India's health system : private versus public

India’s health system : private versus public

In spite of the country’s strong growth these past few decades and some important economic improvements especially regarding agriculture and industry, some social aspects of the nation remain to be enhanced. It is the case, amongst other, of the public health system, which remains well underdeveloped compared to other emerging countries. Overpopulation, HIV, malnutrition, drinking water and so on are still to be overcome.

India’s main health scourges

What makes it really difficult for the Indian Government to improve the general health of the country is that it is affected by numerous severe issues that are interconnected.

Poor sanitation

The first reason for such a low health level in India comes from its low degree of sanitation. Indeed, many household have no toilets or no access to latrines, leading half of the population to defecate in the open. Even when access to sanitation is improved, many do not use it just because they are not used to it. As a result, open air defecation leads to the spread of disease and malnutrition through parasitic and bacterial infections.

Access to safe drinking water

Although access to protected sources of drinking water has highly improved since the 1990’s, the issue persists with only a quarter of the population having drinking water on their premises and as much as two third of the slum population not having access to safe drinking water. Reasons for these figures include falling levels of groundwater caused mainly by increasing extraction for irrigation.


Despite the Government’s efforts to solve this problem, malnutrition persists all over the country. According to a 2005 report, 60% of India’s children under 3 were malnourished, which was way higher than sub-Saharan countries (28%). Malnutrition leads indeed to severe social and cognitive development troubles by children and create irreversible damages resulting in lower productivity. With one in every three malnourished children in the world living in India, this remaining issue is obviously one of the most important the country has to solve.


Malnutrition and drinking water issues, along with the nation’s poor sanitation level, are main factors for disease spread across the country. Indeed, it tends to reduce the immune defence mechanism, which heightens the risk of infections. For this reason, dengue fever, hepatitis, tuberculosis, malaria, rabies and pneumonia continue to plague the country. The problem is that due to increased resistance to drugs, India has developed a ‘totally drug-resistant’ form of certain diseases, such as tuberculosis in 2011. AIDS is also a real plague across the country, with 2.5 HIV-positive Indian patients.

On the other hand, the Pulse Polio launched by the Indian Government in 1995 led to India’s first polio-free year in its history in 2012.

High infant mortality rate

Even so, important disease spread, especially diarrhoeal diseases, keeps affecting a big part of the population, particularly children and infants, which leads to a high rate of early childhood mortality. Inadequate newborn care and childbirth-related causes are also strong factors for this issue: few women have access to skilled birth attendants, quality obstetric care and antenatal care. Left alone the high rate of infanticide regarding female children due to well-anchored traditions such as dowry.

Private vs public health systems in India

While India’s public health system is still on a developing level, its private sector remains the dominant healthcare provider thanks to rapid innovations helping to offer quality treatment at very low cost.

India’s public healthcare

India’s constitution grants to its citizen free healthcare services, that is to say that all government hospitals are required to provide free of cost healthcare facilities to the patients. According to the Government decision, health in India is under the responsibility of the state governments rather than the central federal government, each one possessing its own Government hospitals. Despite everything, penetration of health insurance remains very low and many Indians prefer turning to private health services.

One aspect of India’s public healthcare system that strongly remains to be improved is its absence of emergency services, leading to a very high rate of death in car accident, as policemen are the only authority to be called, but as they do not have any emergency training, death prevails most of the time. For that reason, car crashes are the first cause of death in India, with an average of 18 death per hour.

Private health system

While the private healthcare sector is responsible for the majority of healthcare, most healthcare expenses are paid out-of-pocket by patients and their families rather than through insurance. Indeed, private health insurance schemes do not cover costs of consultation or medication but only hospitalisation and associated expenses.
The reason why India’s private healthcare is so strong is that thanks to rapid innovations helping to offer quality treatment at very low cost, many foreigners come to the country to make the most of its quality treatments at very low cost. This trend has created a real medical tourism market which is one of the country’s most important economic strength.