Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their status and performance?

Sen’s reform direction

• Sen has argued, with Jean Drèze and others, that India under-invests in elementary education and in primary health relative to its income, and that this drags down both growth and democracy.
• The capability view asks whether a child can actually read, and whether a woman can reach a functioning sub-centre, not only whether a school or a clinic exists on paper.
• That view fits Article 21A and the Right of Children to Free and Compulsory Education Act, 2009, and it fits the Directive Principles in Articles 39, 42, 45 and 47, including the State’s duty to improve nutrition and public health.

Primary education: status and suggestions

• The RTE Act, 2009, made eight years of schooling a right, with neighbourhood schools, pupil-teacher ratios, and 25 per cent seats in private unaided schools. Status is better on enrolment than on learning, as successive ASER-type findings have shown.
• Suggestion one: treat learning outcomes as the performance metric. Publish class-wise reading and arithmetic results at the cluster level, and use them in teacher support, not only in ranking States for political praise.
• Suggestion two: fill teacher vacancies and end multi-grade neglect in small schools; a right under the RTE Act is empty if one teacher covers several classes.
• Suggestion three: early childhood care under Article 45 and the National Early Childhood Care and Education Policy must join Class I, because primary failure often starts in an unprepared five-year-old. ICDS anganwadis need education-trained workers, not only supplementary nutrition.
• Suggestion four: Samagra Shiksha (which folded SSA and RMSA) should fund school libraries, special educators, and mother-tongue bridging in the first two years, instead of repeating civil-works saturation.
• Suggestion five: community monitoring through School Management Committees under the RTE Act must be real, with social audits of attendance and midday meals under the National Food Security Act, 2013, so the kitchen and the classroom both work.

Primary health care: status and suggestions

• National Rural Health Mission, later the National Health Mission, expanded ASHAs, Janani Suraksha Yojana, and public facilities, yet outpatient care is still heavily private and out-of-pocket.
• Suggestion one: make the Health and Wellness Centre under Ayushman Bharat a true first point of care with medicines, diagnostics, and a mid-level provider, so primary care is not a referral slip to a distant district hospital.
• Suggestion two: pay, train and legally protect ASHAs and ANMs as the permanent primary-care workforce; honorary volunteer status produces turnover and weak immunisation follow-up.
• Suggestion three: public health cadre and district epidemiology, not only insurance for hospitalisation. The National Health Policy, 2017, already points this way; hospital packages under PM-JAY cannot replace sub-centre work.
• Suggestion four: converge ICDS, NHM, and school health for nutrition, anaemia, and immunisation, because Sen’s “primary health” is a child’s growth chart as much as an adult’s OPD.
• Suggestion five: ring-fence State primary-health spending and fill MBBS and specialist gaps with bonded rural service that is actually served, plus telemedicine as a supplement, not as a substitute for a nurse at the village.

Shared governance suggestions

• Raise the public spend path toward the NHP target share of GDP, with a larger fraction on primary levels, which is Sen’s core fiscal point.
• Use outcome budgets and CAG performance audit of SSA/Samagra and NHM so implementation, not only allocation, is visible to the Public Accounts Committee.
• Do not privatise the first mile; use private providers where public capacity is absent, under publicly paid, quality-audited contracts, which keeps the capability in public responsibility.