Need of Public health experts

India is a land of paradox. It has some of the best health care facilities in the world and emerged as the favourite destination for medical tourism. It is one of the largest exporters of drugs and trained medical personnel to the world. But a significant part of its own population is deprived of even basic medical facilities. Only 43.5% of children are fully vaccinated, infant mortality rate is 57(per 1000) and 56% of children of age under three are underweight (NFHS-III) and 25% of total TB patients in the world are in India. New public threats are emerging due to changes in life style for example India is now estimated to have around 120 million persons with hypertension and 40 million with diabetes (WHO). The emerging diseases and increasing population with migration of qualified manpower are going to put tremendous pressure on India’s public health system which is already in overstretched. Shortage of funds, physical infrastructure & medical personnel, poor quality of services, rampant corruption, poor governance, and lack of convergence among different vertical programmes further worsens the problem.

Though India lacks the financial and human resources to eradicate all disease and provide universal health but the major problem is that existing resources are not optimally utilized due to absence of leadership with solid managerial and public health skills. The lack of public health expertise resulted in poorly designed health programs which were ineffective and inefficient. Health programs were independently implemented instead of adopting inter-disciplinary approach; design and delivery of health programmes doesn’t factor social, economical and geographical barriers like poverty, illiteracy, regional and gender disparities; available resources were either underutilized or poorly utilized for example, in the year 2008-09 out of Rs 373 crore allotted by Government for human resource development for health but only Rs 74.64 crore were utilized; similarly grants provided by other countries, bilateral and multilateral were also underutilized.

Hence the first priority for improvement in public health system should be to develop pool of qualified manpower with good managerial skills. Considering that developing human resources is a long term process, Government should estimate the future requirenments of qualified manpower and accordingly work on developing pool of qualified manpower.

Wastage of resources

( Taken from India today - 22nd October 2009)

According to a report by the Comptroller and Auditor General (CAG), as of March 31, 2009, India is sitting on an unutilised foreign assistance of a whopping Rs 78,037 crore. This has been mounting from Rs 56,920 crore in 2001 to Rs 75,935 crore in March 2007. Even as the country's external assistance has grown, usage has declined from 78.65 per cent in 2000-01 to 61 per cent in 2006-07.

Worse, as India negotiates more loans, an internal assessment of the Finance Ministry reveals that the government has been paying commitment charges of several hundred crores of rupees every year. Between 2004-05 and 2008-09, the government paid close to Rs 700 crore for the non-disbursed portion of sanctioned loans to the World Bank, the Asian Development Bank (ADB) and some bilateral donors.

An estimate of such expenditure since 1991 puts the figure upwards of Rs 1,400 crore. Efficient use of these monies will obviously help push the vision of inclusive growth by putting the economy on a sustainable growth trajectory, creating faster and more productive employment and reducing poverty.

The question is, since India cannot deploy the resources, why does it need to borrow so much? Some of the reasons are-

a) Inefficient handling of land acquisition, site handover, utility shifting, rehabilitation and dispute settlement

b) Unavailability of qualified contractors, engineers and consultants with the required domain expertise

c) High fiscal deficit limits the ability of states to share costs of infrastructure development

d) Poor monitoring and evaluation. There is a paucity of qualified and trained people for this task

 

Considering the poor state of infrastructure and public services, Government and civil society should take this issue seriously. It is a luxury which India can't afford.

Public Policy problems in india

Designing and implementing of public policy in a country like India is a huge task. But in last three years while working in development field, I found that there are some very obvious problems with the way the public policy are designed and implemented in the country. Some of them are –

1. The policies are formulated by the concerned department/ministry but their successful implementation depends upon contribution of different departments/ministries. In the absence of a joint implementation and monitoring system often policies are not implemented properly.

2. Planning and implementation of public polices failed to factor in social, economic and geographical barriers like poverty, illiteracy, regional and gender disparities.

3. Planners and implementers are accountable only to their higher ups but not to the public or stakeholders who are directly affected by those policy.

4. In most of cases before policy formulation not all the stakeholders are consulted which results in opposition by certain stakeholders at the time of implementation.

5. Not enough discussion takes place in parliament before taking major policy decisions. Specially in last few years, the number of Parliament work in a year is decreasing steadily

6. In many cases the policies are formed by Centre but they have to be implemented by states and states depending upon their priorities and availability of resources implement those policies. It results in uneven implementation of policy among different states.

Government and civil society is aware about these problems. But still nothing has been done to rectify these problems. Considering the impact and importance of public policies, there is immediate need of overhauling the complete public policy making mechanism in the country. There is need to make it more responsive to the country’s need and requirements.

Public Policy as a discipline in India: Still in infancy stage

Even after sixty two years of independence, a significant percentage of population is deprived of basic amenities which show the failure of policies adopted by successive government. Though a lot has been written on lost opportunities and government failures but nothing concrete has been done to correct those mistakes. I was trying to understand why public policies in the country have failed consistently. I searched for the relevant material on internet but barring one paper couldn’t find anything useful. I searched for the courses in public policy, found a few but the course contents were nowhere near to courses offered in developed countries. I couldn't understand that why in country like India with poor social and physical infrastructure, and inefficiencies in delivery of basic public services, Public policy as discipline still in infancy stage. Though IIM A and B started a course in Public Policy but the intake is limited and it primarily focuses on officers from various government services. The works of so called “think tanks” or on policy research by some institutes are limited to studying the implementation of some government programmes in a district or at state level. There is serious shortage of people with understanding of public policy designing and implementation. All developed countries and many of the developing countries like China, Japan, Korea, and Singapore have institutions dedicated for researching public policy related issues and imparting knowledge in public policy domain. The output from these institutions is of high quality and helps the government in making right decisions. There is immediate need to develop world class institutions for imparting knowledge in public policy domain and studying the public policy challenges in the country. .