The challenge of designing effective public policies is the marriage of good theory and optimal administrative architecture with the specific local conditions and stakeholder requirements. In a society with widely varying socio-economic conditions and local requirements, it becomes a massive challenge to design welfare and development policies. I have already dwelt on some of these challenges in an earlier post here. However, unfortunately enough, influential and well-meaning opinion makers have tended to grossly simplify this complex reality and see ready-made solutions in buzz-words like decentralization, people's participation, awareness creation, transparency, good governance and so on.
Talk of arm-chair policy making, sample this from Ila Patnaik
"The most important public good that needs urgent attention is rural sanitation. This should be on the top of the priority list of the NREGA... One of the main reasons for the failure of rural sanitation schemes has been an attempt to implement schemes designed at the Centre or in state capitals which do not take account local conditions. The one-size-fits-all approach, such as, when subsidies are given for construction of facilities by BPL families, has not resulted in increased usage or improvements in outcomes measured by health status. For example, there are instances of centralised schemes which privileged the importance of sanitation and built septic tanks and latrines, but these were never utilised, as the community was not involved in the decision-making process.
The lack of awareness about hygiene and sanitation is pervasive. The task involves not merely construction of facilities as a mechanical task to get a subsidy from the government, but of education and awareness. This can, to some extent, come through involvement in decision-making. The power of the NREGA is that the projects taken up are conceptualised at the local level. In this regard, the NREGA has an advantage over Central or state government sponsored schemes, which cannot create public assets suited to the needs of each village. Although some of these top-down schemes are well meant, they still do not have the potential for taking account of local conditions and needs. Effectively, the NREGA provides untied money to the block or village as long as the money is spent on labour intensive work."
I have no problems with the diagnosis that government programs, especially some of the larger Central Government ones, suffer from a rigidity in their guidelines arising from an obsession (or compulsion) to offer an one-size-fits-all prescription. In fact, this deficiency has been widely acknowledged among policy makers for sometime now. But the prescription proposed by Ila Patnaik (again an one-size-fits-all solution among academicians and poverty opinion makers) - of involving people in the decision making process - is far too simple and fails to appreciate the complexity of such challenges.
Policy makers designing programs for the entire country are faced with conflicting choices and a difficult trade-off. On the one hand, in an effort to eliminate leakages and target the delivery, they design programs with multiple layers of monitoring mechanisms, uniform standards for beneficiary selection and strict guidelines outlining the process of delivering benefits to the consumers. However, given the vastly differentiated socio-economic reality of the myriad regions across India, it is impossible to design a comprehensive set of guidelines that caters to all possible socio-economic contexts and contingencies. Therefore, in the process they end up knotting the program in a tangle of bureaucracy that ironically enough increases inefficiency and spawns both rent-seeking and wastage.
On the other hand, if they cast aside norms and components (beyond some basic guidelines) and directly transfer funds to the state and local governments in the belief that these agencies can channel the funds more effectively, they leave themselves vulnerable to being accused of inadequate monitoring (when the program fails, as the history of such interventions makes clear).
Designing a program that avoids getting entrapped in the bureaucratic tangle of norms, components and guidelines, while preserving the basic administrative requirements to effectively monitor and ensure that the program meets its objectives, is one hell of a challenge. Simplistic prescriptions like people's participation and local decision-making, while easy to preach are very difficult to implement.
The magic pill of people's participation in local decision making on welfare and development interventions has a long and chequered history, especially in the last two decades. The most charitable assessment of the high profile People's Plan Campaign in Kerala during the Ninth Five Year Plan, which devloved a large share of the state's development budget to the Panchayats, is to describe it a partial success.
States like Andhra Pradesh and Tamil Nadu have long experimented with people's participation in various welfare and development activities at the village level through local level committees to manage schools, health sub-centers and primary health centers, ration shops, anganwadi centers etc. Local decision-making through gram sabhas, however flawed, have been a common feature of the selection of beneficiaries for many programs involving delivery of individual benefits (eg welfare pensions, new ration cards, new houses etc). However, it cannot be denied that though the nature and quality of people's participation in these gram sabhas and committees are open to debate, they have considerably increased the transparency in the implementation of the respective programs.
However, politically incorrect as it sounds, arm-chair policy makers (and widespread popular perception) fail to appreciate that it is a big challenge to meaningfully involve the people in the decision-making process. Simplified and romanticized notions of people willing and capable of "taking their destiny in their hands" displays ignorance of the practical issues in a real world.
There are serious obstacles that come in the way of effective and meaningful participation by the stakeholders in local decision-making. For a start, socially institutionalized and entrenched local power structures are a serious impediment in most Indian rural contexts. Stakeholders and their institutions (like panchayats) are not adequately empowered, both financially and administratively, to take on these additional responsibilities. They neither have access to technical and administrative expertise to make these decisions (any more effectively) and monitor their implementation, leave alone the resources to execute them.
Then, there is the problem of the opportunity cost associated with people's particpation in such activities. In poorer societies, the opportunity cost associated with attending such gram sabhas are considerable. Such costs come not only in the form of the time required, but other more mundane things like the location and timings of such meetings, the composition of the sabhas etc. Most often, these costs end up disincentivizing those not benefitting directly, leaving only the beneficiaries to attend such meetings.
Similarly on health care, another example of arm-chair policy making
"...important contributions by the government to improvement in public health status has been through interventions that lead to better sanitation, cleaner drinking water and reduction of rats and mosquitoes, in India, health policy has focussed on medical services. Any discussion of a health budget for rural areas allocates funds for tangible assets such as new clinics and wards, as well as towards subsidies on medication and treatment. The number of doctors or nurses, the number of hospital beds and primary health centres have been the focus of health policy and health reports.
The first step in meaningful public intervention for improving rural health is not just to provide subsidised treatment and medicine, but to also prevent the occurrence of such diseases by focusing on preventive measures. Simply by ensuring clean drinking water and proper segregation of waste, we can prevent many episodes of diarrhoea. Similarly, malaria can be averted through good drainage systems. The focus of public policy needs to be clean drinking water, well-functioning drainage and sewerage, systematic garbage disposal and elimination of pests... The policy has not been about doing what it takes to improve the health status of the population. Instead of preventing diseases from spreading, the government takes credit for providing medical care once a child has fallen ill."
There is a distinction to be drawn between the fundamental principles (like, prevention is better than cure) that guide the overall matrix of public policy on a sector, like education or health care, and individual policy or program components that seek to address the numerous specific and immediate problems (on the health care treatment side). Unfortunately academicians mistake the salience of the latter and its apparent importance for policy makers and administrators as ignoring the former.
Our health care system suffers from massive deficiencies and gaps in the basic standards on doctors, nurses, clinics, hospital beds, PHCs etc, which are a necessary pre-requisite for meaningfully addressing the complex health care problems facing us. Given the scope and magnitude (both in numbers of people, the geographical reach, and the staggering diversity of health care issues) of the problems facing us, without addressing these basic hardware issues on a priority basis, no amount of awareness creation and preventive measures can make a dent on the problem.
Now, just look at the preventive solutions (characterized as "simple" by the author!) - clean drinking water, good drainage systems, segregation of waste, systematic garbage disposal, elimination of pests. I am not aware of a single Indian city, small or big, which is even close to achieving these, even in the long-term. While scarcity of resources has been a handicap (though they are increasingly not, atleast in our bigger cities), there are more serious obstacles in the way of achieving these objectives. All of them have more important social dimensions like awareness and civic consciousness, which can neither be regulated into action nor easily incentivized by government policies. They emerge as part of the larger evolution and economic development of the society.
As evidenced by the difficulty associated with getting people to refrain from littering and segregating garbage at source, despite massive and concerted efforts made across the country, awareness creation is not easily achieved. Similarly, as aforementioned, the numerous experiments at decentralized decision-making have, at best, provided only marginal results.
None of these comments are meant to down-play the importance of the issues raised by the likes of Ila Patnaik, all of which are critical to achieving the desired outcomes on these complex problems. It is fine to point out the deficiencies and lapses in public policies on important social and economic challenges. However, simplification of complex problems by offering all-too-easy solutions is tantamount to ignorance masquerading as informed policy prescriptions. It does more harm than any good and deflects attention from the hard-thinking, grounded on the problems in the real world, required to address such complex challenges.