FORMULATION OF INDIA'S HEALTH POLICY 87 medical treatment. This imposes severe strains on an already fragile household, greatly reduces food and calorie intake within the family, and increases the intensity of poverty especially for those near the poverty line.7 At the same time, the enormous financial strain frequently deters many from even availing of basic health care services thereby perpetuating poor health. Ensuring effective entitlement to health needs to be viewed, not in isolation, but as part of a more comprehensive strategy to enhance people's capabilities: Global experience suggests several alternative approaches for overcoming such high levels and magnitude of social deprivations. Dreze and Sen (1989) distinguish between two broad strategies: one called "growth- mediated security" and the other called "support-led security".8 In the first instance, as with South Korea and Singapore, the benefits of rapid income expansion have been consciously channeled into enhancing people's basic entitlements to health and education. The second strategy, followed by countries like Costa Rica and Sri Lanka, has taken the form of direct public support for health, without necessarily making income expansion -a prerequisite for promoting the well-being of the people. In both instances, however, governments have played a very active role in improving the levels of public provisioning in health. Encouraging or promoting a private health care system and financing it through a system of private insurance seems inappropriate for India at this stage for a variety of reasons. First, it will almost inevitably lead to the exclusion of large populations, particularly those without the ability-to-pay , when in fact, given the state of health deprivations, the attempt should be to achieve universal coverage. Second, in a situation where in addition to a lack of purchasing power, many do not even possess the basic ability to make informed choices—especially when we note that nearly 60 per cent of women, some 200 million of them, and 36 per cent of men, some 127 million, cannot even read and write—the assumptions of "perfect information" and efficient functioning of private markets will almost always be violated. While private competition could lead to expanding the choices open to people, it can hardly be seen as an expansion of opportunities in a manner that will enhance their capabilities. Third, given how difficult it is to monitor and regulate private provisioning of health care, government is likely to be ineffective in ensuring safety and good quality to consumers. Fourth, such a scheme is likely to have very little political support given the increasing evidence and awareness that economic reform processes and structural adjustment impose a particularly severe strain on the poor. If the objective of universal health coverage has to be achieved, it is dear that governmental efforts need to be promoted and strengthened/ not withdrawn and minimised. If there is any lesson to be leamt from the irttemational experiences, it is that governments can and must play