It was one fine Sunday afternoon in the mid 90s. I was at Koshy’s restaurant in Bangalore with friends. We were at our mandatory extended Sunday drinks and lunch ritual. P V Narasimha Rao was the Prime Minister. India’s liberalisation programme was going ahead. After years of license raj and economic locked down, we were looking forward to a promised global village. The discussion veered towards the then current politics, a new era that was about to dawn on because of the impending liberalisation. Sridhar shook his vigorously, chuckled a bit as he always did when he came across a foolish idea, and said that we were on a tinderbox, this results of the liberalisation won’t be pretty he argued. I strongly argued for liberalisation, especially looking forward to buying cameras and accessories without having to pay 250% import duty.
We did liberalise, we did globalise. The process had its benefits and positives. However, there is a long and alarming list of things it didn’t accomplish.
By the early 1980s, the share of the top 1 percent was a mere 6 percent of national income. But in 1991, liberalisation precipitously widened disparities again. The top 1 percent now enjoys almost 22 percent of national income, and the richest 10 percent own 80 percent of the wealth, making India one of the most unequal countries, wrote Pulin B Nayak was a professor of Economics at the Delhi School of Economics in New Indian Express.
Poor became poorer, inequality widened, the toll of the environment – extreme. It didn’t bring in any good the fundamental level. We remained a rich yet poor country, full of resources but many poor people..so on and so forth. Our population in the early to mid 90s was about 92-95 crores. Today we are 130. By 2017, 73% of the wealth went to that 1%
Today a handful of mega business people and policymakers seem to be controlling everything, including our thoughts. They mandate and most of us gleefully follow. The current pandemic situation exposed the weakness of our minds and the hollowness of our thinking.
“The gap between rich and poor can’t be resolved without deliberate inequality-busting policies, and too few governments are committed to these,” said Oxfam India CEO Amitabh Behar
If you ask any small business owner how his or her business is doing, you’ll hear words like – “bad, “terrible”, “nightmare”..etc. They say that no one is buying anything including vegetables as they used to, because they do not have cash. Yet, in this current period, Reliance Industries raised over Rs.53000 crores in a rights managed share issue!
This gross inequality and our skewed definitions of success, I believe is the root cause of most of our problems including the destruction of the environment. However, we are not questioning any of these critically largely because of our primary and secondary education system, which is a remnant of the colonial times. Brits set it up to produce clerks and we have been doing since then. I have been teaching in art schools for the last 7 years. I don’t teach them photography or film making – I help them to ‘see” to make them realise that they have a voice and help with ways and means to develop it. I see them struggle to grasp that they have an independent voice because of the 12 years of indoctrination.
I wanted to understand the issues plaguing our education system, so I placed a call to Prof. Pankaj Chandra, the Vice-Chancellor of Ahmedabad University. He is one of the senior-most academicians of this country; he was formerly the director of IIM-B. I had just one question. How do we make our primary and secondary education better in such a way that the students develop abilities to think critically and conceptually?
He suggested changes in four areas
- Do away with standardisation
- Structural autonomy to schools
- Transdisciplinary learning
- Embed capabilities to address real life challenges
Standardisation was the first word he said. About 15-25 lakhs of students take 10/ 12 standard board examinations every year in India. All they go through years of a canned method of learning, evaluating, and teaching. We need to change this. Perhaps standardised examinations could be done away with and leave all schools to be unencumbered he said. A start would be to make a 1000 schools experimental – that do not conform to the norms of standardisation. he added.
Prof. Chandra says that the future of primary education is structural autonomy. Is it possible in the current system? Within every confined and pre-defined structure, you can find space to innovate. Real issues and problems have come into our home and we have addressed them. Only then will we ask critical questions.
Pandemic will force us to relinquish disciplines he says – Can we address climate change with history, philosophy, and science? He asks. Should history by just documenting the reigns on kings and wars? Can it be contextual, can all our learnings be contextual? What is education worth if it can’t address real concerns? Hence make learning transdisciplinary and embed capabilities into the system to address real life challenges.
These are meta changes of course. There would be several challenges in macro and micro levels. Teachers and educators need to be trained better, need to be trained continuously and they need to be paid better. Corruption in hiring teachers to government schools needs to be rooted out…well the list goes on…
The second and as important issue is of public healthcare. India spends 1.28% of its GDP or 5% of the total expenditure on public healthcare. This includes the expenditure on medical and public health, family welfare, and water supply and sanitation. As per the recent data available, there are 11.59 lakhs registered medical practitioners in India, Which makes it .9 doctors for 1000 population. This is still way below the OECD average of 3.2 (https://data.oecd.org/healthres/doctors.htm ). As per the Economic Survey of India 2019-20, we are yet to reach the WHO mandate of a doctor-patient average of 1:1000. Less said the better about the primary healthcare centres of rural areas. Expenditure on healthcare is the major reason for pushing people deeper into poverty. This is because of the exorbitant fees private hospitals charge and the unaffordable cost of drugs. On the other hand, 17-18 of the 100 richest Indians are from the pharma/healthcare sector!
Prime Minister’s health insurance for the poor apparently has seen 1 crore people enrolling. However it’s not a solution, universal access to affordable healthcare is.
A few weeks ago, I heard a ‘Townhall programme’ anchored by Prannoy Roy. The subject of course was all about the Covid-19 pandemic. One of the participants, the current global CEO of IBM, Arvind Krishna. He was suggesting using their AI technology to be an intermediary so to speak. He said that since India didn’t have public health infrastructure and enough healthcare practitioners in place, technology could be used. An IVR operated system, backed by AI can help he said. Patients from rural areas can call a number, IVR could screen them and point them in the direction of a healthcare practitioner if need be he added. He didn’t forget to mention it wouldn’t cost too much. I was not so sure about this idea. How many languages will the AI system need to learn I wondered? So I placed a call to Dr. Unni Karunakara, ( Shinhan Distinguished Visiting Professor at Yonsei University and Assistant Clinical Professor at Yale School of Public Health) and asked two questions. How do we improve India’s public health infrastructure? and secondly, can technology as proposed by Arvind Krishna help?
Unni told me an interesting point. Yes, India needs to spend a lot more on public healthcare. He pointed out that the ability of the states to absorb the spend on healthcare itself is low, hence a lot of the money sent by the centre remains unspent. That’s an area our governments need to work on. While technology can help in diagnostics and testing, there is no evidence of telemedicine bringing down the mortality rate he added. Unni also pointed out that to make it attractive for doctors and healthcare professionals to practice in rural areas, there needs to be supporting infrastructure and such as good schools, connectivity, power ..etc as well. He also stressed the need for an increased number of primary healthcare workers.
I also spoke with Dr. Regi George of the Tribal Health Initiative in Sittilingi in Tamilnadu. Regi and his wife Lalitha set up THI soon after their graduation and have done fantastic work over the last —decades. (You can read their story here). He too was skeptical about using AI-powered IVR for screening patients in a country as complex as India. However, it is important to ramp up public health initiatives in India. Rural areas have many quacks. These are compounders who were working in clinics. They don the roles of doctors in rural areas and treat many common ailments. Dr. Regi thinks it would be good to co-opt them, train them, and use them as secondary health care providers.
Hygiene, hygienic habits are lacking. Good nutrition is lacking too while food grains rot in godowns of the Food Corporation of India. I read a report in Economic Times titled “Billionaires, startups team up to fix broken Indian health care” – It said – “”The loose alliance, whose backers include Infosys Ltd. co-founders Nandan Nilekani and Kris Gopalakrishnan as well as prominent startups from Practo to Policybazaar, will be formally unveiled as soon as this week in an attempt to salvage a decrepit system by digitizing everything from patient data and records to creating online platforms for hospital care and doctor consultations. Called Swasth — meaning health in Hindi — its 100-plus members have pledged to build new services and coordinate…” I posted this on my Facebook timeline wondering what these billionaires are aiming at. Digitizing healthcare information? starting an online healthcare marketplace? In a country where the hygiene standards are so low, millions suffer from nutritional deficiencies, how does this help? One Mr.Krishna Sampath commented “Somehow it escapes these shallow and hollow corporate honchos that health is as much social than merely physiological – lack of sanitation, hygiene, access to clean drinking water, poor quality of food and eating habits that includes high amount of starch, sugar and saturated fats is causing much of the health crisis than just lack of access to doctors and medicines. Failure of governance in ensuring such basic presence and habits is not something where technology can provide solutions. Such technological solutionism is a social pathology of our times as sickening as the ailments that affect the Indian populace.” – Quite telling.