By Arun Kumar, IANS
Washington : Simply informing the poor about government-provided free or low-cost health, educational, and social services can help them take greater advantage of public services, a US study in India suggests. The study found informed villagers went for more prenatal exams and supplements, more vaccinations, paid lower school fees and held more village council meetings.
The finding, reported in this week’s Journal of the American Medical Association, could be an overlooked, relatively easy way to boost health and well-being in developing countries around the world, say researchers at The Johns Hopkins School of Medicine, the World Bank and Case Western Reserve University.
In India and many other developing countries, central and local governments provide a variety of public services in areas of health and education.
However, these services are often inadequately provided. Why services do not reach the poor has been unclear, says the study’s senior researcher, Madhav Goyal, a general internal medicine fellow at The Johns Hopkins School of Medicine.
Previous work suggests that the answer relates to a combination of factors. Local communities may not be able to hold public service providers such as health care workers and teachers accountable.
This lack of accountability may in part be because communities are poorly informed of the services they are entitled to as well as of the legal controls they have over public services.
To test their ideas, research team members looked into the usefulness of educating residents of one of India’s poorest states on the services they are entitled to. “Our hope was that if village residents knew what their rights were, they would be more likely to demand them from service providers,” says Goyal.
The team’s efforts centred on Uttar Pradesh, where one-third of the population subsists on less than $90 per person each year. Less than 60 percent of the population is literate so the team needed to craft an outreach plan that would inform people who couldn’t read.
The researchers first determined which public services are mandated to be available. They then randomly selected 105 village clusters — small groups of adjacent villages with a single head and council members.
The team interviewed households in each cluster, taking a baseline reading of residents’ knowledge of public benefits and how often household members accessed these services.
Then Goyal and colleagues held meetings in some villages, playing a recorded message about public services the community is entitled to and what legal controls the community has in obtaining these.
Villagers could ask questions. Topics included prenatal and delivery care for pregnant women, vaccines for children, public schools, and the right to participate in village government meetings where elected village representatives decide how to use government funds for the development of the village.
Roughly half of the randomly selected villages held these informational meetings. Others received no additional education about public services.
One year later, a second survey of households in the village clusters measured results. Significant differences existed between village clusters with the meetings and those without.
Village clusters that held the educational meetings reported 30 percent more prenatal exams, 24 percent more prenatal supplementations, 27 percent more tetanus vaccinations, and 25 percent more infant vaccinations.
School fees — frequently illegally inflated to Rs.28 or more — dropped down to Rs.18 on an average. Additionally, residents reported holding 21 percent more village council meetings.
“With this minimal intervention — holding these informational meetings — people reported better receipt of services they are entitled to,” says Goyal.
He points out that the informational programme cost only $4,000 or about 22 cents per household. Disseminating the same information by radio and newspapers could lower costs even more.
This strategy could be useful in other similar countries. Though the problems aren’t as prevalent in the US, he says: “This type of intervention would still be useful to explore here”.
Other researchers involved in the study include David Levine of The Johns Hopkins School of Medicine, Priyanka Pandey and Michelle Riboud, both of the World Bank, and Ashwini R. Sehgal, of Case Western Reserve University.
Sahbhagi Shikshan Kendra, an NGO based in Uttar Pradesh, and the World Bank funded the study.