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Demand for Healthcare revived in Rajasthan

  • Posted By
    10Pointer
  • Categories
    Polity & Governance
  • Published
    11th Oct, 2021
  • Context

    The demand for the enactment of a legislation on the right to healthcare has been revived in Rajasthan.

  • Background

    • The pandemic has exposed the deep vulnerabilities of India’s healthcare system.
    • There is a need to make the right to health a fundamental right – and implement it within the framework of legal devices and human rights principles of solidarity, proportionality, and transparency which will help India address the challenges posed by COVID19.
    • Implementing the right to health within India’s framework of co-operative federalism will build capacities where they are most needed – at the grassroots.
  • Analysis

    What is Right to Health?

    • Right to health alludes to and means the most achievable degrees of health that each person is qualified for.

    Health

    World Health Organization defines Health as:

    • “Health is a condition of complete physical, mental and social prosperity and not only the nonappearance of disease”.
  • What does Indian Constitution say about the Right to Health?

    The Constitution of India does not expressly guarantee a fundamental right to health. However, there are multiple references in the Constitution to public health and on the role of the State in the provision of healthcare to citizens.

    For the ‘State’

    • The Directive Principles of State Policy in Part IV of the India Constitution provides a basis for the right to health.
      • Article 39 (E) directs the State to secure health of workers
      • Article 42 directs the State to just and humane conditions of work and maternity relief
      • Article 47 casts a duty on the State to raise the nutrition levels and standard of living of people and to improve public health

    For the ‘Local Government’

    • The Constitution does not ‘only’ oblige the State to enhance public health, it also endows the Panchayats and Municipalities to strengthen public health under Article 243G (read with 11th Schedule, Entry 23).
    • The subject of “public health and sanitation; hospitals and dispensaries” falls under the State List of the 7th Schedule of the Constitution of India.
    • It means that state governments enjoy constitutional directives to adopt, enact and enforce public health regulations.
  • What is India’s apex court’s take on the issue?

    • The Supreme Court of India in Bandhua Mukti Morcha v Union of India & Orsinterpreted the right to health under Article 21 which guarantees the right to life.
    • In State of Punjab & Ors v Mohinder Singh Chawlathe apex court reaffirmed that the right to health is fundamental to the right to life and should be put on record that the government had a constitutional obligation to provide health services.
    • In State of Punjab & Ors v Ram Lubhaya Bagga, the court went on to endorse the State’s responsibility to maintain health services.
    • In September 2019, a High-Level Group on the health sector constituted under the 15th Finance Commission had recommended that the right to health be declared a fundamental right.
    • It also put forward a recommendation to shift the subject of health from the State List to the Concurrent List.
  • International standards pertaining to right to health

    • WHO Constitution: The right to health was first articulated in the WHO Constitution(1946) which states that: “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”.
    • UNHRC: According to Article 25(1) of Universal Declaration of Human Rights “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”. 
  • What are the reasons behind the grim situation of healthcare system (plethora of issues)?

    • Low expenditure in the sector: Much of this is blamed on India’s low expenditure on public health–1.29% of the GDP (in 2019-20), lower than most other countries.
    • Absence of statutory framework: Another critical reason for the weak public health in India is the absence of a statutory framework that guarantees a fundamental right to health.
    • Other major issues include:
      • Deficient infrastructure
      • low number of institutions
      • less-than-adequate human resources
      • Shortage of efficient and trained manpower
      • High out-of-pocket expenditure remains a stress factor
  • Why a fundamental shift in approach to healthcare is required?

    • High-yielding investment: Instead of viewing it as spending, it needs to be seen as a high-yield investment that can considerably cut down future out-of-pocket costs and also increase output.
    • Grave economic impact: A crumbling healthcare system leaves a grave impact on the entire economy.
    • To end discrimination: The constitutional right to health is critical to breaking discriminatory structures that will otherwise continue to perpetuate inequality in all spheres of life, including education, opportunity, wealth, and social mobility.
    • Increased efficiency of health ecosystem: If health is a fundamental right, it will give a spine to the entire health ecosystem, empower doctors and healthcare workers, and ensure transparency, inclusivity, and accountability. 

    Important Government Schemes

    In-General

    • Ayushman Bharat Yojana
    • PM Bhartiya Janaushadhi Pariyojana
    • Rashtriya Arogya Nidhi
    • Pradhan Mantri Digital Health Mission (PM-DHM)

    Women and children

    • Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) program
    • Janani Shishu Suraksha Karyakaram (JSSK)
    • Rashtriya Bal Swasthya Karyakram (RBSK)

    Children

    • Mission Indradhanush & Intensified Mission Indradhanush (IMI) 

    Disease-centric healthcare schemes

    • National AIDS Control Organisation (NACO)
    • Revised National Tuberculosis Control Programme (RNTCP)
    • National Tobacco Control Programme (NTCP)
  • Concluding thoughts

    Given the grim situation of India’s healthcare sector, it is time that the country declares the right to health a fundamental right.

    It is time India declared the right to health a fundamental right. Strong health laws will help build societal resilience to future pandemics and public health emergencies. Emergency responses can’t come at the cost of neglect of human rights obligations. It is critical then that the right to health be implemented, using the principles of transparency, proportionality and solidarity. The COVID19 experience has also demonstrated the importance of a decentralized/polycentric response – India’s co-operative federalism, therefore, must be strengthened.