Author: cprindia

AS PART OF ‘POLICY CHALLENGES – 2019-2024: THE BIG POLICY QUESTIONS FOR THE NEW GOVERNMENT AND POSSIBLE PATHWAYS’
CPR EDUCATION

By Kiran Bhatty

In the context of the declining quality of public education, governance has emerged as an important explanatory variable, quite distinct from the education variables more commonly cited, such as teaching and learning practices or curriculum and textbook quality. An important component of the governance architecture in any sector is its information and data regime, as all aspects of monitoring, planning and policymaking are dependent on it. A look at the data system in the education sector in India reveals that there is much amiss at all levels of data collection and use.

This is not to deny that compared to a couple of decades ago, considerable energy and investment have gone into building a regular school-based decentralized data collection system in India. This District Information System for Education (DISE), set up after Sarva Shiksha Abhiyan (SSA) was launched in 2001, and now called Unified-DISE (U-DISE),1 collects data from 1.5 million schools (government and private) and provides report cards up to the secondary stage for every state, district and school. It is remarkable that this data is compiled and School Report Cards prepared and uploaded on the website on an annual basis. Education data from households is also being collected by Panchayats and compiled annually in Village Education Registers. A few states have supplemented this with data from Child Tracking Surveys, which enumerate the population of school-going children. In addition, the Ministry of Human Resource Development (MoHRD) commissioned three rounds of household surveys in 2006, 2009 and 2014. The SRI-IMRB surveys, as they are called, collect information on children in the age group 6-13 years who are out of school. Other large household data sets have emerged too, in addition to the National Sample Survey (NSS) and Census, such as the National Council of Applied Economic Research’s (NCAER) Indian Human Development Survey (IHDS-I, 2004-5 and IHDS-II, 2010-11), the Annual Status of Education Reports (ASER) since 2005, and now the Socio-Economic Caste Census (SECC). All of them provide data on education indicators and school participation in some form.

However, in the midst of this ‘feast’ of data sources, we get varied, often contradictory evidence on basic indicators such as the proportion of children out of school, the extent of improvement in retention levels, the learning outcomes and the quality of education. Even in areas of education finance, such as teacher appointments and salaries, we do not have an authentic database. Hence, despite the fact that the coverage and scope of data collection by the government has increased enormously with many more indicators added, nagging questions remain about the quality, utility and purpose of the data, with obvious implications for planning and policymaking. Further, with multiple sources of data – both governmental and non-government – in operation, data neutrality also cannot be assumed.

This paper highlights the methodological as well as administrative anomalies in the system, and points to the need for greater decentralized management of data as well as collaboration across agencies for purposes of standardizing definitions and methods of estimation. It further emphasizes the need for public verification of data to ensure authenticity as well as validation across sources to reduce bias.

Methodological Discrepancies

Definitions and Methods of Estimation

The methodological difficulties begin with the range of definitions and methods of estimation used for important indicators by different government and non-government agencies collecting data. For instance, estimates for out-of-school-children (OOSC),2 all collected through household surveys, are based on different ‘questions’ asked by investigators employed by each source. The NSS, for example, asks, ‘How many children are currently attending school?’, while the Census enumerators ask questions related to ‘status of attendance in an educational institution’. The MoHRD survey, on the other hand, claims to follow both the sampling and methodology used by the NSS, and yet arrives at vastly different results. The NSS and MoHRD surveys, which are based on a sample, then extrapolate from their figures the proportion of children that are out of school as a percentage of the population of children in that age group. Using this method, the NSS 71st round (2014) has pegged the figure at a little less than 10% of the child population, amounting to nearly 20 million children, while the MoHRD (SRI-IMRB, 2014) estimates put it at 3% and thus approximately 3 million! The 2011 Census, on the other hand, suggests that more than 15% children in the same age group do not go to school, thus giving us a wildly differing figure of almost 40 million.

Similarly, the figure for the total number of teachers in a school turns out to be not as simple a statistic as it sounds, with teachers being routinely sent on deputation to other schools.3 Thus, it is unclear whether a teacher who is on deputation from another school is to be counted in her current position or in her original school; or does she end up being counted in both? Similarly, information on the employment status of teachers has only two categories in the DISE format – regular and contract – whereas multiple categories that do not fit precisely into these categories also exist (voluntary, assistant, etc.), resulting in highly inaccurate data being collected on such an important indicator. Other gaps in the data collected include: information on salaries paid out by each state to the different categories of teachers and measures of learning outcomes on a regular basis. The problems are compounded by the fact that formats for collecting data are designed centrally and do not take into account local specificities; nor are teachers – often the primary data enumerators – adequately trained to fill the formats.

Validation and Verification of Data

Another aspect of data credibility that has proved to be a weak link in the data collection process is verification and validation of data. While the rules for DISE dictate that 10% of the sample be randomly cross-checked, DISE itself is unable to verify that this process is either regularly or adequately carried out, due to lack of capacities available at the frontline for the process. In addition, the education departments ignore the evidence presented by other government or non-government sources to validate and thus improve the credibility of their data. Data validation faces some mundane difficulties as well, related to different methods and time periods used for estimating different indicators by the agencies that collect data. For instance, the Right to Education (RTE) Act talks about children between 6 to 14 years age, but practically all data agencies (except those under MoHRD) use different age groups when compiling education data, making comparison quite difficult. Similarly, the dates and periodicity of data collection vary across sources. ASER is an annual survey; NFHS followed a six-yearly pattern initially but has now slipped to 10 years since the last survey. IHDS thus far has maintained a gap of six years between its two successive surveys. While NFHS-3 and IHDS-1 roughly cover the same period (2004-5 and 2005-6), neither corresponds to the Census dates, but IHDS-2 (2011-12) does. NSS also follows a different time period for its education surveys.

Administrative Anomalies

The Purpose of Generating Data

Different agencies plan their data collection for different (and specific) purposes, and not necessarily for planning or monitoring education and hence for education policy. For example, the education rounds of NSS are part of the survey on social consumption, which in turn seeks to assess the benefits derived by various sections of society from public expenditure incurred by the government.4 The population census, on the other hand, is the primary source of basic national population data required for administrative purposes and for different aspects of economic and social research and planning.5 The non-government sources also have unique purposes in mind, again not necessarily with education as the primary objective. Thus, NFHS is essentially a health and nutrition survey that also collects data on select education parameters. Similarly, IHDS is geared towards the larger goals of human development and poverty, especially the links between education, skills and livelihood. Only ASER is solely dedicated to education, specifically learning levels. However, it does not tell us how the levels of learning vary with student enrolment or attendance, or any household factor.

What is more surprising is that even the data collected by MoHRD and state education departments, though admittedly for the purpose of monitoring and planning education, is not geared towards policy goals. Instead, data collection and analysis are guided by their use in taking stock of the provisioning of schools, rather than as a mirror of their functioning. Unsurprisingly, therefore, school surveys focus on collecting information related to (i) broad indicators of infrastructure and teacher availability; and (ii) student enrolment and distribution of incentives. Both these sets of data showcase administrative efforts rather than education progress. Even the household survey (MoHRD’s SRI-IMRB) is used only for estimating OOSC. No effort is made to use disaggregated data to understand the problems of specific groups of children or schools.

A second conundrum associated with the purpose and use of education data relates to the fact that planning and policymaking are extremely centralized processes. Thus, data – however collected – plays a limited role in the planning and policy processes. For instance, the Project Approval Board at the MoHRD that approves annual plans and budgets (AWP&Bs) for the states does so on the basis of the finances allocated to it by the Ministry of Finance and the norms of expenditure specified by the central ministry (MoHRD). While the AWP&B for a state reflects the needs of the state, eventual allocations differ widely from it, as they are based on what is made available by the Ministry of Finance through processes that do not involve the education sector. Of course, state plans are themselves based on a process of aggregation that does not involve a genuine decentralized planning process. This is evident from the fact that dissemination strategies are not aligned with the goals of decentralized planning, as data is largely unavailable in usable form at the local or school level. In fact, local data management systems are virtually non-existent, putting paid to the idea of decentralized planning. Thus, while it is true that schools are now asked to prepare their plans through the School Management Committees, in fact what is submitted by them are copies of the DISE format – presumably as indicative of the status of schools and thus reflective of their needs! Eventually, therefore, at the district level – and probably also at the state level – DISE data is referred to for determining the state AWB&P.

Limited State Capacity

A second and perhaps overarching problem confronting the data regime in education is that of limited capacities to design, collect, analyse and use data throughout the government structures, from the central to the local. DISE is run almost entirely on the shoulders of data entry operators of the education departments at the district and block levels. Data that is collected from the ground up amounts to a process of simple aggregation resulting in the loss of specifics, such that by the time it reaches the central level, it barely reflects the ground realities and can hardly serve the needs of the people. The aggregation itself is still done manually at the block level in many states with digitalization appearing only at the district level. Further, implicit in the collection process is a conflict of interest, especially with DISE data as it is entirely dependent on formats filled by teachers. It is well established that teachers might be incentivized to represent information in ways that inflate facts, such as student enrolment.6

In addition, the departmental staff at the state level have not acquired the understanding, through their own qualifications or through training provided by the government, of the relevance and importance of quality data or its use in the planning or policy process. For instance, innumerable formats are designed for monitoring schools, but none of that data is put to any use.7 In fact, it is not even referred to in the monitoring or review meetings held at the block and the district. Unfortunately, the personnel involved in collecting and collating that information are themselves unable to gauge its importance as they see it as simply a chore – of ‘filling formats’. With the import of the data completely lost on them, they are unable to use it in a constructive fashion, making the entire exercise redundant.

The Way Forward

(i) Improving definitions, standardizing them across sources, and using improved methods of collection and estimation of basic indicators.

(ii) Developing capacities of the data regime and giving a greater role to data users, especially the education officials at different levels of government ranging from the national to the local. Necessary technical skills, if provided, will enable them to be cautious when collecting data, as also to interpret and use it appropriately, such as when making plans.

(iii) Providing support to monitoring agencies, such as school management committees, social audit groups, and education researchers, to allow them to publicly verify data that is officially collected. This requires data to be made publicly available especially at local levels. The lack of local data management systems – at the level of the school or even Panchayat – is a huge lacuna in the information and data regime of the education sector. Even the DISE formats that are filled by the teachers and sent up the bureaucratic ladder are not available at the school level. While schools are asked to keep a copy of the DISE Data Capture Format, they are unable to maintain more than the current year’s format, if even that. This is perhaps because schools do not have computing facilities, and hence all records are paper records – poorly maintained and not updated. In other words, even the information that is generated in the school is sent up to the next level for eventual digitization at a higher level (district or block level, as the case may be) where computing facilities are available. The digitized information, however, does not flow back to the school, for the same reason cited above. As a result, no institutional memory is built up for purposes of tracking change or progress in a school. Ideally the format should be verified by the parents and larger community before being sent up, to ensure accuracy. Further, data not collected by DISE could be maintained at the school and Panchayat levels as well and used for making school plans. At any rate, it could form the basis for questioning the centralized planning process.

(iv) Reducing bias by validation through the use of multiple data sets. Validation of data against different sources, especially in the case of data used for policy, can ensure that bias is factored in and therefore a more judicious use of data is effected. Multiple data sets have other uses as well. For instance, while any single data set cannot collect information on all relevant issues, data collection is known to be a very expensive and time-consuming process. Thus, information collected by NSS on household expenditures – which demonstrates that 70% of all OOSC in urban areas are concentrated in the lowest quintile, while in rural areas they are in the lowest two quintiles – is relevant information that can and should be used by the education department without having to repeat the exercise. Similarly, NFHS data provides linkages between education participation and family health, also of importance to the education department.

(v) Making better use of data through proactive collaboration of different government and non-government agencies. For instance, if household and school data were available in the same portal, it would maximize their use. Similarly, if the NSS education rounds were better coordinated, along with standardization of definitions of important indicators, it would greatly help in serving the cause of education goals. Streamlining the planning process to enable planning based on decentralized data will go a long way towards improving the use of data at the local level as well as ensuring a more genuine decentralized planning process.

Other pieces as part of CPR’s policy document, ‘Policy Challenges – 2019-2024’ can be accessed below:

• The Future is Federal: Why Indian Foreign Policy Needs to Leverage its Border States by Nimmi Kurian
• Rethinking India’s Approach to International and Domestic Climate Policy by Navroz K Dubash and Lavanya Rajamani
• India’s Foreign Policy in an Uncertain World by Shyam Saran
• Need for a Comprehensive National Security Strategy by Shyam Saran
• A Clarion Call for Just Jobs: Addressing the Nation’s Employment Crisis by Sabina Dewan
• Time for Disruptive Foreign and National Security Policies by Bharat Karnad
• Multiply Urban ‘Growth Engines’, Encourage Migration to Reboot Economy by Mukta Naik
• Schooling is not Learning by Yamini Aiyar
• Clearing Our Air of Pollution: A Road Map for the Next Five Years by Santosh Harish, Shibani Ghosh and Navroz K Dubash
• Protecting Water while Providing Water to All: Need for Enabling Legislations by Philippe Cullet
• Interstate River Water Governance: Shift focus from conflict resolution to enabling cooperation by Srinivas Chokkakula
• Managing India-China Relations in a Changing Neighbourhood by Zorawar Daulet Singh
• Beyond Poles and Wires: How to Keep the Electrons Flowing? by Ashwini K Swain and Navroz K Dubash
• Regulatory Reforms to Address Environmental Non-Compliance by Manju Menon and Kanchi Kohli
• Safe and Dignified Sanitation Work: India’s Foremost Sanitation Challenge by Arkaja Singh and Shubhagato Dasgupta

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¹ U-Dise or Unified-DISE is a database of all students from grades 1 to 12.
² Non-government sources do not collect information on this variable at the national level.
³ It is common to send a teacher appointed to a particular school to another, if there is a shortage in the other school. While shortages exist in a very large number of schools, such deputation typically takes place if the demand for more teachers is raised loudly enough or the political configuration is such that the school is able to draw a teacher towards their school, typically creating a shortage in the school from which the teacher is deputed!
⁴ http://mail.mospi.gov.in/.
⁵ http://censusindia.gov.in/Data_Products/Library/Indian_perceptive_link/C…
⁶ See Bhatty, Saraf and Gupta, ‘Out-of-school Children in India: Some Insights into What We Know and What We Don’t’, Economic and Political Weekly 52(49) (2017)
⁷ See Bhatty and Saraf, ‘Does Government’s Monitoring of Schools Work?’, CPR Working Paper (New Delhi: Centre for Policy Research, 2016).

FULL VIDEO OF BOOK LAUNCH
INTERNATIONAL POLITICS ECONOMY

Watch the full video (above) of the book launch of ‘The Other One Percent: Indians in America’ co-authored by Sanjoy Chakravorty, Devesh Kapur, and Nirvikar Singh.

In conversation with Pratap Bhanu Mehta, author Devesh Kapur discusses how a population from a ‘low-income’ developing country like India become among the most educated and highest income group in one of the world’s most advanced countries in one generation.

CPR FACULTY G PARTHASARATHY UNPACKS THE CONTEXT AND THE ROAD AHEAD
INDIA-PAKISTAN POLITICS SOUTH ASIA

On April 14, you wrote in The Indian Express that imaginative diplomacy alone is not enough to deal with the Pakistan army. Can you elaborate on this more, especially drawing on your own experience as a former Indian High Commissioner in Pakistan?

The answer to your query on why imaginative diplomacy alone will not be enough to deal with State sponsored terrorism can be illustrated in two examples. First, with the advent of General Zia ul Haq as President in 1977, Pakistan adopted a conscious policy of subverting sections of the population from (Indian) Punjab. This occurred regularly during the visits of Sikh pilgrims there, which led to their training disaffected youth in terrorism. Pakistan also started a worldwide campaign to mobilise disaffected Sikhs living abroad for the cause of “Khalistan” (an independent Sikh Homeland).

This situation continued till the mid 1990s. This serious situation was not resolved through diplomacy alone. Matters were ultimately sorted out when India took effective political action by holding elections in Punjab, and the State police dealt with the terrorist issue. In the meantime, world powers like the US and UK were persuaded to pressurise Pakistan to end its support for violence and terrorism in Punjab.

The second instance is the intrusion across the Line of Control in Jammu and Kashmir, by Pakistani forces in Kargil in 1998-1999. This carefully planned intrusion would have continued had India’s military action not forced the intruders from Pakistan’s Northern Light infantry, to vacate areas they had occupied, in violation of the letter and spirit of the Simla Agreement.

In the meantime, effective diplomacy ensured that we persuaded the international community that Pakistan had endangered peace and security by its actions. Facing diplomatic isolation and military disaster, Prime Minister Nawaz Sharif had to rush to Washington to ask President Clinton to bail him out of a humiliating situation. Mr Sharif was compelled to agree in Washington that he would withdraw his intruding forces and respect the sanctity of the Line of Control. The whole exercise was a military and diplomatic fiasco for Pakistan, and required decisive military action, together with astute diplomacy.

In a second article titled The General, the “Spy”, and no talks with India, you have called the Pakistan Army Chief General Raheel Sharif the most ‘destabilising’ factor in the subcontinent and the reason why the Pathankot joint probe process fell through. In these circumstances, what is the road ahead for Prime Minister Modi, who made imaginative and bold moves in reaching out to Nawaz Sharif personally?

Pakistan realised that Mr Modi’s visit to Lahore had turned global opinion in India’s favour, since the world saw PM Modi’s visit as reflecting a genuine desire for resolving issues and living at peace with Pakistan. The Pathankot attack happened immediately after the visit. It was seen by the world as being entirely unacceptable and contrary to Pakistan’s protestations of being desirous of good relations with its neighbour. But is this diplomatic gain for India going to get Pakistan to end sponsorship of terrorism and resolve issues with India peacefully through bilateral negotiations? The answer is no.

As I have written in my article, the Pakistan army will wait for the world to forget what happened in Pathankot, in the same way as memories of the Mumbai attacks faded with the passage of time. I have little doubt that once the snows melt in July, infiltration across the Line of Control will again pick up.

In such a scenario, the road ahead for Mr Modi is to continue with diplomatic engagement with Pakistan to assess if there are any signs of Pakistan being prepared to end its support for terrorism. We also need to monitor the evolving political situation within Pakistan. The Pakistan army is going to have difficulties in sustaining its current stance toward India, given that it is fighting a battle with its own people in all four provinces of the country, including Punjab, which is the political base of Prime Minister Nawaz Sharif. This is going to lead to internal contradictions within Pakistan. India must be prepared to take advantage of that situation.

Lastly, would you like to comment on the road ahead for Pakistan?

My sense is that Pakistan is going to face more trouble on its border with Afghanistan than on its border with India. The Taliban leadership that the ISI has stitched together under Mullah Mansour is going to extend and expand its military actions within Afghanistan. The tribal areas in Pakistan bordering Afghanistan will becomes increasingly troubled and violent. This will become a morass into which the Pakistan army will be drawn, ever deeper.

The Pakistan army will become more preoccupied in dealing with developments on its borders with Afghanistan rather than its eastern borders with India. And with President Obama categorically stating that American troops will not be withdrawn from Afghanistan this year, the Afghans can be expected to hold their own against the Pakistan backed Taliban. We can only hope that the more costly their adventure on the Afghan border turns out to be, the more likely the Pakistan army will be to see reason, on the Indian border.

NEW ARTICLE IN THE ‘INTERNATIONAL JOURNAL OF WATER RESOURCES DEVELOPMENT’
POLITICS ENERGY RESEARCH

SOUTH ASIA ECONOMY
What does the next decade in South Asian electricity trade have in store? In a new article in the International Journal of Water Resources Development, Aditya Valiathan Pillai and Sagar Prasai analyse four crucial variables that will enable, and at times, constrain progress on cross-border electricity trade:

The health of distribution companies in India: India’s distribution companies are likely to shy away from relatively expensive Himalayan hydropower due to a combination of supply factors, such as a steep fall in renewable prices and the abundance of cheap thermal energy in the domestic market. These traditionally loss-making entities are also in the process of responding to incentives for financial rectitude created by new power sector reforms, namely UDAY (Ujwal Discom Assurance Yojana).
The role of hydropower in India’s ambitious transition to renewable energy: India’s much-lauded addition of renewable capacity presents a long-term opportunity for hydropower developers in Bhutan and Nepal. Meeting peak demand, particularly after the sun goes down, has long been a function well-served by hydropower. At present, however, India is leaning towards coordinating existing coal and hydropower capacity to balance the grid until the current target of 175 GW renewable capacity addition is met.
Bangladesh’s power crisis and import dependency: Bangladesh’s depleting natural gas reserves, which supply nearly two-thirds of the country’s power sector, may result in the nation steadily importing hydropower from Bhutan and Nepal to reduce dependence on expensive imported coal and gas. Importantly, the country’s master planning for the power sector indicates that power imports will play a significant role in the energy mix.
The governance of regional electricity trading arrangements: Regional politics have repeatedly disrupted progress in creating an electricity market, first under the SAARC framework (due to faltering relations between India and Pakistan), and now in the sub-region. In India, the Ministry of Power’s 2016 guidelines on cross-border electricity trade have imposed conditions on who can trade electricity across India’s borders. Increasingly, regional electricity trade is being challenged by growing geopolitical competition between India and China.
In an analysis of these factors, the authors find that progress on cross-border electricity trade and hydropower development in the region will be incremental in the next decade, hindered by mixed demand signals and the turbulence of geopolitics. They argue that in a fragmented marketplace led primarily by individually-priced bilateral agreements, dynamic political relationships in the region will continue to deter investors. They conclude that the future trajectory of cross-border electricity trade will be shaped by India’s stewardship in the region.

LISTEN TO THE PODCAST ON HOME-CHEFS AND THE GIG ECONOMY DURING THE COVID-19 PANDEMIC
ECONOMY PODCAST

The COVID-19 lockdown forced many businesses, big or small, to innovate and find creative ways to stay relevant. This included small restaurant owners and home-chefs across the country. In the first episode of The Gig Sisters, we look at the stories of three women entrepreneurs in the food space and how they leveraged platforms to sustain themselves when everything else came to a standstill. Do their differing strategies tell us something about how platforms operate and what that means for their business?

The Gig Sisters is a new podcast by the Jobs Initiative at the Centre for Policy Research. It is an output of a collaborative research project called Digital Platforms and Women’s Work in Sri Lanka and India. Our partners on the project are World Resources Institute India, Indian Institute for Human Settlements, LIRNEasia in Sri Lanka. The project is a part of the Women, Work, and Gig Economy consortium managed by the JustJobs Network and funded by the International Development Research Centre. The show is edited and mixed by Anmol Karnik.

FULL VIDEO OF TALK BY PRATAP BHANU MEHTA
INTERNATIONAL POLITICS

Watch Pratap Bhanu Mehta (above) talk about the global crisis of liberal democracy. Addressing the global rise of right-wing authoritarian populism and nationalism of various varieties, he questions the nature of this crisis.

Dr Mehta elaborates on the origins of the anxiety about the future of liberal democracy by examining some of the common themes emerging from across the world.

The talk was delivered at Brown University’s International Advanced Research Institutes (BIARI) in June.

FULL VIDEO OF TALK
URBAN GOVERNANCE

Watch the full video (above) of the talk by Aishwarya Tipnis, where she discusses the recognition and conservation of ‘everyday buildings’ as ‘heritage’ in India, with a special focus on small towns.

In this talk, Tipnis presents the case study of Chandernagore, an erstwhile French Colony situated about 40 kms from Kolkata, where multiple efforts are being initiated by the voluntary sector in an attempt to preserve and valorise the essential ‘urban character’ of the city, instead of letting it fall prey to ‘piecemeal suburban redevelopment’.

The question and answer session that followed can be accessed here.

PAPER CO-AUTHORED BY JISHNU DAS
HEALTH

Health care providers without any formal training provide more than 70% of all primary care in rural India. A new study by Jishnu Das, Abhijit Chowdhury, Reshmaan Hussam and Abhijit Banerjee combines unique data from standardised patients with random assignment to a training programme conducted by The Liver Foundation in West Bengal to assess whether training can improve their quality of care. Findings of this study were published as a paper in the journal Science, titled The impact of training informal health care providers in India: A randomized controlled trial.

Why is the research important?

In many low-income countries, including India, health care providers without formal medical training account for between one-third and three-quarters of primary care visits. What should be done about such informal providers in India is a highly charged debate.

While the Indian Medical Association argues that any kind of training would legitimise an illegal activity, others believe that training can act as a stop-gap solution to rural India’s severe shortage of trained personnel and serve as an effective complement to reform in the public sector. There is currently no evidence on the benefits of training (or the lack thereof) on the quality of care provided by informal providers.

What does the research do?

When people in Indian villages fall sick, they often go to a village provider–who in many cases, has received no formal medical training. As the source of primary care, these providers are asked to provide a broad range of services. They are expected to treat patients with conditions that can be managed in a primary care setting; refer patients with serious conditions to higher level care; and diagnose and manage patients with chronic conditions.

This study was uniquely designed to assess whether a 9-month long training programme, implemented through 72 teaching sessions, would allow informal providers to improve along each of these three types of services. The research assessed:

Does training improve the ability of informal providers to correctly diagnose and manage different conditions?
Does training decrease the use of unnecessary medicines, injections and antibiotics among informal providers? The researchers were concerned that any positive effects may not be sustainable if training adversely affected the providers’ patient loads, and in turn the profitability of their practice. Hence, they also assessed how does training affect the patient load and revenues of informal providers?
How was the research conducted?

The study was completed in three phases. In the first phase, 152 informal providers were randomly selected (out of a total of 304) to participate in a training programme implemented by The Liver Foundation. The training program was implemented over 9 months in 72 classroom training sessions. The remaining 152 providers were offered training after the completion of the study and thereby served as a ‘control’ group.

In the second phase, Das et al. sent standardised patients to all providers in their sample, regardless of whether they had received training or not. The standardised patients were recruited from West Bengal. Each standardised patient was extensively trained to present one of three different conditions and all three conditions were presented to each provider to evaluate their ability to correctly diagnose and manage them.

Since the implementers of the training programme did not know what conditions the standardised patients were going to present, and therefore could not tailor the training to these conditions, the researchers interpret their results in terms of upgrading in overall skill level of the providers.

In addition, the standardised patients did not know whether the providers they visited had been trained by the Liver Foundation. Finally, standardised patients were also sent to every public clinic in the 203 villages that the informal providers came from as an additional benchmark for the effect of training. Reflecting the scarcity of trained medical professionals in the region, the study was able to locate only 11 Primary Health Care Centers in these villages, each of which we evaluated using standardised patients.

Because standardised patients allowed the study to assess care only for these three conditions and not for the multitude of cases that informal providers are asked to provide care for, in the third phase, the researchers sat in the clinics of the informal providers for a full day, recording key details of all clinical interactions.

What were the key findings?

Average attendance in the programme was 56 percent. The main reasons for non-attendance were distance from the training centre and excessive rain. The correlation between attendance and distance to the training centre suggests that if each provider could access training within 5 kilometers from his or her clinic, attendance would increase to 80 percent.
Assignment to training increased the likelihood of correct case management by 7.9 percentage points against a control group mean of 52 percent. If attendance had been 100 percent (instead of the 56 percent observed), training would have increased correct case management by 13.3 percentage points instead. The study found that providers assigned to training were more likely to complete recommended checklists of history questions and examinations, both among standardised patients and in clinical observations.
Public sector doctors were 14.7 percentage points more likely to correctly manage a case than untrained informal providers. Training closed half the gap in correct case management relative to the public sector.
However, there was no decline in the use of unnecessary medicines, antibiotics or injections among providers who were trained. Strikingly, both trained and untrained informal providers were less likely to give unnecessary medicines and antibiotics relative to doctors in the public sector.
The training increased the patient load of the provider. Although the study did not experiment with providers’ willingness to pay for the programme, it computed that the increased revenue would compensate for the cost of training within 66 days if the research used the higher end of its patient load estimates, or 210 days if it used the lower end of its patient load estimate.
Interpreting the findings:

Informal providers are the mainstay of India’s primary care system. The study demonstrates that training informal providers does not worsen care, as has been argued by representatives of the Indian Medical Association. In contrast, it found that training improves their ability to correctly diagnose and manage multiple conditions and although it does not reduce their likelihood of providing unnecessary medicines or antibiotics, it doen’t increase it either. The low costs of training imply that permanently hiring just 11 additional fully trained MBBS providers into the public sector would be as costly as training 360 informal providers every year through this programme.

The full paper can be found here, subject to user access.

SUMMARY OF A BLOG SERIES BY ACCOUNTABILITY INITIATIVE
BUREAUCRACY

Find below a summary of a series of blogs by Accountability Initiative (AI) at CPR on the challenges in navigating the complex government bureaucracy to access basic services and benefits:

In Water Problems in a South Delhi Slum – Challenges of Access, Usage and Awareness, Kriti Seth narrates the problems a common person faces in accessing clean water in the slums of Delhi through the experience of an Anganwadi worker. Lack of awareness of redressal mechanisms and difficulty in approaching relevant authorities compounds the problem. The words of the Anganwadi worker interviewed summarise the crux of the issue, ‘navigating the matrix of zones and departments (like Water, Water sewer, Water maintenance etc.) listed on the Delhi Jal Board website and deciphering the confusing acronyms to finally get the appropriate phone number was a challenge to a comparatively technically sound person like me.’

In Soochna ka Adhikar: Ek Pehlu Ye Bhi.. (Right to Information: Another perspective…)AI’s PAISA Associate (field staff) in Himachal Pradesh, Indresh Sharma describes the roadblocks faced by Arun, a local dairy farmer, who tried to access information through the Right to Information (RTI) Act regarding a road construction on government owned forest land. This led to a bitter dispute with panchayat and land department officials, and as a result, Arun and his family suffered adverse personal consequences, including severe monetary and psychological damage. The piece acknowledges the strengths and power of the RTI Act, but also urges the government to strengthen its provisions, so that such incidents do not recur.

Sachai Ki Jeet (Truth’s Victory), is in essence, a case study on citizen-led actions that demand accountability from the bureaucracy. Dinesh Kumar, AI’s PAISA Associate in Bihar, details the inadequacies of the Public Distribution System (PDS) in Bihar, through which millions of families access daily rations for food at subsidised rates. He shares the story of his relative who mobilised others like him and fought against a nexus of corrupt ration dealers and a hostile bureaucracy to successfully retrieve ration that was rightfully due to him.

In Right to Whose Education, Vincy Davis shares the ongoing story of a man’s mission to get his child admitted to a private school under the quota reserved for students from economically weaker sections under the Right to Education Act (RTE Act 2009). The story traces Sunil’s journey during which he has to face hurdles at every point, and despite having the requisite documents as well as substantial support from his employers, his fight to get his son admitted is still not over.

In Aadhar in Public Service Delivery: An Enabler or a Disruptor , Taanya Kapoor shares a story of the tribal areas of Madhya Pradesh, where the mandatory requirement of Aadhaar enrolment to avail key public services and direct benefit transfers has affected the most marginalised, particularly by restricting their access to cash for daily use. She illustrates this point by sharing the story of a woman from Satna district, one of the most underdeveloped areas in the state, and her struggle to get an Aadhar card made, and consequently being unable to acquire her family’s share of ration from the fair price shop. While, a scheme like Aadhar may be well-intentioned, what needs to be questioned is the sheer incapacity of the state system to tackle implementation issues, which affect many people on a daily basis, writes Kapoor.

In the last two blogs of the series – Bridging Gaps between Citizens and the Bureaucracy – Part 1 and Part 2, Vincy Davis reflects on the journeys of various people whose struggles have featured in the blog series in an attempt to identify common issues within these diverse contexts. One of the main themes that emerges is the struggle to implement a digital India with very low levels of digital literacy, and the implementation process being beset with issues of access; grievance redressal; and bureaucratic complexities. Davis also shares some tried and tested hacks to counter these issues, and lays down a path towards long-term solutions.

BHARAT KARNAD ANALYSES
POLITICS SECURITY

Bharat Karnad, Research Professor at CPR and a national security expert traces the trajectory of the Indian government’s approach to signing the Logistics Exchange Memorandum of Agreement (LEMOA) with the US in a series of select articles over March and April, 2016, listed below:

India in America’s coils?: Questioning the move by the Indian government to sign the LEMOA, Karnad comments that it would effectively reduce India to a client state of the US.
No LEMOA — possible reasons: In this blog, Karnad analyses the reasons for the postponement in the signing of the LEMOA, and calls it interim relief.
Has PM Modi Developed Cold Feet Over The Logistics Agreement with the US?: Welcoming the move that the signing of the LEMOA was likely postponed indefinitely by the Indian government, Karnad writes that New Delhi must have a grander vision for India’s foreign and strategic policies.
The Logistics Exchange Memorandum of Agreement (LEMOA) is one of the three major foundational agreements between India and the US which facilitates the exchange of logistics between military forces of the two nations. The most significant of these will permit the military forces of each country to resupply and replenish, and stage operations out of the other’s military air bases, land facilities, and ports.