Introduction & Overview
Effective governance of the social sector, encompassing health, education, and human resources, is paramount for a nation's holistic development and the well-being of its citizens. These sectors are critical for building human capital, driving inclusive growth, and realizing the demographic dividend.
India has implemented ambitious policies and numerous schemes to address persistent challenges like inadequate infrastructure, quality gaps, accessibility issues, and human resource deficits. This module examines the key indicators, policies, and major schemes in health, education, and skill development, along with their performance and inherent governance challenges, highlighting the continuous efforts required to build a robust and equitable social sector.
Development and Management of Health Sector
Key Health Indicators
Infant Mortality Rate (IMR)
Deaths per 1,000 live births (under 1 year). India: 27 (2021, SRS), significant decline but higher than global average and developed countries.
Maternal Mortality Ratio (MMR)
Maternal deaths per 100,000 live births. India: 97 (2018-20, SRS), meeting SDG target of 100.
Total Fertility Rate (TFR)
Average number of children born to a woman over her lifetime. India: 2.0 (2019-21, NFHS-5), below replacement level, indicating demographic transition.
Life Expectancy at Birth
Average number of years a newborn is expected to live. India's life expectancy improved to 69.4 years (2018-22).
Child Malnutrition
High prevalence of stunting, wasting, and underweight among children under 5. NFHS-5: 35.5% stunted, 19.3% wasted, 32.1% underweight.
Anemia
High prevalence among women and children. NFHS-5: 57% women (15-49 years) and 67% children (6-59 months) are anaemic.
Challenges in Health Sector
High Out-of-Pocket Expenditure (OOPE)
A significant portion of healthcare expenditure is borne by individuals, pushing many into poverty.
Weak Public Health Infrastructure
Inadequate number of Primary Health Centres (PHCs), Community Health Centres (CHCs), and hospitals, especially in rural and remote areas.
Shortage of Human Resources for Health (HRH)
Acute shortage of doctors, nurses, paramedics, and specialists, particularly in rural areas (doctor-to-population ratio below WHO recommendation).
Rising Burden of Non-Communicable Diseases (NCDs)
Increasing prevalence of diabetes, hypertension, cardiovascular diseases, and cancers, placing a dual burden on the health system.
Urban-Rural & Interstate Disparities
Significant variations in health outcomes and access to healthcare between urban and rural areas, and among different states.
Quality of Care & Affordability of Medicines
Concerns about quality of services, lack of regulation in private sector, patient safety issues, and access to affordable medicines.
Public Health Expenditure in India
Current Public Health Expenditure vs. National Health Policy Target
Source: National Health Policy 2017, Ministry of Health & Family Welfare.
National Health Policy (NHP), 2017
To achieve the highest possible level of health and well-being for all, through a comprehensive primary healthcare approach, providing universal access to quality health services without anyone facing financial hardship.
- Achieving Universal Health Coverage (UHC).
- Strengthening Primary Healthcare as the bedrock of the health system.
- Promoting preventive and promotive health (wellness approach).
- Reducing out-of-pocket expenditure.
- Ensuring access to affordable, quality medicines and technology.
- Developing adequate human resources for health.
- Increase public health expenditure to 2.5% of GDP by 2025 (from current ~1.2%).
- Achieve TFR of 2.1 by 2025.
- Reduce Under-5 Mortality Rate (U5MR) to 23 by 2025.
- Reduce MMR to 90 by 2020 (achieved 97 by 2018-20) and further to 70 by 2030 (SDG target).
- Reduce IMR to 28 by 2019 (achieved 27 in 2021).
- Reduce premature mortality from NCDs by 25% by 2025.
Major Health Schemes
National Health Mission (NHM)
Launch: 2013 (merging National Rural Health Mission - NRHM (2005) and National Urban Health Mission - NUHM (2013)).
Objective: To achieve universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to people's needs.
Performance: Significant improvements in IMR, MMR, TFR, and institutional deliveries. Strengthening of PHCs and CHCs.
Challenges: Inadequate funding, human resource shortages, quality of services, inter-state disparities, implementation gaps, weak monitoring.
Ayushman Bharat (AB)
Launch: 2018. It is a flagship scheme with two interdependent components:
1. Pradhan Mantri Jan Arogya Yojana (PMJAY)
Objective: Provides a health insurance cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization. Covers over 12 crore poor and vulnerable families (approx. 55 crore beneficiaries) based on SECC 2011 data.
Performance: World's largest government-funded health assurance scheme. Reduced out-of-pocket expenditure for millions, facilitated access to secondary/tertiary care.
Challenges: Awareness among beneficiaries, fraudulent claims (though checks are in place), quality of care in some empanelled hospitals, portability issues initially (now largely addressed), urban-rural disparities in access.
2. Ayushman Bharat - Health and Wellness Centres (AB-HWCs)
Objective: To transform existing Sub Centres (SCs) and Primary Health Centres (PHCs) into HWCs to provide Comprehensive Primary Health Care (CPHC). This includes promotive, preventive, curative, palliative, and rehabilitative services.
Performance: Thousands of HWCs operationalized across the country, expanding the scope of primary care.
Challenges: Inadequate staffing, infrastructure gaps, supply of drugs and diagnostics, digital connectivity, ensuring quality of services.
Governance Challenges in Health Sector
Accessibility
- Geographical Barriers: Lack of healthcare facilities in remote, tribal, and hilly areas.
- Infrastructure Deficits: Insufficient number of hospitals, PHCs, and specialized care centers.
- Digital Divide: Limited access to telemedicine or online health services for those without digital literacy or internet.
Affordability
- High OOPE: Despite schemes like PMJAY, high out-of-pocket expenditure remains a major burden.
- Cost of Medicines: High cost of essential medicines and diagnostics.
- Insurance Coverage Gaps: Many still lack comprehensive health insurance.
Quality of Care
- Varying Standards: Disparity in quality between public and private facilities, and across regions.
- Lack of Standardization: Absence of uniform quality standards, especially in the private sector.
- Patient Safety: Concerns about medical errors, infections, and unethical practices.
Regulation
- Weak Regulation of Private Sector: Inadequate regulatory framework for private hospitals, clinics, and diagnostic centers.
- Absence of National Health Authority: Health is a state subject, leading to fragmented regulations.
- Lack of Transparency: Opaque billing and treatment processes.
Human Resources for Health (HRH)
- Acute Shortage: Severe shortage of doctors (especially specialists), nurses, and paramedics.
- Rural-Urban Imbalance: Unwillingness of medical professionals to serve in rural areas.
- Training Deficiencies: Gaps in quality of medical education and continuous professional development.
- Brain Drain: Migration of skilled health professionals abroad.
Inter-sectoral Convergence & Data
- Lack of effective coordination between health, nutrition, sanitation, and water supply ministries.
- Data Gaps: Challenges in collecting granular, real-time health data for effective planning and monitoring.
Development and Management of Education Sector
Key Education Indicators
Gross Enrolment Ratio (GER)
Total enrolment as % of official age group. India's GER has improved across all levels, e.g., GER in Higher Education increased to 27.3% in 2020-21 (AISHE report).
Dropout Rates
Percentage of students discontinuing education at various levels. Dropout rates remain high, especially at secondary and higher levels, varying across states and social groups.
Learning Outcomes
Actual knowledge and skills acquired by students. ASER reports consistently highlight poor learning outcomes at primary levels.
Challenges in Education Sector
Access vs. Equity vs. Quality
While access (enrollment) has largely improved, challenges persist in ensuring equitable access (for marginalized groups, remote areas) and, critically, the quality of education.
Poor Learning Outcomes & Curriculum Irrelevance
Students often lack foundational literacy and numeracy skills. Curriculum often not aligned with contemporary skills needed for employment.
Teacher Issues & Shortages
Shortage of qualified teachers, high absenteeism, lack of training (especially for inclusive education), poor motivation, non-teaching duties.
Employability & Digital Divide
Significant mismatch between skills acquired through education and demands of the job market. Digital divide limits access to online learning.
Infrastructure Deficits & Regulation of Private Education
Inadequate classrooms, toilets, libraries, labs, especially in government schools. Concerns about unregulated private institutions, charging high fees, and compromising quality.
High Dropout Rates
Especially after elementary education, due to socio-economic factors, lack of interest, or poor quality of teaching.
National Education Policy (NEP), 2020
Launch: Approved by Union Cabinet in July 2020. It is the first comprehensive education policy in India in 34 years (after NEP 1986).
Vision: To transform India into a vibrant knowledge society and global knowledge superpower by providing high-quality education to all.
Key Features Overview:
New Curricular Structure
Replaces 10+2 system with a 5+3+3+4 foundational, preparatory, middle, and secondary structure.
Early Childhood Care & Education (ECCE)
Emphasis on universal provision of ECCE for children aged 3-6 years.
Foundational Literacy & Numeracy (FLN)
Mission-mode approach to ensure FLN by Class 3 by 2025 (NIPUN Bharat Mission).
No Hard Separation & Vocational Ed.
No rigid separation between academic, extracurricular, vocational streams. Integration of vocational education from Class 6 onwards.
Multilingualism
Promotion of multilingualism, teaching in mother tongue/local language up to Class 5 (preferably Class 8).
Holistic Progress Card
For students, assessing skills, capabilities, not just rote learning.
- Multidisciplinary Approach: Promoting multidisciplinary universities and institutions.
- Flexible Curriculum: Multiple entry/exit points, academic bank of credit (ABC).
- Light but Tight Regulation: Single higher education regulator (excluding medical/legal) – Higher Education Commission of India (HECI).
- Research Focus: Establishment of National Research Foundation (NRF).
- Internationalization: Allowing foreign universities to set up campuses.
- Teacher Education: Reforms in teacher training (4-year integrated B.Ed. degree).
- Digital Education: Leveraging technology for learning (National Educational Technology Forum - NETF).
- Public Investment: Increase public investment in education to 6% of GDP (from ~3%).
Implementation Status: NEP 2020 is a guiding policy document; implementation is a long-term process involving central and state governments. Many aspects are gradually being rolled out (Pilot projects for ECCE, NIPUN Bharat Mission for FLN, PM SHRI Schools, Academic Bank of Credit, NRF Bill passed).
Challenges: Huge financial outlay, center-state coordination, teacher capacity building, resistance to change, ensuring equitable digital access, language diversity management.
Major Education Schemes
Samagra Shiksha Abhiyan (SSA)
Launch: 2018 (an overarching program subsuming Sarva Shiksha Abhiyan (SSA), Rashtriya Madhyamik Shiksha Abhiyan (RMSA), and Teacher Education (TE)).
Objective: To ensure inclusive and equitable quality education at all levels from pre-school to senior secondary.
Performance: Improved enrollment and retention rates, especially at elementary level. Building of school infrastructure. Challenges: Ensuring quality of learning outcomes, addressing dropout rates at secondary level, fund utilization, teacher absenteeism, and quality of teacher training.
Rashtriya Uchchatar Shiksha Abhiyan (RUSA)
Launch: 2013.
Objective: A centrally sponsored scheme to improve the overall quality of State Higher Educational Institutions (HEIs) through strategic funding.
Performance: Supported infrastructure development and academic reforms in many state universities/colleges. Challenges: Inconsistent fund utilization by states, slow pace of reforms, achieving quality outcomes, politicization of appointments.
PM SHRI (PM Schools for Rising India) Schools
Launch: 2022.
Objective: To upgrade and develop more than 14,500 schools across the country as PM SHRI Schools, which will be exemplars of the National Education Policy (NEP) 2020 and demonstrate its full implementation.
Focus: Holistic, equitable, inclusive, joyful education, focus on discovery-oriented learning, competency-based teaching, integration of technology. These will also have green school initiatives. Challenges: Ensuring uniform quality across all schools, replication of best practices, teacher capacity building, and sustained funding.
Governance Challenges in Education Sector
Access and Equity
- Digital Divide: Limits access to online learning for students from marginalized communities or remote areas.
- Geographical Barriers: Lack of schools or higher education institutions in remote areas.
- Gender/Socio-economic Disparities: Dropout rates higher among girls, SC/ST, and economically weaker sections.
Quality of Education
- Poor Learning Outcomes: Rote learning focus, inadequate foundational literacy/numeracy, lack of critical thinking skills.
- Curriculum & Assessment: Outdated curriculum, focus on exams rather than holistic development.
Teacher-Related Issues
- Shortage: Acute shortage of qualified teachers, especially in rural areas.
- Quality of Training: Inadequate pre-service and in-service teacher training.
- Absenteeism & Motivation: Issues of teacher absenteeism and lack of motivation.
- Non-teaching Duties: Teachers often burdened with non-teaching duties.
Regulation of Higher Education
- Fragmented Regulation: Multiple regulatory bodies leading to overlapping jurisdictions.
- Quality Control: Challenges in ensuring quality and preventing commercialization in private institutions.
- Accreditation Issues: Weak accreditation processes.
- Lack of Autonomy: Limited autonomy for many universities due to bureaucratic control.
Human Resources and Skill Development
Demographic Dividend – Opportunities and Challenges
Demographic Dividend: A phenomenon where a country's working-age population (15-64 years) grows larger than its dependent population (children and elderly). India is currently in this phase, with the peak of its working-age population projected to last until around 2040-2050.
Opportunities
- Increased Workforce: Higher proportion of productive individuals.
- Higher Savings & Investment: Fewer dependents can lead to higher savings and investment rates, fueling economic growth.
- Innovation & Entrepreneurship: Young population can drive innovation and entrepreneurship.
- Global Workforce: Potential to supply skilled workforce globally (e.g., healthcare, IT).
Challenges to Harnessing DD
- Jobless Growth: The economy may not be generating enough quality jobs to absorb the large incoming workforce.
- Skill Gap: Mismatch between the skills possessed by the workforce and the skills demanded by industries.
- Quality of Education: Poor learning outcomes and lack of critical thinking skills limit employability.
- Health & Nutrition: Poor health indicators (malnutrition, anemia) can reduce workforce productivity.
- Gender Disparity in LFPR: Low female labour force participation rate (LFPR) means a significant portion of the potential workforce is underutilized.
- Informal Economy: Large informal sector with precarious jobs, low wages, and no social security.
Skill India Mission and its components
Skill India Mission (Launch: 2015): An umbrella initiative by the Government of India to converge various skill development efforts across ministries and departments. Its vision is to create an "ecosystem to empower the Indian youth with employable skills." Nodal Ministry: Ministry of Skill Development and Entrepreneurship (MSDE).
Key Components:
Pradhan Mantri Kaushal Vikas Yojana (PMKVY)
The flagship scheme of MSDE for skill training (short-term, special projects, recognition of prior learning - RPL). Performance: Trained millions of youth. Challenges: Quality of training, low placement rates, lack of industry connect, limited awareness, high dropout rates.
National Skill Development Corporation (NSDC)
A not-for-profit public limited company established in 2008 (PPP model). Role: Catalyzing the private sector's involvement in skill development by providing funding, developing standards, and facilitating training. Challenges: Ensuring quality of training partners, monitoring outcomes, industry alignment.
Other Key Initiatives
National Policy for Skill Development and Entrepreneurship, 2015; Pradhan Mantri Kaushal Kendras (PMKKs); Industrial Training Institutes (ITIs) upgrade; Apprenticeship Promotion Scheme; SANKALP & STRIVE.
Overall Challenges for Skill India:
- Skill Gap and Mismatch: Persistent mismatch between skills imparted and industry requirements, leading to poor employability.
- Quality of Training: Concerns about the quality, relevance, and standardization of vocational training programs.
- Low Private Sector Engagement: Insufficient engagement of industry in curriculum design and placements.
- Lack of Social Acceptance: Vocational education often viewed as inferior to traditional academic degrees.
- Informal Sector Dominance: Training often not tailored for the large informal sector.
- Data Gaps: Lack of robust data on employment outcomes of trained individuals.
Conclusion & Way Forward
The governance of India's social sector—health, education, and human resources—is a colossal and continuous undertaking, critical for realizing its demographic dividend and achieving inclusive growth. While comprehensive policies like NHP 2017 and NEP 2020, coupled with flagship schemes (Ayushman Bharat, Samagra Shiksha, Skill India Mission), have significantly improved access and outcomes, persistent challenges related to quality, affordability, equity, and human resource deficits remain.
The way forward demands a sustained, comprehensive, and adaptive approach focusing on:
Increased Public Investment
Raising public expenditure in health and education to recommended GDP targets.
Strengthening Public Infrastructure
Expanding and upgrading PHCs, CHCs, public schools, and vocational training centers, particularly in rural and underserved areas.
Human Resource Development
Addressing shortages of doctors, nurses, teachers, and skilled trainers through increased intake, quality training, and incentivizing rural service.
Focus on Quality and Outcomes
Shifting from mere access/enrollment to ensuring measurable learning outcomes, health impacts, and employability.
Bridging Digital Divide
Ensuring equitable access to digital learning and health services, and promoting digital literacy.
Effective Regulation
Strengthening regulatory frameworks for both public and private sectors to ensure quality, transparency, and affordability.
Inter-sectoral Convergence
Promoting seamless coordination between health, education, nutrition, sanitation, and skill development for holistic human capital formation.
Data-Driven Governance
Leveraging data analytics for targeted policy formulation, implementation, and monitoring.
Only through a sustained, comprehensive, and adaptive approach can India effectively harness its demographic dividend and build a resilient, equitable, and high-performing social sector.