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By he Prat ich iResearch eam:Kr" lMARRnrunSunHRAN6su Snrurnn. ABDUR RnrreuIAnl ruDAM MUTHERJEE' AMRtTA SrrucuprA

With an introduct ion yAunRTyA Srrrr

Tkz*W*,Yry*,yy{T\ * *r - - r - r trrlrnarv Health{"r .

befvlcesA Sruoy tN We sr BTNGAL AND JHnnKHAND

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r \W{hencitizens cannot even get free medical diagnosesorblood tests,or obtain basicmedication fot cleady dentifiablesubstantial llnesses, here is something deeply wrong with theframework of statehealth services.r A far-rcachingreotgatizatton of public health ser\'lcesseems o be needed.r Many of the changesthat are needed are matters ofbetter orgatizanon, rather than of larger expenditure.r It is particnlutly important to bdng the issue ofresponsibility in medical services nto the spodight of publicattention, along with the prevalenceof 'quacks' and theexplosion of expensiveprivate practitioners to whom thepatients tend to go becauseof the lack of elementaty publichealth services.r The remedymust also ie in mote public discussion,n themedia and elsewhere,about appalling exclusions n statehealth services,with disastrous mpacts on the lives of thepoor, along with non-performanceby a substantialpatt ofthe public health care officials, including doctors.

Amartva Sen

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f . _PTETACE.qwhydoyouwastedmeandmoneyonresearch?, ' .W.ewefeaskedthisquest lonrepeatedly by many people (including government

officials and non-governmentfunctionaries)inboththestatesof\TestBengalandJharkhand.Seniorgovefnmentofficers and NGo functionaries added, "Enolugh research has been done' Now it ist imetodosomesubstant ia lwofk. , , \Teponderedoverthequest ionser iouslyandasked ourselves, "Can research play an effective tole in making things better? Doesit have a positive impact o" ptoilt" lives?To what extent can research nfluence thepolicies and program-t' of tht 't"tt to make them more effective?"

The role of research n the developmental field, especially n the formulation ofpolicies, is undeniably important' Yet' the scepticism we encountered made us reviewtheimpact thatPrauchi"o*" teseatchworkhashad'At thet imeofwr i t ingth isreport, the small Pratichi reseatch team' which began work in May 2001 under theguidance of its Charr Professor Amatya Sen (with a modest one roomed rentedoffice and an equally modest budget) had completed three tTdi-tt on primary edu-cationin\festBengalandJharkhand.TVoofthesehavealreadYbeenpublishedandthe third is forthcomi,tg't'i|t"'t releaseof the preliminary findings of the first studyon the Delivery of Primary Education in West Bengal (on 10 November 2001) andthe publication of the "po" (on 16 A"go'-t 2002)havenot

only attracted wide mediaattention in rhe state in iarticrrlar and in the countty in general' but have also creat-edanimportantpublicdi"oo"tonthestateof-primaryeducationin\[estBengal'Apartfrommediaintervention,ourtrusthastriedtomakeresearchfindingsandpol-icysuggest ions(formulatedonthebasisof thef indings)avai lableforparentsandteachers of primary schools through Bangla' Hindi and tilt* translations of thewith pafents and teacheSsz

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These initiatives are in keeping with Pratichi's objective of intervention through peo-ples' action. That is to say, he reports are not meant as criticism of rhe governmentor other agenciesbut ate aimed at the public domain, in order to create an environ-ment for peoples' participation in developmental activities.\{/hile the prelirninary indicationsgathered so far, do nor allow for complacen-cy' they do give cause for belief in meaningful research.The parent-teachers'work-

shops and other feedback fora (we have received hundreds of very valuable respons-es frorn many villages and individuals) confirm that the reports have made a positiveimpact upon peoples' awareness.There is considerable evidence for this claim ofwhich we will put forth only two. The research team has seen some primary schoolswhere the teachershave become active, rising from their self-admitted "hibern aiLon",in "removing the dust and stains from the system that have been gathering sinceIong". Second, in a district of West Bengal, the Chairperson of the District PrimaryEducation Council verbally acknowledged the veracity of our findings while takingnew initiatives like the formation of mother-teacher committees. The experiments,he said, "are yielding excellent tesults"3.In addition to this, many residents of the study villages insisted that Pratichihighlight the issues relating to the public health delivery system. The demand for apublic discussion on basic health (and primary education and social security) that hadbeen raised in academia (particulady by Amartya Sen) has now emerged ftom thegrassroots (where most of the respondents are not familiar with the original worksof sen). Now the question is, 'lwhy another study?" particulady when there is aplethora of research work availableon health.First of all, the very valuable studies thatarc avatlableare either specific to cer-tain issues (R.eproductiveand Child Health is probably the most researched area)orof a very general nature, which certainly give a wider picture but which do not always

deal with the intricacies and interconnections berween health and other der.'eloo-mental issues.Health services,as Rabindranath ragore pointed outin 1,923, must be seen aspart of the overall framework of society and culture". Health as defined by thervodd Health organisation is "optimal, physical, mental and social well being:' andrequires an analysisof the complexities of various related issues n the broader spec-trum of development. An illuminatrng discussion by Drdze and Sen in India:Deuelopment nd Participalian4undedjnes the importance of the interconnectionsbetween health, education and development.The Pratichi (India) Trust considered it important to make an enquiry into thestateof the health del,iverysystemaimed at finding such nterconnections. The inves-tigation has deliberately been made in a relatively small geograpl:iLcalarca o deepenthe scope of the study. S7ehope this study will aid in the understanding of some ofthe problems concerning pubJic health and health services through vigorous pubJicdiscussion.ril/eare grateful to a number of individuals and organisations for extending manykinds of support. We apologise for not being able to mention everyone separately.

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Proiessor Amart\,a Sen,chair, Pratichi (India) Trust hasbeen the main guiding forcof the studl'and,despitehis busv schedule, c consistentlvook note of the pr6greof the study and advised he research cam. We orvea debt of gratitude to professoJeanDrdze u'ho tead the eadierdrafts and generouslvgar.ehis suggestions rom timto tlme. V'e arc greatlv ndebted to NIs Antara Dev Sen,our NlanagingTrustee,without whose help this report u'ould not have seen he light of da1-.Xreare particulalgrateful to Dr. A.I{. Rov of Economic Information Technologr,, {olkata, ProfessDikshit Sinha of vis'a-Bharati, Santiniketan,Dr. N.c. Gandhi, x{S, Dr. DipankaChakrabortt',NID, and Dr. Amalendu Bikash Toong, NIBBS, for their r.aluablecontributions during the course of the studv and their comments on an earlier drafShivadina Se n and Samantak Das, members of the pratichi co-ordinationCommittec at Santiniket^n) apatt from academic suggestionsduring the course ethe studv and on the draft report have consistenth, providecl moral strength aninr,-aluable upport to the team. It u,ould have been cxtremeh, difficult fcrr thresearch team t() conduct the studr- n Dumka u,ithout a u.ide range of supporextendedbv the members of the Ar-o Ardari Trust, Dumka, a Santalwoment NGO()ur sincercgratitude to al l of thcm.

\!'e arealsograteful to Libi T. Johnson, Debu Dattagupta and BasuclcvBesra otheir comments ()n an ear[er draft. \\'e are greatlv indebted to Dr. p. Iiosh1Coorclinator, Pratichi (India) Trust and Saumik N{ukherjee,Administratir.e ()fficerPratichi Research ()ffice, Santiniketan, for their support all through the studThanks arc due to Arabinda Nandr.,Sumita }fukherjec anclRaran Ghosh for logistical and other support.Th e studv eam s alsogratcful to a great numbcr of respondents at various lcr-els.

1. Rana et al Q002) 'l'he Praticlti Education Report I, with an introcluction byAmartya Sen; and Rana et al (2003) JharkhandreEtohop \'ecet'reak,bosta (Santalitranslation of 'The Stateof Primarv Education inJharkhand). The trnglish ver-skrn cr f the report on Jharkhand u'ill also be pubiished \rerysoon as a part of .I-bePratichiEducatianReport I (comprising a rep()rt based on a second study on pri-m2r1r dr.r,ion in \&'estBengal,a rcpoft on primarl, education n Jharkhand anda comparati'e analvsisof rhe $7estBengal andJhatkhand studics).2. On 6 Julv 2002, at Bolpur, West Bengal and ,n 6 Jul,v 2003, at l)umka,Jharkhand.3. Intervieu'with Nfr. Gautam Ghosh, Chairperson, Birbhum District primarvEducation Council4. Dtd.zeand Sen ([1995]2002)