Karnataka can be a Leader for Primary Care and Elementary Schooling

India’s rich states should lead the way in new policy ideas for social welfare. Karnataka is among the prime candidates. Blessed with a high per capita income, a health and education system better than the national average, an active civil society and a skilled workforce, the state ought to have high quality schools and primary health care centers which are used by all sections of society. Its wealth and intellectual prowess must be reflected in its policy ideas to strengthen elementary schooling and primary healthcare- two sectors without which the health and education systems become dysfunctional. Karnataka has recently witnessed a slew of policy actions. Increase in incentives for ASHA workers, enrolment drives for primary schools, push to fill critical health vacancies and steps to bring transparency in health staff transfers.

Are these enough for Karnataka to achieve high uptake of elementary schools and primary health care across all social and economic groups? Karnataka has a long distance away from this goal. Uptake of Urban Primary Health Care (UPHC) facilities in Karnataka is at a poor 7% (NFHS 5) and enrolment in class I in urban private schools a high 55% in 2021-22 for which data is publicly available as per the old school structure (UDISE). The initiatives seem few and far between in a context of low policy attention to these areas over the last decade 2014-2024.

Karnataka’s budget allocation for health and education – a crude indicator of the policy attention given to a particular sector – is low compared to other states. In 2025-26, the Health budget for the state was 4.9% while average across all Indian states was 6.2%. And education budget was at 10.8% which is lower than the average 15% across states (PRS budget analysis Karnataka 2025). Another way to understand state level policy focus is to look at state-level initiatives.   In primary care and elementary education for urban areas in the last decade (2014-2024) very few initiatives focus on strengthening UPHCs and urban elementary schools. Flagship programs such as the Karnataka Public School Program, Namma Clinics, Ayushmati Clinics focus on select facilities only. Most other initiatives focus on a small aspect of the school and primary care system- for example, classroom construction (Viveka Scheme), or medical helpline (Alpamitra Helpline). They improve schools and UPHCs but systemic issues remain neglected. This in turn keeps uptake of these facilities low even among the poor.

The impact on Karnataka’s health and education, particularly those at the level of primary care and elementary education are clearly visible. For many indicators, Karnataka’s performance is either marginally above national average or actually below it. For example, according to NFHS-5, immunization based on vaccination card in Karnataka is 88%, in India this is 89%.  OOPS for a delivery at a public facility in Karnataka is 4954 INR but the Indian average is 2916 INR. In elementary education, according to NAS 2021, the average Math competency in class VIII in Karnataka is 50% which is marginally higher than the Indian average of 46%.

What can be done? Karnataka needs higher budget allocation and more state-level initiatives which are designed and funded by the state and therefore under its own control and reflect Karnataka’s health and education priorities. It’s important that Karnataka’s own civil society groups, communities and political leaders own these initiatives within their own spheres of politics, community mobilization, and civic actions.

I propose four policy recommendations. Presently, health and education initiatives become part of election campaign narratives but seldom are political leaders engaged in ensuring outcomes. For enabling this, we need to create knowledge pathways. Health and education outcome data needs to be segregated assembly constituency wise and made publicly available. This data is needed for citizens and party workers to channel everyday challenges facing schools and UPHCs into an actionable political agenda. Second, we need to break the idea that government schools and UPHCs are the option of the last resort for the poorest of the poor. Unless we, as a society, need government provided health and education, there will always be dual standards: good schools for the Haves and rudimentary government schools for the Have-nots. To attract the middle classes, government schools need to reach the standards of the average private school. No one wants a costly school education. For this, a ‘Diversity Index’ needs to be created. Each assembly constituency must be ranked on health and education outcomes but also on the extent to which elementary schools/UPHCs are used by the non-poor people as well. This will provide a knowledge output for mobilisation for middle class constituents and create the knowledge to hold the bureaucracy accountable for ensuring standardisation between private and government schools, particularly in urban areas where the competition from low-cost private schools is very high. Third, government provided health, and education is not generosity towards the poor. It’s a constitutional commitment and fundamental for economic growth. Not just productivity, but bare bone growth. For a growing economy, you need consumption, for consumption people need money, and the less they spend on costly health and education, the more disposable income they have. This case needs to be made in raw numeric terms for Karnataka. How much can a household save when they use good government schools and UPHCs? And what does this mean for the economy? A government appointed commission which is answerable to the chief minister having representation from globally renowned economists and health and education experts needs to produce a report on contribution of government provided health and education to the economy.

Will it lead to an immediate increase in budget allocations and more state level initiatives on strengthening all schools and UPHCs emerge? No. But these are the essential first steps in pushing Karnataka to claim its rightful position as a leader in providing a visionary and socially irreplaceable health and education system. It needs to build on its long history of pathbreaking programs in Health (Yeshaswaini, Primary Health Care task force) and Education (Nalli Kalli).