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Primary health and primary education in India are neglected areas

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 Pooja is.
 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 Indias 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 PHCs 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 structure.

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 results.

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 teachersprofessional development. The NEP lately has addressed most of the visible shortcomings that are tormenting the overall education sector.

The invisible challenge: Children falling behind

There 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 GDP.
 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 primary education.

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”