Chapter 2: Role of the Government in Health — Study Notes
Chapter 2: Role of the Government in Health
Context and purpose
In a democracy, people expect government welfare through essential services like education, health, housing, roads, water, electricity, etc.
This chapter uses health as a concrete example to explore the meanings, problems, and roles of government in health provisioning.
Highlights public and private aspects of health care and the unequal provisioning in India.
The Constitution supports the idea that the right to health is linked to fundamental rights, but actual provisioning remains unequal.
The chapters aim to help learners visualise the ideal role of government and the meanings behind its structures, and to discuss how to change the situation.
Teaching approach and classroom goals (from the Teacher’s Note)
Do not rely on dry, didactic lectures; make sessions interactive and student-led.
Encourage questions like: Who is the most powerful person? Why can't the MLA solve the problem?
Use familiar issues (water, transport, school fees, books, child labour) to discuss and understand how problems are tackled.
Encourage expressing views on public issues and understanding government roles through exercises.
Use wall charts to express ideas and facilitate discussion.
What is health? – Broad concept and related factors
Health is our ability to remain free of illness and injuries, but it is broader than disease alone.
Other factors affecting health include: clean drinking water, pollution-free environment, adequate food, housing conditions, and mental well-being.
Health includes physical, social, and mental well-being; it is related to daily life functioning and overall quality of life.
Activity: Pick two situations from a collage not related to illness and write two sentences on how they relate to health; discuss in groups.
Prompt for reflection: Would you associate all or some pictures with ‘health’? In what ways?
Healthcare in India: Key facts and contrasts (left vs right column framing)
India has the largest number of medical colleges in the world and is among the largest producers of doctors.
Approximately more than new doctors qualify each year.
Healthcare facilities have grown substantially over the years:
1950: government hospitals
1991: hospitals
2017: hospitals
India gets many medical tourists; some hospitals compare with the best in the world.
India is the third largest producer of medicines and a large exporter of medicines.
Most doctors settle in urban areas; rural areas have fewer doctors per population.
Public health challenges (illustrative numbers):
About five lakh people die from tuberculosis every year.
Almost two million malaria cases are reported annually.
About 21% of communicable diseases are water-borne (diarrhoea, worms, hepatitis, etc.).
Half of all children do not get adequate food and are undernourished.
Common framing question: We have money, knowledge, and people with experience, yet health services are not available to all. This is a paradox that the chapter explores.
Private vs public outlook: private sector grows, but public services often do not keep pace; healthcare is expensive and unequal.
UNICEF statistic: more than a million children die each year in India from preventable infections.
Public health system and its rationale
Public health services are government-run hospitals and health centres designed to cover rural and urban areas and to provide treatment for a wide range of health issues.
Village level: usually a nurse and a village health worker; Primary Health Centre (PHC) at rural levels; District Hospital oversees health centres; large cities host government hospitals and specialised government facilities.
Public health systems are funded through taxes paid by the public; aim to provide quality care either free or at low cost to ensure accessibility for the poor.
Public health actions include disease prevention and control (e.g., TB, malaria, jaundice, cholera) and ensuring a broad set of health services for all.
Tax rationale: taxes fund services that benefit all citizens (defence, police, judiciary, highways) and also relief/rehabilitation in disasters, and targeted services for the poor (e.g., health care).
The judiciary has acknowledged government responsibility to provide health services, including emergency treatment, and to reimburse patients for expenses in certain cases.
Private health facilities and ethical considerations
A large number of doctors operate private clinics; urban areas host many private hospitals and nursing homes; private laboratories provide tests (X-ray, ultrasound, etc.).
Private facilities require payment for services and are not government-controlled; costs can be high and unaffordable for many.
The UNICEF statistic underscores affordability issues: many people cannot afford all medicines; barely 20% of the population can afford all medicines during illness.
Private sector concerns include potential over-prescription (unnecessary medicines or injections) to earn more; emphasis on rational prescribing and generic names is promoted by ethics codes.
The Medical Council of India’s Code of Medical Ethics advocates prescribing drugs by generic names and rational drug-use practices.
The private sector also includes large hospital networks run by private companies and doctors, as well as drug manufacturers and medical shops.
Economic, social, and ethical dimensions
Access and affordability: Private services are more prevalent in urban areas; public services are essential to reach rural and poor populations but are underfunded or unevenly distributed.
Household financial strain: Illness often leads to borrowing or selling assets, especially among poor households; around 40 ext{%} of those admitted to hospital have to borrow money or sell possessions to pay expenses.
Nutritional status and health: Undernutrition exacerbates vulnerability to illness; poor health is linked to broader social determinants (nutrition, housing, sanitation, water).
Women’s health priorities are sometimes treated as less urgent; tribal areas often lack adequate health centres, and private services may be unavailable or unaffordable.
The interaction between health and basic amenities (water, sanitation, housing) is emphasized; improvements in water and sanitation can control many diseases.
Case examples and country comparisons
The Kerala experience (decentralisation):
In 1996, 40% of the state budget was delegated to panchayats to plan and implement local health and development needs (water, food, women’s development, education, health centres, anganwadis, water schemes).
Improvements included better functioning water supply schemes, schools, and health centres; but persistent problems included shortages of medicines, insufficient hospital beds, and not enough doctors.
This illustrates that simple budget transfers are not sufficient; ongoing resource and management challenges remain.
Costa Rica: health-focused development without a standing army
Costa Rica decided not to have an army, freeing up resources to invest in health, education, and basic services.
Government prioritizes safe drinking water, sanitation, nutrition, housing, and health education as part of development.
Health and education are treated as essential to development and human welfare.
Kerala and Costa Rica illustrate different models: decentralised local governance with budget devolution vs. strategic national investment in social sectors; both emphasize health as a cornerstone of development.
Sustainable Development Goals (SDGs) are referenced in the rural health context, including mobile clinics and other innovative approaches to reach underserved areas.
Exercises and maps:
Students may be asked to outline Kerala on a map of India and discuss its health strategies.
Rights, duties, and legal frameworks
Constitutionally, it is the State’s duty to raise nutrition and living standards and to improve public health; the government must safeguard the Right to Life and ensure timely health care, including emergency treatment.
Courts have emphasised state responsibility to fund or reimburse health expenses in emergencies when government facilities cannot provide timely care.
The goal is to ensure health care access for all, particularly the poor and disadvantaged; health outcomes depend on both health services and broader living conditions (nutrition, sanitation, housing).
Practical implications and questions for discussion
How can health care be made more affordable and accessible for all segments of society?
What roles should government, private providers, and civil society play in achieving universal health coverage?
How can public health systems improve efficiency, reduce queues in government hospitals, and ensure quality care?
How do social determinants (nutrition, water, housing, sanitation) interact with health outcomes, and how should policy address them?
What lessons can be drawn from Kerala’s decentralised budgeting and Costa Rica’s health-focused development model for other states or countries?
Exercises (summarised prompts from the chapter)
Exercise 1: Explain why health is a wider concept than illness and describe terms from the Constitution related to living standard and public health.
Exercise 2: Identify different ways the government can provide healthcare for all and discuss.
Exercise 3: Compare private and public health services in your area using a provided table framework (Facility, Affordability, Availability, Quality).
Exercise 4: Explain how improved water and sanitation reduce disease with examples.
Exercise 5: List and describe Primary Health Centres (PHCs) or government hospitals near you; observe facilities and personnel; report findings.
Quick glossary of select terms (definitions)
Public: An activity or service meant for all people, organised by the government. People can demand these services and raise questions when they don’t function.
Private: An activity or service organised by individuals or companies for private gain; not owned or controlled by the government.
Medical tourists: Foreigners who come to India for medical treatment in facilities offering world-class care at relatively lower costs.
Communicable diseases: Diseases that spread from one person to another via water, food, air, etc.
OPD: Out Patient Department; where patients are treated without admission.
Generic names: Chemical names of drugs; global standard names (e.g., acetylsalicylic acid for Aspirin).
Facility, Affordability, Availability, Quality: Four dimensions used to compare private vs public health services.
RMPs: Registered Medical Practitioners (primarily in rural areas).
SDG: Sustainable Development Goal; global development targets.
Notable quantitative references (for quick recall)
Doctors: 30,000 doctors per year.
Hospitals (government):2,717 in 1950; 11,174 in 1991; 23,583 in 2017.
TB deaths: five lakh per year.
Malaria cases: two million per year.
Water-borne communicable diseases share: 21 ext{%} of cases.
Undernourished children: 50 ext{%} of children
Private cost example: Rs at reception in a private hospital (illustrative cost, not a universal price).
Affordability, private vs public access: only about 20 ext{%} of people can afford all medicines during illness.
Among hospitalised poor, around 40 ext{%} borrow money or sell assets to pay for expenses.
Kerala: 40 ext{%} of the state budget goes to panchayats for local development and health planning.
SDG and global context
The chapter places health within the framework of Sustainable Development Goals (SDGs) and highlights global comparisons (e.g., Costa Rica’s approach) to illustrate alternative development pathways focused on health and education as central to development.
Connections to broader themes
Examines representation, accountability, and public welfare in government functioning (as introduced in the Teacher’s Note for Chapters 2 and 3).
Encourages linking health issues to other public goods (water, sanitation, education, nutrition) and to tax-based funding and public budgeting.
Emphasizes ethical considerations in medical practice (generic prescribing and rational use of medicines).
Summary takeaway
Health provision in India is a public good with strong private sector participation. The government’s challenge is to ensure universal, affordable, quality health care while addressing social determinants of health. Decentralised governance (as in Kerala) and a health-first allocation of resources (as in Costa Rica) illustrate potential paths, but sustaining improvements requires addressing systemic issues such as financing, manpower distribution, infrastructure, and equitable access across urban-rural divides.
Note on terminology used in exercises
Public health system terms: PHC (Primary Health Centre), district hospital, OPD, etc.
Private sector terms: clinics, nursing homes, laboratories, and private hospitals.
Policy terms: Rights to Life, duty of the state, universal health coverage (contextual).