To: Government of Karnataka

From: Rahul Kumar

Government plays a very important role in providing public health. Health coverage consists
of 4 components:
1. Public Health
2. Primary Care
3. Secondary Care
4. Tertiary Care

We will analyze the pros and cons of expansion of government health infrastructure from
the above-mentioned perspectives.
Advantages:
1. India seriously lacks the infrastructure required for providing adequate public health.
For example – In 2017, there were a total of 25650 public health centres operating in
India. Each of them was expected to serve 20000-30000 people. However, more
than 8% of these PHCs did not have a single doctor, 22% did not have a single
pharmacist etc. Providing Insurance will not help if there is a lack of infrastructure.
Investments need to be made to improve the reach and quality of infrastructure. The
government can then subsidize insurance schemes. This will allow more people to
avail its benefits.
2. Disease surveillance is a key Essential Public Health Function. It requires mining data
from various sources like news media and health workers and then use insights
obtained to improve the health services. However, this can lead to serious security
and privacy concerns. It’s better to keep such data away from the hands of private
players until and unless strict and clear rules have been made on how the data
should be handled. In the absence of this, the medical data can be exploited for
gains.
3. Lack of doctors and other medical staff – India has a very low doctor to patient
ratio/medical staff to patient ratio. The importance of this was clearly seen in the 2 nd
wave of Covid in India. If the government fails to improve this, similar situations can
arise in the future. A lot of investment is required to provide proper education and
training.
4. One health – This concept says that the health of people is very much related to the
health of animals and of the environment that we share with them. Destroying the
habitat of animals such as bats lead to increased contact between the bats and
humans. They carry viruses that can be transmitted to humans and can lead to
diseases that are fatal to human life. Government intervention is required to prevent
this. Only government can ensure the increase in forest cover or habitat restoration.
Private players will not be concerned about this.
5. Social determinants of health need to be considered as they play a very important
role in defining the quality of life of a person.
There is a need to improve the income level of people living in the villages. Education
needs to be improved as the education level of a mother determines the mortality
rate of children. People growing up situations of economic instability have lower life
expectancy. People should have access to a clean environment. Lack of drainage,
lack of proper drinking water, overcrowded environment etc can have serious
 impacts on the well-being. All these things can only be improved when government
makes investments and improves infrastructure and quality of life.
6. Superstitions and myths about ailments and medicines are very prevalent in India.
For example – Some people believed that measles was caused by angering a
goddess. Such beliefs hinder access to primary healthcare. Investment in awareness
programs is required to remove such issues.
7. Even though 70% of the population lives in rural areas, secondary services are almost
absent in these areas. There is high dependence on the private sector which is very
expensive leads to a high out of the pocket payment environment which can be
clearly avoided by more investments.

Limitations:
1. Even if govt wants to invest, it has inadequate resources available for UHC. There is a
significant increase (3-4 times from current levels) required to meet the UHC goals.
2. Tertiary healthcare can be provided only by bringing in affordable insurance
schemes.
3. Private players have more resources (higher percentage of doctors, hospital beds,
better equipment etc.). Taking a cooperative rather than competitive approach will
help improve the accessibility and quality of public health services.

Conclusion
Although it may seem like government is inefficient in managing public health, it’s just a
matter of time and better planning before we come on the right track to achieve public
health services in countries like Brazil and Thailand. Although partnerships with the private
sector can help the government bridge various gaps, increasing investments will solve more
pressing problems and is the need of the hour.