UNIT ed

TWO T sh
R l i
E u b
N C e p
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b
t o
ot
n

16
State Government

ed
Teacher’s note

T s h
R l i
These two chapters (Chapters 2 and 3) on public welfare. Though both the executive

b
State Government are an attempt to and the legislature are presented, one

E u
discuss the functions and structure of should not expect students to retain fine
government through concrete situations. distinctions. It would be best to patiently

C p
We have chosen ‘health’ as an example; encourage them to ask questions such as,

N e
there could have been other, equally “Who is the most powerful person?”, “Why

© er
important, choices. can’t the MLA solve the problem?”, etc.
Such queries will enable them to construct
Chapter 2 discusses ‘health’ as an a sense of the government apparatus.
important issue for people.. There are both

b
public and private aspects of health It is important that learners acquire the
provisioning. Healthcare in India is not confidence to express their views on public

o
available to all. While the Constitution issues and understand the role of

t
supports a view that the right to health is government through the exercises given in
an aspect of our fundamental rights, its the chapters. You could choose familiar

t
provisioning is rather unequal. Through issues such as water, transport, school-

o
the accounts provided, learners will begin fees, books, child-labour, etc., for them to
to visualise the ideal or desired role of discuss and arrive at how these problems

n
government, and the meanings behind its need to be tackled. Allow them to express
structures. Some ways in which this these ideas through wall charts. Given that
situation can be changed are also discussions on the government and its
discussed. functioning often lead to boredom and
cynicism, we need to be able to make
Chapter 3 focuses on how the the classroom session less didactic and
government functions, and discusses ideas more interactive while teaching these
of representation, accountability and lessons.

17
 2
CHAPTER
CHAPTER

ed
T s h
R l i
E u b
N C e p
© Role r
e
bGovernment
of the

t o in Health

o t In a democracy people expect the

government to work for their welfare. This

n
could be through the provision of
education, health, employment, housing
or the development of roads, electricity
etc. In this chapter we shall examine the
meanings and problems related to health.
Look at the sub-headings of this chapter.
In what ways do you think this topic is
related to the work of government?
 ed
T s h
R l i
E u b
C
What is health?

N e p
We can think of health in many ways. Health means

© er
our ability to remain free of illness and injuries. But
health isn’t only about disease. You may have
associated only some of the situations in the above
collage with health. What we often ignore is the fact Would you associate all or some of

b
that each of the above situations is related to health. these pictures with ‘health’ ? In
Apart from disease, we need to think of other factors what ways? Discuss in groups.

o
that affect our health. For example, if people get clean

t
drinking water or a pollution free environment they

t
are likely to be healthy. On the other hand, if people
do not get adequate food to eat or have to live in Pick two situations from the above

o
cramped conditions, they will be prone to illness. collage that are not related to

n
illness and write two sentences on
All of us would like to be active and in good spirits how they are related to health.
in whatever we may be doing. 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.

Chapter 2: Role of the Government in Health 19

 Healthcare in India

Let us examine some of the aspects of healthcare in

Can you provide a title to these India. Compare and contrast the situation expressed
columns? in the first and second columns.

India has the largest number of medical Most doctors settle in urban areas.
colleges in the world and is among the People in rural areas have to travel long
largest producers of doctors. distances to reach a doctor. The number

d
Approximately15,000 new doctors qualify of doctors with respect to the population is
every year. much less in rural areas.

Healthcare facilities have grown

substantially over the years. In 1950, every year. This number is almost

h e
About five lakh people die from tuberculosis

T s
there were only 2,717 hospitals in India. unchanged since Independence!

i
In 1991, there were 11,174 hospitals. In Almost two million cases of malaria are

R l
2000, the number grew to 18,218. reported every year and this number isn’t

b
decreasing.

C E
India gets a large number of medical

u
tourists from many countries. They come
We are not able to provide clean drinking
water to all. 21per cent of all

p
for treatment in some of the hospitals in communicable diseases are water borne.

N e
India that compare with the best in the world. For example, diarrhoea, worms, hepatitis, etc.

© er
India is the fourth largest producer of Half of all children in India do not
medicines in the world and is also a large get adequate food to eat and are
exporter of medicines. undernourished.

b
o
In order to prevent and treat illnesses we need

t
appropriate healthcare facilities such as health

t
centres, hospitals, laboratories for testing,
ambulance services, blood banks, etc., that can

o
In India, it is often said that we provide the required care and services that patients

n
are unable to provide health need. In order to run such facilities we need health
services for all because the workers, nurses, qualified doctors and other health
government does not have enough professionals who can advice, diagnose and treat
money and facilities. After reading illnesses. We also need the medicines and equipment
the above left hand column, do that are necessary for treating patients. These
you think this is true? Discuss. facilities are required to take care of us.

20 Social and Political Life

 India has a large number of doctors, clinics and
hospitals. The country also has considerable
experience and knowledge in running a public
healthcare system. 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. We will go into more detail on this later.
Moreover, there has been a phenomenal
advancement in medical sciences whereby many new
technologies and treatment procedures are available

d
in the country.

However, the second column points out how poor

the health situation in our country is. With all the

h e
T s
above positive developments we are not able to

l i
provide proper healthcare facilities to people. This is

R
the paradox – something that is contrary to what we

b
would expect. Our country has the money, knowledge

E u
and people with experience but cannot make the
Patients usually have to wait in long
necessary healthcare available to all. In this chapter,

C p
queues in public hospitals, like this one.
we will look at some of the reasons for this.

N e
© er
The story of Hakim Sheik
Hakim Sheik was a member of the Paschim Banga Khet Mazdoor Samity (PBKMS), an organisation
of agricultural labourers in West Bengal. One evening in 1992, he accidentally fell off a running

b
train and suffered head injuries. He was in a very serious condition and needed immediate
treatment.

t o
He was taken to a government hospital in Kolkata but they refused to admit him because they
did not have a spare bed. Another hospital did not have the facility or the specialised doctors

t
necessary for his treatment. In this way he spent 14 hours in a critical state and was taken to

o
eight different government hospitals, but none of them admitted him.

n
Finally, he was admitted in a private hospital, where he received treatment. He spent a lot of
money on his treatment. Angry and upset over the indifferent attitude of all the hospitals that
refused to admit him, Hakim Sheik and PBKMS filed a case in the court.

Read the story given above. Then

imagine that you are a Judge in
the court. What would you say to
Hakim Sheik?

Chapter 2: Role of the Government in Health 21

 THE COST OF A CURE
Aman and Ranjan are good friends.While Ranjan I had viral fever and Oh! Me, too! I just got back to
comes from a well-to-do family, Aman’s parents have had to go to the school on Monday. My Daddy
hospital... took me to see the doctor
to struggle to make ends meet...
at the new hospital in
Hi Aman! Good to Kingsway. It was very exciting!
see you back! How have
you been?

ed
h
The building looked so posh. I thought it Daddy had to pay Rs 500 at the reception counter

T s
was a five star hotel! Daddy said that was itself – before we even met the doctor! There was

i
because it was a private hospital, with the nice music playing and everything was really clean

l
best of facilities. and shiny.

ER b
C p u
N e
© er
b
t o
The doctor asked for many tests...but After the test results came, we went back to the

t
everyone was so friendly! The lady who took doctor. He looked through them and said everything

o
my blood for testing told me so many jokes was fine, and I only had viral fever. He prescribed lots
that I forgot to feel the pain! of medicines and rest.

n
...and have you ...and so young man – this pink pill should be
heard the one taken three times a day, and the white tablet
about Batman once before bed time – that’s for the
on Reality TV? bodyache! This one is a syrup – don’t
worry, it’s tasty

Thank you
Doctor...I feel
better
already!
 ...and it really did! We went to a big
You see, I’ve been dying to tell you all Government Hospital. We had to wait in a long
about it! But what about queue at the OPD counter. I was feeling so sick
you? Which hospital did
that I had to lean on Abba all the time!
you go to?

Um...it wasn’t as nice as your’s

d
at all! At first, Abba didn’t want

e
to take me because he said it
would take too much time...

T s h
We got the test results after three days...and went

i
When our turn came, the doctor examined me, and back to the hospital.There was a different doctor

l
asked for a blood test.Then we had to go and stand in that day.

R
another long queue! People were crowding around in

b
the testing room too.
Show me his OPD

E
card...and the test results

u
– quickly please!

N C e p
© er
b
t o
t
He seems to be suffering from My hospital was nice, but
they gave me too many

o
a bout of viral fever – nothing
to worry about. All he needs is medicines and the whole
thing cost more than

n
this one fever-reducing
medicine. Rs 3,500!

That much! My
treatment cost just
Rs 150!
 Why did Ranjan have to spend so Public and private healthcare services
much money? Give reasons.
From the above story, you must have understood
What problems did Aman face in that we can roughly divide up various healthcare
the public hospital? How do you facilities in two categories –
think the hospital can work in a
better manner? Discuss. (a) Public health services and

Where do you go when you are ill? (b) Private health facilities.
Are there any problems that you
face? Write a paragraph based on Public health services

d
your experience.

e
The public health service is a chain of health centres
What problems do we face in and hospitals run by the government. They are linked

h
private hospitals? Discuss. together so that they cover both rural and urban

T s
areas and can also provide treatment to all kinds of

l i
problems – from common illnesses to special services.

R
At the village level there are health centres where

b
there is usually a nurse and a village health worker.

E u
They are trained in dealing with common illnesses
and work under the supervision of doctors at the

C p
Primary Health Centre (PHC). Such a centre covers

N e
many villages in a rural area. At the district level is

© er
the District Hospital that also supervises all the
health centres. Large cities have many government
hospitals such as the one where Aman was taken
and also specialised government hospitals such as

b
the ones in Hakim Sheik’s story.

o
The health service is called ‘public’ for many

t
reasons. In order to fulfil its commitment of providing
A doctor in a rural healthcare centre
healthcare to all citizens, the government has

t
giving medicines to a patient.
established these hospitals and health centres. Also,

o
the resources needed to run these services are
obtained from the money that we, the public, pay to

n
the government as taxes. 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. Another important function of public
health is to take action to prevent the spread of
diseases such as TB, malaria, jaundice, cholera,

24 Social and Political Life

diarrhoea, chikungunya, etc. This has to be organised
by the government with the participation of people
otherwise it is not effective. For example, when taking
up a campaign to see that mosquitoes do not breed
in water-coolers, roof tops, etc., this has to be done
for all houses in the area.

Recall the case of Hakim Sheik. Would you like to

know what the court said in this case?

According to our Constitution, it is the primary

d
duty of the government to ensure the welfare of the

e
people and provide health care facilities to all.

h
The government must safeguard the Right to Life

T s
of every person. The Court said that the difficulty A woman and her sick child at a

i
government hospital. According to

l
that Hakim Sheik had to face could have cost him

R
his life. If a hospital cannot provide timely medical UNICEF, more than two million

b
treatment to a person, it means that this protection children die every year in India from

E
preventable infections.

u
of life is not being given.

C p
The Court also said that it was the duty of the In what ways is the public health

N e
government to provide the necessary health services, system meant for everyone?

© er
including treatment in emergency situations.
Hospitals and medical staff must fulfil their duty of List some public health centres
providing the necessary treatment. Hakim Sheik was (PHCs) or hospitals near your
denied treatment at various government hospitals. place. From your experience (or by

b
Therefore, the Court asked the State Government to visiting any one of them), find out
give him the money that he had spent on his the facilities provided and people

o
treatment. who run the centre.

t
Private health facilities

t
o
There is a wide range of private health facilities that
exist in our country. A large number of doctors run

n
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.

Chapter 2: Role of the Government in Health 25

 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
A post-operative room in a leading manufacturing and selling medicines. Medical shops
private hospital in Delhi. are found in every corner of the country.

Healthcare and equality:

ed
h
Is adequate healthcare available to all?

T l i s
In India, we face a situation where private services

R
are increasing but public services are not. What is

b
then available to people are mainly private services.

E
Private health facilities can mean

u
These are concentrated in urban areas. As these
many things. Explain with the help services are run for profit, the cost of these services

C p
of some examples from your area. is rather high. Medicines are expensive. Many people

N e
cannot afford them or have to borrow money when

© er
there is an illness in the family.

In order to earn more money, these private services

encourage practices that are incorrect. At times

b
cheaper methods, though available, are not used.
For example, it is common to find doctors prescribing

o
unnecessary medicines, injections or saline bottles

t
when tablets or simple medicines can suffice.

t
In fact, barely 20 per cent of the population can

o
afford all the medicines that they require during an

n
In rural areas, a jeep is often used to serve
as a mobile clinic for patients.

26 Social and Political Life

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
This pregnant lady has to travel many
again. Those who are poor are in the first place

d
kilometres to see a qualified doctor.
undernourished. These families are not eating as

e
much as they should. They are not provided basic
necessities like drinking water, adequate housing,

h
clean surroundings, etc., and therefore, are more

T s
likely to fall ill. The expenses on illness make their

l i
situation even worse.

R b
Sometimes it is not only the lack of money that

E u
prevents people from getting proper medical
treatment. Women, for example, are not taken to a

C p
doctor in a prompt manner. Women’s health

N e
concerns are considered to be less important than

© er
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.

What can be done?

b
t o
There is little doubt that the health situation of most
people in our country is not good. It is the

t
responsibility of the government to provide quality

o
healthcare services to all its citizens, especially the
poor and the disadvantaged. However, health is as

n
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. Look at the following example–

Chapter 2: Role of the Government in Health 27

 The Kerala experience

In 1996, the Kerala government made some major

changes in the state. Forty per cent 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

d
of the village were taken up. Health centres were

e
also improved. All of this helped to improve the
situation. Despite these efforts, however, some

h
problems – such as shortage of medicines,

T s
insufficient hospital beds, not enough doctors –

l i
remained, and these needed to be addressed.

ER b
Let us look at an example of another country and

u
The above map of India shows the state of its approach to issues of health.

C
Kerala in pink.

p
The Costa Rican approach

N e
© er
The inside back cover (cover three) of this Costa Rica is considered to be one of the healthiest
book has a map of India. Using your countries in South America. The main reason for
pencil outline the state of Kerala on this can be found in the Costa Rican Constitution.
this map. Several years ago, Costa Rica took a very important

b
decision and decided not to have an army. This
helped the Costa Rican government to spend the

o
money that the army would have used, on health,

t
education and other basic needs of the people. The
Costa Rican government believes that a country has

t
to be healthy for its development and pays a lot of

o
attention to the health of its people. The Costa Rican
government provides basic services and amenities

n
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.

28 Social and Political Life

 EXERCISES

1. In this chapter you have read that health is a wider concept An important part of the
than illness. Look at this quote from the Constitution and Constitution says it is the “duty of
explain the terms ‘living standard’ and ‘public health’ in the State to raise the level of
your own words. nutrition and the standard of
living and to improve public
2. What are the different ways through which the health.”
government can take steps to provide healthcare for all?
Discuss.

d
3. What differences do you find between private and public

e
health services in your area? Use the following table to
compare and contrast these.

Facility Cost of services

T s
Availability of service
h
Private

R l i
Public

E u b
C p
4. ‘Improvement in water and sanitation can control many
diseases.’ Explain with the help of examples.

N e
Glossary
© er
b
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

o
these services and also raise questions about their non-functioning.

t t
Private: An activity or service that is organised by an individual or company for their own profit.

Medical tourists: This refers to foreigners who come to this country specifically for medical treatment

o
at hospitals that offer world–class facilities at a lower cost than what they would have to pay in

n
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.

Chapter 2: Role of the Government in Health 29