The Turnaround of Health and Education in a Beleaguered State: Public Policy Implications for UP

Rajesh Chakrabarti

Bihar: A snapshot • India’s 12th largest state • 3rd most populous, • More people than Germany • GDP similar to Uzbekistan, • Per capita income comparable to Eritrea • Riverine, fertile, flood-prone • Fractious, caste-based social and political order • Largest “poor” population in India, with over 2/5th of the population below poverty line • 26 of its 38 districts belong to the 69 socio-economic ally “backward “districts in India,

Bihar, circa 2005

• Relative decline of Bihar in the 90’s: – Bihar’s PCY as % of India’s – 1985: 59%; 2005: <26%. – Only state in India with de-urbanization:

urban population: 1981: 13%; 2001: 10% – Law and Order in shambles; Kidnapping for ransom an

“industry”

The “turnaround” during 2005-2010

• Law and Order: 2004: 2008: – Dacoity 1297 640

– Robbery 2909 1536

– Road dacoity 287 146

– Kidnapping for ransom 411 66

• Road building: 2004-05 2009-10 – Km of road built: 385 3474

– Expenditure incurred 236 3045

– Travel times have fallen by more than 50% between most parts of the state.

The “Turnaround” in Health & Education

• Before and After: 2004-05 2010-11

– Avg. Footfall per month 39 5200 in health care facilities

– Institutional child delivery ~45,000 1.246 m

– Routine immunization < 20% 67% (> all-India avg.)

– Out-of-school children in 2011 reduced by 85% from 2005,

– Drop-out rate in 2011 was a sixth of what it was in 2005.

– The teacher student ratio had dropped by 40%

The “Turnaround” in Health & Education (contd.)

• Before and After: 2004-05 2010-11

– Schools with at least a toilet 27,000 45,000

– Schools w Separate girls’ toilet 8,000 31,000

– Drinking water availability 45,000 64,000

– Children receiving textbooks 76 lakhs 199 lakhs

– SSA fund utilization 300 cr 4500 cr

Social Infrastructure: Health

• Focus on PHCs

• Monitoring doctor attendance

• Public-private partnership approach – Co-opting the competition where monitoring does

not work

•Funding from National Rural Health Mission (NRHM)

• Free drugs •Incentives for institutional delivery

Social Infrastructure: Education

• Enabling access to schools • Filling teacher gap • Monitoring teacher attendance • Monitoring schedule in higher education

The Monitoring Mechanism • To monitor the attendance of the primary school teachers • PPP model by outsourcing virtually everything – starting from machinery and telecom, to bill-payment and people. • A team of 60 people was hired; all 60 would sit in the headquarters, of which 38 would be in the call-centre. • These call-centre executives were all management graduates. They would talk to the schools, take the reports, analyze them and then submit it to the higher bureaucracy in a cohesive format. •This was a big contract—Rs 1 crore a month—and there was good participation from companies like Wipro.

Challenges remain…

• Let’s face it: Bihar is no heaven on earth today – The “Quality” challenge

– Supply of qualified personnel (23 ANM and 6 nursing colleges)

– Of quacks and tutors • Universal tutoring: good or bad?

– The health and education infrastructure • Schools and health centers

• Building and maintenance

– Leakages out of the system

Pitfalls and caveats of the study

• Not a scientific “Evaluation” exercise

– No benchmarking, attribution , RCT

• A focus on inputs and intermediary variables

• Outputs – knowledge and health conditions – need to be measured

Sasaula, Sitamarhi…

Images from Sasaula

Not just stats: An outsider’s assessment

HOW WAS IT DONE? – A CASE STUDY

Harder questions:

• Can it be replicated elsewhere?

•If Bihar can do it, no excuse for anyone else

• Is the change permanent?

Thank you