Role of the Government in Health

"In a democracy people expect the government to work for their welfare. This could be through the provision of education, health, employment, housing or the development of roads, electricity, etc. In this chapter, we shall examine the meaning and problems related to health."

Public health is a subject where state government has power to make laws. It is part of the State list of our constitution.

1.0What is Health?

• Health means our ability to remain free of illness and injuries.
• But health isn't only about disease.
• Apart from disease, we need to think of other factors that affect our health.
• For example, if people get clean drinking water or a pollution free environment they are likely to be healthy.
• On the other hand, if people do not get adequate food to eat or have to live in cramped conditions Patients usually have to wait in long queues in public hospitals, like this one they will be prone to illness.
  
• It isn't healthy to be dull, inactive, anxious or scared for long stretches of time.
• We all need to be without mental strain.
• All of these various aspects of our lives are a part of health.

Some Stats on Health Condition in India

2.0Healthcare in India

• In order to prevent and treat illnesses, we need appropriate healthcare facilities such as health centres, hospitals, laboratories for testing, ambulance services, blood banks, etc., that can provide the required care and services that patients need.
• In order to run such facilities, we need health workers, nurses, qualified doctors and other health professionals who can advice, diagnose and treat illnesses.
• We also need the medicines and equipment that are necessary for treating patients. These facilities are required to take care of us. (i) India has a large number of doctors, clinics and hospitals. (ii) The country also has considerable experience and knowledge in running a Public Healthcare system. (iii) This is a system of hospitals and health centres run by the government. It has the ability to look after the health of a large section of its population scattered over hundreds of thousands of villages. (iv) Moreover, there has been a phenomenal advancement in medical sciences, whereby many new technologies and treatment procedures are available in the country. (v) With all the positive developments, we are not able to provide proper healthcare facilities to people. This is the paradox - something that is contrary to what we would expect. Our country has the money, knowledge and people with experience but cannot make the necessary healthcare available to all.

Article 21 of the Indian Constitution guarantees the right to life and personal liberty. It states that no person shall be deprived of their life or personal liberty except according to the procedure established by law. This fundamental right is one of the most important and widely interpreted provisions in the Indian Constitution, ensuring protection against arbitrary actions by the state.

3.0Types of Healthcare Facilities

We can divide the healthcare facilities into two types: (a) Public Healthcare facilities (b) Private Healthcare facilities

Public Healthcare facilities:

• The public health service is a chain of health centres and hospitals run by the government.
• They are linked together so that they cover both rural and urban areas and can also provide treatment to all kinds of problems - from common illnesses to special services.
• At the village level, there are health centres where there is usually a nurse and a village health worker.
• They are trained in dealing with common illnesses and work under the supervision of doctors at the Primary Health Centre (PHC).
• Such a centre covers many villages in a rural area.
• At the district level there is the District Hospital that also supervises all the health centres.

The health service is called 'public' for many reasons - (i) In order to fulfil its commitment of providing healthcare to all citizens, the government has established these hospitals and health centres. (ii) Also, the resources needed to run these services are obtained from the money that we, the public, pay to the government as taxes. (iii) Hence, such facilities are meant for everyone. One of the most important aspects of the public health system is that, it is meant to provide quality healthcare services either free or at a low cost, so that even the poor can seek treatment. (iv) Another important function of public health is to take-action to prevent the spread of diseases such as TB, malaria, jaundice, cholera, etc. (v) According to our Constitution, it is the primary duty of the government to ensure the welfare of the people and provide healthcare facilities to all. (vi) The government must safeguard the right to life of every person. (vii) The court said it is the duty of the Government to provide the necessary health services, including treatment in emergency situations.

Private Healthcare facilities:

• There is a wide range of private health facilities that exist in our country.
• A large number of doctors run their own private clinics. In the rural areas, one finds Registered Medical Practitioners (RMPs).
• Urban areas have large number of doctors, many of them providing specialised services.
• There are hospitals and nursing homes that are privately owned.
• There are many laboratories that do tests and offer special facilities such as X-ray, ultrasound, etc.
• There are also shops from where we buy medicines.
  
• As the name suggests, private health facilities are not owned or controlled by the government.
• Unlike the public health services, in private facilities, patients have to pay a lot of money for every service that they use.
• Today, the presence of private facilities can be seen all around.
• In fact, now there are large companies that run hospitals and some are engaged in manufacturing and selling medicines.
• Medical shops are found in every corner of the country.

4.0Healthcare and Equality

• In India, we face a situation where private services are increasing but public services are not.
• What is then available to people are mainly private services.
• These are concentrated in urban areas.
• As these services are run for profit, the cost of these services is rather high.
• Medicines are expensive. Many people cannot afford them or have to borrow money when there is an illness in the family.
• In order to earn more money, these private services encourage practices that are incorrect.
• That times cheaper methods, though available, are not used.
• For example, it is common to find doctors prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicines can suffice.
• In fact, barely 20 per cent of the population can afford all the medicines that they require during an illness.
• Hence, even for those whom one might not think as being poor, medical expenses cause hardship.
• It was reported in a study that 40 per cent of people who are admitted to a hospital for some illness or injury have to borrow money or sell some of their possessions to pay for the expenses.
• For those who are poor, every illness in the family is a cause of great anxiety and distress.
• What is worse is that this situation tends to happen again and again.
• Those who are poor are in the first place undernourished.
• These families are not eating as much as they should.
• They are not provided basic necessities like drinking water, adequate housing, clean surroundings, etc., and therefore, these are more likely to fall ill.
• The expenses on illness make their situation even worse.

Sometimes it is not only the lack of money that prevents people from getting proper medical treatment. Women, for example, are not taken to a doctor in a prompt manner. Women's health concerns are considered to be less important than the health of men in the family. Many tribal areas have few health centres and they do not run properly. Even private health services are not available.

5.0What can be done?

• There is little doubt that the health situation of most people in our country is not good. It is the responsibility of the government to provide quality healthcare services to all its citizens, especially the poor and the disadvantaged.
• However, health is as much dependent on basic amenities and social conditions of the people, as it is on healthcare services.
• Hence, it is important to work on both in order to improve the health situation of our people. And this can be done.

The Kerala experience:

• In 1996, the Kerala government made some major changes in the state.
• Forty percent of the entire state budget was given to panchayats.
• They could plan and provide for their requirements.
• This made it possible for a village to make sure that proper planning was done for water, food, women's development and education.
• This meant that water supply schemes were checked, the working of schools and anganwadis was ensured and specific problems of the village were taken up.
• Health centres were also improved. All of this helped to improve the situation.
• Despite these efforts, however, some problems - such as shortage of medicines, insufficient hospital beds, not enough doctors - remained, and these needed to be addressed.

The Costa Rica approach:

• Costa Rica is considered to be one of the healthiest country in South America.
• The main reason for this can be found in the Costa Rican Constitution.
• Several years ago, Costa Rica took a very important decision and decided not to have an army.
• This helped the Costa Rican government to spend the money that the army would have used, on health, education and other basic needs of the people.
• The Costa Rican government believes that a country has to be healthy for its development and pays a lot of attention to the health of its people.
• The Costa Rican government provides basic services and amenities to all Costa Ricans.
• For example, it provides safe drinking water, sanitation, nutrition and housing.
• Health education is also considered very important and knowledge about health is an essential part of education at all levels.

6.0Glossary

• Public - An activity or service that is meant for all people in the country and is mainly organised by the government. This includes schools, hospitals, telephone services, etc. People can demand these services and also raise questions about their non-functioning.
• Private - An activity or service that is organised by an individual or company for their own gain.
• Medical tourists - This refers to foreigners who come to this country specifically for medical treatment at hospitals that offer world-class facilities at a lower cost than what they would have to pay in their own countries.
• Communicable diseases - These are diseases that are spread from one person to another in many ways such as through water, food , air, etc.
• OPD - This is the short form for 'Out Patient Department'. This is where people are first brought in and treated in a hospital without being admitted to any special ward.
• Ethics - Moral principles that influence a person's behaviour
• Generic names - These are chemical names of the drugs. They help in identifying the ingredients. They are globally recognised. For example, acetyl salicylic acid is the generic name of Aspirin.

7.0MIND MAP