Puzzles of new data on health outcomes

Context: The issues with the policymaking in India has been highlighted by the fact that despite the increased coverage of toilets, National Family Health Survey shows an increase/stagnation in child stunting.

Understanding the problem of policymaking in India:

• Focus on input-outputs based framework: They neglect outputs and outcomes which is required for a broader economic growth and creating human development outcomes.
  • For E.g. in education: policy focus has remained to increase school buildings, and recruitment of teachers and outcomes are based on enrolment and not on actual learnings.
  • In Sanitation: Policy focus has been on increasing the number of toilets and output was measured from the extent of open defecation rather than health outcomes/child stunting.
  • Thus, vast increases in the input have not delivered gains in the outcome.
• Issues with organising policy on a “Mission mode”: There has been a temptation to leave the malfunctioning structures intact while focussing on new objectives as a mission mode. Issues –
  • Develops tunnel vision: When an organisation is told that it will be measured by some target, employees tend to develop tunnel vision, and pursue that target in a narrow- minded way.
    • For E.g. When traders in banks are told that they have to produce trading profits, they do this while often sacrificing the long-term Health of the bank along the way.
  • While Mission mode is fine for episodic problems (e.g. Kumbh Mela), it is not a substitute for deeper reforms.
  • An organisation placed in such a state tends to run unthinkingly, intensifying policies without questioning them.

Way forward: To deal with the policy issue

• Policy modifications: Based on research on the NFHS data. e.g.  Exploring the correlations between toilets, childhood morbidity, and stunting to solve the child stunting problem.
• Deeper changes in organisational design: require high intellectual capacity and take place slowly.
• Aim for high Gross Domestic Product (GDP): GDP is a determinant of human development outcomes.
  • High growth in the 1991-2011 period resulted in progress on issues like poverty and human development.
  • The difficulties of the economy from 2011 onward have hampered human development outcomes leading underweight and stunted children.
  • Increasing private investment will help in achieving sustained GDP growth.