By;M. Santosh Kumar Patra
Bhubaneswar,06/05/19:Now and then the country will sustainnaturally only by the means of solidarity, peace, and integrity. It is possible only when the population of the countrymeet wellbeing equally. Human well can only be established, when all people receive equal opportunities for physical, social and mental health and quality education. Fundamentally everybody should live in absence of disease and morbidity and Education ensures development across generations and establishes solidarity in the fraternity. In a decent democracyitis imperative that wellbeing of health requirebetter and quality government support and research based efforts on scientific, sociologic and physiologic aspectsof public health and education. Education without quality is wasting of resources of the country and killing the time of thousands of our children. Schooling without learning is a sin; the government should ensure it equally, qualitatively and universally. Keeping in the same spirit the right to Education Act 2009 reserves equal opportunities legitimately to all children but not all children, specifically the tribal, Dalit and Minority receives it equally. Yet the Right to Health not capture a space in the constitution, but it does not restrict citizen to claim the rights. The Constitution also incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health. Article 21 of the Constitution guarantees protection of life and personal liberty to every citizen. Going a head the supreme court of India ratified health is integral to the right to life and the government has a constitutional obligation to provide health facilities to all citizens. Failure of a government hospital to provide a patient timely medical treatment results in violation of the patient’s right to life thus the Court has upheld the state’s obligation to maintain health services with certain standard norms.
The government needs to take affirmative and radical steps in improving quality access to health care and education as standards ratified in the constitution. As part of concurrent list political parties just not announce popular schemes to bag the vote but also announce high standard commitments on Health and Educating. And the commitments not just limit in construction of school building and scholarship for meritorious children.
Why claiming for better quality education and health is not bad, on this debate the popular citizen perspective on health and education would be the human capital development and in the progressive perspective, progress in health and education the counts the result outcomes against Human Development indices. This measurement relying on three indicators (Life Expectancy, Education and per capita Income), of which two are on health and education. The third one is pertinently interdependent on these two indicators. In spite of focussing on other aspects of development, political parties should also focus on strengthening the basic foundational and development needs of our children, adolescent and youth of the country. Over many decades no symbolic development in health and education is being realised in the country, only few accessing quality education elements and many are lagging behind.
Since several decades the state of health at primary health care and primary education at school levelis not delivering the principle deliverables related to access, quality, free and compulsoryprovisions. In health people spending their hard earnings to access health care and in education many schools does not meet the basic elements of Right to Education, according to governments own data the basic RtE norms are fulfilled only in 12.6 percentage schools at the country leveland the percentage is abysmally low with 6.7 %in Odisha. As per the TMST report, in Odisha, total estimated out of pocket spending (OOPS) on all types of medical care was `27.55 billion. The share of OOPS was around 80% which was much higher than the national average i.e. 70%. Of the entire OOPS, medicines are having the major share in public hospitals (India: 66.5%, Odisha: 62%). Besides this, thelife expectancy in Odisha is lower than the average years of national level. India counts its survival years at 67.9 and People of Odisha survive till the age of 65.8 years. Crude death rate also at highest level, at the national level the CDR in India is 6.5, the Odisha average stands at 7.6 in number. OOP expenditure per delivery in public health facility is estimated up to Rs. 3,198 in India and families in Odisha spend rupees up to 4,225.
Children stay out of school is very high in many parts of the country, as per the recent survey by W&CD and mission Shakti of Odisha in 2018 claimed that 55,868 girls in the age group of 11-14 years stay out of school.The DISE data shows gradual decline in dropout rates but in absolute term there are many children stay out from school. In accordance with the direction of the Hon’ble High Court, the School and Mass Education Department conducted a house-hold survey to identify all children in the state up to the age of 14 years and to ensure that they get facilities as per the RTE Act, 2009 and the Rule, 2010. From this survey, it is ascertained that 41,656 children found out of the school in the state during 2016-17. The number rise up high if calculated against the transit rate up to class eight.
The figures are absolutely worrying, adding to the access norm, the provisioning of teacher, doctor, paramedics in Education and Health is abysmally low as compared to the national standards norms, the country need near to 5 lakh doctors as per the WHO norm of one doctor to 1000 population, each year more than 67 thousand students join MBBS course, it would have resolves way back in one decade if all trained doctors retained. It is unfortunate that doctor education is largely managed by tax payer’s money. Showing different reason many training doctors are leaving the country and few don`t serve in public hospitals. Many alsodo not show interest to go and serve in CHC and PHC level. If companies, private and foreign nations drain our doctor, how is it possible to accommodate the public health standards of the nation and it would be very difficult to discharge justice without appropriate doctors retention policy.
After implementation of RtE Act, it is mandated that schools less than 60 student will get two teachers and proportionately more if the number of pupil is increasing. Most recent numbers for 2015-16 revealed that there were 97,273 single teacher schools in the country at the primary, upper primary and secondary levels which is about 8.8% of the total such schools in the country. Of these the largest numbers were in primary schools which is 81,893 such schools account for 83.6% of the total single teacher schools. 14,851 or 15.2% single teacher schools were at the upper primary level and 1,179 or 1.2% were at the secondary level. As per 2016, OPEPA (Odisha Primary Education Program Authority) data more than 1991 primary schools are managed by single teachers.
There is an acute shortage of health specialists in rural areas. In 2012, according to the World Bank, India had 0.7 doctors per thousand people. In contrast, the United Kingdom had 2.8 doctors per 1000 persons and China had 1.8 doctors per 1000 persons.
In terms of spending, the amount India spends on public health per capita every year is Rs 1,112, less than the cost of a single consultation at the country’s top private hospitals. That comes to Rs 93 per month or Rs 3 per day.At 1.02 percent of its gross domestic product (GDP)–a figure which remained almost unchanged in nine years since 2009–India’s public health expenditure is amongst the lowest in the world, lower than most low-income countries which spend 1.4 percent of their GDP on healthcare. In education the government spends around 27 thousand rupees to a school manged by the central government, which is meant for privileged classes of the society, in the same country the governmentis spending only 3 thousand rupees per student in schools where the most marginalised children’s are studying. The variance intentionally or unintentionally restricts many to access fair education and health opportunities. This is a gross violation and weakensthe principle of equity and equality.
The hue of uncared intention towards education and health manifests unhappiness and anger among the most deprived sections of the country. In order to strengthen the democratic function democracy represented by political institutions should ratify affirmative actions. The affirmative actions should be there in formulation of manifesto and election campaign. Moreover their vision statements should spell high order standards on education and health to all.
Parties should also take utmost care in addressing inequality issues and ensure access, availability, and quality.Adequate health and Education Services has to be delivered on free to all and maintain universal norms without undermining the provisions articulated in the Acts.
In April 2019 citizens of the country is casting votes to form government for the 17thLokSabha and state assemblies in few states, keeping this opportunity in mind demands political parties should do affirmative commitments on the below stated public demands on health and education
1) Frame fair legislations on health and include the same in the ambit of rights in the constitution
2) Allocate adequate resources from a current trend of low spendingto 3 % GDP to health and 6 % GDP to Education.
3) Strengthening public health and education systems.
4) Odisha state government should bring state policy on education and
5) Ensure implementation of RtE norms at school points in letter and spirit.
6) In Healththe public health standards should be installedat all levels with basic focus on recruitment of doctors, paramedics andregularisationof the existing man power engaged in health and education work at different points.
It is high time now to regulate private providers and the private institutions as they charge arbitrary costs on service users, patients and parents. In many cases it has been noticed that the private providers are violating the ethical treatment protocols of government.
Nevertheless the government should also amend the accountability framework and make institutions and individuals more accountable on service delivery, its quality and ethics.
Countries those perform better human development outcomes have taken sufficient measures in health and education and sustained the growth adequately. Therefore political parties must promise high standard assurances on health and education without waiting users to knock the door. Hence the current commitments only by few parties in the manifesto and political campaign does not enshrining the rights of people, the same has to be displayed by all parties, supremo’s and office bearers of political parties. All political parties should talk now on health and education and not just limit their optimistic announcement of popular cash transfer schemes.
Writer is a Social Worker based at Bhubaneswar