| Public deficiencies
The victims of the recent Rajdhani Express mishap were afflicted with a double scourge : a tragic accident and a thoroughly callous and inefficient railways and hospital administration. It is torment enough for relatives to cope with the loss or suffering of their dear ones, but it is unbearable to see that in moments of deep distress, their loved ones do not receive even a modicum of the healthcare and relief assistance that any human being deserves.
The complete breakdown in disaster management of the Indian Railways and of the public healthcare system in the vicinity of the site of accident, which incidentally was not that isolated a place, is illustrative of a deficiency that has become routine and endemic in nature. This, in turn, is indicative of a much deeper social malaise, namely, the progressive irrelevance of the public services to the upper and middle classes and their greater reliance on the private sector, which again allows the public services to deteriorate further.
The “have enoughs” routinely castigate the quality of public healthcare or other public utilities and call for reform. However, the suggested reform seems to be in the direction of opting out of public services and turning to private agencies for them. A recent poem by A.K. Rao pithily captures this attitude of the “privilegentsia”: “Do not worry that there is no power supply, we have a generator/ Do not worry that there is no public transport, we have a limousine/ Do not worry that the telephone does not work, we have a wireless cellular phone/ Do not worry that there are no good schools, we have tutors for our kids/ Do not worry that there is no hospital, we have personal doctors.”
But is there a private solution to every public deficiency' Unfortunately, no. As we were rudely made aware of it recently, disaster, unlike deprivation which targets only the unprivileged, spares none. Therefore, without displacing private or voluntary initiatives, we need to work to fix rather than abandon the scheme to improve public services, particularly disaster management and the health services.
Two asides are apposite here. First, recall that the government is making serious efforts to introduce Vedic astrology as an independent, if optional, course in universities. This is at a time when resource crunch in universities is acute and when we must incorporate programmes with more immediate applicability. For example, there is a dire need to include in the university curriculum hitherto neglected subjects such as disaster management, road and rail safety, occupational health of workers and labourers, rural health and so on. There are no structured training programmes in any of these subjects in India. Currently all that we do with these recurrent problems is firefighting. But as the recent accident glaringly shows, management of disaster is itself going to be a disaster, unless backed by sustained public efforts, investment, research and application.
Second, despite our current preoccupation with privatization, what remains sparingly researched is the issue of the “publicness” of the public healthcare system. Research has shown that the healthcare system in the country is already highly privatized insomuch as a large proportion of the household expenditure on health is absorbed by either private hospitals or private medical practitioners. Besides, an overly alarmist view of the so-called menace of population growth has routinely prompted policymakers to divert precious resources away from improving basic healthcare facilities toward achieving the sacred goal of birth control and family planning. As a result, we end up treating malaria, as a doctor of a public healthcare centre candidly admitted on television, with contraceptive pills that are in abundant supply. A visiting Chinese team of health officials recently made a similar observation about the oversupply of highly qualified doctors in India, coupled with the paucity of basic healthcare infrastructure and barefoot paramedics — the two well-known pillars of success of public health and healthcare in China.
Those who argue that disparity in private and public provisioning exists in all societies, obscure the differences among countries and systems. Indeed, even within our own national boundaries, public provisioning is not in an equally dismal state everywhere. For example, one may recall another train accident in Kerala in the recent past in which almost all the victims, while grieving their personal loss, unhesitatingly acknowledged the prompt assistance offered to them by the local administration, health officials, villagers as well as railway officials.
What, therefore, seems to underpin and influence the performance of publicly provided services is the involvement and commitment of the public or their lack, especially that of the affluent section whose voice counts. One could argue that the commuter rail system in Mumbai functions well primarily because it caters to all — the privileged or the unprivileged, Dalit or Brahmin, salaried or self-employed, villager or urbanite. This is what makes it public. It is in the interest of all these users to ensure that the system functions at some level of satisfaction.
Perhaps there never was a golden age when public schools, public hospitals, or the public transport system functioned superbly, but it is possible that earlier they offered services of some quality that satisfied the basic needs of our previous generation. But as public institutions expanded gradually to allow the participation of the hitherto excluded population groups and as the deficiencies of the system grew progressively, the relatively better-off section of society responded to the decline in quality by opting out of the system in favour of private solutions. The “lesser” citizens, of course, have no other choice but to depend on the poor services.
The growing disillusion of the affluent with public institutions and their massive reliance on the private sector have severely weakened any effective demand for improved performance of the public sector. Devoid of both voice and choice, the present clientele of public institutions, namely, families at the lower end of the socio-economic scale, can create little or no pressure on the bureaucracy and policy-makers for meeting its basic needs. Second, this staying away has created higher resistance among the middle and upper classes to subsidize public provisioning.
In this atmosphere of indifference, apathy or even resistance to “basic services for all”, one can perpetuate the gloom in the current state of affairs, but can we not try to set the ball rolling the other way' In other words, can we not incite action rather than allow stagnation' It is necessary not to individualize or privatize a task which demands collective concern and action. Obviously, the privileged will have to join their fellow citizens in the task of improving the performance of government-run institutions. Even if they are willing and able to avail themselves of the special privileges of the private sector, this should not diminish or dilute their responsibility as part of the citizenry to bear the social cost of reinvigorating public schools, public hospitals or public transport.
On the contrary, if we allow our government schools to cater only to the underprivileged, if we let our local trains to be named “maidservant expresses” (trains coming from the South 24 Parganas to Calcutta are often referred to thus), and our state hospitals to serve only those below the poverty line, we shall not be able to escape the disastrous effects of widespread public impoverishment, much as we try to take refuge in our private pockets of prosperity.