[EPW] Healthcare as a Right

health

Context

  • In September this year, the Rajasthan State government introduced the Rajasthan Right to Health Bill, 2022 in the state legislative assembly.
  • As it is still being debated in the legislative assembly and has become a major part of public discourse among health care providers as well as different interest groups.
  • It becomes important to understand its legal dimensions, and more importantly, the short term and long term implications of its implementation.

What is Right to Health?

  • The right to health is the economic, social, and cultural right to a universal minimum standard of health to which all individuals are entitled.
  • It was first articulated in the WHO Constitution (1946).
  • It states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.
  • It defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Features of this Right

The 1948 Universal Declaration of Human Rights mentioned health as part of the right to an adequate standard of living (article 25). It covers-

  1. Highest attainable standard of physical and mental health
  2. Reduction of the stillbirth-rate and of infant mortality
  3. Healthy development of the child
  4. Environmental and industrial hygiene
  5. Prevention, treatment and control of epidemic, endemic, occupational and other diseases
  6. Assure to all medical service and medical attention in the event of sickness

Locating right to health in India

  • Fundamental rights: Article 21 of the Constitution protects and upholds the right to life and liberty.  Courts have often taken a progressive stance in expanding the scope of the right to life to include the right to health.
  • Directive Principles: Articles 38, 39, 42, 43, & 47 of the DPSP put the obligation on the state in order to ensure the effective realization of the right to health.
  • Judicial observations: In State of Punjab and Ors versus Mohinder Singh Chawla (1996), the Supreme Court proclaimed the right to life includes within its fold the right to health.

What is the Rajasthan Bill about?

  • In bringing forth the right to health bill, the Rajasthan government has acted on its constitutional mandate by providing health care services to residents of the state.
  • Falling under Item 6 of the State List in the Seventh Schedule of the Constitution, the state governments have the duty to ensure the promotion of public health and provision of medical services.

What are the rights and duties prescribed in the Bill?

  • OOP Expenditure control: The preamble of the Bill at the outset makes the intentions of the government clear -promoting health care without causing catastrophic out-of-pocket expenditure.
  • Free checkups: The Bill provides for free and affordable health check-ups, and surgery in both private and public hospitals.
  • Special provisions for residents: It makes it a matter of right for the residents to avail free services as laid down in various insurance schemes.
  • Right to medical information: The Bill goes one step further in in tackling another thorny issue of the right to medical information in medical establishments.
  • Rights to healthcare providers: The Bill has also provided rights for health care providers such as exemption from liability in bona fide acts, a safe working environment, and access to protective gears.

Key feature: Balancing the burden of rights

  • While the residents have enough incentives and protection to seek medical care and information about the same, health care providers would not be at a disadvantage in doing their duty.
  • If followed in other states, this balance of rights and duties can help in creating a robust health infrastructure and improving overall public health levels.

Obligations on the state government

With rights, come duties.  The government would be obligated to-

  1. Provide funds
  2. Set up institutions
  3. Set up grievance redressal systems
  4. Coordinate among different departments and offices for adequate and
  5. Safe drinking water and sanitation

Issues in the realization of Right to Health

  • Poor Infrastructure:  There is a dearth of hospitals in India.
  • Fewer doctors per thousand: The WHO mandates that the doctor-to-population ratio should be 1:1,000, while India had a 1:1,404 ratio as of February 2020.
  • Lack of primary healthcare services: The existing public primary health care model is not adequate for existing healthcare burden.
  • Lack of funding: Expenditure on public health funding has been consistently low in India (approximately 1.3% of GDP).
  • Burden of NCDs: Heart ailments are rising like anything in India. It is challenging to tackle Non-communicable Diseases, which is all about prevention and early detection.

Major policy move: Ayushman Bharat

The Ayushman Bharat Yojana, now called the Pradhan Mantri Jan Arogya Yojana (PMJAY), aims to be one of the world’s largest health insurance schemes. It covers-

  • Healthcare cover of Rs. 5 lakh per family
  • All families listed in the SECC database to be covered
  • Priority to the girl child, women and senior citizens
  • Secondary and tertiary care
  • Cashless and paperless registration and administration
  • Private sector participation in helping to achieve public health goals

Way forward

  • Universal health coverage: As part of the SDGs, all countries have pledged to deliver universal health coverage (UHC) by 2030.
  • Increasing healthcare professionals in numbers: India has handled the COVID-19 pandemic exceptionally well. However, considering the rise in the number of infections, India is in dire need of more medical staff and amenities.
  • More funding: Public funding on health should be increased to at least 2.5% of GDP as envisaged in the National Health Policy, 2017.
  • Revamping medical education: The government needs to rapidly build medical institutions and increase the number of doctors.
  • Enhancing pandemic preparedness: With COVID-19 we risk once again falling into the trap of a narrow vertical disease-specific approach.
  • Use of technology: There is a growing use of mobile apps, online consultations, e-pharmacies, and other tools. These are all welcome and must be leveraged.

Conclusion

  • The Bill appears to be an ideal starting point for making the right to health a more attainable and tangible fundamental right.

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