Indian development excludes women form key education and health opportunities while not recognizing care work

Inclusive growth implies that the gains of development are shared between all citizens in ways that are just. That is to say, the state takes positive action to compensate the traditional disadvantages of the weak, the deprived and the vulnerable so that each citizen attains a minimal level of capabilities necessary for survival and functioning. India's record in this regard is far from satisfactory; inequalities on grounds of religion, caste and ethni city are rampant and these get compounded once again for women of all groups on grounds of gender. An unacceptably large section of the population, among whom women form the majority, still continues to suffer from hunger, ill-health and ignorance.

Education: Access to education and skill training exemplifies these failures. Despite the constitutional provision of a right to education and the Sarva Shiksha Abhiyan campaign, there are still persistent gaps and discrimination in access to education on grounds of religion, caste, ethnicity and gender. Regrettably, this time too, policymakers do not appear to have any vision for redressing that situation. Too much of early childhood education is being left largely to underpaid female teachers who, in spite of being state employees, are denied workers' rights.

The planners make no mention of action on the recommenda tions made by the various commissions and committees set up during the Eleventh Plan, which is when significantly the big push for education was announced. There is an intention to bring in the private for-profit model into educational institutions. The empha sis on the ppp model for all levels of education must be backed up with evidence and justification to show how it has been success ful either in extending facilities to the deprived or in generally improving the quality of education. This is especially true of train ing in skills. Access to skills has become a prerogative of those who can pay exorbitant fees. Women are deprived on several grounds since families have reservations regarding spending large amo unts on a daughter's education. And if the family budget is con strained, then the choice automatically is in favour of the son.

There is also no reason to believe that the ppp model will cater to the urgent need for skill training and upgrading among numerous workers in the unorganised sector who, as men tioned before, can find no markets for their traditional skills unless these are coupled with modern inputs and some entre preneurial skill. To universalise access to these skills at all levels and to all social groups, the state needs to promote flexible vocational school education as well as enterprise-level training that is sensitive to local opportunities and traditional skills. The Twelfth Plan must pick up the challenge of ensuring that all children, including differently abled children, are able to enjoy equal access to education and educational institutions.

Health: The most glaring form of gender discrimination is in the health sector, where it is visibly manifested in the low female-male sex ratio, the high levels of and sex differentials in morbidity and mortality as well as differential access to treat ment and care. The zero-to-six child sex ratio has continued to decline from 927 to 914 as per the provisional results of Census 2011. Differentials in morbidity and mortality and differential access to treatment and care for women are causes for concern. Juxtaposed against the high communicable and non-commu nicable disease burden is the low public sector provisioning for health and the unmet commitments on provision of access to care. Public expenditure on healthcare in India is among the lowest in the world, both as a proportion of total expenditure on healthcare and as a percentage of gdp. Government expend iture on healthcare in India constitutes only 19.67% of total expenditure while 71.13% is spent by households themselves (Ministry of Health and Family Welfare 2009). In contrast, government expenditure on healthcare is 87% of total health related expenditure in the United Kingdom (uk), 80% in France, 64% in Thailand and 46% in Sri Lanka (ibid). Clearly, public expenditure on healthcare in India is among the lowest in the world.

The Eleventh Plan fell severely short of raising the share of public expenditure on health from less than 1% of gdp in 2006-07, to 2-3% of gdp. The likely achievement will be only 1.4% of gdp. The approach paper suggests that total health expenditure will be increased to 2.5% of gdp by the end of the Twelfth Plan, but there is no basis for determining whether this is adequate. Nor is there a road map for achieving this number.

There is need for recognition of the critical care work provided by women, that saves the public health system both time and cost. The primary burden of caregiving within the home falls on women. This needs to be recognised and support provided to alleviate the difficulties, drudgery and depression that surround provision of care. Macroeconomic policy takes the "reproductive" economy where women undertake most of the work for granted, and assume that it will adjust to changes induced by macroeco nomic variables. While the approach paper notes that the bur den of financing healthcare falls excessively on households in the form of out-of-pocket expenses, the solution suggested is publicly financed healthcare services through high quality, district-level plans for health services, funded primarily by the states. This will be a non-starter as several states will not have the required funds.

While ill-health affects both men and women, the problems get compounded for women due to higher morbidity in both rural and urban areas, lack of access to and control over resources, restrictions on mobility, unrecognised care work bur den, high levels of anaemia and greater fear of stigma. Additionally, women are victims of domestic and other forms of violence. This is a public health issue but public provisioning for implementing the Protection of Women from Domestic Violence Act 2005 that has been passed falls far short of needs. In addi tion to reducing maternal mortality and providing reproductive healthcare, the focus of health provisioning for women has to be on planning for women's survival and health throughout the life cycle. This requires that data on disease burden and health seeking behaviour be presented separately for males and fe males. Data show that reported morbidity is higher among women than men. However, disease-wise information is spo radic. Strategies are needed for identification of specific barriers to access to healthcare and removal of these constraints.

Shortfalls in essential infrastructure, nurses, doctors, and other staff and drugs must be corrected and access to primary health centres (phcs), community health centres (chcs) and medical care be provided based on population and area norms. Access to healthcare cannot depend on the vagaries of public-private or pub lic donor partnerships. The state must take responsibility for acc ess to quality healthcare - preventive, promotive and curative - for all, with special responsibility for vulnerable groups. However, the "vulnerable" cannot be determined by ownership of a below poverty line (bpl) card, since that will lead to errors of exclusion.