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Two recent government decisions draw attention to the muddled thinking that has characterized health policy in India. One, the government has decided to open seven new ‘’AIIMS’’( All India Institute of Medical Sciences) in different parts of the country. Second, it has made one-year rural service mandatory for medical graduates as a pre-requisite for registration.
It is fallacious to believe that mandatory rural posting would solve the multitudes of problems that plague the rural health care delivery system. No doubt, the system is in shambles: severe lack of facilities, absent doctors, and missing drugs has prevented the rural poor from receiving adequate medical care. However, how will the government ensure the presence of medical graduates in rural health care centers when a vast majority of government doctors posted in rural areas practice in urban centers while still drawing their salaries? While treating medical graduates as sacrificial lambs, the government has shows its love for grand gestures by investing its money in tertiary care–a task best left to the private sector. One cannot help but conclude that the government’s twin decisions are devoid of sound reasoning and driven by extraneous considerations than any real desire to ameliorate the condition of rural poor.
If the government was serious about improving the rural health system, it could have achieved its purpose by investing in primary health care system (rather than building new AIIMS) while at the same time incentivizing rural practice for medical graduates: waiver of fees and a preference in post-graduate medical education. It would be facile to dismiss it as one off case; instead, it is an expression of how a systematic neglect of policy education has stymied policymaking in India. As Professor Mukul Asher has pointed out in an op-ed in the Far Eastern Economic Review, India truly needs to breed more policy wonks.
Expand policy education
Unlike in the United States, medical schools in India admit students immediately after high school. Medical students have little opportunity to interact with students of other streams and develop a broader perspective. Health policy departments in most state medical schools are either non-existent or chronically undermanned and under funded. Naturally, doctors in India develop little understanding of the larger health policy issues. This trend can be seen across almost all professional schools including elite schools like the Indian Institutes of Technology. The government has compounded this folly by promoting specialist universities devoted exclusively to medical or engineering studies. The University Grant Commissions’ deemed university concept which has allowed even single faculty institutions to claim university status has been the proverbial last nail in the coffin. This narrow compartmentalization not only stunts student growth but also is an obstacle to cross-disciplinary research. There is an urgent need not only to expand policy education but also to bring such schools within the ambit of larger institutions so that they can leverage their collective strengths.
For policy schools to be truly independent, their functioning should be independent of the government. It is here reputed private universities and the industry must come together. Institutions like Manipal University already enjoy a reputation for academic excellence. With endowments from industry, they should build independent policy schools that can contribute to the task of nation building. Rather than funding universities, Indian industrialists have preferred to build institutions directly under their administrative control. This is counter-productive; as such institutions can never truly claim complete independence limiting their credibility and influence.
Education is fine, but where are the opportunities?
Public policy graduates in United States have multiple opportunities to work with both the legislature and the government. To give just one example, Congressional Internships allows new graduates to understand the legislative process and apply theoretical knowledge to the challenges of the real world. On the other hand, Congress members benefit from their specialized knowledge and the technical know how.
Such opportunities are largely absent in India due to a mixture of ignorance and bureaucratic resistance. No doubt, think tanks like PRS India are doing their bit to enhance understanding of the legislative process. However, attachment of policy analysts directly to legislators would be more beneficial. Government agencies can also offer policy students internship so that they can study government functioning from close quarters.
Currently, the biggest driver of public policy in India is the higher judiciary. From traffic to zoning laws, the Courts have repeatedly intervened in areas that by strict constitutional demarcation are preserve of the executive. However, much of this policymaking has been arbitrary, driven more by good intentions than a clear understanding of the policy process. While changes in the law curriculum–with greater emphasis on understanding the intersection between law and public policy are required, the Courts can help by adopting the system of judicial clerkships. This would not only train young lawyers but by exposing them early to policy making, would prepare them for future judicial responsibilities.
Reforming the Bureaucracy
There is little doubt that in a democracy, public policy is a largely a prerogative of the elective representatives of the people. However, an independent bureaucracy is essential to translate the vision into effective policy instruments. Indian civil services are a direct derivative of the British system and are designed more for ruling than governance. In an era of globalization, a system completely reliable on career bureaucrats is liable to come up short when faced with a fast changing world. Lately, bureaucratic independence, an essential prerequisite for an effective government has been seriously compromised. What is required is fundamental changes in administrative framework.. The UPA government’s Administrative Reform Commission has proposed some welcome changes; however, it has merely tinkered with the system whereas whole sale changes are the need of the hour. There is at least two things the government needs to do urgently.
First, strengthen the Right to Information Act. The legislative intent behind the American Government in the Sunshine Act explains beautifully explains its rationale: ‘’the people are the only legitimate foundation of power, and it is from them that the constitutional charter … is derived. Government is and should be the servant of the people, and it should be fully accountable to them for the actions which it supposedly takes on their behalf.’’ The Right to Information Act (RTI) can truly transform governance in India. However, the government needs to think og innovative solutions to make information accessible to the common man. Recently, the Bihar government started a call center where people can call in with their queries and a trained staff would not only fill up their forms but also follow up with the concerned authorities.
Second, introduce a Lateral entry system. Bureaucrats in India are typically selected through an examination and rise through the ranks. This system leaves no scope for entry of professionals who develop an interest in public service in the later stages of their career. A lateral entry system would allow the government to take address this problem and utilize the expertise of such professionals. After all, there is no reason why those who have succeeded in industry or academia cannot succeed in the government This is not to discount the importance of career bureaucrats but to emphasize that the best person be chosen for the job. This would also serve to insulate the policy process from blatant political interference.
Ultimately, a policy driven government is a function of a more open and transparent system where the government is willing to subject the policymaking process to independent evaluation. This not merely requires statutory changes like the Right to Information Act but a fundamental re-evaluation of the relationship between the government and the citizenry.
Acknowledgment: Professor Mukul Asher and Nitin Pai
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2 Responses to “Towards A More Policy Driven Government”
DesiPundit » Archives » Policy matters May 9th, 2007 at 3:25 pm #
[...] the recent government decisions in the medical arena as backdrop, Confused convincingly argues for a policy driven government. If the government was serious about improving the rural health [...]
anonymous May 22nd, 2007 at 1:06 pm #
SOVEREIGNTY OR GLOBALISM, WHICH?
(WE CAN’T HAVE BOTH)
By E J EKKER
The most disturbing thing about the question is that, just to ask it implies such a loss of faith in, and touch with, God as to signal a hopeless surrender to those forces of evil so dedicated to the enslavement of mankind.
Yet most people do not see the stealthy, surreptitious, deliberate insertion of the tools of separation of men from God and, thus, from their own sovereignty. Those tools range from the most insidious, addictive drugs (either in direct, “raw” form, or blended with tobacco, wines, and liquors), through the degradation of family values through movies and TV “sitcoms” and the exploitation of sex and music, and finally to the aggrandizement of corruption in politics and the virtual abandonment of the Herculean effort required to maintain a decent and effective school system. These covert tools of world control are far more pervasive and damaging than are the few indiscriminate bombings attributed to “terrorists” which often share the same goal of world domination.
Dictionaries and Encyclopedias will define sovereignty in political terms, as though only states/nations could possess it. Sovereignty is far more than that. Sovereignty also describes that appropriate relationship between God and man; a relationship wherein there is no “broker” in between God and man, and wherein sovereignty, provided by God, is matched by the acceptance of responsibility by the man. (The use of the term “man” is intended to include women and children; God does not discriminate.)
And so, Sovereignty is that status of freedom granted by God in exchange for the acceptance of responsibility (for himself) by the individual.
Nations, like men, are born sovereign. Men lose their sovereignty in many ways, but God provides a way for each to restore his sovereignty by rejecting commitments made for him by others and reaffirming his direct connection to God. Nations usually lose their sovereignty through colonization, losing a war with a neighbor nation, or by taking loans from the IMF/World Bank which require their political leaders to sign agreements giving up certain basic rights regarding the responsibility of the nation to determine the amount of currency it may issue, or have in circulation, in addition to arms and nuclear restrictions.
Nations, too, have a way to regain their sovereignty–by reestablishing their responsibility for themselves. One of the several significant objectives of Global Alliance Investment Association (GAIA) is to provide the ways and means for nations caught in the IMF/WB debt trap to regain their sovereignty.
“Globalization”, transparency, open markets and open ownership, options, “puts” and “calls”, derivatives, “short” (commodities, common stock and currency) sales, currency trading, and foreign exchange are all tools of, and invented by, the international bankers (the trading elite) for the purpose of “winning” the money and property earned by the working (producing) people. Other, less visible, tools are organizations such as the “Black Nobility”, the Club of Rome, the Trilateral Commission, the Bilderbergers, Freemasons, and the Council on Foreign Relations, to name only a few. Even the United Nations was formed by and is used to implement the policies of the international bankers’ “cartel”. Through its ownership of virtually all of the major press and media, commerce and manufacturing, transportation and communication, and its loans to those it does not own, in combination with its control (through its lobbies) of the governments of nearly all of the “developed” nations, the cartel maintains a strangle-hold on the economics of the world.
That economic strangle-hold is maintained by using all of the tools listed above plus two more: first, the “brainwash” effect of controlling the content and curricula of the major (and most minor) schools of economics and banking for two centuries so that the not-yet-developed nations believe that the source of all money (foreign exchange, especially) is from those “wealthy nations” and banks controlled by the cartel, and second, that the issuance of new currency by a nation leads inevitably and immediately to a dilution of the valuation of that currency–which is strictly enforced because the cartel dictates and controls the value of every currency and it allows no one to forget it–except Malaysia. Dr. Mahathir was absolutely correct when he said, “The IMF and the international bankers (Jews) use the foreign exchange value of our currency to ‘discipline’ us–our only recourse is to set and freeze the value of the ringgit.” In September 1998, after losing some $240B to the manipulators, they froze the currency value and stopped the “short” selling in their stock market, which actions have proven so successful that even the major press occasionally admits that the Malaysian economy is much healthier than those “saved” by the “austerity” of the IMF.
To regain sovereignty, each nation must regain control of the value of its currency. As long as the international bankers, via the manipulation of “foreign exchange rates”, are able to control the value of a/all nations’ currencies, they will be able to rob, pillage and steal the assets of the victim nations. Only by committing and maintaining its currency on a “common denominator” with other nations can a nation break the foreign control of the value of its currency. That common denominator is, and has always been, gold. Gold has been used as the foundation of money for millennia. Only in the last one hundred years has it been derided and criticized into a secondary role by the fiat paper money advocates, the international banking cartel.
Not only have they ridiculed and scorned gold, they have preached that a return to the gold standard is so complicated that it has become virtually impossible. That is, of course, as wrong as so many other things they preach in their prestigious “schools of economics”. Perhaps, if you have no gold in your nation, returning to a gold standard might require some thought and planning, or the assistance of an alliance of nations dedicated to the achievement of economic independence. But for a nation in Southeast Asia, especially the Philippines, it is easy, actually much easier than continuing to try to cope with others manipulating the value of your currency.
In 1945 at a conclave later called “Bretton Woods” the Allied Nations, seeing that they would win World War II, began to plan for the “post victory recovery period”. One of their devices was the United Nations, others were the World Bank and the International Monetary Fund. The few “nationalistic” delegates who recognized the seeds of world domination and control in those high-sounding “charters” were quickly quashed by the bankers. Wars cost a lot of money and the bankers, especially the Federal Reserve System in the US, had created paper money to loan unstintingly; they were not about to be denied the objectives of their having orchestrated the war in the first place. “Reconstruction” would require a lot more money and they knew that if they could coordinate and consolidate their control of the money supply, they could virtually control the world.
That is why any nation that has accepted a WB/IMF loan is prevented by those loan agreements from deciding the amount of its own currency it shall issue, or from paying off those loans by issuing its own currency to do so. Thus it should be made clear that sovereignty can only be achieved by a nation after the WB/IMF loans have been repaid so that the agreements are no longer in force. If the nation’s own currency is not acceptable as payment, what is? US dollars, foreign exchange currencies, and probably gold and gold-based money; only by reading the agreements can we be sure.
If the Philippine debt to the WB/IMF is some $50B, it would take approximately 5,000 metric tons of gold to pay it. Does the Philippines have that much gold? Yes, many times that. Does the WB/IMF need or want gold? They say they do. If the problem is that easily solved, why hasn’t it been done?
Could it be that there is a “borrowed money syndrome” here that promulgates the idea that WB/IMF money need never be paid back? That paying it off, especially in GOLD, is a huge waste? Or could it be that the local bankers and finance people are so accustomed to the status quo that they never question whether it can, or should be, paid off? Who would benefit if the WB/IMF debt were paid and the country returned to a gold-based currency? Just about everyone except the WB/IMF and the international banking cartel; to confirm that, President Estrada should be asked who it is that is pushing him so hard for constitutional change. It seems that someone is more than a little desperate to effect that change; quite obviously there are forces at work that want to collect on their campaign support by being allowed to buy Philippine companies and properties at fire-sale prices.
What would be different if the Philippines were returned to sovereignty and its currency based upon gold? To state it in a broad sense, within a few years the Filipino people could easily achieve a standard of living equal to or greater than exists in the US or Japan. Inflation would be zero (gold does not “inflate”) so the 10% “inflation component” in domestic interest rates could be removed, leaving interest rates around 4% (instead of 14%). That alone is a huge boon to all of government, commerce and industry and would free billions of pesos for more constructive use. Even the federal tax rates could be greatly lowered at the same time as wages for all governmental employees can be increased to reduce the need for graft and corruption. No one in the nation would need to borrow money “offshore” (there is a way for the central bank to provide adequate gold-based money without depreciating the value of the peso) so all of the concern over the nation’s “credit rating” would be gone (and gold-based money provides an immediate and automatic AAA rating anyway). There would need be no concern over “foreign exchange” and “balance of payments” because gold-based currency is directly acceptable as payment for goods and services (without the waste of time and expense of going to an intermediate foreign exchange currency) and a nation with gold-based currency need not worry about its balance of payments since the big problem of enough “foreign exchange” has been solved–it is no longer needed. There would be no need for Overseas Workers to send “forex” home. Wages would soon be better (in real terms) here than anywhere. The Finance Department would not have to crawl and beg for foreign loans because none would be needed, the nation would have plenty of money.
New money can be printed, practically without limit, if it is always used first to purchase gold to be held as reserves within the banking system of a nation, even if it must purchase the gold from “off shore”. In fact, as gold reserves are accumulated the peso will increase in relative value, helping to elevate the level of its purchasing power which is especially beneficial to the poor. This nation has more than adequate gold “on shore” and thus can double the value of its gold-buying by buying from its own people with its newly issued currency. Infrastructure facilities, new or improved utilities, port and airport improvements, railroads and rapid transit systems and highways all increase the value of the nation–all of which can be matched by measured and appropriate increases in the money supply. This nation is not starving for money because it is poor; it is poor because the IMF agreements allow the “rationing” of the money supply, removing virtually all semblance of sovereignty.
The Administration might say, “But we don’t have 5,000 tons of gold and the IMF agreements prevent us from printing $50B worth of pesos to pay for that much gold; how can we get enough gold with which to pay them off?” Suffice to say, without giving away our strategies, that there are several ways it may be done with the assistance of Global Alliance Investment Association. All that is now required is the WILL; when we work together we can find the WAY.
The failure of the World Trade Organization in Seattle exposed “globalization” for the farce it is. Its beneficiaries are almost exclusively the “transnational” corporations that already have most of the world’s wealth, the same corporations that are owned/ controlled by the elite international banking cartel, and who are the owners of the Federal Reserve System and the guarantors of the debt of the US Treasury to Global Alliance. To be positioned to do business in a GLOBAL community does not require that a nation open itself to allowing foreigners to buy up the best of its properties, businesses, and natural resources; it does require strong financial reserves and a freely recognizable currency which are both entirely within the reach of the Republic of the Philippines.
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