPL card; by 2012 this proportion had risen to 56 per cent (rural) and 36 per cent (urban). But while an effort was made to include the poorest, affluent households also benefitted. Among households with monthly per capita incomes of Rs 2,000-2,500, the proportion of households with BPL cards grew from 25 per cent to 43 per cent in rural areas and from 15 per cent to 29 per cent in urban areas.

Inefficient targeting

This low relationship between income and type of ration card is worrisome because it suggests that it is difficult for us to identify the poor and target subsidies. NFSA plans to provide subsidised grains to 75 per cent of the rural households so it should cover most of the poor; but for urban households where only 50 per cent are expected to receive BPL cards, this inefficient targeting could be highly problematic with poor households being excluded from receiving subsidised grain while some middle income households benefit.

Apart from retargeting of PDS, the years 2009-2012 also saw runaway food price inflation. So looking at the IHDS data from 2005 and 2012 allows us an opportunity to examine the role of PDS in household food security during times of high inflation.

The biggest change took place in people who actually purchased grains in PDS, termed PDS off take. Only 25 per cent of the respondents purchased grain from the ration shops in 2004, but over 50 per cent did so in 2012. Food price inflation accounts for much of this increase but perhaps increasing efficiency of PDS shops could also account for some of the increase. People with APL cards are supposed to receive grains at the market price and only 12 per cent APL households purchased grain from PDS shops in 2005. By 2012 this proportion had risen to 29 per cent. Even if they had to pay the full PDS price, in an era of rapidly rising prices, full PDS price was still lower than the market price. This increase was particularly large in the cities. However, since the quantities that can be purchased via PDS by BPL households is limited, only about 4.5 kg of grains per month per person was purchased from PDS, forming about 45 per cent of the total grain consumption. Once households decided to buy from fair price shops, the amount they purchased was determined by the allowance and did not vary between two survey years or across different income groups.

These observations create an interesting quandary. On the one hand, PDS has begun to play a far greater role in the household food consumption in recent years and with the expansion of its role under NFSA, will be even more important. On the other hand, it only covers less than 50 per cent of a household’s cereal intake. If the expansion of PDS results in an increase in market prices, it may have a substantial negative impact on household budget and may well counterbalance the benefits of food subsidy.

Vast regional differences

While we have painted a national picture here, regional differences in the importance of PDS in household food budget are vast. Whereas in north-central India only about 40 per cent of the people buy grains from ration shops, nearly 85 per cent in the south use food from ration shops.

These observations suggest three major challenges for the country as we move forward. First, identifying the poor is likely to remain a problem, particularly for the urban areas. Second, since PDS covers less than half of the households’ cereal budget, if the expansion of NFSA affects cereal prices it will impact all households, even those covered by NFSA. Third, inter-State disparities will continue to persist given the complex equation between the Centre and the State in providing food subsidies.

SOURCE: SONALDE DESAI, HINDU

MGNREGA ANALYSIS

The Centre’s rural employment guarantee scheme can be substantially improved, but it has undeniably helped Dalits, Adivasis and women find work

In an era of growing globalisation and rising inequality, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) stands out as a unique attempt to provide a social safety net via a massive public works programme. The government as an employer of the last resort is an idea that has existed in policy discourse around the world for much of the 20th century, gaining most currency during the Great Depression in the United States. However, MGNREGA takes this policy to a new realm because of its massive reach, universal nature, and its initiation during a period of rapid economic growth.

It is a good time to explore the reach and impact of MGNREGA. India Human Development Surveys of 2004-05 and 2011-12, organised by the National Council of Applied Economic Research (NCAER) and the University of Maryland, surveyed about 27,000 rural households in 2004-05, before the Act was passed, and in 2011-12 when the programme was implemented in all districts. Hence, it provides a unique opportunity to examine household well-being before and after the implementation of the Act.

Our scorecard on MGNREGA focusses on three issues: (i) The reach and targeting of the programme; (ii) Experience of the households that participated in MGNREGA; and (iii) Broader changes in the rural labour markets between 2005 and 2012.

The MGNREGA website claims that 500 lakh households — about 36 per cent of rural households — obtained employment from MGNREGA in 2011-12. Our household survey finds only about 25 per cent of the rural households participating in MGNREGA. Another independent household survey, the National Sample Survey of 2009-10, also finds about 25 per cent of households participating in MGNREGA.

Well-targeted scheme

Regardless of the discrepancy between administrative statistics and actual usage, the programme is remarkably well-targeted. This targeting operates at three levels. At the village level, the uptake in villages with low levels of infrastructure is higher (28 per cent) than in villages with better infrastructure (21 per cent). It is more difficult to organise new programmes in more backward areas, so MGNREGA’s success in achieving this goal is quite remarkable.

At the household level, households from the marginalised communities — Dalits and Adivasis — are far more likely to participate in MGNREGA (36 per cent and 30 per cent respectively) than other households (20 per cent). At the individual level, older workers are disproportionately more likely to participate in MGNREGA than in the general labour force. Women, too, have higher participation rates; although only 29 per cent of all non-agricultural wage workers are women, 44 per cent of all MGNREGA workers are women.

However, even for those households doing MGNREGA work, the number of MGNREGA work-days is not very large. About 50 per cent of participating households work 40 or fewer days. MGNREGA administrative data shows that less than 10 per cent of the households complete their full 100 days; the India Human Development Survey (IHDS) data record about 15 per cent of the participating households completing 100 days. In the run-up to the election, the government has raised the limits for Schedule Tribes (ST) households living in forest areas to 150 days, from 100. But 85 per cent of the participating ST households and 95 per cent of all ST households have not exhausted their current limit of 100 days. When asked by IHDS interviewers why they had not completed the full 100 days, 75 per cent of the MGNREGA participants cited “No Work” as the primary reason. It would seem more important to focus on ensuring the full 100 days of work for everyone than to increase entitlement to 150 days.

For those households that participate in MGNREGA, the income from MGNREGA forms about 14 per cent of their total income. While the Act mandates payment in cash for people who are not offered work, we found few respondents knew about this provision and even fewer availed of it.

It is not clear whether MGNREGA is providing alternative sources of work or attracting people who were formerly underemployed or disguisedly employed. The IHDS data document an increase of just five days of work for men over a 12- month period in rural areas and four days for women. This is not a massive increase, suggesting that some of the MGNREGA work may have replaced rather than added to former work.

The IHDS also documents other changes in rural labour markets. Among workers, non-farm work has grown substantially while an exclusive agriculture focus has declined. The proportion of individuals who focus solely on agricultural activities— cultivation, agricultural labour, and animal care— has gone down from 51 per cent of men aged 15-59 to 35 per cent; for women the drop is from 84 per cent to 66 per cent. Much of this drop comes from changes in agricultural wage work and caring for animals; own-account cultivation is unchanged. While we do not know that MGNREGA caused these changes, the alternative non-farm employment is certainly part and parcel of broader changes in rural labour markets.

Increase in daily wage

This declining agricultural employment has accompanied wage growth for daily wage workers, particularly agricultural labour. For male agricultural workers, daily wages in constant terms grew from Rs. 90 a day to Rs. 134; for male non-agricultural workers they grew from Rs.126 a day to Rs. 155. The growth for women agricultural workers was from Rs. 62 to Rs. 91 and for non-agricultural workers from Rs. 77 to Rs. 111.

These wage increases for women are particularly interesting. Historically, the lack of non-agricultural work has constrained women’s wages. If MGNREGA is in any way associated with the growth in women’s wages, this is a positive outcome. But these observations may also point to a real concern for farmers — a possible lack of availability of agricultural workers and high wages during harvest time. Rising agricultural wages for both men and women and simultaneously declining agricultural wage work suggest that it would be a sensible precaution to ensure that MGNREGA work is not timed for the peak agricultural periods.

The above discussion has noted several concerns with MGNREGA, particularly the discrepancy between official data and household reports on usage as well as the potential wage impact. But we have also noted that the programme has been particularly successful in providing employment to Dalits, Adivasis, and women, thereby serving as an attractive employer of the last resort to the most disadvantaged workers.

SOURCE: SONALDE DESAI, HINDU

Declinig Sex Ratio

On International Women’s Day, the Election Commission of India held a special campaign to bring women voters to the polls. Although men and women vote at a more or less similar rate in State elections, women are 6-8 percentage points behind in the Lok Sabha elections where national issues dominate. These disparities prompt us to take a deeper stock of gender inequalities in Indian society.

India Human Development Survey (IHDS), a nationally representative survey of about 42,000 households conducted by researchers from the National Council of Applied Economic Research (NCAER) and the University of Maryland, provides interesting insights for developing a gender scorecard covering the years of rapid economic growth between 2004-2005 and 2011-2012. NCAER is the oldest think tank in India, and the only one outside the government which carries out large independent household surveys on social and economic issues. The IHDS is carried out under oversight from an advisory panel comprising eminent academicians, representatives of civil society and those of a variety of statistical agencies. It is the only national panel survey covering the same households.

When it comes to changes in the nature of gender relations in India, IHDS records a story of both progress and disappointments. The scorecard on gender reflects a broad stagnation in social mores where some achievements are cancelled out by backsliding in other areas; broader economic impacts on gendered outcomes are by and large negative; and some remarkably successful policy initiatives have been overlooked in an era of overall disenchantment with public policies.

Social stagnation

On social issues, IHDS paints a picture of overall stagnation, except for a few bright spots. The declining gap in school enrolment between boys and girls is the shining story of the past decade. In 2005, among children aged between 6-14, 88 per cent of girls and 92 per cent of boys entered school. By 2012, the percentage for both sexes rose to 96 per cent.

However, if we read this improvement in women’s literacy to indicate an overall improvement in their status, we are in for a disappointment. Women remain bound by strict patriarchal norms that govern where they go (18 per cent don’t even go to a Kirana shop), whether they can venture outside the home alone (50 per cent do not travel alone by bus/train even for a short distance), how much input they are allowed in household decisions vital to themselves and their children (only 25 per cent have the final authority on what to do when they are sick) and even whether they have any input in who they marry (only 25 per cent actually met their husbands before marriage). Rising incomes do little to improve women’s status since richer households appear to be more determined to control their movements and autonomy than poor households.

Perhaps the greatest area of concern lies in steadily declining sex ratios. Census 2001 recorded only 927 girls between the ages 0-6 compared to 1,000 boys. This ratio dropped to 919 in 2011. It is a paradox that although today’s parents are even more likely to prefer boys to girls than those of the last decade, often resorting to illegal sex-selection practices to ensure the desired sex composition, the discrimination against daughters in education is steadily declining.

While this stagnation in women’s ability to control their own fate is disappointing, some of the other gender indicators are downright alarming. During years of rapid economic growth, women’s employment has steadily declined. In spite of the attempts the IHDS survey made to capture diverse sources of women’s work, women’s work participation rates for those between the ages 15-59 dropped from 58 to 54 per cent for rural women and from 23 to 20 per cent for urban women between 2005 and 2012. While rising household incomes may explain some of these declines, the consequences for women’s empowerment are worrisome.

Moreover, women remain concentrated in the agricultural sector. In 2005, 73 per cent of the rural men did any agricultural work; by 2012 this number fell to 65 per cent. In contrast, the decline for women has been smaller, from 91 per cent to 86 per cent. Women’s participation in non-farm work would have been even lesser without the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). With the slow but steady migration of men out of agriculture into non-farm economy, agricultural work is slowly becoming feminised, leaving women concentrated in an increasingly smaller portion of the economy.

Public policy successes

What role do government policies play in shaping gendered outcomes? Here, there are a number of positive signs. Programmes like Janani Suraksha Yojana (JSY) have had a tremendous impact. Hospital delivery rates soared between 2005 and 2012. In 2005, before the implementation of JSY, which provides cash benefits of up to Rs.1,400 for a hospital delivery, only 50 per cent of the deliveries took place in a hospital; by 2012, this had risen to nearly 70 per cent. Implementation of the no-frills bank account has increased women’s financial inclusion.

The proportion of women with their name on a bank account has risen from 18 per cent to a whopping 38 per cent in these seven years. Efforts aimed at ensuring women’s participation in MGNREGS have also borne fruit. The scheme mandates that at least a third of beneficiaries should be women. IHDS records that 44 per cent of the beneficiaries are women.

While these major programmes have had an impact on women’s lives, many other schemes have proven to be remarkably ineffectual.

Only about one per cent of households have registered their daughters for the much trumpeted girl-child schemes that provide cash incentives for the survival and education of girls. Moreover, even large schemes often suffer from operational difficulties; the demand for hospital-based deliveries has fast outpaced the ability of government hospitals to deliver reasonable quality care.

So how will the women voters react in the 2014 election? Would these policy achievements outweigh the social stagnation and economic concerns?.

COURTESY:Sonalde Desai is senior fellow at the National Council of Applied Economic Research and professor of sociology at the University of Maryland. This is the first in a series of five opinion pieces based on the findings of the new IHDS. The views expressed are personal.