Even after 70 years of Independence the tragic incidents like Death of children at BRD Medical College hospital in Gorakhpur proved that India's state capacity is weak specially at delivering quality education and public health to its citizens.
Failure of Democratic institutions:
The process of democratization has not been able to steer successive governments to deliver better health and education services.
- In general, democratic institutions in India have negatively affected the provision of public health because Electorates typically prefer public funds to be used to provide private goods (such as medical care), rather than public goods (such as sanitary measures to protect the health of the population as a whole).”
- In fact the non-democratic regimes of East Asia were more successful in delivering quality public health services. It has been argued that “elite capture” which help divert public funds meant for primary healthcare towards provision of tertiary medical services.
Failure of Economic forces:
- It has been argued that there is no link between economic growth and better institutional delivery.
- On the contrary higher economic growth may actually lead to degradation in governance quality. A 2002 paper by Daniel Kaufmann and Aart Kraay came to this very conclusion and the duo speculated that “elite influence and state capture” might be the reason that a virtuous cycle between economic growth and quality of governance doesn’t manifest.
State capacity: “thick accountability” and “thin accountability”
Lant Pritchett of Harvard University goes into the details of the state capacity. He draws distinction between “thick accountability” and “thin accountability”. For an organization, thin accountability is based on measures of objective performance and is judicable. On the other hand, thick accountability comprises justification of organizational actions to internal culture and external stakeholders.
- For example, thin accountability will have parameters like the attendance record of teachers in schools and nurses in hospitals, and thick accountability will involve quality of diagnosis of a patient and the learning outcome of students. It is evident that an organization with weak capacity may well be able to deliver on thin accountability metrics but will always struggle with thick accountability.
- Setting the curriculum for schools is, therefore, something states with a weak capacity will be able to deliver much better than ensuring teaching standards. In healthcare, similarly, tertiary healthcare service is easier than making doctors deliver in primary healthcare centres.
The dichotomy is that same Indian state which struggles at primary healthcare and education is able to organize the world’s largest elections, enrol billions of people in a biometric Aadhaar programme, and send Mangalyaanto orbit Mars. The parameters of accountability in these cases—number of voters in elections, number of registrants in Aadhaar, the cost of an orbiter mission—are objective and judicable. Moreover, these organizations have all been driven by a mission-oriented focus. The culture of internal accountability in a mission-oriented organization is much better.
The Success of organisations like ISRO, RBI, and to great extent Supreme Court of India is partly due to infusion of a sense of mission in these organizations. But the engendering of such attitudes in an organization takes time and is not always successful. This will involve creating a few initial successes, replicating, repeating and multiplying them. And then crafting organizational narratives around those successes. The governments at the centre and in the states should embark on this task with a “missionary” focus.