The Right to Healthcare in India: A Growing Concern
Written by Eesha Bisht
Fourth Year, BA. LLB. Symbiosis Law School, Pune
Source: DistilINFO Health
Disclaimer: Please note that the views expressed below represent the opinions of the article's author. The following does not necessarily represent the views of Law & Order.
Introduction
The Universal Declaration of Human Rights provides for healthcare under Article 25[1] and states that everyone has a right to live a life of good health and wellbeing. The right to good health is one of the fundamental rights of every human being irrespective of their religion, class, caste, race and beliefs and is inherent to a life of dignity under Article 21[2] of the Indian Constitution. According to the World Health Organization, the human right to health means attaining the highest standard of physical and mental health.[3] This would include the right to basic human necessities like food, housing, water, sanitation, medical services, etc. In the 21st century healthcare facilities are no doubt becoming expensive. In a developing country like India, they are also not easily accessible to the marginalized sections of the society.
Keeping these problems in mind, the central government released the National Health Policy on 16th March 2017.[4] The policy seeks to improve the current health and sanitation situation in India.
However there are certain shortcomings of the same.
Role of the Indian Judiciary in Securing Health of Citizens
The Directive Principles of State Policy in India do not have any binding value. These are directions which the state has to follow but are merely of persuasive value. Therefore since the same cannot be enforced in the court of law, the state can use it as a weapon to escape responsibilities especially when it comes to ensuring good standards of health for its citizens. The courts in India therefore have brought the right to health under the purview and scope of Article 21 of the Indian Constitution which preserves the right to life and liberty of every Indian citizen and thereby has also expanded its scope. The apex court, that is, the Supreme Court has also allowed people to approach it directly for the protection of their human rights, including the right of health.
In Parmanand Katra v. Union of India[5], the Supreme Court clearly held out that all medical professionals who are in charge of public health have an obligation to protect it. The court has also held that there is a need for sensitization of the right to health. Therefore, through Article 21 of the constitution, the judiciary has many a times laid down the importance of health.
Further, in Bandhua Mukti Morcha v. Union of India[6], the court emphasized on the Directive Principles of State Policy under the Indian Constitution and held that even though they hold persuasive value still it is the duty of the state to implement its provisions with regard to health and wellbeing of all and that dignity and health has been interpreted to be included under Article 21 of the Constitution of India.
In Consumer Education and Research Centre v. Union of India[7], the court dealt with occupational health hazards and said that the right to health is an integral factor to lead a life which is meaningful and medical care needs to be provided for attaining the highest living standards possible. The government therefore has a responsibility to work for the welfare of the public and to provide adequate medical aid to everyone.
State is the legal guardian of people and it has to ensure security as well as safety for all its citizens.
By including health in the purview of fundamental rights, the citizens would be able to hold the state accountable if it fails to fulfil its duties towards them.
The healthcare industry in general is divided into several areas so that health requirements of all individuals can be met.
National Health Policy 2017
In order to achieve the maximum possible level of well-being and good health throughout India, the National Health Policy 2017[8] was brought forward to bring in certain preventive and promotive healthcare developments in order to prevent diseases and promote good health of Indian citizens, thereby shaping the health system of the country effectively.
The policy undertakes the duty to deploy health professionals by per unit of population in rural areas since there is lack of awareness and resources to deal with health and sanitation issues in villages. Health and hygiene is also to be made a part of the curriculums in schools.
Its main objective is providing universal access to quality health care services without people facing financial constraints while accessing the same.
The policy aims to reduce under five mortality to 23 per 1000 live births by 2025,[9] Increase Life Expectancy at birth from 67.5 to 70 by 2025.[10] It also aims to reduce the disease burden by one third from the level in which it currently exists.[11]
Furthermore, in order to grant easy access and financial relaxation in urban areas, the policy proposes free emergency care services, free medicines and treatments /diagnostics in all public hospitals across cities in India.[12]
The policy further places a lot of emphasis on bringing more medical and healthcare professionalism along with Affordability & Quality Care.
Under the policy, 2 beds per 1,000 population has to be distributed in a manner to enable access within emergency hours or the first hour after a traumatic injury, where from the emergency treatment, the victim is most likely to benefit.[13] Also in many public hospitals, free medicinal drugs and services are already being provided under the policy.[14]
Unless the masses are educated and informed about the diseases, the symptoms of the diseases and its treatment , there is no guarantee that people will avail these despite treatment being free. Thus the government needs to ensure that as provided under the policy, people at large are made aware about treatment This is because there are still a certain number of people who believe in homely remedies rather than consulting doctors.
Also, one of the objectives of the policy is health assurance and it seeks to fulfil it by ‘strategic purchasing’ from privately run institutions.[15] However purchasing from the private sector seems more like the Government itself is abandoning its responsibility to provide healthcare services by borrowing from the private sector.
The government in the Health Care Policy of 2002 had promised to increase health spending to 2 percent of the GDP. It’s to be seen whether in the policy of 2017 increase in health expenditure from 1.15% to 2.5% of the GDP would be fulfilled by 2025.[16]
The Surat Health and Sanitation Model
Surat, once infamous for its plague outbreak in 1994, has now completely transformed itself and has emerged as a leader in sanitation and public health, something public health policies must look forward to achieve.
In the year 1994, a pneumonic plague was caused because of rats in Surat (Gujarat) after which the government officials therein had declared a public health emergency. All schools, colleges and public places were asked to be shut down. Even Industrial units, banks and offices were closed until further notice. Due to the migration of infected people from Surat the plague also spread to five states. A total of around 55 deaths and 693 suspected cases were reported from India due to the plague outbreak which started from the city of Surat.[17] The disease was eventually controlled from spreading further and after much difficulty was put under control. The plague however, in itself raised some very serious concerns about public health infrastructure and facilities in the city and the government was also called out for being inefficient as it did not deal with the plague before it spread.
The Municipal Commissioners of Surat rebuilt the whole trash collection in place and street cleaning commenced on a large scale, hygiene standards were strictly enforced in food establishments and conditions of slums improved with construction of paved streets and toilets.
Municipal Corporations across Surat had also started doing door-to-door disease surveillance around the year with strict monitoring.
The disease-ridden city is today one of the cleanest cities in the country today. The city was divided into six zones and the head of each zone was given administrative and financial powers of a Municipal Commissioner. Not only this, the city was further divided into 52 sanitary districts, each with its own sanitary inspector.
The city has two major public hospitals, and a number of maternity homes. The government through the National Health Policy 2017 should ensure that maternity homes across rural areas are built and teaching hospitals which carry out the task of not only treating patients but also educating people be established as has already been done in Surat. Not only this, public health and sanitation policies in India also need to bring in more innovation in existing measures as has been brought in by the city of Surat which has been quite innovative in its response to public health issues. It has a mosquito surveillance programme in place and a real-time monitoring system that monitors and tracks health, water and solid waste complaints in the city. A deputy medical officer, monitors diseases every day in Surat, the central government must take inspiration from Surat and thus ensure that such medical officers are also placed around the different districts of states in India to monitor health and sanitation situations. The monitoring and recording system in the city of Surat also reduced malaria and dengue cases by eradicating mosquito breeding sites which is in itself is also commendable.
Conclusion and Recommendations
During the plague of 1994 in Surat, a system of monitoring was established through daily activity reports and fines were levied for pollution and littering which largely added to Surat’s success in coming out as a clean city. There also needs to be a deployment of more trained doctors and nurses which can help meet the National Health Policy 2017 goals of reducing infant mortality rates by focusing primarily on the health of the mother. Even though the National Health Policy 2017 tries to address a majority of these issues, it still lacks significantly in terms of ensuring implementation and seeing to the fact that the funds allocated under the same are utilised adequately and without misuse. Trained experts interested in the field of medicine and social work can also be deployed at various levels to aware people about health and sanitation issues. Even though the policy of 2014 had proposed changes to be brought in the undergraduate curriculum to deal with emerging issues like adolescent health and mental health, the same now needs to be mandated. Equally important is the need to increase the number of paramedical workers and training institutes in India.
There should also be adequate focus on the mental health of the people, especially adolescents. The government should also mandate the presence of counsellors at educational institutions.
More investments in health infrastructure should be seen to be made by the government at the centre and low cost medicinal drugs for serious ailments should not just be proposed but also seen to be made affordable. Policies with strong emphasis on implementation have reaped some successful results in the past (for instance, Pulse Polio Programme) and the same thus needs to be ensured through the new National Health Policy, 2017. Each state should appoint health officers in various districts to monitor the working of local clinics and hospitals. The current budget allocation for health should be increased more and must specially focus to provide for promoting health of people, preventing disease and improving the quality of health services. The poor here who are unable to afford health care services are not seen as a source of earning revenue, but rather the disadvantaged sections of the society whose growth, health and prosperity should be of great importance and concern. Governments at both the centre and the state level should successfully collaborate to reduce the burden on the country and also should work towards eliminating all sorts of malpractices which take place in the health sector.
A right policy action with strong implementation measures becomes extremely important to deal with various health and sanitation issues in the country. When it comes to tackling problems in the healthcare industry India needs an approach which is holistic. A critical aspect of human life is health which is also a globally recognized principal for faster socio-economic development of any nation. Health has become an important part of any nation’s public service and planning as only a healthy citizen can contribute adequately to a nation’s prosperity.
[1] Article 25, The Constitution of India, 1950 [2] Article 21, The Constitution of India, 1950 [3] Human Rights and Health, WHO, https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health [4] National Health Policy 2017, https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf [5] Parmanand Katra v. Union of India, AIR 1989 SC 2039. [6] Bandhua Mukti Morcha v. Union of India, AIR 1984 SC 812. [7] Consumer Education and Research Centre v. Union of India, 1995 AIR 922. [8] National Health Policy 2017, https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf [9] National health Policy 2017, 2.4.1.2 Mortality by Age and/ or cause [10] National health Policy 2017, 2.4.1.1 Life Expectancy and healthy life [11] National health Policy 2017, 2.4.1.3 Reduction of disease prevalence/ incidence [12] National health Policy 2017, 3.3 Organization of Public Health Care Delivery [13] National health Policy 2017, 3.3.2 Secondary Care Services [14] National health Policy 2017, 3.3 Organization of Public Health Care Delivery [15] National health Policy 2017, 2.3.1 Progressively achieve Universal Health Coverage [16] India to increase public health spending to 2.5% of GDP: PM Modi, https://economictimes.indiatimes.com/news/economy/policy/india-to-increase-public-health-spending-to-2-5-of-gdp-pm-modi/articleshow/67055735.cms [17] Godshen Robert Pallipparambil , The Surat Plague and its Aftermath , http://www.montana.edu/historybug/yersiniaessays/godshen.html BIBLIOGRAPHY
1. Human Rights and Health, WHO, https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health
2. National Health Policy 2017, https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf
3. India to increase public health spending to 2.5% of GDP: PM Modi, https://economictimes.indiatimes.com/news/economy/policy/india-to-increase-public-health-spending-to-2-5-of-gdp-pm-modi/articleshow/67055735.cms
4. Godshen Robert Pallipparambil , The Surat Plague and its Aftermath , http://www.montana.edu/historybug/yersiniaessays/godshen.html