Essential Services

Oxfam's Objective for Essential Services

People living in poverty, especially women and girls, will realize their rights to accessible and affordable health, education, and social protection.

Status of Essential Services in India Today

A broad look at some of the essential services in India will tell us the severely stressed situation under which these sectors are right now. This has meant that the poor have been constantly hit disproportionately in accessing these services and there has been a cascading effect in terms of worsening of people's socio-economic situation due to the spiralling costs in availing these services.

A quick look at some of the indicators would illustrate this clearly:

India spends less than 1% of GDP on health and less than 3% on education, much less compared to even some developing countries. This means that almost 80% of the total health cost is borne out of pocket resulting in 40% of the population borrowing money to meet the cost of hospitalisation. The paradox is that while it is known as 'Pharmacy of the Third World' due to its generic drugs, just about 30% of its own population has access to essential drugs. This has led to every second malnourished child in the world being an Indian and an extremely high number of maternal deaths during and after pregnancy taking place in India.

Similarly, on education front low levels of public investment have led to huge dropout rates of children reaching up to 40% at the primary stage and 52% at elementary level despite the official version of more than 90% enrolments. Of course the most vulnerable communities like dalits, tribals, Muslims and girls are the worst hit in this scenario. There is a huge infrastructure issue and according to an Oxfam report itself, half of India's schools have a leaking roof or no water supply, 35% have no blackboard or furniture, and close to 90% have no functioning toilets.

On other fronts like water and sanitation which is crucially linked to the issue of public health as well, even today the sustainable coverage for water is only approximately 50% population and for sanitation only about for 25% population.

The other crucial aspect in this respect is that of food security but here too the target of Below Poverty Line families in government schemes is problematic as officially it covers only approximately 28% of the population. However, in a recent report by N.C. Saxena Committee appointed by the Government of India, it has been recommended that 52% of the population should be brought under its net. Further even among the existing Public Distribution System, 58 per cent of subsidized food grains do not reach the BPL families, 22% reach APL and 36% is sold in black. The other crucial scheme in this aspect of late has been National Rural Employment Guarantee Act. But even after three years of implementation, the average number of days of employment provided is only 42 days as against 100 in a year.

A sober analysis will also tell us that the problem faced on all these fronts, though part of a long historical legacy, has worsened over the last couple of decades due to certain key shifts in the developmental trajectory of India. It tells us that there was a gradual disinvestment from the public services from whatever meager resources were there. It also meant that a kind of 'normalization' took place with the perception that the people's basic rights are not rights but actually 'services' to be bought from the open market. Those who could afford could buy better education for their children, better health care for themselves, safe drinking water and so on. The rest, a vast majority of the people, were left to fend for themselves. A clear hierarchy of services, first rate for those who could afford second rate for those who couldn't!

This scenario demands urgent attention with some key policy premises: Non-state providers can fill gaps, demonstrate change but cannot replace the role of the state - government has all the power to 'go on scale'. At the same time, civil society actors are critical in mobilising, articulating, and sustaining demand on governments to deliver essential or otherwise basic services.

We, at Oxfam India, firmly believe that access to quality essential services is not merely a human need but also a human right. It is our understanding that inequities in access to quality essential services perpetuate further inequality. It also hampers the ideal of an inclusive growth of a nation. In this sense, provisions of good basic services are precursor to growth led equitable development.

Areas of concern

• In-sufficient public spending on Essential Services remains a big concern;
• There is inequity in access based on geographical location, social status, economic capacity and religious identity;
• Quality of services remains a big challenge; very often there are no parameters for the same;
• There are severe implementation gaps in programmes and policies even where they exist;
• There is an acute crisis of ineffective governance system down to the grassroots level which demands urgent attention;
• There is also an urgent need to pitch for a greater social accountability of dominant private sector in these services; and
• Very often there is a lack of knowledge of rights amongst people and there is also a parallel attitude of indifference among the wider civil society which further perpetuates inequities.

Oxfam's Work on Essential Services

Oxfam has been part of a nation-wide process to work with improving access to quality, universal and free education through the mainstream education. It has been working with civil society groups and communities at the grassroots to build State and national level linkages for a large-scale impact. Similarly, it has also worked towards issues of improvement in the delivery of public health services through improving the space for community's role in monitoring of government schemes like National Rural Health Mission, specific programmes on HIV/AIDS etc. It has been working towards greater realization of food and employment rights through effective implementation of National Rural Employment Guarantee Act. It has also been part of a national network to bring in larger policy reforms through a call for greater accountability of state, greater investment through a regular budget tracking and through a constant pressure to include the most marginalized in the delivery of quality essential services.

It is in this context that there are clear opportunities for Oxfam to adopt a twin strategy i.e. strong grassroots backed movements to realize the potential of the existing policy and plans while also pushing for greater policy reforms at the State and national level.