More is not needed when less is enough - standardisation paradox in development

In recent months, I have blogged on several occasions urging caution with unqualified embrace of many closely held narratives in international development. These have been about digitisation, middlemen, leakages, efficiency, supply side etc.

This post is about the high credentials benchmarks associated with several areas of development. Earlier posts here touched on the problems of standardisation in development policy making and here discussed  the problems of harmonisation in the context of international trade and globalisation. 

The problem of occupational licensing as an entry barrier into labour markets is an acknowledged problem in developed countries too. Its manifestation in India is in the informal market - the non-accreditation or even acceptance of informal service providers, from plumbers to medical practitioners. 

Take the example of medicine. The formal medical practitioners, dominated by doctors with MBBS and specialist qualifications, have been very vocal advocates of banning and even criminalising informal medical practitioners. This is despite the latter making up 80-90% of the point of first contact in India and it being impossible to even imagine a health care system without their presence. 

The formal practitioners accuse these informal providers of practicing quackery. That's doubtless a valid accusation and a matter to be dealt with. But here too there is nothing black and white. Sample this scoring of the average provider competence levels of information practitioners compared to formal MBBS doctors across several Indian states.

The same study finds,

The medical knowledge of Informal Providers (IPs) is highly correlated with that of MBBS providers in the same state. Informal providers in high-performing states routinely outperform MBBS providers in low-performing states and in fact, in these states, the difference in quality between MBBS and non-MBBS providers is small. This trend implies that across Indian states, equal qualifications do not imply equal quality. The knowledge of an informal provider in Gujarat or Tamil Nadu is substantially higher than that of a fully-trained MBBS provider in Bihar or Jharkhand.

As I have blogged earlier here and here, India does not require full-fledged MBBS doctors to manage its primary health care centres. Trained nurses can manage most of the primary care activities, including normal deliveries. So the case for credentialing nurses accordingly. In practice, given the high share of doctor vacancies, a large number of PHCs are in any case managed by nurse practitioners.

The OECD does a ranking of countries on entry barriers to occupations, and India figures prominently as a country with very high entry barriers for professional services - accountant, architect, lawyers, and real estate agents.

Even in the cases of vocational professions like plumbing, electrician, carpentry, welding etc, there is a case that credentialing requirements may be impeding formalisation and productivity improvements. Have we not seen too many examples of accomplished service providers without any of the formal credentials but who are denied access to the formal market (either being employed by service companies or being functional employees of regular companies)? And equal or more numbers of examples of poor quality service providers but with all the requisite credentials? 

In such occupational categories, where the experience of learning by doing is arguably more important than formal academic training (a point amplified by the poor quality of prevailing academic trainings in ITIs/VTIs), there is perhaps a case for alternative approaches to credentialing. For example, is there a case for a very credible institutionalised system of market-driven (but regulated), periodic, and levels-based certification?

These problems manifest in an even bigger challenge in school education. Especially in the primary schools, India's education system suffers from a problem of very high and aspirational learning benchmarks. This graphic illustrates how over-ambitious curriculum, represented by curricular pace (CP), leads to students falling behind in Indian schools.

In all these cases, the status quo is massively welfare reducing.

It represents the problem of standardisation paradox. On the one hand, standards and accreditation are a much needed requirement to improve quality of service delivery across areas of activities. But on the other hand, standardisation often involves grafting excessive and aspirational qualifying benchmarks which ends up distorting incentives and defeating the purpose of standardisation.