Serve the Essentials: What governments and donors must do to improve South Asia's essential services

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This report presents an insightful assessment of essential services in South Asia, with special focus on health and education. In this as in many other fields of social enquiry, the comparative perspective is of great value, and the report makes excellent use of this perspective by scrutinizing regional contrasts in South Asia - between as well as within countries. Somehow, this comparative South Asian perspective has been overlooked in development studies. One of the central insights of development economics is the importance of human capabilities, both as an end and as a means of development. At early stages of development, capabilities related to nutrition, health and elementary education are of special importance. For instance, literacy and education (especially female education) make wide-ranging contributions not only to economic growth but also to demographic change, social equality, political democracy, and many other aspects of development. Similarly, good health is a fundamental basis of the quality of life as well as of social progress.
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  Acknowledgements This report was written by Swati Narayan.Special thanks for invaluable comments and inputs to Jean Drèze, Bethan Emmett, Ben Phillips, Kate Raworth,Balasubramanyam Muralidharan, Sarah Ireland, Sunitha Rangaswami, Anne Lancelot, Christian Dennys, RajivDua, Cherian Mathews, Ronnate Asirwatham, Prasen Jit Khati, Farid Hassan Ahmed, Madhusree Banerjee, LeslieBrowne, K. M. Enamul Hoque, Shipra Saxena, Jo Walker, Gopa Kumar, Kiran Bhatty, Tom Noel and Indivar Mukhopadhyay. Thanks also to Anil Prabhakar Tambay, Jo Zaremba, Kate Simpson, K.A. Jahan Rume, GShantakumari, Kavita Gandhi, Divya Mukund, Basira Mojaddidi, Medha Soni and Roshani Yogaraja for sourcingphotographs.The report was copy edited by Jacqueline Smith and designed and printed by Mensa Computers Pvt.Ltd, New Delhi;mensa@vsnl.com© Oxfam International 2006This publication is distributed in print and available fromOxfam (India) TrustSouth Asia Regional Management CentreC 28-29, Qutub Institutional AreaNew Delhi - 110016, IndiaTel: +91 11 42396000Fax: +91 11 42396099Email: newdelhi@oxfam.org.ukCopies of this report and more information are availableto download at www.oxfam.org.ukOxfam (India) Trust operates in India and is a part of Oxfam GB, U.K. Oxfam GB is a member of OxfamInternationalPublished byOxfam (India) TrustSouth Asia Regional Management CentreC 28-29, Qutub Institutional AreaNew Delhi - 110016, India All rights reserved. This publication is copyright, but maybe reproduced by any method without fee for advocacy,campaigning, and teaching purposes, but not for resale.The copyright holder requests that all such use beregistered with them for impact assessment purposes.For copying in any other circumstances, or for re-use inother publications, or for translation or adaptation, prior written permission must be obtained from the publisher. Front cover images:  Child using a water tap at standpoint built near campsites built after the earthquake at GahridupattaMuzaffarabadOxfam GB/ Pakistan/2006School students studying in the open air in BadakshanprovinceBasira Mojaddidi/Oxfam GB/Afghanistan/2006Health service provider administering an injection to achild at a dispensary/sub center in Bharatpur district,Rajasthan, IndiaOxfam GB/India/2006 Back cover image:  Government dispensary/sub-centre in Bharatpur district,Rajasthan where a delivery had taken place the previousnightOxfam GB/India/2006  InternationalInternational Serve the EssentialsServe the EssentialsServe the EssentialsServe the EssentialsServe the Essentials What Governments and Donors Must Do to ImproveSouth Asia’s Essential Services  One of the central insights of development economics is the importance of human capabilities,both as an end and as a means of development. At early stages of development, capabilitiesrelated to nutrition, health and elementary education are of special importance. For instance,literacy and education (especially female education) make wide-ranging contributions not only toeconomic growth but also to demographic change, social equality, political democracy, and many other aspects of development. Similarly, good health is a fundamental basis of the quality of lifeas well as of social progress.Further, both theory and evidence point to the importance of public services in these fields. Economictheory draws attention to pervasive “market failures” in the private provision (especially unregulatedprovision) of essential services such as health care and elementary education. Empirical evidencesuggests that rapid reductions in undernutrition, illiteracy, ill health and related deprivations aretypically based on extensive public action. This pattern can be seen in South Asia itself, whether welook (say) at Sri Lanka’s lead vis-à-vis other South Asian countries, or at Kerala’s outstandingachievements vis-à-vis other Indian states.This report presents an insightful assessment of essential services in South Asia, with specialfocus on health and education. In this as in many other fields of social enquiry, the comparativeperspective is of great value, and the report makes excellent use of this perspective by scrutinizingregional contrasts in South Asia – between as well as within countries. Somehow, this comparativeSouth Asian perspective has been overlooked in development studies. For instance, an Indianeconomist or sociologist is much more likely to compare India with, say, China or the UnitedStates than with Bangladesh or Sri Lanka. Yet there is a great deal to learn from looking around us within South Asia. For instance, I am sure that many development experts in India would besurprised and interested to learn that private schools have been banned in Sri Lanka since the1960s, or that in Sri Lanka “few people live more than 1.4 km away from the nearest healthcentre”.On the prescriptive side, this report argues that the state has an “inalienable responsibility toprovide universally accessible and robust public delivery systems for essential services”. In thisrespect it is a useful antidote to the current passion for targeting, user fees and other means of “rationalizing” (read downsizing) public services in developing countries. One can argue about theprecise range of services that should be provided through “free and universal” public facilities.But when it comes to basic entitlements such as primary education and health care, I believe thatthis is indeed the best approach. And it is certainly important to reaffirm the notion that ensuring universal access to essential services is a social responsibility. This is, indeed, the central principleof the welfare state. Foreword
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