Public Health and the Government-Notes

 

Public Health and the Government-Notes

As citizens of a country, we expect the government to look after the basic needs of its people. Clean drinking water, proper sanitation, minimum food, education and health facilities are required for all. No one should be excluded, nor should this inclusion be dependent on whether one is rich or poor. Since we consider all citizens to be equal, these basic neccessities should be available to people in all situations. In this chapter, using the case study of health, we will examine how far the provisions of the Constitution are being satisfied in our country.

In order to prevent and treat illnesses, we need appropriate facilities such as health centres, hospitals, laboratories for diagnosis, ambulance services, blood banks etc. We require qualified health workers, nurses, doctors, lab technicians etc. who can advise, diagnose and treat illnesses. We also need medicines and equipment that are necessary for treating patients. To prevent illnesses, in addition to vaccinations we need enough food, safe drinking water, proper sanitation (safe disposal of faeces) and a clean environment. India has a large number of doctors, clinics and hospitals. India also has the experience and knowledge of running a public healthcare system. This is a system of hospitals and health centres run by the government catering to a huge population scattered over lakhs of villages. Moreover, there has been much advancement in medical sciences in the form of technology and treatment procedures.

India is the fourth largest producer of medicines in the world and is also a large exporter of medicines. India has the largest number of medical colleges in the world. Approximately 15,000 new doctors qualify every year. Health care facilities have grown substantially over the years. In 1950, there were only 2717 government hospitals in India. In 1991, there were 11,174 hospitals. In 2000, the number grew to 18,218. For some people, the best facilities are available while the others do not have basic health care. This is contrary to what the Indian Constitution desires for all the people in the country. We have the money, knowledge and experience to change this situation. How can this be done would be discussed further in this chapter.

Healthcare Services Kiran and Sarita are classmates in a school in Kharimnagar. They are close friends. Sarita comes from a well-to-do family, while Kiran’s parents struggle to make ends meet. The rainy season had just ended and there was an outbreak of viral fever. Both fell ill at about the same time. When they were back in school, they talked about their illness. Soon after Sarita got fever, her father took her to a private hospital near their house. Sarita’s father paid Rs. 100 at the registration counter. They were given a card and asked to wait.

Very soon, the doctor saw her, and recommended a number of blood tests and a chest X-ray. They went to the respective counters and everything was easy and comfortable. When they came back to the doctor after the tests, he prescribed a medicine for the fever and asked them to visit again the following day with the test results. The following day, the doctor went through the test reports and said that everything was all right. He felt Sarita had a viral infection and there was no cause for worry. He prescribed several medicines. After that, she was feeling much better and was back at school. Kiran also had fever and body ache. His father could not take time off his work and they went to the nearby Government Hospital only after two days. They had gone quite early that day, but already there was a long queue. Kiran was feeling very ill and could barely stand, but he had no choice. Finally, after waiting for almost three hours, they were able to see the doctor. After examining Kiran, the doctor said that they should get a blood test done. The blood test took another two hours. They were told to come the next day for the report. The same process of waiting was repeated. The doctor looked at the report and said that Kiran had a viral fever like many others in town. He prescribed some medicines for the fever and asked Kiran to take lot of fluids and rest. Kiran got well and attended the school. Sarita really felt sorry for Kiran that he had to undergo so much hardship to seek treatment. She felt lucky to have gone to the modern private hospital where everything was so smooth and easy. When Kiran asked her how much they had spent, she said Rs. 3,500 for hospital charges and medicines. Kiran said, “We spent only Rs. 100.”

From the story above, you must have understood that we can roughly divide the healthcare facilities into two categories: a) Public health services and b) Private health services.

Public Health Services

The public health service is a system of health centres and hospitals run by the government to provide treatment to all kinds of problems - from common illnesses to special services in both rural and urban areas. At the village level, there is a volunteer called ‘ASHA worker’ who helps people in getting health services. The Anganwadi centre in the village serves as a centre to provide nutrition and immunisation services to young children. Children’s weights are also monitored here to see whether they are growing as per their age. The Sub Centre covers a population of 5000 people, who may be in one or many villages in a rural area. This Centre has Multi Purpose Health Assistants (MPHAs) (Female and Male). They are trained in dealing with common illnesses and provide immunization to children, care for pregnant women, take steps to prevent diarrhoea and malaria.

 These Centres work under the supervision of Primary Health Centres (PHC) located at the mandal level. Each Primary Health Centre covers a population of 30,000 (roughly five Sub Centre areas). For every 4 to 5 PHCs, there is a Community Health Centre which is a 30 bed hospital and has some specialists. Some surgeries are done at this level. At the divisional level is the Area Hospital that has 100 beds. At the district level is the District Hospital. Large cities have many government hospitals such as the one where Kiran was taken to. It is called ‘public’ for many reasons.

 The government in order to fulfil its commitment of providing healthcare to all citizens has established these hospitals and health centres. Also, the resources needed to run these services are obtained from the money that we all - the public - pay to the government as taxes. 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 poor families can seek treatment. Another important function of public health is to take action to prevent the spread of diseases such as TB, malaria, jaundice, cholera, diarrhoea, chikungunya etc. This has to be organised by the government with the participation of people, otherwise it will not be effective. Take the example of a campaign to see to it that mosquitoes do not breed in water coolers, roof tops etc. This has to be done with the participation of all the residents in the area. In a village, everyone must be involved to see to it that the water near taps/ handpumps does not form stagnant pools where mosquitoes breed Private Health Services There is a wide range of private health facilities that exist in our country. In the rural areas, one finds Registered Medical Practitioners (RMP). In rural areas, another popular provider of healthcare is the untrained medical persons. Urban areas have a large number of doctors, many of them provide specialised services in their private hospitals and nursing homes.

There are many private laboratories which test blood, urine, stool or offer special facilities such as X-ray, ultrasound etc. 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. As the name suggests, private health facilities are not owned or controlled by the government. Unlike the public health services, patients have to pay a lot of money for every service that they avail. Public or government services are financed by taxes collected by the government. Therefore the fee people pay for public health services are often low. In the case of private healthcare actual 'costs' and 'profits' enter the calculation and therefore the fee are generally higher.

Health Insurance Medicine is too expensive for some chronic diseases for the ordinary people. So, if public gets the health insurance, they may get qualitative services with the help of an insurance scheme. And there are many insurance companies in the market, both in the public and private sectors. Healthcare and Equality In India, we have a situation where private services are increasing but public services are not. The private services are mainly concentrated in the urban areas. As these services are run for profit, the costs are rather high. But, the situation in public service at present has changed due to the ambulance services of ‘108’ and ‘104’. Ambulance numbered 108 reaches in time to provide first aid in emergency cases and also provide access by taking the victim (patient) for further follow up medication at near by health centre.

Vehicles numbered 104 is a with health personnel and medicines providing monthly visits to rural areas for health checkups and providing medicine etc. In fact, barely 20% of the population can afford the cost of medicines that they require during an illness. Even for those who are not poor, medical expenses cause hardship. It was reported in a study that 40% of people who are admitted to hospital for some illness or injury have to borrow money or sell some of their possessions to pay the expenses. For those who are poor, every illness in the family is a cause of great anxiety and distress.

What is worse, such a situation arises again and again. The poor do not have access to basic necessities like drinking water, adequate housing, clean surroundings etc. and are more likely to fall ill. These families do not eat as much as they should and are thus undernourished. The expenses on illness make their situation even worse and they may have to sell off some of their possessions.

Taking an ill person to the hospital means loss of wages for another person for the day, or for many days if the patient is admitted in the hospital. Basic public facilities Water is essential for life and good health. We need water to meet our daily needs. Safe drinking water can prevent many water-related diseases. India has one of the largest number of cases of diseases caused by lack of clean water such as diarrhoea, dysentery, and cholera. Over 1,600 Indians, most of them children below the age of five, reportedly die everyday because of water-related diseases. These deaths can be prevented if people have access to safe drinking water. Like water, there are other essential facilities that need to be provided for everyone. Healthcare, sanitation, electricity, public transport, schools are also necessary. These are known as public facilities. The important characteristic of a public facility is that once it is provided, its benefits can be shared by many people. For instance, a school will enable many children to get education. Similarly, the supply of electricity to an area can be useful for many people: farmers can run pumpsets to irrigate their fields, people can open small workshops that run on electricity, factories require this for their machines, students will find it easier to study and most people will benefit in some way or the other.

The Government’s Role Given that public facilities are so important, someone must take the responsibility of providing these to the people. This ‘someone’ is the government. One of the most important functions of the government is to ensure that these public facilities are made available to everyone. Let us try and understand why the government must bear this responsibility. We have seen that private companies operate for profit in the market.

 In most of the public facilities, there is no profit to be had. For example, what profit can a company accrue by keeping the drains clean or running an anti-malaria campaign? A private company will probably not be interested in undertaking such work. But, for other public facilities such as schools and hospitals, private companies may well be interested.

 We have many of these, facilities particularly in large cities. Similarly, if you are living in a city, you would have seen private companies supplying drinking water in sealed bottles. In such cases, private companies provide public facilities but at a price that only some people can afford. Many people who cannot afford to pay for such facilities will be deprived of the opportunity to live a decent life. This is against the Constitutional promise for equal opportunities for all and the right to a decent life for everyone.