Mentor’s Comment

This article analyses the National Convention on Health Rights and its significance in reframing health care as a rights-based public good. It highlights systemic failures in public health financing, privatisation-driven inequities, medicine access barriers, and workforce distress, while foregrounding the demand for a legally enforceable right to health in India.

Why in the News

The National Convention on Health Rights (December 11-12) is being held in New Delhi, coinciding with Human Rights Day and Universal Health Coverage Day, bringing together 400+ health professionals, community leaders, and activists from over 20 states. It is significant as it attempts a post-COVID national reset of India’s health policy discourse, challenging the long-standing trend of commercialisation and privatisation of health care. The convention highlights a stark contradiction: while health crises have intensified, public health spending remains at just 2% of the Union Budget, with per capita public spending at only ₹25 per day, forcing households into high out-of-pocket expenditure. The event is notable for explicitly framing health as a justiciable right, not merely a welfare objective.

Introduction

India’s health system stands at a crossroads where rising private sector dominance, weak public provisioning, and inequitable access coexist with constitutional commitments to dignity and equality. The National Convention on Health Rights seeks to reclaim health care as a public responsibility by addressing structural distortions exposed during the COVID-19 pandemic and by proposing an alternative rights-based framework.

Privatisation and the Erosion of Public Health Systems

1. Privatisation of Services: Expansion of public-private partnerships has transferred medical colleges and health facilities to private entities, weakening public capacity and oversight.
2. Cost Escalation: Commercial health care has made treatment unaffordable for large sections dependent on public provisioning.
3. Regional Resistance: Movements in Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh, and Gujarat highlight citizen-led opposition to health sector privatisation.
4. Regulatory Gaps: The Clinical Establishments Act, 2010 remains weakly implemented, allowing opaque pricing and unnecessary medical procedures, including excessive caesarean sections.

Inadequate Public Financing and Insurance-Centric Models

1. Budgetary Allocation: Public health receives only 2% of the Union Budget, insufficient for universal access.
2. Out-of-Pocket Expenditure: Low public spending results in high household health costs, deepening poverty.
3. Insurance Dependence: Government-sponsored insurance schemes prioritise hospitalisation rather than preventive and primary care.
4. Structural Limitation: Insurance-based models fail to strengthen health systems or reduce systemic inequities.

Health Workforce Crisis and Structural Injustice

1. Pandemic Exposure: COVID-19 highlighted the indispensable role of doctors, nurses, paramedics, and support staff.
2. Workplace Insecurity: Health workers face inadequate social security, unsafe working conditions, and poor remuneration.
3. Justice Deficit: The convention stresses the absence of legal and institutional mechanisms to protect health workers’ rights.
4. Systemic Link: Workforce distress directly undermines service quality and system resilience.

Access to Medicines and Regulatory Barriers

1. Household Burden: Medicines constitute nearly 50% of household medical spending, making them the most significant cost driver.
2. Market Distortions: Irrational fixed-dose combinations, unethical marketing, and high retail mark-ups inflate prices.
3. Policy Barriers: Patent regimes, regulatory gaps, and GST on medicines limit affordability.
4. Public Manufacturing: Strengthening public sector drug production is identified as critical for universal access.

Social Discrimination and Health Inequities

1. Structural Exclusion: Caste, gender, disability, and sexuality shape access to health care.
2. Marginalised Groups: Dalits, Adivasis, Muslims, LGBTQ+ persons, persons with disabilities, and those living with HIV face systemic discrimination.
3. Intersectional Determinants: Food security, environmental pollution, and climate change exacerbate health vulnerabilities.
4. Rights Framework: Non-discrimination is positioned as central to the right to health.

Reimagining Health Care as a Fundamental Right

1. Public Provisioning: Emphasis on strong, decentralised, community-led public health systems.
2. Participatory Governance: Inclusive planning and local accountability mechanisms strengthen service delivery.
3. Legal Anchoring: Health care framed as an enforceable fundamental right rather than a discretionary policy choice.
4. Political Engagement: Parliamentary dialogue sought to translate convention outcomes into policy reform.

Conclusion

The National Convention on Health Rights articulates a coherent alternative to market-driven health care by grounding access, affordability, and equity within a rights-based public framework. It reinforces the principle that health systems must serve people rather than profits.

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