Inadequate government funding keeps healthcare, education in crisis mode

Tackling a once-in-a-century pandemic and its cascading effects, passing key policies and laws, and yet implementing only incremental reforms instead of systemic ones – this summarises the government's 10-year report card on health and education.

The covid test

The pandemic exposed chinks in India's public-infrastructure armour in both education and health, and its urgent need for funding. Yet, money ploughed into these ministries has been range-bound, and their collective budget for 2024-25 as a share of GDP is lower than pre-covid levels, even as tax collection has hit new records.

Views about the government's pandemic response remain polarised. While the vaccination of over a billion people was creditable, the loss of lives exposed administrative deficiencies. "In hindsight, covid management could have been better," said K Sujatha Rao, a former union health secretary. “While the introduction and scaling-up of vaccinations was extremely creditworthy, the huge amount of human suffering, be it in terms of loss of life or jobs, could have been avoided or substantially reduced had policy been based on public-health principles."

Mampi Bose, a faculty member at Azim Premji University, said that while covid-19 laid bare the importance of health research, it did not lead to bigger budgets for this.

Education was badly hit, too, as school closures and economic distress cut short many children’s studies and caused them to shift from private schools to government schools. As classrooms went online, the entire system was caught unawares and the resulting learning losses could take years to undo.

Ayushman Bhava?

Ayushman Bharat, launched in 2018, is one of the government's flagship health schemes. Its two components—revamping existing primary healthcare centres and giving ₹5-lakh-a-year insurance cover to poor families—aim to provide need-based care.

Having catered to 63.3 million hospital admissions worth ₹79,664 crore to date, the scheme has helped many Indians reduce their out-of-pocket spending. Participation from government hospitals has improved since its initial days, said Oommen Kurian, senior fellow at Observer Research Foundation, adding, “Now there are more government hospitals than private ones in the scheme, thus offering additional resources to the public health infrastructure."

However, the insurance cover component (Pradhan Mantri Jan Arogya Yojana, or PM-JAY) has seen a consistent, gross underutilisation of funds. Anaudit by the Comptroller and Auditor General in 2023 also found implementation problems such as delays in hospital empanelment and processing of rejections, and dead patients availing treatment.

Experts also point out that allocation for primary healthcare needs to go up. “More investment is needed in primary and preventive care and infrastructure for curative services," Bose said.

Fighting diseases

India’s non-communicable disease burden has risen sharply due to fast-food consumption, limited policy action and sedentary lifestyles. A 2023 health ministry-funded study showed that 11.4% of Indians aged 20 and above (over 100 million) are estimated to be living with diabetes, while 28.6% are obese.

The government has rolled out screening programmes and affordable cardiovascular and diabetes medicines under its generic-drugs scheme, but regulations to tackle “high fat, salt and sugar" foods are weak. The food safety regulator’s 2022 proposal to introduce star ratings to red-flag unhealthy packed foods is in cold storage.

Meanwhile, maternal and child deaths have come down – infant mortality by 28%, under-five mortality by 30%, and maternal mortality by 25% between 2014 and 2020 – showed latest-available data from the Sample Registration System. Some impressive outcomes were also seen in malaria control and immunisation, Rao said.

On the flip side, the government has failed to meet its elimination and prevalence reduction targets for infectious diseases such filariasis, kala-azar and tuberculosis.

Several other initiatives to tackle issues around nutrition, housing, drinking water, indoor air pollution, sanitation, and rural roads have also had immense positive externalities on healthcare issues, Kurian pointed out.

“However, despite a solid foundation and a tech backbone for a universal healthcare push being prepared over the last decade, we have yet to see focused, additional resources being ploughed into the sector as seen in drinking water, sanitation and housing," Kurian said. “That remains the binding weakness, and the primary reason behind the shortfall of human resources and high vacancies in public healthcare, despite improvements."

Policy leap in education

One initiative that the government counts as a milestone is the 2020 rollout of the first revision to the National Education Policy (NEP) in nearly three decades. The NEP has been lauded for a focus on improving early-childhood learning through foundational skills.

“This new policy did three things simultaneously: it acknowledged the vital importance of early childhood education, elevated it to the status of school education, and integrated it into the continuum of educational opportunities offered to children," non-profit Pratham Education Foundation said in a 2022 report.

However, setbacks haven't been far behind. Experts have said the exit options now available at various stages of college could encourage students to drop out. With education being on the concurrent list, the cooperation of states is vital to its success, but some states governed by opposition parties have voiced concerns about it while others have talked about ditching it entirely.

Education = employability?

More children are now in schools, especially at the secondary level, which had previously been a huge challenge. The gross enrolment ratio—children enrolled at a grade as a share of the population in the relevant age group—for higher secondary rose from 44.5% in FY14 to 57.6% in FY22.

But with the spotlight increasingly on learning outcomes and employability, these successes won’t suffice. Pratham’s surveys have shown little improvement in reading and numeracy skills among children, and a Wheebox survey showed just over 52% of young adults are ready to enter the job market. While the government has made progress, its record on adequate budgeting and calibrated reform remains sketchy.

This is the fourth part of an ongoing Plain Facts series covering the top election issues as well as the current government’s report card after nearly 10 years in power.

Part 1: In charts: Story of polls, freebies and politics

Part 2: Why low unemployment rate hides the full picture

Part 3: A decade of flip-flops on farmers’ issues