Current Situation :
- India accounts for one-third of pregnant women and about a quarter of child deaths.
- Infant Mortality Rate is 56 per 1000 births and is worse than lower income countries like Bangladesh.
- Right to Health is essential to enjoy other fundamental rights like Right to Education, Employment etc.
In this background, it is heartening to see that some parties have included Right to Health in their manifestos for General Elections-2014. In this article we try to see what should be the features of right to health in India. In addition, we will try to briefly give the importance of health due to its impact on other social indicators like poverty, education etc.
Q. What is the importance of RTH in India?
- Skewed health infrastructure: In last 20 years, urban private health infrastructure has increased manifold. As they are profit driven and thus are located in urban areas, government intervention is necessary for rural areas and also in providing cheap healthcare in urban areas to the poor. Unaffordable healthcare in India is also a reason for inequity in India.
- Bad health indicators: Indian health indicators (maternal mortality, infant mortality etc) are worse than lower income countries. Maternal mortality has decreased significantly in last 10 years primarily due to increase in percentage of institutional deliveries due to a government scheme (Janani Suraksha Yojana). This means government’s intervention can do miracles.
- High out of pocket expenditure: Public expenditure is dismally low in India at 1.5% of GDP. Most of the developed and emerging countries are spending way more than this amount. Due to this reason, out of pocket expenditures in India are high. According to recent WHO report, 24% of families paying for healthcare in India are paying more than their capacity. Due to this spending, they have to transfer their children from private schools to free government school and have to reduce other productive expenditures. An accident or a major disease can push Indian family below poverty line!
- Supreme Court judgement: Supreme Court, while expanding the scope of Right to Life, observed right to health as a fundamental right to citizens. It should be noted that Right to Health is essential to enjoy other fundamental rights like Right to Education, Employment etc. It is the obligation of government to ensure affordable healthcare for citizens.
Q What should be the components of Right to Health in India?
- Universal Health Coverage: Provision of affordable healthcare across India and diminish the gap between urban and rural areas, poor and rich and backward and developed areas in terms of accessibility to affordable healthcare.
- Comprehensive: Unhygienic conditions due to unavailability of toilets and safe drinking water should be addressed. Parliament missed the chance to include these components in Food Security Act but they should be included in Right to Health Act. As water and sanitation are already covered under different schemes of government, need is to give legal status to these schemes through comprehensive Right to Health legislation.
- Expansion of health infrastructure: This is just like providing primary schools to every citizen within minimal distance (in Right to Education). Affordable primary healthcare centers with adequate staff (doctors and nurses) and equipment should be present within comfortable distance for every citizen. According to World Health Organization, number of doctors and nurses are not in line with globally accepted norms. This should be corrected immediately.
- Immunization: Universal immunization for children should be implemented effectively. Presently, it is being done through Universal Immunization Program. However, it should be given legal basis for better implementation.
- Maternal and Child Care: Steps for this have already been taken through National Rural Health Mission. A fully funded National Health Mission (for urban and rural areas) has been envisaged in 12th five year plan. This should be given legal sanction through Right to Health.
- Health Insurance: There are few schemes which provide cashless healthcare at various hospitals for the poor. However, there are implementation issues (lack of information, bureaucratic hurdles in passing the fund, low coverage etc) due to which poor end up paying significant amount for the healthcare. Government should devise a public-private partnership model through which it can give coverage for treatment and deaths of citizens.
These are just few points which should form the core of Right to Health Legislation. Readers should think of additional points and ponder over their feasibility.
Q. What for now?
Goods and service delivery in India has increasingly becoming right-based in India. MGNREGA, RTE, RTI and Food Security Act are manifestation of this fact. In our view, time has come to have RTH which can prove to be a game changer. India can gain from a healthy working population especially in present context when India is getting demographic dividend. As we have mentioned before, failure to feed, educate and keep it healthy may be catastrophic for India.
Some political parties have included this clause while some have given importance to other areas like corruption, economic growth etc. Following set of questions should be asked from them:
- Will you pass RTH in parliament?
- Can you give a time guarantee?
- Will you increase public expenditure in health sector?
- Will you implement NHM as an umbrella mission to implement universal health coverage as envisaged in 12th five year plan?
In our view, health is a very important determinant of nation’s progress and hence should be given due space in public debates at various platforms. Unfortunately, this has been dismally low in social media. This should be increased. In ongoing elections, every political party should be viewed through a prism of health and significant weightage should be given to their points related to health while deciding your vote.