Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Health Systems leapfrogging in India: Need and Possibility
India’s Progress in Health Sector
No doubt India has had its set of challenges in the health sector in terms of efficiency and effectiveness but India has made a lot of progress in the health sector in the last decade. The same can be seen from the following improvements in the key indicators of health in India:
Life expectancy has increased by almost four years during the last ten years.
The rate of infant mortality has declined from 57 to 37 fatalities per 1,000 live births in ten years.
The number of institutional births rose to 79% in 2015, from 41% in 2005.
India was also declared polio-free in 2014, and tetanus-free in 2015.
Reasons for India’s progress
The reasons which have helped India in the above mentioned progress are:
Active and increased involvement of the public and private sectors.
Government initiatives have mobilized communities on health.
There has been increased access to public health services.
There is increased utilization of the available infrastructure.
Almost 900,000 female community health volunteers (ASHAs, or accredited social health activists) have been deployed in rural areas and coverage of state-sponsored insurance schemes has also expanded.
Private-sector innovation has improved cost efficiency and as a result services of international quality standards are available at low-cost.
Implementation of well-defined protocols for complex procedures has assisted in reduction of error rate.
Pioneering rare and complex surgical procedures have addressed local challenges and increased access to healthcare.
Challenges for India’s Health Sector
In spite of the above progress and developments, India’s health sector is still facing a lot of problems which act as a hurdle for further progress and as a result India has missed its Millennium Development Goals for healthcare, especially maternal and child mortality rates.
India has a high incidence of communicable diseases and non-communicable diseases (NCDs). NCDs account for 60% of deaths in the country.
Government expenditure on healthcare at 1.3% of gross domestic product (GDP) currently is very low compared to peer countries.
Acute shortage of Public health infrastructure and staff availability. India faces a 50% shortfall in the supply of doctors.
Inadequate utilization of and negligence in the maintenance of scarce public healthcare facilities. This also forces the people to go for expensive private healthcare thus increasing the cost of healthcare.
Various public and private sector initiatives using new technologies and operating models have not been designed well for a higher scale.
Governance of large public health programmes is weak.
Leapfrogging in Health Reforms
The need of the hour for India is to create a financially sustainable health infrastructure which is of very high quality and cost efficient as well. India should opt for accelerated sustainable approach rather than a usual lengthy approach which includes high spending but marginal improvements. Therefore, India should scale up healthcare innovations or leapfrogs along with the current initiatives.
Leapfrogging means using a new technology, operating model, or pattern of behaviour to help a system skip development stages that were previously considered unavoidable.
Technology includes new health-related activities and products.
Operating model refers to modification in the organizational setup or in the delivery of health-related activities.
Behavioural change refers to the evolving preferences and conduct of various individual and institutional stakeholders such as patients, health workers and payers.
Study of leapfrogging strategies across the world have helped in identified six essential results that should be achieved. A well-chosen combination of leapfrogs could also pave the way for an eventual transformation of the healthcare system.
Ensure that innovation should appeal to a universal human trait. This makes leapfrog adoption easier.
Adapt to survive, diversify to thrive. Operating models have to be designed as per needs of local communities. Customized products and services should be provided.
Empower communities to shape and own the model. Encouraging community ownership of the model will result in a much higher impact, due to greater involvement of emotionally connected community participants.
Actively build partnerships both within and outside the healthcare industry for innovations.
Ensure design-to-scale. Engagement with the government is essential to design solutions that target the gap in public healthcare and can scale up effectively.
Objectively evaluate the progress and ensure corrections based on regular review.
The Ecosystem Approach
Public-private Partnership model has certain limitations such as mistrust, push of commercial solutions, short-term financing, white elephant assets, and unclear outcomes with lower efficiency. As a result, the ecosystem approach is recommended. Ecosystem Approach mobilizes multiple stakeholders around a common, measurable outcome or goal. The concerned stakeholders are incentivized to collectively brainstorm for solutions and innovative business models to finance and deliver sustainable results.
Ecosystem Approach v/s PPP Model
The ecosystem approach is better than traditional PPPs in three significant ways:
Ensures collective design of smart and holistic solutions by providing a forum for stakeholders to work together.
Example: GAVI, the global vaccine alliance, is leveraging new technologies and partnering with the private sector for efficient supply chain and data management, workforce training.
Higher financial sustainability is achieved through innovative models.
Example: Social Impact bonds have gained traction in multiple capital markets as a tool for corporate social responsibility funding.
Data-based decision-making helps in reviewing and identifying course corrections. A project management office can help in this.
The Ecosystem Model needs to be supplemented by appropriate reforms, robust governance and a genuine will for change. For the success of this model, the government has to ensure that it provides the requisite platform for engaging various stakeholders, and support the scaling-up of promising leapfrogs. On the other hand the private sector, including hospitals, pharmaceutical and non-governmental organizations, will have to focus on developing tailored, low-cost products and process innovations. Global partners can provide financing, expertise and access to their networks, to promote the growth of a sustainable Indian healthcare ecosystem.
Connecting the dots
What is leapfrogging? Discuss the need for a leapfrogging approach and how it can assist in transforming the healthcare sector in India?
Discuss the challenges that India’s health sector faces. How can a multi-stakeholder approach help in addressing those challenges?
TOPIC:General Studies 2
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Education in 2017- What should be the focus?
Education is more than a way of being, it is an art of becoming. Education is not only about a process of nurturing the human soul, as the ancient Greeks understood it through the notion of paideia which meant the acquisition and transmission of excellence. But education is also what philosopher Bertrand Russell defines as- “a certain outlook on life and the world.”
India holds an important place in the global education industry. India has more than 1.4 million schools with over 227 million students enrolled and more than 36,000 higher education institutes. India has one of the largest higher education systems in the world. Higher education system in India has undergone rapid expansion. Currently, India’s higher education system is the largest in the world enrolling over 70 million students.
However, there is still a lot of potential for further development in the education system.
Education is not only about books as followed by the Indian education system. The learning has to come from surroundings and then tailor made into value added education. The union budget 2016-17 termed education as one of the nine pillars of the budget. But there are mammoth challenges faced by Indian education system- enrolment, excellence and employability. Thus, the focus of education should be to address these major challenges.
Public education has no substitute. Hence, its quality and quantity should be reaffirmed explicitly through actions. This involves subsequent increase in budget allocation and striving to reach 6% of GDP in coming years. Thus, there is need for more public investment. Regional and rural-urban disparities must be addressed too while allocating education budgets.
Educators have a special responsibility in education —social, political, human and epistemic. Teaching is at the heart of education system but India has one of the weakest teacher education programme (B.Ed) in world which deprives children of a bright future which comes from creative present. India has around 8.8 million teachers but this existing teacher base requires massive investment in effective capacity development.
Along with it, the teachers have to be trained with new teaching and learning pedagogies adapted from best practices across the world. The ‘rote learning’ method has to go and instead bring in environment which allows children to learn at their own pace.
Already, the concepts of flipped classrooms (pedagogical model where short video lectures are viewed by students before they attend the class. The in-class time is devoted to discussing it or other related activities) and MOOC (Massive Open Online Course) have already started taking off, especially in some of the leading Indian institutions.
The improved quality of teachers should be backed by the increased number of teachers in schools.
Vocational education has to be made a par of basic education upto standard XII along with academics. Education needs to realign itself with changing times and therefore has to develop fundamental capacities—e.g. independent thinking, problem-solving—so that people can adapt instead of providing narrow skills for jobs.
Skill Development has been focus of the present government which should rationalise which skills it aims imparts.
On an average, private schools do not perform better than public schools. But still there is a prolific rise in private schooling in the past decade and no significant improvement has been visible. Thus, it has to be understood that privatisation of education is no solution to increase the quality and quantity of educated children.
However, it does not mean that private schools should not be encouraged. They can bring in new ideas and perspectives which can be also considered by others.
But, commercialisation of education has to stop as education is no commodity.
Just by ranking lists or assessments, the quality of education won’t improve. “Testing”-based “accountability” of educators is a disaster, it damages the education system at its core. Examinations must be improved to assess real and deep capacities rather than memorization and procedural skills.
Technology is not the panacea to solve the problem of poor learning standards. They help just as the books do. That is why, any investment in technology should be assessed properly before shelling out millions on setting up infrastructure.
The learning capability of the children have to be improved with multiple tools.
Higher education has a bright future in idea. The government is taking various steps to increase the outreach of higher education after primary education. Several MoUs have been signed between India and Australia in the fields of higher education and research, including technical and professional education, schools, vocational education and training.
Also, GIAN brings talent pool of scientists and entrepreneurs, internationally to encourage their engagement with the institutes of Higher Education in India so as to augment the country’s existing academic resources, accelerate the pace of quality reform, and elevate India’s scientific and technological capacity to global excellence.
Education and learning are deeply determined by the socio-economic conditions of the child. The best teachers cannot compensate for deprivation and poverty at home. Hence, there should be proper arrangements made in school for children belonging to all class and castes of society.
Also, the schools should be secular and non-discriminative institutions where the ideals of constitution are respected and followed.
There is a need for dramatic improvement in our early childhood-care system and also in education for children with disabilities. The school infrastructure, including specially trained teachers is the basic impediment while imparting education to children with disabilities. The government needs to undertake various actions to make education an ‘inclusive activity’.
Mother tongue is the most effective medium of education in early grades. However, given the reality of the social capital of English, all children must have the opportunity to learn the language.
On regulatory front, HRD ministry is likely to move towards giving greater autonomy to government backed institutions — like the Indian Institute of Managements (IIMs) — in deciding their future. This is more likely to be in the fashion of allowing them the freedom to experiment with technology and with the new ways of reaching out to people.
Economic aims of India should be fulfilled by education by providing individuals become economically independent. It is not without any reason that India is charted out to be global leader in having the youngest population which can become a path breaker in achieving sustainable economic success. However, these economic aims should usher in equality and narrow down disparities.
Education is not an economic service. It is a social-human and moral endeavour; it’s about people and their aspirations for the good life.
Hence, education should lead to development of good human beings and a good society based on principle of Constitution of India, thereby creating a foundational value of India’s democracy.
Connecting the dots:
Why is education vital for India to grow as a developed society? Give reasons.
Education sector is facing multiple challenges in 21st Critically examine the reasons and enumerate ways to bring solution to them.
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