District panchayats are empowered to appoint doctors in vacant positions. The State has successfully trained a new cadre of community health workers for more than 50,000 villages. The role that panchayats in Madhya Pradesh are playing may provide a strategy for all other States with respect to primary education and health. This is critical in view of the fact that the bureaucrats stationed in the State capitals manage the prevailing system in most States. Rarely were the teachers present in the schools and doctors in the PHCs.
Infrastructure is notoriously bad.
The PHCs did not have a telephone, transport, or even the basic minimum medical equipment. Some PHCs had no work since patients never came there, but did have 10-12 fulltime employees, including a position for a computer person. As long as monitoring of primary schools and PHCs continues to be at the State-level, there is little hope of any improvement. In some villages of Uttar Pradesh there were privately-run primary schools. Of course, this will require strict monitoring, preferably by the Prime Minister's Office to ensure that funds are being used for the purpose they are meant for.