Public services and their providers !

It is so natural that we clean the house, when we are using it regularly. An abandoned one will attract our attention, only occasionally. Same is the case with our public services especially health and education.  It is not that no one is using these facilities. In fact, a majority is using them.  For example, in 2012, the Annual Status of Education Report (ASER) found that 28% of children in the age group of 6-14 years have attended private schools. Though the private school enrolment has been on the rise since 2009, even in rural areas, around 70% still rely on public schools.

In the health sector, studies show that there is a massive shift from public to private sector. According to National Family Health Survey 2005-06, for 70% of urban households and 63% of rural households, the private medical sector is the main source of health care. This is not so good a sign, as the lower income category is spending huge amounts on healthcare by opting for relatively expensive private services. Also, the fact remains that many still rely only on public services for they cannot afford or private is inaccessibly far.

Keeping aside the quality of private services, which is equally questionable, the statistics show that private is comparatively preferable. A recent study by Michigan State University education researcher challenged the claim that private school students outperform their counterparts in public schools. There are many studies, which bring out the reasons for these dismal public services and how to mend them. The purpose of this article is not to get into any of those details but to raise only one question – “is it because the public services are not good that the government officials/politicians (say the elite class - supposing it includes lower, middle and upper elite) do not use them or that the services are bad because the elite class do not use them? In other words, are our public services dirty because the service providers themselves do not use them?

Ideally, policies cannot enforce compulsory use of the public service by the public officials themselves. Practically, that is impossible as elite themselves make laws and implement them. Yet the dismal public services and I-do-not-use-it-anyway syndrome force us to think of this perception. The possible consequences of this kind of an attitude in education and health sectors could be many.

As the author of an article ‘An official vote of no confidence’ (The hindu, opinion oped, September 16^th 2013) pointed out – ‘The fact is that the decline of government hospitals was in part associated with the decision of ministers and officials to give themselves the benefit of being monetarily compensated for private health care’. The recent order to reimburse approved expenditure on treatment abroad for IAS and IPS officers is manifestation of such lack of confidence.

This might also be the reason for increasing governmental affinity towards private health, for wrong reasons. In addition to the voluntary shift by people who can afford, to private services, there is a developing tendency to subsidize private services by government.  This precisely means that public money is pumped into private sector leaving no scope for developing public sector and the subsidies bill will further shoot up. Arogyasri scheme in Andhra Pradesh was PPP scheme introduced to provide quality health services upto 2 lakh per annum to BPL families free of cost through an identified network of public and private providers. Soon corporate interests, corruption etc have tainted its purpose. Private hospitals have boomed with this cash rich scheme and sidelined public hospitals. Also, studies conducted by many NGOs show that many surgeries and operations have been conducted, whether a patient actually needed it or not.

  

No special study is needed to say that a very few or none at all, of the government teachers send their children to government schools. Yet an enthusiast in Tamil Nadu has painstakingly collected an important information through RTI filings. It says that over 73% of the primary government school teachers in TN send their own children to private schools. The irony is that the same teachers association has been avidly promoting government schools, just to save their own jobs. This is just one instance.

To answer the main question, it is two way. Elite do not use government services for obvious reasons. But this definitely has had an impact on development of public services. If the elite use the services, the investment, maintenance, monitoring and overall working would have been better than what it is today in the public sector. After all, we are notorious for cleaning of roads or laying them over night before a VIP visit. If I never have to use the road I am building, why maintain it in good condition or for that matter why build it in the first place?

This brings us to the question – “Is it important to attract the elite to use the public services in education and health?” Whether this becomes a part of conscious policymaking or not, this is definitely something to work on. India is still not in a position to let the market decide the course of the ‘public goods’ health and education.  

More on this …. In a follow up article ! With views from experts