Role of the Government in Health

• Why health is a right and a government responsibility.
• Public vs private healthcare — differences and who can access each.
• India's healthcare system: primary, secondary, tertiary levels.
• Case study: Costa Rica — universal healthcare model.
• Government health schemes in India.

Health as a right

• Article 21 of the Indian Constitution guarantees right to life — courts have interpreted this to include the right to health.
• The Directive Principles (Article 47) direct the state to improve public health and nutrition.
• A healthy person is more productive → health is both a human right and an economic need.

Why can't health be left only to the market?

• If healthcare is only private:
  • Poor people cannot afford treatment → die from curable diseases.
  • Doctors concentrate in cities → rural areas have no doctors.
  • Profit motive → unnecessary tests and procedures.
• The government must provide affordable, accessible healthcare especially for poor and rural citizens.

Public healthcare system in India

Three levels:

• Sub-centres cover 3,000–5,000 people (plains) / 1,000–3,000 people (hilly/tribal areas).
• PHCs: at least one doctor + staff for 20,000–30,000 population.
• In practice: understaffed, under-equipped, underfunded — especially in rural areas.

Private healthcare

• Private hospitals range from small clinics to large corporate hospitals.
• Advantages: better equipment, less crowded, faster service.
• Disadvantage: expensive — beyond reach of most Indians.
• Most private healthcare concentrated in cities.

Problems in Indian healthcare

Case study — Costa Rica (Latin America)

• Small country (population ~5 million) invested heavily in public healthcare.
• Free healthcare for all citizens — primary, secondary, tertiary.
• Key features:
  • Community health workers visit every household regularly.
  • Immunisation campaigns; maternal health support.
  • Clean water and sanitation linked with health policy.
• Result: Life expectancy ~80 years (comparable to USA); infant mortality very low — achieved on a fraction of USA's healthcare spending.
• Lesson: Political commitment and universal public provision matter more than wealth.

Government health schemes in India

The way forward

• Universal Health Coverage (UHC): every person gets quality health services without financial hardship.
• India needs more investment in public health (currently ~1.3% of GDP; WHO recommends 5%+).
• Train more doctors, nurses, ASHA workers; post them in rural areas.
• Address social determinants: clean water, sanitation, nutrition → prevent disease before it occurs.

• Why can't healthcare be left entirely to the private sector?
• Name the three levels of public healthcare in India with an example of each.
• What are two major problems in India's healthcare system?
• What lessons does the Costa Rica example offer about public health?
• Name two government health schemes and what they do.

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