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February 23, 2023 12:15 am | Updated 05:51 am IST
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It is often thought that Indian voters do not pay attention to health as a political issue. File | Photo Credit: The Hindu
The famous adage ‘It’s the economy, stupid’ has been used to explain election outcomes. But other aspects of government performance receive less attention. It is often thought that Indian voters do not pay attention to health as a political issue. The Lokniti-CSDS survey data allows us to assess the extent to which voters do hold the government to account on this issue.
We asked voters to say whether different services have got better, stayed the same, or got worse over the past five years. Most voters report that government hospitals (52%) have got better, though a sizeable number say that they have stayed the same (31%) or got worse (12%). Public evaluations of health services are therefore more positive than evaluations of employment opportunities, which only 14% think have improved; but behind education and electricity which 57% and 66% think have improved (Table 1).
Voters are more likely to attribute responsibility for running government hospitals to their State government than to the Central government (37% compared to 14%). We, therefore, look first at whether performance-based voting on health issues occurs in State elections. Table 2 shows the link between performance evaluations of government hospitals and support for the Chief Minister’s party in the Vidhan Sabha elections. Overall, voters who said hospitals had got better were about 10% points more likely to vote for the Chief Minister’s party than those who said hospitals had stayed the same or got worse (except in T.N.).
By contrast, performance evaluations of government hospitals have less of an impact on how people vote in general elections. Voters do not tend to reward or punish the Central government in the same way, perhaps because they do not hold it responsible for the provision of health services. Table 3 shows that performance evaluations are less likely to impact whether or not people vote for the BJP in general elections, particularly in States where the BJP is not in power at the State level. In States with a BJP Chief Minister (Gujarat and U.P.), people who said hospitals had got better are more likely to vote for the BJP in general elections than people who said that they had stayed the same or got worse. But in States where the Chief Minister is not from the BJP (Bihar, Rajasthan, and T.N.), people who said hospitals had improved are less likely to vote for the BJP in the general elections.
The findings show that State-level governments can be held to account for the quality of health services they provide. This suggests that there is electoral value for them to do more to strengthen and claim credit for health system performance.
Oliver Heath is Professor of Politics, Royal Holloway, University of London; Louise Tillin is Professor of Politics and Director, King’s India Institute
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