Is it too much to expect Modi govt to declare right to health as a fundamental right?

Healthcare today is faced with several challenges right from medical education, primary prevention of disease, delivery of healthcare, funding for healthcare, scientific inputs, drug pricing etc.

In the ancient times, promotion of good health was learnt through day-to-day experience, and so developed the concept of developing resistance to diseases through healthy nutrition or through specific methods like the use of herbs or other natural products.

Modern scientific medicine carried forward that knowledge through extensive research to find normal functioning of the body, the causation of disease and methods of management of the disease and promotion of good health.

In India, health planning started with the formation of a committee popularly known as Bhore committee under the chairmanship of Sir Joseph Bhore in 1943 to survey the then existing position regarding health conditions and health organizations in the country. The committee in its report in 1946 recommended that “the health programme should be developed on a foundation of preventive health work” and that “if the nation’s health has to be built, such activities should proceed side by side those concerned with treatment of patients”.

It was based on the principles that “no individual should be denied to secure adequate medical care because of inability to pay; health programme must lay special emphasis on preventive work; health service should be located close to the people; medical services should be free to all without any distinction and doctor should be a social physician”.

The committee also observed that “health and development are inter-dependent and improvement in other sectors like water supply, sanitation, nutrition, employment led to improvement in health status”.

Interestingly this was also the period when the British government introduced National Health Services in England. The Soviet Union had already introduced the concept of State’s responsibility of healthcare to all in 1936.

In the first few decades after independence, direction of the healthcare in our country was based on these principles, which gave priority to public health. During that period, much of the health care was developed in State sector with a special emphasis on the need for basic healthcare services.

As a follow up, India signed Alma-Ata Declaration in 1978 which identified primary healthcare as the key to the attainment of the goal of ‘health for all’ and conceptualized ‘health as the core function of development, encompassing the securities of life, livelihood, and basic services including food, health, education, housing, sanitation, drinking water, electricity and transportation’.

Over the years, neo-liberal economic policies were adopted due to which there occurred a policy shift towards health that treats health as ‘techno-dependent and amenable to commodification’.

Even the World Health Organisation (WHO) started working under the influence of international monopoly corporates and took a position to increase privatization and partnership with multinational companies.

In our country, we find that the public sector is now responsible for the preventive services while the private sector on the other hand is investing heavily in secondary and tertiary care with a profit motive making the advanced care out of reach of low and even middle-income group population.

There has been a paradigm shift in the approach from the first National Health Policy 1983 which emphasized on promotive, preventive curative and rehabilitative services. The National Health Policy (NHP) 2017 however made a leap forward to corporate-centric and insurance-based healthcare system. As a result, public funds are being diverted to the private insurance and health care sector.

Presently, 75% of healthcare expenditure comes from the pockets of households – 80% for OPD care and 60% for Indoor care. This catastrophic healthcare cost is an important cause of impoverishment which further adds to poor health. No wonder, the government recognises the fact that every year, 6.3 crore people are pushed below the poverty line because of out of pocket expenditure on health.

India has roughly 20 health workers per 10,000 population. Total doctor-population ratio including the doctors of modern medicine and AYUSH as stated by Mansukh Mandaviya, Union Minister of Health and Family Welfare in the Rajya Sabha April 5, 2022, is 1:834.

It is to be noted that Govt. doctor-population ratio is 1:11,926 in contrast to the desired 1:1,000. This is a major cause of inequality in healthcare to the marginalized sections who are dependent solely on State healthcare system.

WHO recommends minimum of 5% of the GDP as expenditure on health, while in contrast, our public health spending is hovering around 1.1% of GDP.

That out of a population of 100000 in our country, 32 persons die due to tuberculosis every year, is a matter of grave concern and shame. Similar is the condition of other communicable and non-communicable diseases.

Because of poor planning, diseases like malaria, tuberculosis, cardiac illnesses, diabetes, cancers etc. got ignored during the COVID pandemic. Despite this, the Constitution of India does not expressly guarantee a fundamental right to health.

It is imperative to set up a Primary Health Centre for every 30000 population, with 24-hour service, a Health Sub-Centre for every 5000 population and a fully staffed Community Health Centre with all facilities for every 100000 population. Round-the-clock ambulance service is required for every 30000 population.

Women medical and paramedical personnel must be posted in all health centres and hospitals in adequate numbers. All government health facilities should adhere to Indian Public Health Standard (IPHS) norms.

Medical education too needs to be reformed along the same lines. To begin with, the shift from opening medical colleges in the State sector to the private sector must be reversed. According to the website of the National Medical Commission (NMC), presently India has 605 medical colleges with 90825 seats for the under-graduate course. Out of this, 306 colleges with 45035 seats are in the State sector.

The number of colleges in private sector is 289 with 43965 seats and there are 10 ‘other’ colleges with 1825 seats.

The tuition fee in private colleges ranges from Rs 60 lakh to over Rs 1 crore. This is far beyond the capacity of even the middle classes. Therefore, students look for relatively cost-effective institutions.

Studying abroad costs around Rs 30 lakh which includes the cost of travel and stay. This attracts many to opt for that. We have seen how medical students in Ukraine had to suffer during the on-going war with Russia.

Since nutrition is the key to good health, it is imperative that malnutrition is eliminated by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two thirds of India’s people and ensures maternity entitlements to all pregnant women. The govt must set up Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children.

Even though expenditure on drugs forms nearly 63% of the out of pocket expenditure on health, till date we lack a rational drug policy that allows drugs to be sold only under their generic names. The drugs’ pricing policy is faulty, allowing pharmaceutical companies to fix prices at their own will.

There is a need to ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system through quality conscious pooled procurement systems and promotion of manufacture of essential medicines. Drugs’ prices should be calculated based on their cost of production.

The recommendations of the report of ‘Committee on High Trade Margins in Sale of Drugs’ submitted on 9th December 2015 need to be implemented. The National Pharmaceutical Pricing Authority too must be strengthened further.

It is disgusting that unscientific non-evidence based methods of treatment are being spread in health care. Promotion of cow urine, cow dung and Ramdev’s Coronil as treatment of various diseases including COVID-19 has been done by higher ups in the government including the then Union Health Minister Dr Harshvardhan, who himself is an ENT surgeon.

The latest decision of the NMC to introduce ‘Charak Shapath’ instead of a scientific oath by the doctors of modern medicine is totally unscientific. The ‘Charak Samhita’, written in 300 BC, says among other things that physicians must live a life of celibacy and grow a beard and prohibits them from attending a patient who is not liked by the king. This means women cannot be doctors.

Some colleges have made it compulsory for the internes of modern medicine to get raining in AYUSH. It may be understood that there is conceptual difference about causation and treatment of disease not only between modern medicine and AYUSH but also between various constituents of AYUSH.

The National Medical Commission (NMC) has also decided that the medical students of modern medicine should undergo training under a yoga teacher and observe 21st June as Yoga day.

There has to be a concerted effort to develop a healthy India through a scientific outlook. Otherwise, the health of the vast majority of our poor population will continue to be exploited through false beliefs and myths in healthcare and exorbitant charging.

The State must come forward to take responsibility for health to all and declare health as a fundamental right.

(IPA Service)

Views are personal