There are two broad themes in the initiatives contained in the YSR Congress Party’s (YSRCP) 2019 manifesto. The first is a shift from supply to demand-side subventions by relying on cash transfers and the second is the establishment of democratic administration.
I believe that currently, these are stand-alone initiatives and require to be made complete in order to maximise their effects.
For instance, consider some examples of cash transfers in the YSRCP manifesto. Financial assistance of Rs 50,000 to farmers, fee reimbursement to students, reduction of pension age from 65 to 60, enhancing pension to Rs 2,000 per month to the poor elderly and Rs 3,000 for the disabled and assistance of Rs 15,000 to all mothers who send their children to school.
Generally, there are three types of cash transfers – providing cash grants, distributing vouchers, and giving cash for work. A cash grant is the distribution of free cash to targeted beneficiaries; vouchers are denominated in money terms or in physical quantities of specific commodities; and cash for work is the distribution of money to perform physical labour.
The plan of action for implementing these initiatives should consist of two steps. First, implement the initiatives as set out in the manifesto. This will form the core of all development and welfare programmes.
Second, introduce conditionalities after some time in order to achieve specific objectives, such as reducing specific types of poverty and disadvantage, dealing with different types of risk, incentivising desirable types of consumption and promoting positive spending, developing markets for products and services, removing social, market and administrative discrimination that prevent the poor to engage more fully in development processes and achieving goals emanating from wider public interests.
The advantages of the YSRCP doctrine consisting of a central core with surrounding conditionalities are well documented in development and rehabilitation literature.
First, apprehensions about outflow of capital from productive activities to meet domestic shocks and stresses (such as serious health ailments) are reduced. Second, multiplier effects on agriculture and livelihoods are likely to increase demand for local goods and services. Moreover, the flexible and fungible nature of money facilitates engagement of the poor in productive enterprises.
Third, cash transfer is less costly to administer, less prone to corruption, and potentially cost-efficient if appropriate contextual conditionalities are established. Fourth, DCT makes the life of the poor dignified – they no longer have to stand as supplicants before development administrators. Additionally, women and the aged are empowered if the cash transfer is made in their favour. Finally, cash transfer increases choices available to the poor and accounts for variations in preferences for goods and services from poor to poor (for example, family decides how much to spend on food and education).
The YSRCP’s manifesto also promises to address the issue of unemployment by providing jobs at the village secretariat to ten youths in every village. “In addition to this, around 3.5 lakh village/ ward volunteers will receive Rs 5,000 a month as honorarium”. All these can be leveraged to bring about democratic administration.
The idea of democratic administration is commonly associated with professor Vincent Ostrom of Indiana University. Democratic administration celebrates polycentricity in public administration and the appointment of village/ward volunteers is a step towards this actualizing this idea of diffusion of power at the grassroots level with several benefits, such as increased accountability, reduction in corruption and greater efficiency. The competition between decision centres at the cutting edge would also increase flexibility and responsiveness of the last-mile functionaries.
Democratic administration requires identification of activities to be entrusted to these volunteers. The identification of activities should be based on Walter Stohr’s “subsidiarity principle”, which was also recommended by the II Administrative Commission. Subsidiarity is a multilevel process that mandates that processes and decisions that can be best performed at local levels should be executed there. Only those that cannot be satisfactorily done at local levels (e.g. income tax) should be “delegated” to higher levels of government. In this sense, the process is one of reverse delegation. Let us apply this to the case of provision of complete health care in the YSRCP manifesto.
The manifesto promises universal healthcare coverage for lower and middle class under Arogyasri. Any individual with an annual income of up to Rs 5 Lakh can avail the Universal Health Card and benefits for free. Moreover, Universal Health Cards will be applicable for any medical expenses over Rs 1,000. Furthermore, Arogyasri would be applicable to all medical treatments of above Rs 1,000, all medical expenses would be borne by the government regardless of the location of the hospital and the eligibility limit to avail of benefits would be enhanced to Rs 5 lakh per year.
Applying the subsidiarity principle would lead to the following activities being entrusted to the volunteers.
- PHCs and sub-centres are the first line of contact with patients and constitute the 4th tier of healthcare. Volunteers would supervise these centres who would leverage on the Government of India’s allocation of Rs. 1200 cr. to develop 1.5 lakh centres to provide comprehensive health care, including for non-communicable diseases and maternal and child health services, apart from free essential drugs and diagnostic services.
- Volunteers will also lead in providing digital health care to unserved patients. Sensors and detectors will provide information on vital indicators of patients to doctors, directly, through already available platforms. This will also somewhat address the issue of non-availability of doctors.
- Volunteers will ensure universal health check-up is required at periodic intervals. Health screening of both mothers and children will be done, especially for lifestyle diseases, which are an emerging concern for public health. For adults Cancer, Cardio-vascular Diseases, Diabetes and Respiratory Diseases, account for most deaths in India (before the age of 70). The goal will be to conduct universal health checkup of the entire population and to issue a family health card (on the lines of a soil card) to all. This health card should be in an electronic form. For this Anganwadi and Asha workers will be given an additional Rs 1,000 subject to, (1) universal checkup of all and reduction in diseases of all households in the village and (2) paying particular attention to the health cards of those suffering from chronic diseases such as kidney ailments and Thalassemia who will be given a separate pension of Rs 10,000 per month.
- Volunteers would also access the Jan Aushadhi stores established by the Government of India to provide reasonably priced medicines to people.
What Andhra Pradesh has to do is develop models by bundling several initiatives within larger frameworks, such as cash transfer and democratic administration in order to maximise their benefits. For example, the above model will lead to a reduction in health expenditure – in India nearly 5-6 crore people fall below the poverty level every year due to spending on catastrophic health expenditure.
The reduction in health care spending will occur because this model focuses on preventive and protective care, as well as using digital means to provide symptomatic treatment – all precursors to onset of major ailments requiring large expenditures. In this way, this model will prevent regression into poverty.
Sameer Sharma has a PhD from USA and a DLitt from Kanchi University. The article is based on his research and practice and views are personal.