The India that is most impoverished is also the India that is most dependent on public services to survive. This is because they are too poor and too disenfranchised to be able to access or afford private services.
In a country the size of India, which has multiple regional and even intra state disparities, there is no one-size-fits all. While there are public services that operate under a broad umbrella, the delivery mechanism is either inadequately supported be that in manpower, or poorly overseen or inefficiently delivered.
The causes for this range from not having enough trained field staff, to a poor understanding of the needs of particular communities or even pilferage in the system through vested sources, resulting in the program having no impact on the intended beneficiaries.