There is a very strong,
if not dominant, belief among development researchers that lack of adequate
information and awareness is responsible for holding back reforms that could
have improved development outcomes.
Accordingly, they believe that if the poor
quality of student learning outcomes or care delivered by government doctors
are appropriately highlighted it could trigger the reforms required to address
these deficiencies. Similarly, a credible demonstration (say, empirically or
through rigorous field experiments) of the effectiveness of cash transfers or
technical solutions to eliminating an inefficiency in a public service delivery
system would lead to its adoption. Even the more prudent among them believe
that it would go a long way towards achieving the reforms.
This betrays an inadequate
understanding of the dynamics of political change. Political change is and has
always been about ideological or populist waves anchored around a problem or felt-need that galvanize the public (or
stakeholders) mood into demanding action. In fact, as Lant Pritchett has argued, development itself is a faith-based movement. Knowing
about a problem is not the same thing as having the urge to address the problem. Change happens
not when stakeholders become aware of some problem but when they are triggered into
action. And there is some distance to travel between knowing and acting.
Consider the two
examples of poor quality of education and health care delivered by public
institutions across India and many developing countries. It is now exhaustively
documented, by both public audits and third party assessments, that student
learning levels in government schools across India are shockingly low. Every
year, for nearly a decade, the annual ASER reports, through quantified metrics
on learning achievements, tell us that less than a half of Class V children
have achieved even Class II competencies. Furthermore, learning levels have
been worsening. The same reports have also consistently shown that private
schools achieve better results at a fraction of the cost of public schools. It
is also well documented that teacher truancy is a major problem in government
schools. Conventional wisdom would have it that learning outcomes should occupy the center of the education agenda.
Similarly, a number of
studies have exposed the poor quality of care in primary health centers (PHCs).
In fact, the Planning Commission itself estimates that PHCs account for less
than one-fifth of all first contact in the referral chain. The remaining are
with private care providers, mainly the unqualified rural medical practitioners
(RMPs). Numerous studies have shown widespread unauthorized absenteeism among
nurses and doctors. Recent studies have also shown that compared to even RMPs,
PHC doctors spend less time per patient and mis-diagnose more frequently. Again conventional wisdom would have it that primary health care reforms, including integration of RMPs, should be a no-brainer.
Many of these findings
come from rigorous studies like randomized control trials conducted by very
reputed agencies and researchers. In any case, none of them have been disputed
by any of the stakeholders. Further, most of them have cognitively striking
headline numbers, which presumably should unsettle any rational audience.
However, in reality, the impact of such research findings has been remarkably
marginal. Researchers blame governments and express incredulousness at its unwillingness
to take action to change the order.
India is not alone in being afflicted by this trend. One only needs to look at public debates in the United States to understand the persistence and hold of ideological and other prejudices on the face of overwhelming evidence. Arguments in favor of lowering the marginal income tax rate, despite unambiguous evidence of dramatic concentration of wealth and declining returns to labor income, dominate conservative thinking. Climate change deniers and opponents of gun control are not amenable to conclusive evidence and well-reasoned arguments that contradict their views.
But I am not one bit
surprised by this. Paradigm re-defining reforms rarely happen because someone
comes up with striking figures that reveal something completely new and deeply
unsettling, forcing governments into action. Almost always those insights are
widely known and have been deeply internalized by most stakeholders, though not
necessarily quantitatively. It is just that the changes - in terms of
re-orienting values as well as accommodating losses of various stakeholders -
required are much more daunting than could be achieved with mere revelation of
facts, however unsettling. They require upending of well-established political
and administrative orders and social values, which would cause loss to powerful
and entrenched vested interests and destabilize the passive tolerance (for
whatever reasons) of poor quality service by its intended beneficiaries (or now
losers!).
The debates on these
issues have a dynamic of their own, and needs to accumulate the importance and
urgency that generates the demand for immediate and decisive action. They need
some long enough period of deep personal engagement by those immediately affected
with the problem. But unfortunately a mere dissemination of information about
ground realities is unlikely to, by itself, result in the deep engagement required. It
would need careful strategic communication to get the stakeholders to face up to
the reality and demand change. People are too cognitively ensconced, despite the
obvious failings of the existing arrangement and their resultant losses, to come
out and fight for change.
This is not to say that such research has no role in addressing such issues. But research findings, while undoubtedly important to the public debate on these issues, are just one of the contributors to change. The most important trigger for action on such issues is the realization and internalization of the need for change among atleast the most important stakeholders.
It is one thing to
legislate rules that promise good quality education or health care, but entirely
another thing to actually create the conditions that will enable its
realization. In fact, in areas like education and health care, we may already
have enough information and insights to stop worrying about them and get down
to the business of actually creating the conditions required for change. Advocates
of change need to realize this and work to create the conditions for change. Merely
providing more information or insights alone may already be into the phase of diminishing returns.
