Improving Child Health and Schooling

This paper has two objectives. First, it provides information on student absenteeism in elementary school in two districts of the North Indian state of Bihar. While teacher absenteeism has received a significant amount of attention in the literature, less is known about student absenteeism. Knowledge of student absenteeism is critical for policies that attempt to improve schooling outcomes. It also helps the design of other programmes that deliver services, such as health and nutrition, to children through schools. The extent of student absenteeism may critically affect coverage of any programme delivered through schools. However, it is also necessary to understand the determinants of absenteeism since any systematic variation in absenteeism, across schools and amongst students within a school, will also influence the distribution of programme benefits.

A second objective is to assess the extent to which variation in coverage reflects components of the design of the programme. This is particularly useful from a policy point of view, since it suggests methods whereby coverage can be enhanced, even given prevailing levels of student absenteeism. Prabhat P. Ghosh and Anjini Kochar investigate this in the context of a specific programme, the Government of Bihar’s programme for providing health checkups to all school children, termed the Nayi Pidhi Swasthya Guarantee Yojana (NPSGY).

High levels of infant and child malnutrition constitute one of the major challenges facing India. This is particularly true of states like Bihar with malnutrition amongst children ages 0-3 estimated to be as high as 58.4%, relative to the national average of 46%. In reducing malnutrition, the Government has been thwarted by the low performance of village-level health institutions. National Family and Health surveys reveal that only 28% of children between the ages of 0 to 5 avail of services provided through village centers, Anganwadis, which constitute the delivery point for the Government’s nutrition programme for pregnant women and children (ICDS). A mere 20% of these children were weighed in the year preceding the survey, and, of those weighed, only half of their mothers received nutritional counseling.

The Government of Bihar’s Nayi Pidhi Swasthya Guarantee Yojana (NPSGY) is a unique programme designed to address these constraints. Rather than rely on village-level health functionaries, the programme follows a centralised approach which utilizes the services of health officials at Primary Health Centers. This provides village household’s access to specialists and experts. It, however, overcomes the major problem associated with the centralised delivery of health care, the distance households must travel to avail of these services. Services are provided “at the doorstep,” through health camps in every government school.

The study draws on a small survey that we ran in two districts of the state, covering 3 PHCs and 32 schools. Focusing attention on students in grade 2 in 2011-12, Ghosh and Kochar collected information on whether the child received a health report card (and checkup), as well as attendance data for that child for each month of the school year. Combining this with information on the month of the school visit by the PHC team, they are able to assess whether the programme affected absenteeism, and how the design of the programme affected the relationship between attendance rates and programme coverage.

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