Paper short abstract:

The Indian pharmaceutical sector supplies 50% of the global demand for vaccines. It has the second-largest share of the pharmaceutical and biotech workforce. Yet, suffers from the triple burden of medical skilling. In this paper we conduct a Skills for Trade and Economic Diversification analysis and tie it up with the capabilities approach to identify the gaps in health skilling.

Paper long abstract:

The Indian pharmaceutical sector supplies fifty percent of the global demand for vaccines. It has the second-largest share of the pharmaceutical and biotech workforce. Yet, the country suffers from the triple burden of medical skilling - the shortage of qualified professionals, the lack of 21st-century skills like transversal and soft skills among the health staff, and the lack of specialists.

Globally, India ranks third in pharmaceutical production (by volume), and fourteenth in value terms. Indian pharmaceutical exports touched USD 24.44 billion in FY21. Foreign direct investment in the sector stood at USD 17.99 billion between April 2000 and March 2021. The Indian pharmaceutical sector supplies fifty percent of the global demand for vaccines. It has the second-largest share of the pharmaceutical and biotech workforce. As per the Economic Survey 2021, the Indian pharmaceutical market will grow threefold in the next decade. Yet, the country suffers from the triple burden of medical skilling. By the triple burden of health skilling, we mean the shortage of qualified professionals, the lack of 21st-century skills like transversal and soft skills among the health staff, and the lack of specialists.

We apply the capabilities approach to identify the gaps in the space of health skilling. There are hardly any studies that apply the capabilities approach to the space of health skilling. Mitchell et al (2017) is the only existing study that conducts a review of studies applying the capabilities approach to the health field.

In this paper, we will be focusing on the following issues:

1. Increased demand for skilled labor force for the COVID-19 vaccine supply chain: vaccine production, distribution, and delivery process

2. Increased demand for skilled medical professionals possessing both core and people-centric skills

3. Increased demand for specialists possessing both core and people-centric skills

4. Strategies for India’s medical tourism, internal and abroad

5. Missing skills curriculum, anticipation, matching, and jobs: A case study from West Bengal

Given the triple burden of health skilling the following strategies may be useful. This is in addition to improving the medical infrastructure in the country. Initiatives by the Central government like the PM Ayushman Bharat Health Infrastructure Mission, the setting up of the All-India Institute of Medical Sciences (AIIMS) as part of the Pradhan Mantri Swasthya Suraksha Yojana across 12 new locations are some of the much-needed health sector reforms that were long pending.

• Pay greater focus on the inculcation of transversal skills among health care professionals. Transversal skills are core or soft skills that are required by health professionals to work in a people-centered care system. These skills are of three categories: skills for managing people-centered care; (ii) skills for managing complex tasks; and (ii) skills for creating a positive work culture. People-centered care adopted by both government and private sector health professionals will improve closer collaboration between patients and health professionals. It can help strengthen internal medical tourism. India already ranks 10 out of 46 countries on the Medical Tourism Index.

• There is a global lack of psychiatrists in India. Post- covid the demand for mental health professionals has increased considerably. In this context, India can aim to be the next telemedicine tourism hub. There was a rise of 20 percent in mental health professionals during the pandemic in India itself.

• eHealth skills need to be quickly adopted by medical professionals. ICT skills have gained greater prominence for sharing and communicating information across multi-disciplinary teams. The ethical issues associated with tele-counseling need to be well understood.

5. Missing skills curriculum, anticipation, matching, and jobs: A case study from West BengaL

West Bengal is a state located in the eastern region of India. The state is suffering from a serious skill crisis not only in health but also in other sectors. This is due to lack of effort by the state government in developing the skilling ecosystem of the state. Also, a concerted failure to attract industrial magnates to set up industries, create more jobs and entrepreneurs. The state suffers from the triple burden of health skilling. The skilling courses at the school level (West Bengal Board of Secondary Education) do not incorporate any training on health and pharma related courses. Training post schooling is also limited with minimal placement opportunities and entrepreneurial activities. As per the skill development attractiveness matrix, health care ranks high on youth aspirations.

The Government of India should consider setting up a separate skilling body and exercise for the vaccine and pharmaceutical industry focussing on developing and distributing Covid related vaccines and medicines. The Covid vaccination skilling exercise needs greater focus. The country requires more entrepreneurial activities in this context other than the initiatives by the major players. A STED or skills anticipation and matching exercise requires quality data and regular intervals. There is a major lack of data and policy coordination in West Bengal to conduct any such analysis. The large-scale unemployment and youth not in education and employment reflect the same. Along with the STED analysis we need to conduct a consistent application of the capabilities approach to identify the gaps in the space of triple burden of health skilling.

Reference

Mitchell, P. M., Roberts, T. E., Barton, P. M., & Coast, J. (2017). Applications of the capability approach in the health field: a literature review. Social indicators research, 133, 345-371.

Paper short abstract:

This paper shifts the focus to human rights public institutions at the national level in Brazil and Portugal, in order to explore the concept of domestic institutional capacity for human rights. The theoretical framework of new institutionalism was utilized.

Paper long abstract:

Traditional academic, political, and legal discussions have mainly focused on human rights as an international agenda, a topic of judicial conflict, or a concern of social movements. This article shifts the focus to public human rights institutions, particularly those at the national level in Brazil and Portugal, in order to explore the concept of national institutional capacity for human rights. To face this challenge, the article is based on the theoretical framework of New Institutionalism, with special emphasis on the Historical and Discursive perspectives.

We propose an analytical model to understand the national promotion of human rights. In this sense, the government needs to develop a strong and specialized institutional capacity, which involves two main aspects: institutions and public policies. This article analyzes these aspects in a comparative way between official Brazilian and Portuguese institutions and their human rights public policies, proving the importance of paying attention to these to internalize the human rights commitments assumed internationally, in the context of the United Nations.

Paper short abstract:

This proposal explores the complex implementation of Chinese private education reforms using a capability approach. Through policy analysis and fieldwork in 23 schools, it identifies key instruments and factors driving capability formation, challenging oversimplification. Emphasizing dynamic implementation and contextual nuances, the research contributes crucial insights into Chinese education.

Paper long abstract:

This proposal explores the dynamic implementation of Chinese private education reform policies through a capability approach lens, addressing the complex interplay between national policies and localized interpretations. The research contends that these policies aim to enhance education capabilities, encompassing practical, cross-cultural, citizenship, and 21st-century capabilities.

Methodology:

Policy Analysis: Utilizing the policy instruments framework, the study examines how 50 key reform policy documents operationalize capabilities at the national level.

Fieldwork: Employing a multi-site qualitative approach, the research traces policy interpretation and implementation in 23 private schools, analysing interview and observational data.

Key Findings:

Capability Alignment: The study identifies inducements, mandates, capacity-building, system-changing, and hortatory policy instruments shaping capabilities at the national level.

Actor-Based Conversion Factors: Three influential factors—parental demand, local policy priorities, and school leadership synergy—drive capability formation at the school level.

Discussion:

Policy Implementation Dynamics: The paper emphasizes the dynamic interaction among actors in policy implementation networks, highlighting the impact of conversion factors.

Contextual Factors: The research argues that real-world complexities demand a nuanced understanding of interactions, emphasizing the need to evaluate policies based on their impact on individual capabilities.

Conclusion:

The study challenges oversimplified policy implementation contexts and calls for a deeper understanding of interactions, shifting focus from abstract justice ideals to assessing policies based on individual capabilities. The findings contribute to discussions on education policy decentralization, experimentation, and accountability within policy implementation networks, emphasizing the unique role of private education in China's socialist system.

Significance:

This proposal offers a comprehensive analysis of Chinese private education reform, addressing gaps in current research by delving into localized interpretations and the dynamic interplay of actors. The findings contribute valuable insights to the conference theme of education policy and its impact on individual capabilities, fostering a deeper understanding of the challenges and opportunities within the Chinese education landscape.

Paper short abstract:

The paper assesses the short- and long-term effects of a graduation programme in Malawi on (income and multidimensional) poverty and climate resilience. It uses a mixed methods approach: survey and qualitative data were collected in two different years. Therefore, the paper contributes to generating evidence on the capacity of graduation programs to ensure a sustainable exit from poverty.

Paper long abstract:

To tackle poverty and vulnerability over the last decades the government of Malawi has implemented a number of noteworthy social protection and broader anti-poverty programmes. The most known and probably successful is the Social Cash Transfer Programme (SCTP). While impact assessments indicate that this programme has improved its beneficiaries’ access to basic goods and services, they also show that it does not ensure their sustainable graduation out of poverty. To address this weakness, the Government of Malawi together with IFAD launched the Financial Access for Rural Markets, Smallholders and Enterprise Programme (FARMSE) and in particular one of its components, the Ultra-Poor Graduation (UPG) intervention. Inspired by graduation programmes, such as BRACS model in Bangladesh and similar interventions elsewhere, the UPG targets the SCTP beneficiaries and provides them with seeds capital and different types of training and coaching. The general objective is to ensure a sustainable exit from poverty of its beneficiaries, by alleviating capital and knowledge/skills constraints. The UPG of FARMSE was implemented by five different NGOs in six districts of Malawi, covering 20,800 beneficiaries, all SCTP recipients.

While over the last years, scholars have produced new evidence on the effectiveness of graduation or social protection plus interventions, very few have looked at these effects after the end of the project. Another important evidence gap consists in understanding whether a limited set of interventions – compared to the original BRAC model that encompasses 4-5 different components – could be as effective as the comprehensive one. This would permit to save resources in resource-constrained areas. This study intends to contribute to filling this gap, by analyzing the short- and long-term effects of the UPG in Malawi on income and multidimensional poverty, as well as on households’ resilience to climate shocks.

This study relies on primary data collected in two different years, 2021 and 2023 as well as pre-intervention data obtained from the SCTP targeting registry. In each of the six districts, the two surveys covered a sample of programme beneficiaries as well as a control group, i.e. a sample of household living in the same district, with similar characteristics (including being SCTP beneficiaries) of the beneficiaries. The survey included several modules on, among other things, food security, expenditures, education, and resilience to shocks. While this paper mostly relies on these quantitative data, we also collected qualitative data which were especially useful in understanding the specific selection criteria used by the NGOs and the mechanisms that explain the results of the quantitative analysis. The qualitative analysis is also important given the limited sample size used in the quantitative analysis, especially for the 2023 survey due to difficulties in tracking households back after two years.

To assess programme effects, we will use a difference-in-difference econometric strategy. We will also use different measures to identify who are the real beneficiaries and, therefore, conduct different robustness analyses. The main dependent variables are: income poverty, graduation based on a multiple set of indicators identified by IFAD, multidimensional poverty, and indicators of resilience to climate-related shocks. The latter will primarily focus on drought, flood, and cyclone, events that have often occurred in different parts of Malawi in the last years. Moreover, the analysis will also look at intermediate outputs such as participation in the Village and Saving Loans groups, investment in productive activities, livelihood diversification.