Pooja’s mother Kantadevi is an Asha worker
and also a member of a self-help group in the vicinity of Meerut. Although coming
from a poor family having limited means, she educated and nurtures Pooja to the
best of her ability. Taking available help of government under ‘National Health
Mission’ she was able to raise a healthy daughter. Moreover under mandatory 25%
reservation of the EWS section she passed 10th from a renounced
private school of Meerut.
Now in 2020 Pooja is a well-acclaimed surgeon
in Delhi serving thousands of patients in AIMS.
The success of Pooja was only possible because
her mother is taken care of in both aspects: her primary health as well as her
basic education. Sadly most of the children of our country are not as lucky as
In the following essay, we will discuss issues
revolving around neglect of primary health and primary education in India.
Primary health and India
After Independence, there has been significant
improvement in the health status of people. Though the situation is still worrisome
as per the study of WEF (World Economic Forum). It has placed
India in 150th position among 191 countries of the world. Even Bangladesh, Nepal, Sri Lanka is ahead of India. Being a diverse country
with a bundle of resources, India is still deficient in delivering basic quality
life to its citizens who are suffering from acute hunger and one of the worst
health crises of the century (covid-19). In time there is an urgent need to
understand the realities of primary healthcare in India.
To begin with, the most serious drawback of
health service is the neglect of rural masses, hilly, and remote areas.
The SC/ST and the poor people are the ones who feel the brunt of this disparity.
Although there is a large number of PHC’s and rural hospitals, yet the urban bias is visible.
Almost 31.5% of hospitals and 16% of hospital beds are situated in rural areas
where 75% of the total population resides. The panacea to this mess is that a Doctor in
the government service must mandatorily serve in rural areas before getting
his/her first promotion. (As suggested under National health mission) moreover, the conversion of primary health centers (PHC) into health and Wellness Centres
recently in some states like Tamilnadu proved instrumental.
Instead of evolving a health system dependent
on paramedical (like bare-footed doctors in China), India is still hanging on
regular doctors. This is because India doesn’t develop its own indigenous
The primary health system of India depends almost
on imported western models. It has no roots in the culture and tradition of the
people. It has completely neglected preventive, pro-motive, rehabilitative, and
public health measures
Furthermore, the government contribution to the health sector constitutes only 0.9 percent of the GDP. In India, public
expenditure on health is 17.3%, while in China and Sri Lanka it's 24.9% & 45.4% respectively. Therefore public
funding on health should be at least 2.5% of GDP as envisaged in the National
Health Policy2017 to target some structural changes in the long run.
Considering future developments of medical
research, the country needs to be focused on drugs and vaccines for tropical
diseases which are normally neglected by international pharmaceutical companies
on account of their limited profitability potential. National health mission
should take note of it in his future policies.
Lastly in India, health services especially
allopathic are quite expensive. It hits the common man hard. Therefore more emphasis
should be given to the alternative systems of medicine. Ayurveda, Unani , and Homeopathy systems are less costly substitutions. Lately “Ayushman Bharat
program”, an umbrella health scheme has done well to understand the
complications of primary health and child malnutrition giving encouraging
Primary education and India
Increasing the supply of inputs such as
infrastructure or teachers in India's primary education system can ensure 'schooling
for all' but not 'learning for all'. In recent decades India has made
significant progress on access to schooling and enrollment rates in primary
education but dropout rates and low levels of learning remain challenges for
the state and central governments.
All currently available data on student achievement
suggests children are performing far below the level that is expected of them.
Take a typical standard, five classes. The estimates from the oft-quoted Annual
Status of Education Report (ASER) suggests that of all rural children
enrolled in standard five; only half can fluently read text from a standard two
textbook. In arithmetic, only half of all standard five children can do a basic
two-digit subtraction problem. This data paint a very gloomy picture of primary
education in India. The major reasons for this neglect in primary education are
the inherent challenges associated with it.
The visible challenge: Inadequate inputs
If you ask teachers or officials about the
biggest challenge for improving learning outcomes they will probably point to
the numerous gaps in the system. Some schools continue to lack adequate
infrastructure; several states still face an acute shortage of teachers. Many
will complain about the poor quality of institutional support for teachers’ professional
development. The NEP lately has addressed most of the visible shortcomings that
are tormenting the overall education sector.
The invisible challenge: Children falling
is another less visible problem. Again taking the example of a typical fifth standard
classroom. Here teacher faces a classic dilemma: Should he focus on those
children who have basic skills, who are more likely to attend school regularly
and, are, therefore, easier to teach? Or the other half of the class who are not
even at standard one or two-level? Sadly, it appears that most of the educated
citizens, education experts, planners and policymakers, Union, state and local
governments do not see this problem, let alone fixing it.
“Education, work, and access to health care are key
elements for development and just distribution of goods” Words of Pope Francis
Deciphering the twin problem
In a developing country like India Education
& Health is Social Investments, not Just PublicExpenditure.The NCMP (National Common Minimum Programme) aims
to increase public expenditure on Education to 6%and on Health to 2-3% of the
Likewise, the government must prioritize the needs
of traditionally marginalized groups in their all-round development. The
poorest districts of the country and most vulnerable groups– including Women,
Children, People with Disabilities, and communities like the Dalits, Adivasis,
denotified Tribes, and Muslim Minorities – must be the focus while planning for
basic health and education amenities. The cluster model of having hospitals and
schools in the same building suggested by the national educational policy can be a game-changer. It can be applied in convergence with the mid-day meal scheme.
Tamilnadu’s sub-center Model providing
the first contact point between the primary health care system and the community along with the hub and spoke model is worth considering. In Kerela
digital education initiative called “first bell” during covid 19 can be
implemented pan India with certain reforms.
Moreover, the quality of services even in the
poorest areas of the country should commensurate with the standards and norms
envisaged by the National Development Goals. National education policy “aspirational
districts program” gives flexibility to the areas which need special
attention in the education sector. Similar reforms can also be undertaken in areas
that need maximum primary health care recognition.
In hinterland and urban slums, even the poorest
families spend as much as Rs.350 per child per year (which amounts to more than
10% of the monthly income of a family that is able to earn Rs. 100 per day) for
uniforms, stationery, transport, and more if tuition is added. Increasing the penetration
of health insurance in order to minimize out of pocket
expenditure along with the strengthening Right to Education to the poorest
of the poor can resolve the problem.
Recently Himachal Pradesh launched the “Suraksha Tablet”, a single dose misoprostol tablet to be administered after
delivery, in order to prevent post-partum bleeding and consequent death
serves well in promoting primary health from inception. These initiatives by the state government can be more effective rather than a rigid centralized scheme
as state government are more familiar with the ground realities
Lastly New Education
Policy, which stresses on improving school outcomes through 5+3+3+4 the system, teaching in mother tongue aims at revolutionizing primarily education the system in India, though the key to success lies in its implementation
In the final analysis Health and education
are the 2 pillars on which the structure of our human capital stands. If India
wants to reap its demographic dividend, stand as Atam Nirbhar Bharat, and reach
a goal of 5 trillion economies the answer revolves around primary health and
In the future, we resolve to produce Pooja in
every home so that they not only empower herself but her family and those
families will empower the entire India.
As it said “change only a village, the village will change the whole country”