Education for All

Well another social issue which is quite the double edged sword. As most Indians must be aware, the government has a program called “Sarva Shikshya Abhiyan (SSA)” or “Education for All”. The government has made primary education compulsory in the country and provides the same either free or at nominal cost (with special focus on girl’s education :)). The aim is obviously to increase the literary rate in the country. And as we have seen in the past few years, Indian “minds” are becoming quite the hot property world over. Like I have said in many of my previous posts, in a country as diverse as India with wide socio economic disparity, cultural disparity (and sometimes even baseless theories), this move deserves kudos and it is bearing fruit. The literacy level in the rural area has been increasing at a greater rate than the urban literacy rate.

But there was an issue that gained a lot of media attention a couple of years ago. In a Delhi school comprising of children belonging to the higher middle class and the “Page 3” of society, the parents raised a hue and cry over the government of India’s rule that each of these schools should include a minimum number of students belonging to the poor sections of society. Parents cited the reason as the negative effect such kids would have on the students of this “crème de la crème” of society.

From the point of view of parents and students studying in the school, this is a perfectly valid point. One pays a premium fees at private schools to provide excellent education for their children. Of course the environment and fellow students have a big role to play in providing the “excellent” education. So parents are bound to get anxious when their children are put in the same environs as students from poor families. Since bad habits are easy to pick-up, these environs are bound to affect the language, the behaviour and sometimes even the thought process of these students. At the same time, the poor kids are bound to experience an inferiority complex giving rise to “the evils of complexity”.

However, from the point of view of the government, this issue should be seen in a different light. The government of India is answerable to every section of society and every individual of the country. Through this move, they are trying to improve the standard of living of the future generation. Now this is a way of the government to ensure that every child receives an education. But for the poor families, it’s about giving their child a better education with the hope that one day they will be able to change their future for the better. It’s about making an opportunity equally and fairly available to every child.

Which parent would not like to see their son or daughter to grow up to be a young confident person who does not see any limits in life and who thinks big! While I am not saying that a public school education is incapable of helping achieve this dream, the chances are generally perceived to be higher in a private school.

This is where I feel the school plays a very key role in integrating both these sections of society together and ensuring equal opportunities to all. It is actually the task of the teachers, staff and faculty to bridge this divide and at the same time ensure that the students are taken care of especially emotionally. I am proud today that I went to a convent school which provided subsidized and free education to a few students every year. I did have some classmates who belonged to not very financially stable families. But once in school in our uniforms, there was no divide and no discrimination. While I am not anyone to comment on the positive effect we had on them, I am happy to say that to a great extent, my school has been responsible to a great extent in shaping the person I am. One not only learns to be sensitive to the differences in society, but more importantly becomes a more balanced and reasonable person. The family obviously has an equal role to play in this.

While this is not exactly relevant to the previous case, two other interesting articles in the paper in the last two days got my attention to this topic. That of children born with autism and ‘Down syndrome’. Both articles had a similar theme. These children can grow up to lead a good and independent life if they receive an education at regular school along with other “normal” kids. Studying with children in a regular school (as opposed to receiving an education from a special school), these children learn faster, learn how to deal with everyday situations, learn what to say and when to say it, learn to appreciate their own success and that of others. This is because they learn a lot through imitation. There are regular schools in USA that have special integration programmes for students with ‘Down syndrome’ and autism.

This is good not only for students with special needs but even for people like you and me. These children don’t need our sympathy (and I hate it when somebody calls them “bechara”). They need our support and they need to know that they are equally capable. If there is anyone who needs special attention, its “normal” people who get uncomfortable in their presence and don’t know how to behave. Its principals, faculty and parents of schools who refuse to admit such students. It’s people who look at this world in monotones. So really, it is us who need special attention and education!

Democratic evils and the silver lining…

Well this one is a sequel to the previous post. I didn’t expect to write on this subject so soon again. But there have been some developments and stories in the news yesterday that are worth the mention here!

The National AIDS Control Board (NACB) has recently announced that it will provide free second line ART treatment for AIDS in four cities of India – Delhi, Kolkata, Ahmedaba and Hyderabad. In addition, it will launch this program in four more states from December. Several doctors from these states will be sent to Thailand for training on how to properly administer this treatment. Btw, Brazil provides the second line ART treatment for free in a national move to help contain the spread of AIDS and AIDS related deaths in Brazil.

For more, you can read the same on:

http://timesofindia.indiatimes.com/HealthSci/Second-line_drug_free_to_combat_AIDS/articleshow/3170106.cms

But that was the good part. There was also an article in the paper that reaffirmed the ironic state of medical education. Private medical institutions are sprouting up all over the country. Rural stint is not mandatory if graduating from a private institute. Since one ends up coughing a sizeable amount for medical education from these private institutes, graduates are in hurry to receive their return on investment as soon as possible. Therefore, such students end up seeking jobs with private hospitals and do not prefer the public hospitals which typically pay less than most private hospitals. Fair enough.

Additionally, another news article stated that resident doctors in hospitals are highly susceptible to tuberculosis due to lack of hygiene and sufficient protective gear and sanitation. Given these conditions, how can we expect these doctors to consider public hospitals? And for those who are currently working there, it is absolutely dangerous to put them through these unhygienic working conditions. Not only are we putting them through danger, it is also dangerous for the other patients.

So the question arises, that while there are some silver linings in our public healthcare system, are we equipped for this? Have we reached a point where so much damage has been done that it will be very difficult for us to address this issue? Well the optimist that I am, I don’t want to believe that there is no way out. But sometimes, Reality Bites!

Democratic Evils

A new post has been so long overdue that it’s beyond the point where I can make excuses about it. I have thought of a million topics I wanted to write a post but somehow, it never happened. And then just now I watched an ad on television which said “Stop Talking. Start Doing”. So I am going to do just that :)

I am currently working on a project with a global consulting firm in India on the healthcare sector of our country. Of course I cannot divulge details of the project (confidentiality issues of a consulting firm ;)). Now, I have been doing a lot of research on this subject and believe me it is an eye opener!! Here is my take on the sorry state of our healthcare sector. (Something you won’t find in our project ;))

Background:
Healthcare sector can be divided into pharmaceutical and medical sector. The medical sector in turn comprises of public healthcare sector and private healthcare sector. Your public sector typically consists of facilities and treatments provided by your central and state government. Private providers include NGOs, not-for-profit organizations and the for-profit organizations.

The cost of treatment in a public centre is highly subsidized and free in cases of some treatments. However, for the same treatment, you could end up playing 2 to 3 times more at a private hospital and almost 20 times at a private dispensary for common non-hospitalized ailments. Therefore, it is the duty of the government to provide affordable and accessible treatment to all sections of society. Their motto, of course, being “Health for All”.

Reality Bites:
Unfortunately, the true picture is not only alarming but also depressing to a great extent. 40% of the population in our country go under heavy debt due to a single hospitalized treatment. Most of them finance the same through borrowings from friends and family. But what is more surprising is that the most affected population is not the ones who are ‘Below Poverty Line’ (BPL) but the middle class segment that is the most affected. The reasons for this being (in short without divulging into too many details):

· Preference for better medical care and service which is unavailable at a public hospital. The perils of awareness and literacy!! (There is a brilliant statement in the report for this…but damn I cant use it).
· Lack of accessibility to public providers in our country.
· Perception (which is partially true too) that private providers have better doctors.

Isn’t it ironic, don’t you think?
While analysing the reasons for the same and reading up on the healthcare sector of the other countries of the world, what was ironic was that countries like China and Cuba (with all their economic problems like India) have excellent public healthcare system. The issues of accessibility, quality and affordability have been addressed there and they have truly provided health for all. The reason I think they have been successful at this…Socialist/Communist political system in these countries. And then I wonder, is democracy a deterrent for our country?

Funds are not an issue in our country. Both the central and the state government have enough funds required to provide quality healthcare. In fact, at many a times, funds are under-utilized in India. However, what is lacking in our country are the following:

· Lack of stable political system: In our country a lot of time is wasted in waiting for approvals and bills to pass through. Then if we are lucky to get these processed fast, the actual implementation gets delayed and sometimes even halted. While the Gujarat government has been successful in reducing this bottleneck, the question arises…why cant the rest of the country?

· Lack of qualified resources: Qualified resources are a scarcity in our country (please note, the government is not even adding the clause “good”. Just “qualified”). That’s the extent to which we lack qualified doctors and nurses. Cuba provides free medical education to all medical students and over and above that binds every student to a contract where they have to necessarily serve the public sector for three years or else pay a very heavy fine. While I am not advocating free medical education (in a country where you are expected to be a doctor or an engineer, this cannot exactly be implemented ;)), the mandatory public service should be implemented honestly. In fact, the migration of doctors outside Cuba not only reduced, but today there is a surplus of doctors in Cuba.

· Bribery and “working around the system”: Neha said something today to me that at the point seemed very funny but it’s so true. In India, if you need to get anything done, just be prepared to “shell out money and give it below the table…that’s it. Your work will be done!”. So this very easily gets you out of the compulsory public service.

China, Cuba and other developing and emerging countries are faced with situations very similar to India. Wide socio-income divides, poverty, illiteracy etc. But because of their communist and socialist outlook, they have implemented policies and no questions asked. No opposition parties, no unions. They “Stopped Talking and Started doing”.

There have been successful initiatives in India in Tamil Nadu, Delhi and North east India. However, they have all been isolated initiatives and have failed in other parts of the country. There seems to be a lack of will on part of the state government and sometimes, a certain degree of helplessness. China has been the fastest growing developing nation in the world and as far as healthcare is concerned, it’s definitely not “Third World”. Cuba is a very high Human Development Index (comparable to developed nations) as far as healthcare is concerned.

While I am not advocating socialism or communism, I wonder that in a country as diverse as us with diverse economic and cultural disparity, would such a system have worked better. Would such a system address issues of disparity and inequitable distribution of resources? Would it truly provide “health for all”?