This document summarizes the turnaround in health and education in the Indian state of Bihar from 2005-2010. It describes how Bihar had fallen behind other states economically and in terms of development by 2005, with high crime rates, poor infrastructure, and low education and health indicators. Through focused policy changes and increased funding and monitoring of programs, Bihar was able to significantly improve law and order, build roads, boost education access and quality like increasing the number of schools, toilets, and textbooks, and dramatically improve health indicators like institutional child delivery and immunization rates between 2004-05 and 2010-11. However, challenges remain around quality, infrastructure, and leakage within the system.

1. The Turnaround of Health and
Education in a Beleaguered State:
Public Policy Implications for UP
Rajesh Chakrabarti

2. Bihar: A snapshot
• India’s 12th largest state
• 3rd most populous,
• More people than Germany
• GDP similar to Uzbekistan,
• Per capita income comparable
to Eritrea
• Riverine, fertile, flood-prone
• Fractious, caste-based social and
political order
• Largest “poor” population in
India, with over 2/5th of the
population below poverty line
• 26 of its 38 districts belong to
the 69 socio-economic ally
“backward “districts in India,

3. Bihar, circa 2005
• Relative decline of Bihar in the 90’s:
– Bihar’s PCY as % of India’s – 1985: 59%; 2005: <26%.
– Only state in India with de-urbanization:
urban population: 1981: 13%; 2001: 10%
– Law and Order in shambles; Kidnapping for ransom an
“industry”

4. The “turnaround” during 2005-2010
• Law and Order:
–
–
–
–
Dacoity
Robbery
Road dacoity
Kidnapping for ransom
• Road building:
2004:
2008:
1297
2909
287
411
640
1536
146
66
2004-05
2009-10
– Km of road built:
385
3474
– Expenditure incurred
236
3045
– Travel times have fallen by more than 50% between most
parts of the state.

5. The “Turnaround” in Health & Education
• Before and After:
– Avg. Footfall per month
in health care facilities
– Institutional child delivery
– Routine immunization
2004-05
39
~45,000
< 20%
2010-11
5200
1.246 m
67%
(> all-India avg.)
– Out-of-school children in 2011 reduced by 85% from
2005,
– Drop-out rate in 2011 was a sixth of what it was in 2005.
– The teacher student ratio had dropped by 40%

6. The “Turnaround” in Health & Education
(contd.)
• Before and After:
– Schools with at least a toilet
– Schools w Separate girls’ toilet
– Drinking water availability
– Children receiving textbooks
– SSA fund utilization
2004-05
2010-11
27,000
8,000
45,000
76 lakhs
300 cr
45,000
31,000
64,000
199 lakhs
4500 cr

7. Social Infrastructure: Health
•Funding from National
Rural Health Mission
(NRHM)
• Free drugs
•Incentives for institutional
delivery
• Focus on PHCs
• Monitoring doctor attendance
• Public-private partnership approach
– Co-opting the competition where monitoring does
not work

8. Social Infrastructure: Education
•
•
•
•
Enabling access to schools
Filling teacher gap
Monitoring teacher attendance
Monitoring schedule in higher education

9. The Monitoring Mechanism
• To monitor the attendance of the primary school teachers
• PPP model by outsourcing virtually everything – starting
from machinery and telecom, to bill-payment and people.
• A team of 60 people was hired; all 60 would sit in the
headquarters, of which 38 would be in the call-centre.
• These call-centre executives were all management
graduates. They would talk to the schools, take the reports,
analyze them and then submit it to the higher bureaucracy in
a cohesive format.
•This was a big contract—Rs 1 crore a month—and there was
good participation from companies like Wipro.

10. Challenges remain…
• Let’s face it: Bihar is no heaven on earth today
– The “Quality” challenge
– Supply of qualified personnel (23 ANM and 6
nursing colleges)
– Of quacks and tutors
• Universal tutoring: good or bad?
– The health and education infrastructure
• Schools and health centers
• Building and maintenance
– Leakages out of the system

11. Pitfalls and caveats of the study
• Not a scientific “Evaluation” exercise
– No benchmarking, attribution , RCT
• A focus on inputs and intermediary variables
• Outputs – knowledge and health conditions –
need to be measured

12. Sasaula, Sitamarhi…

13. Images from Sasaula

14. Not just stats:
An outsider’s assessment

15. HOW WAS IT DONE?
– A CASE STUDY
Harder questions:
• Can it be replicated elsewhere?
•If Bihar can do it, no excuse for anyone else
• Is the change permanent?

16. Thank you