People's Democracy

Providing Basic Services To All

Jayati Ghosh

IN South Asia we are used to living with contrasts. We were earlier used to the jet set and bullock cart set coexisting; now we are used to being seen as the new dynamic economic region of the world, even as large parts of our population continue not just to stagnate but even to experience absolutely terrible conditions of living. We are also used to large regional differences in income, consumption patterns and even access to basic needs.

RATHER NEW EXTENT OF INEQUALITY

Yet the extent of inequality that we are currently experiencing is nevertheless something rather new, across the subcontinent. In several countries of the region including India, the recent rapid economic growth has been associated with unexpectedly large increases in consumption of the rich, and the flaunting of lifestyles even among the upper middle classes, which could not be imagined earlier. Yet the conditions of large numbers of ordinary people, of cultivators and workers in unorganised sectors, have deteriorated.

This is particularly marked in terms of access to basic services of health, sanitation and education, which mark the dominant conditions of life along with access to food and employment. A new report brought out by Oxfam International (“Serve the essentials: What governments and donors must do to improve South Asia’s essential services”, New Delhi 2006) brings this out very clearly, by providing important insights not only into the poor provision of most such services, but also the lessons from variations among the different countries of South Asia. 

Some of the information provided here is well known. These include the sheer inadequacy and incapacity of the physical infrastructure and human resources required to provide essential services; the inefficiencies that persist in public delivery systems; and the inequalities of access that are determined by gender, caste, community, income and class. 

SERVICE PROVISION ACROSS COUNTRIES

But there are other insights that emerge from a comparative study of service provision across countries, which are not so widely known. The superior performance of Sri Lanka in the region, in terms of human development indicators, is recognised, but the critical role played in this by public provision and government regulation is less advertised. For example, universally accessible free health care is provided at basic level, subsidised by progressive taxation measures, and ensuring that the rich pay for out-of-pocket health expenses more than the poor. This is in fact the opposite in the other countries in the region, such as in India where the very inadequate and poor public provision forces even the poor to spend out-of-pocket for private health care, and where private spending accounts for more than four-fifths of total health expenditure. 

An even more startling contrast emerges in education. Private schools covering classes 1 to 9 have been banned in Sri Lanka for decades, yet educational achievements, especially in school education, are the best in the region. User fees were also eliminated early, yet Sri Lanka has managed to achieve and sustain universal elementary education. Currently the government of Sri Lanka spends only 3 per cent of GDP on education, but it benefits from a legacy of higher spending in the 18950s and 1960s, which built up the basic educational infrastructure. 

There is also greater recognition of the importance of recurring expenditure, which is all too often ignored in planning for expansion of public education. Sri Lanka allocates at least 27 per cent of educational spending on recurrent items such as textbooks and school uniforms (which are provided free) as well as on other running expenses apart from salaries, all of which lead to improved quality of provision. 

Other important lessons emerge from the recent successes of Bangladesh in improving school access, particularly for girl children, over the 1990s. Fertility rates in Bangladesh have been reduced by more than half and infant mortality rates by two-thirds. All this is in sharp contrast to Pakistan, where several of these indicators have stagnated or worsened despite comparable economic growth rates. 

IMPORTANCE OF FREE & UNIVERSAL BASIC SERVICES

The most significant lesson that can be drawn from this report is the absolute importance of providing free and universal access to basic services as far as possible. The report notes, and provides several instances to elaborate how, user fees for essential services contribute to increased inequality and effectively exclude the poor from benefiting from such services. It therefore makes a strong case for the abolition of user fees and the increase in public allocations to provide essential services to all. 

While not explicitly stated in the report, this is important not only in welfare terms or because the poor have a human right to health and education. It is also because the social costs of poor health and inadequate educational development are large and will be even greater for future generations, so it is in society’s interest to invest substantially in these areas. 

Instead of emphasising this, South Asian governments “have systematically reneged on their social contract to deliver public services, adopting …skewed governmental priorities resulting in rapid privatisation of public utilities and erosion of the public service ethos.” (page 29) This, and associated corruption, have made the public delivery of essential services deficient across large pockets of South Asia. 

What is significant is that this is not seen as a cause of abandoning the public initiative, but instead for rebuilding public infrastructure and regenerating the ethos of public service. 

This very refreshing analysis then leads to some currently unusual, bold but very relevant prescriptions: governments across South Asia must commit strongly to the universal provision of quality public services. This means more financial outlays, removal of user fees and recognition of related expenses. It must also rebuild the public sector work ethos, rewarding public workers adequately, encouraging a more responsive work culture with community and civil society participation and supervision, and by isolating and weeding out corruption.

These are such eminently sensible recommendations that it is shocking to realise that the current policy debate will find these to be outlandish suggestions. What needs to be brought home to policy makers in the region is that such a commitment to public service provision is essential not only for greater equality and democracy, but also for the very future of our societies.