Here is the first of four ideas that I talked about in my TED Talk titled Education for All - More of the Same or Something Different? on December 13th, 2010 at TEDx Kumaun
The first idea, a policy innovation, is to take a leaf out of the Government's own RSBY Project and replicate it to provide a quality education for every single child in the country.
A little over three years ago, the Government of India took up an extremely ambitious large scale challenge. The Govt wanted to provide free health care to all Below Poverty Line (BPL) persons across India, about 250-300 million of them, and launched the Rashtriya Swasthya Bima Yojana (RSBY) in October 2007.
How does the RSBY work?
The RSBY is a National Health Insurance Scheme run by the Ministry of Labour and Employment. The Central Government funds 75% of the scheme and the State Governments fund the balance 25%. The State Governments are responsible for implementation.
The Government pays an annual premium of about 400-600 rupees per household to an insurance company, which ensures healthcare and hospitalization cover up to 30,000 rupees per family per year. The RSBY scheme covers five members in each familiy including the head of the household, the spouse and upto three dependents.The insurance covers most diseases requiring hospitalisation. Pre-existing conditions are also covered from day one, with no age limit. Out-patient consultation is free, but the cost of out-patient health care will have to be borne by the beneficiaries themselves. Each BPL beneficiary is required to pay a nominal amount of Rs. 30 per year to cover administrative costs.
The RSBY is a cashless, paperless scheme and comes with a biometric smart card for each beneficiary, containing their fingerprints and photographs. Healthcare is available to the beneficiaries at any of over 5,000 empanelled private hospitals and over 2,000 empanelled Government hospitals across India. The BPL beneficiaries are free to go to any empanelled hospital of their choice anywhere in India based their own priorities of quality, accessibility, convenience or whatever else matters to them. More hospitals continue to be empanelled and these hospitals are required to meet a basic set of guidelines to become empanelled hospitals.
The Government's healthcare strategy
With a clearly defined goal of providing free health care for every single BPL family in a timebound manner, the Government did not think of setting up and running hospitals in every single district or block across the country. If the Government had decided to set up new hospitals across India, a huge amount of capital expenditure would have been needed for setting up the hospitals, besides hiring all the doctors, nurses and other supporting staff. There would have to be an annual budget allocated to run all these hospitals and the responsibility of administering and managing these hospitals would have fallen on the Government. All this would have taken time and by the time the infrastructure was built and made operational, many people would have been denied much needed healthcare for a couple of decades.
The Government wisely chose to focus on outcomes rather than inputs. It took on the responsibility of funding the health care for all BPL families, but chose not to provide the healthcare all by itself. By paying an insurance premium per person to an insurance company, which itself may be either a Government owned or a private Insurance Company, the Government made the insurance companies responsible and accountable for the administration and delivery of health care. These insurance companies bid for the RSBY contracts for every single district across the country. Different companies win the bids for different district and will be responsible for administering the RSBY at the ground level. Only one insurance company is given the contract for an entire district.
The insurance companies in turn work with both Government and Private Hospitals which will ultimately provide the health care to the BPL beneficiaries. The investments in setting up the hospitals will all be incurred by the private sector and the Government may also choose to set up a few hospitals in regions where the private sector doesn't venture quickly enough. The RSBY scheme has put purchasing power in the hands of the BPL families and private entities will respond to that by setting up new hospitals in areas with large number of BPL families to meet their healthcare needs. [Aside: A rural healthcare startup recently announced plans of setting up hospitals that will come up at the block level in rural areas to provide healthcare to BPL families under the RSBY.]
The progress in RSBY so far
22.7 million families have already been covered in just over 3 years time. That is a truly amazing achievement in terms of scale, cost and timelines. Encouraged by the progress, the Government is now considering extending this scheme beyond the BPL families to cover many more persons.
Doing an RSBY in Elementary Education
We need an RSBY kind of approach if we are to provide a quality education for every single child in the country in a time-bound manner. Imagine what can be achieved by replicating this model in Education. There is a simple equivalence between the RSBY model and an Education model.
Healthcare – RSBY Model
Elementary Education
Costs are shared by the Centre and the States, with the States being soley responsible for implementation.
Costs are shared by the Centre and the States, with the States being soley responsible for implementation.
The Government funds
healthcare for all BPL families and refrains from building and managing hundreds of new hospitals.
The Government funds
education for every single child and refrains from building and managing thousands of new schools.
The Government lays down
quality guidelines and regulations for the hospitals that want to get empanelled to provide healthcare to the BPL families.
The Government lays down
quality guidelines, standards and regulations for the schools that want to get empanelled to provide education to children in the country.
With purchasing power in the hands of the BPL families,
private investors will respond to the demand for healthcare and set up and run hospitals all across the country.
With purchasing power in the hands of the parents (of all the children)
private investors will respond to the demand for quality education and set up and run schools all across the country.
BPL families can choose to go to
any of the empanelled hospitals including both Government and Private Hospitals.
Parents can choose to send their child to
any of the empanelled schools including both Government and Private Schools.
The Government pays
premium to the Insurance Company who in turn pay the hospitals,
to cover the costs of healthcare provided.
The Government pays
the school fees for children enrolled in the empanelled schools,
to cover the costs of providing education.
If the Ministry of Labour & Employment can make a huge impact with the RSBY, there is no reason why the Ministry of Human Resource Development can't take a leaf out of the RSBY and come up with a similar project to help us reach out to over 200 million children and ensure every one of them gets a quality Education within 10 years.
I will describe the other three ideas covered in my TED Talk in subsequent posts.
