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Preamble:
There has been a lot of fanfare on achieving Vikasit Bharat by 2047, the centenary year of Independence. It is certainly a laudable goal, but what does it mean to the common man? Do we need a model of our own or blindly follow the Western Model of development? This article deliberates on that and presents a way forward.
- Does the Western Model of ‘Developed World’ suit us?
Often, people tend to imagine that India would look like USA or Europe by 2047, as Vikasit Bharat. If so, then the thought provoking question arises? Are the people in those countries happy? The answer is a blunt ‘No’, as reflected by the recent Mayoral Election of New York City, leaning for a change towards an affordable living. If that is the case, do we want to reach such a situation by 2047, when we have the so called Vikasit Bharat? I am sure everyone would say ‘No’ if that doesn’t make people happier. Hence, there is a need to define what we want in the Indian context, rather than blindly follow the Western model of development.
For example, USA is six times the geographic size of India, but with roughly 1/4th population. Which means, it has 20-25 times more per capita land compared to us. Just look at what has happened to our cities by now, following that model! In Bangalore, probably we have more cars than the roads can comfortably accommodate. If everyone in Bangalore owns a car by 2047, there won’t be even a place to park them, leave aside mobility. Hence, the concept of development has to suit our needs and perceptions.
Next, as another example, take the case of old people in USA. Even a couple, who had an excellent earning in their lifetime and own a nice bungalow, have to move out to old age home at some point, when they cannot physically clean & maintain their house by themselves or afford expensive outside services. Hence, the pleasure of living happily in such a big & comfortable house of yester years, with a lot of pleasant memories, is denied by their model of ‘Developed world’. Does it make them or the society around them happy? The obvious answer is a ‘NO’.
- The Indian Context:
Now, look at the other end of the spectrum, what is happening in India. In every walk of life, there are some set/percentage of people who are happy, irrespective of their level of economy and the type of occupation they have, including mundane jobs such as being a maid, driver, roadside hawker etc. At the same time, the people who have struggled to earn and build a good house/mansion are not that desperate as in USA, when it comes to its maintenance, as there are people available for hire at affordable cost. Also, those who get hired in most cases are happy, for the dependability it offers as a vocation for their regular occupation & income. But, yes if we ask any of them, they will have certain desires for a better quality of living, to be happier. Hence, there is a need to arrive at a rational model for Vikasit Bharat, which is a win-win and makes a larger percentage of people at various levels happy. It should be achieved without disturbing the interdependence of people and their ability to have a vocation, based on their intrinsic strength.
Having said the above, there must be a built in the system which offers people opportunities to grow, matching their intrinsic strengths, irrespective of the economic background of their parents. Which means, we would in principle have to offer a system equivalent to the Western model of development, which helps capable people reaching to their goals in life, matching to one’s own intrinsic strength. How do we achieve that?
III. A suggested model for Vikasit Bharat:
Basically, for a family to be happy, they should have security for food, shelter, education and health, as the basic necessities, irrespective of their occupation & income. Let us address them, one by one:
- Food:
Let us assume that food and day today living would be taken care of by the available employment opportunities at any given time, supplemented by ‘The Food Security Act 2013’ and complimented by the so called freebies from time to time, based on the way the society evolves.
- Shelter:
This requires focused attention. Best way to address it would be, to offer incentives to own a house. Let us say 75% subsidy for 1bhk not exceeding certain area (say 600 sft super built). Similarly, 50% subsidy for 2bhk not exceeding certain area (say 900 sft super built) and 25% for 3bhk not exceeding certain area (say 1200 sft super built). There could be approved builders offering such accommodations, with certain warranties & guarantees towards quality, durability and minimum life span. The standards, Checks & Balances, can evolve with time.
Given that there would be budget limitations every year, the system of reverse auction could be introduced in each category, if the demand exceeds the available funds. Those seeking lesser subsidy than threshold get the preference, in turn allowing more people to use allowable budget. The idea is to expand those under shelter, in each category. 40% of yearly budget for supporting such housing be earmarked for 1bhk. Similarly, another 40% for 2bhk and the rest 20% for 3bhk. Such a distribution leads to construction of roughly 40% 1bhk, 35% 2bhk and 25% 3bhk houses in a given year, under this subsidy scheme. This scheme is more like the current PLI scheme in vogue for certain types of industry.
- Education:
Today, in the name of quality, we have literally shifted Education to private establishments, who are exploiting like in any other commercial venture, for maximizing profits, both in white & black. The result, government schools have literally lost their credibility in cities. The parents find it so difficult to get a seat in a good private school, that often they are found sending the children to far off distance schools, adding to the nightmares of city traffic. The whole exercise is so expensive and tedious, often parents stop at one child, as they cannot afford the money & logistic nightmares. Hence, it is the need of the hour to revert back to government schools, by takeover of education from private hands, at least up to graduate level. Private can be permitted to offer at postgraduate level, professional and specialized vocational courses, on lines of IITs, IIMs etc.
On Quality of Education: One immediate question that will raise the eye brows would be, the impact on quality. Yes, the highest marks may fall from 95-100% to 80-85%. It should be in fact be a welcome development, as the children are ground unnecessarily for that very high 95-100% targets. When it comes to getting seats in engineering or medicine, it is the relative merit which matters. And the successful admissions would be at much higher percentage than demanded by the minimum requirements. We all went through such a system in our childhood and we have no regrets when we look back. After all, we as the individuals really groom to our potential only after we get into graduation level and later. To all those worried about quality of output, be aware that it is now certainly degraded by private institutions, when they offer professional courses such as medical seats against high donations, producing mediocre doctors.
Merit Scholarships: Should be offered to all those who cross a certain threshold, after Tenth Standard onwards, if they move out of the parents’ house and stay independently. Pay half that for those staying with the parents, with an income below certain threshold. This will ensure that all students with a certain capability can pursue education, matching their intrinsic strength and ambition.
Boarding Schools: Allow private boarding schools of certain high standards, reflected by the average annual results over five years, in locations away from cities. These are meant to help upper income families who can afford and are too busy with their enterprises.
- Health:
Universal Health Cover is another sector which requires a real revamp, to ensure that the population at large have the basic health cover, at notional cost. This is another major contributor to the fear of couples not going beyond one child and also on their reluctance to volunteer supporting old age parents. Hence, this subject requires more detailed deliberation, as follows.
D1. Corporate Culture: Today, in the name of better medical care, the corporate sector has taken over the healthcare, particularly in cities. The way they are run with corporate profits as the basic motto, even the doctors would have forgotten the oath they take towards service, on becoming a doctor. One can’t blame them, if they have financial targets to achieve. Added to that, it is increasingly becoming difficult for patients to trust & approach any private hospital. It is due to the fear of being misled with unnecessary tests, procedures and often with consciously delayed treatments (to deteriorate the patients for emotional vulnerability) to maximize the billings. Hence, it is essential to limit the corporate sector only to specialized procedures and treatments. However, they be encouraged to support medical tourism of patients from abroad, which is a win-win for both.
D2. Wellness Clinics: Let us have ward level public clinics, with a staff nurse and an assistant supporting him/her, to look after the clinic maintenance & equipment. Let the private doctors come from outside and charge on per patient basis. Let the patients be asked to give a confidential feedback on the doctors they consult (in terms of stars), for others to appreciate. Also, let people be permitted to go to any ward, based on such feedbacks & their conviction on doctors visiting the specific ward. For each ward, let there be one female and one male doctor visiting the clinic in morning half. Another such set in the evening half. One among them should be a wellness doctor, who focuses on vitamin & mineral supplement treatments, as most of the senior citizens are victims of inadequate advice on how to keep themselves healthy. To ensure certain minimum level of income, the doctors be paid some fixed honorarium per month, in addition to per patient charges. The feedback from the patients over a period of two years be used as a reference for review, for continuation of the services of the concerned doctors. This scheme is best implemented initially in cities and moved down to villages as it matures.
D3. Pradhanmantri Jana Aushadi Pharmacies: be established close to the ward clinics, for access to affordable medicines. Patient specific subsidies be deducted in such billing (based on income category of the patient) by such pharmacies, however with clear mandate that such subsidies shall be reimbursed by the respective governments (central/state/local), who have offered them.
D4. Diagnostic Centers: Patients requiring further investigations & diagnosis, for longer treatments, are referred by the ward clinics to identified diagnostic centers. They can be modelled in a similar way to ward clinics, however with specialist doctors visiting such diagnostic centers. Each Diagnostic center be associated with a Test center, with required facilities for routine tests. Again the charges for such tests can be subsidized for various category of patients by the concerned governments, and all such subsidies shall be reimbursed by the offering government. Patient feedback system should be placed for rating both the doctors and the Test centers. This scheme also be better implemented first in cities and moved down to villages as it matures.
D5. Corporate & Private Hospitals for Specialized Treatments & Procedures: Local Government(s) can identify & recognize Corporate Hospitals & Private hospitals, from time to time, who can offer specialized treatments, based on some agreed rates/norms. While billing, subsidies offered to certain category of patients can be claimed from the respective governments. Patients not availing any subsidy can be allowed to choose any private hospital of their choice. To avoid promotion of their own hospitals and misuse (as prevailing now), Corporate & Private Hospitals should not permitted to have OPDs. However, they can have Emergency wards & treatments. Corporates and private hospitals are expected to resist these changes. But, they will fall in line once they realize the benefits of an assured stream of patients from the associated diagnostic centers. Such a system will reduce their other overheads, and they just have to focus on improving their capabilities & efficiency in the given specialization.
D6. Private Practice: Doctors who are not working either in government clinics or corporate hospitals be permitted private practice, at their own clinics. It is meant for those rich patients, who prefer them for convenience & continuity. But, it should be mandated that any referral for specialized treatments be through the government diagnostic centers, for second opinion & confirmation. It will help prevent exploitation of vulnerable patients. But, this restriction be imposed only after the diagnostic centers gain stability and reputation.
- To Sum Up:
Food, Shelter, Education and Health should be the focus sectors of any road map towards Vikasit Bharat. If all these are established and made available, the quality of life at the lowest levels will considerably improve. It will in turn improve their ability to have more children and support their elderly parents, which is the need of the hour.
Bringing in a better quality of life has to be an essential part of Vikasit Bharat, even seen from a traditional Indian outlook. However, it will not happen unless there is focused spending towards these sectors on a priority basis, which require enormous funding on lines of defense. To that extent, the model of development, growth and GDP based perceptions will have to change. For example, where there is sufficient surface transport infrastructure, there is no need to go for airports in smaller towns, with exception to hill regions. Additionally, increase the revenue by taxing Ostentatious Spending on marriages, show offs and etc. GST at the highest rate should be charged on such expenditure (on the whole expenditure), as they can afford.
Dr K Sham Sunder
Outstanding Scientist & a former Project Director of ADA