Health: A Fundamental Right
By providing quality healthcare facilities to all citizens, the State must bring health in the ambit of a fundamental right
Health is a basic human right. Every person has the right to live a healthy life and contribute effectively to society's development. As the right to health is included in the country's directive principles, it becomes the duty of the State to provide comprehensive universal healthcare to all its citizens. It has to ensure the prevention of disease, promotion of good health and rehabilitation of the diseased and the infirm.
Nutrition is the basic premise that ensures good health. A poorly nourished person is more likely to be taken ill. Therefore, prerequisites for a healthy life are safe drinking water, proper sewerage facilities, balanced nourishing food with sufficient calories and other nutrients, proper housing and healthy environmental surroundings. There is a need for providing special care to women, children and the elderly. Unfortunately, we are far from meeting these requirements. Our hunger index stands at 103 out of 118 countries. This is a serious matter. How do we expect children with stunted growth to build a healthy developed nation?
Various studies have concluded that to ensure comprehensive primary healthcare there is a need to enhance public health spending on health to a minimum of 5 per cent of the GDP. As per the National Health Accounts (NHA) estimate for 2014-15, the Government Health Expenditure (GHE) per person per year is just Rs 1,108. This is in contrast to the Out of Pocket Expenditure (OPE) of Rs 2,394, which comes out to be 63 per cent of the total health expenditure which is Rs 3,286 per person. Even this expenditure is not homogenous. The spending on health varies on socioeconomic status, gender, religion, caste and geography.
The average share of OPE on healthcare as a proportion of total household monthly per capita expenditure was 6.9 per cent in rural areas and 5.5 per cent in urban spaces. This led to an increasing number of households facing catastrophic expenditure due to escalating health costs. More than 40 per cent of the population has to borrow or sell assets to access health treatment. This is entirely against the principles of equity and justice. Already marginalised sections, Dalits, Muslims and other socioeconomically weaker groups are the worst-affected.
Flaws in planning and implementation of policies had been pointed out by the Comptroller and Auditor General of India (CAG) in 2017. The audit pointed towards inadequate funding, under-spending of available financial resources, delays in transfer of funds, diversion of allocated programme funds, limited capacity to spend due to shortages in infrastructure and human resources, among other issues.
The recently launched National Health Protection Scheme (NHPS) aims to cover almost half the population with publicly funded health insurance. Private health insurance companies and healthcare providers are already expecting huge dividends from NHPS. There is also a proposal for Health and Wellness Centres (HWC) to deliver preventive, promotive, curative and rehabilitative services. With a low financial allocation, this will hardly be fulfilled. There is also a shift from the public provisioning of health towards privatisation.
To improve the health of the people, drastic steps need to be taken at various levels. Health should be declared a fundamental right irrespective of religion, age, sex, caste and socioeconomic status. The government owes its responsibility of delivering health to all by ensuring universal access to quality healthcare, education and other day-to-day needs. For this, there should be continuous evaluation of people's health status. Health should receive an adequate scope in political agenda and policymaking bodies.
Certain steps that need urgent action is the rationalisation of drug prices — regulating drug prices in line with the rationalisation of trade margins in medical devices. The ex-factory cost of drugs should be based on actual costs. Trade margin on drugs and medical devices should be capped to a maximum of 30 per cent.
It is also imperative to provide free medicines and investigations across all public hospitals on the lines of Tamil Nadu, Kerala and Rajasthan. The State must pledge to increase public expenditure on healthcare from 1.1 per cent to 2.5 per cent of GDP immediately and then increase it to 5 per cent in the subsequent five years.
Medical education has to be revamped and brought within the access of all sections of society. Tuition fees of 100 per cent seats in private medical colleges must be regulated.
The Constitution guarantees six fundamental rights to Indian citizens as follows: (i) Right to Equality, (ii) Right to Freedom, (iii) Right against Exploitation, (iv) Right to Freedom of Religion, (v) Cultural and Educational Rights, and (vi) Right to Constitutional Remedies.
Fundamental Rights are justiciable, as they can be enforced, whereas the directive principles are non-justiciable, in that, they are not enforceable in the court of law. It is time health is included as a fundamental right if we wish to fulfil our dream of building a healthy India.
(The author is Senior Vice President, Indian Doctors for Peace and Development. The views expressed are strictly personal)