Rights Related to Health: Issues and Challenges in India

The right to health refers to the highest attainable standards of physical and mental health that every human being is entitled to. Recognized as a fundamental human right, it requires that every individual has access to health services, safe and potable water, adequate sanitation, healthy food, and health-related education and information. The right to health is an essential component of human dignity, and it is the responsibility of governments to ensure that this right is protected and promoted for all individuals.

Constitutional and Legal Provisions

• Directive Principles of State Policy (DPSP): Part IV of the Indian Constitution ensures social and economic justice for its citizens. Articles 38, 39, 42, 43, and 47 obligate the state to ensure the effective realization of the right to health, although these principles are not enforceable by law.
• International Conventions: India is a signatory to Article 25 of the Universal Declaration of Human Rights (1948), which grants the right to a standard of living adequate for health and well-being, including food, clothing, housing, and medical care.
• Fundamental Rights: Article 21 of the Indian Constitution guarantees the fundamental right to life and personal liberty. The right to health is inherently included in this provision as essential for a life with dignity.
• Judicial Pronouncements: The Supreme Court of India has reinforced the right to health through various judgments. In the Paschim Banga Khet Mazdoor Samity case (1996), it held that the government is obligated to provide adequate medical facilities. In Parmanand Katara vs. Union of India (1989), the Court ruled that every doctor, whether at a government hospital or otherwise, has the professional obligation to extend his services for protecting life.

Significance of the Right to Health

• Right-Based Healthcare Services: Recognizing health as a right compels the government to take necessary steps towards ensuring access to health services for all. This approach ensures that healthcare services are delivered based on need rather than the ability to pay, promoting equity in health.
• Wide Access to Health Services: Ensures that everyone can access quality health services that improve their health outcomes. This includes preventive, curative, rehabilitative, and palliative health services that are scientifically and medically appropriate.
• Reduce Out-of-Pocket Expenditure: Protects individuals from the financial burdens of healthcare expenses, reducing the risk of impoverishment. By reducing out-of-pocket costs, the right to health helps prevent families from falling into poverty due to medical expenses.
• Enhance Overall Well-being: Access to health services improves the overall well-being of individuals, leading to a healthier and more productive population. A healthy population can contribute more effectively to the economy and society.
• Promote Social Justice: The right to health is closely linked to social justice, ensuring that marginalized and vulnerable groups have access to necessary health services. This helps in reducing health disparities and promoting equality within society.

Challenges Related to the Right to Health in India

• Inadequate Healthcare Infrastructure: Despite improvements, India’s healthcare infrastructure remains inadequate, especially in rural areas. There are only 1.4 beds per 1,000 people and one doctor per 1,445 people, with over 75% of healthcare facilities concentrated in metropolitan areas. This disparity leads to unequal access to healthcare services.
• High Disease Burden: India faces a high burden of communicable and non-communicable diseases. Addressing diseases like tuberculosis, HIV/AIDS, malaria, diabetes, and heart diseases requires significant investment in healthcare infrastructure and resources. The double burden of disease strains the existing healthcare system.
• Gender Disparities: Women face significant health disparities, including limited access to healthcare, higher maternal mortality rates, and gender-based violence. India ranks low globally for the health and survival of females, highlighting the need for targeted health interventions. Cultural and social norms often restrict women’s access to healthcare.
• Limited Health Financing: With public spending on healthcare at only 2.1% of GDP, India’s health financing system limits the government’s ability to invest adequately in healthcare infrastructure and services. This low level of investment results in inadequate healthcare facilities, shortage of medical professionals, and insufficient medical supplies.
• Geographical Disparities: There is a significant disparity in healthcare access between urban and rural areas. While urban areas may have advanced healthcare facilities, rural areas often lack basic medical services. This geographic divide affects the overall health outcomes of the rural population.
• Quality of Healthcare Services: The quality of healthcare services in India varies widely. While some urban centers have world-class medical facilities, many rural and remote areas suffer from poor-quality healthcare services. Ensuring consistent quality of care across the country remains a challenge.
• Out-of-Pocket Expenditure: A significant portion of healthcare expenses in India is paid out-of-pocket by individuals. High out-of-pocket expenditure can lead to financial hardship and prevent people from seeking necessary medical care. This is particularly problematic for low-income families.
• Health Workforce Shortage: India faces a shortage of healthcare professionals, including doctors, nurses, and paramedics. The existing workforce is unevenly distributed, with a concentration in urban areas, leading to inadequate healthcare in rural regions.
• Health Awareness and Education: Lack of awareness and education about health issues, preventive measures, and available healthcare services leads to poor health-seeking behavior. Public health education and awareness campaigns are essential to improve health outcomes.
• Administrative and Regulatory Challenges: Inefficiencies in healthcare administration and regulatory frameworks hinder the effective implementation of health policies and programs. Bureaucratic delays and lack of coordination between different government agencies can impede progress.

Government Initiatives for Ensuring the Right to Health in India

The Indian government has implemented various programs and policies to ensure the right to health for its citizens. These initiatives aim to improve healthcare infrastructure, enhance access to medical services, and address the specific health needs of different population groups. Below are some key government initiatives:

National Health Mission (NHM)

Launched: 2013 (restructuring the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM)) Objective: To provide accessible, affordable, and quality healthcare to rural and urban populations. Key Features:

• Strengthening health systems: Enhancing healthcare infrastructure and human resources.
• Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A): Focusing on reducing maternal and child mortality.
• Communicable and Non-Communicable Diseases: Addressing prevention and treatment.
• Health and Wellness Centres (HWCs): Establishing 150,000 HWCs to provide comprehensive primary healthcare.

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)

Launched: 2018 Objective: To provide health coverage to economically vulnerable families. Key Features:

• Health coverage: Provides a coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.
• Beneficiaries: Covers over 10 crore poor and vulnerable families.
• Cashless and paperless access: Beneficiaries can avail services in empaneled hospitals across India.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

Launched: 2003 Objective: To correct regional imbalances in the availability of affordable and reliable tertiary healthcare services. Key Features:

• Setting up AIIMS: Establishing new All India Institutes of Medical Sciences (AIIMS) in various states.
• Upgrading government medical colleges: Improving existing institutions to provide better healthcare services.

Rashtriya Swasthya Bima Yojana (RSBY)

Launched: 2008 Objective: To provide health insurance coverage to Below Poverty Line (BPL) families. Key Features:

• Health insurance: Provides coverage of up to ₹30,000 for hospitalization expenses.
• Smart card: Beneficiaries receive a biometric-enabled smart card for cashless transactions.
• Empaneled hospitals: Services can be availed at empaneled public and private hospitals.

National Nutrition Mission (POSHAN Abhiyaan)

Launched: 2018 Objective: To improve nutritional outcomes for children, pregnant women, and lactating mothers. Key Features:

• Reduction of malnutrition: Aiming to reduce stunting, undernutrition, anemia, and low birth weight.
• Convergence: Integrating various programs and schemes for better implementation.
• Community participation: Involving local communities for effective execution.

Janani Suraksha Yojana (JSY)

Launched: 2005 Objective: To reduce maternal and neonatal mortality by promoting institutional deliveries. Key Features:

• Cash incentives: Providing financial assistance to pregnant women for institutional deliveries.
• Accredited Social Health Activists (ASHAs): Incentivizing ASHAs to facilitate safe deliveries.

Pradhan Mantri Matru Vandana Yojana (PMMVY)

Launched: 2017 Objective: To provide partial wage compensation to pregnant and lactating women. Key Features:

• Financial assistance: Providing ₹5,000 in three installments for the first living child.
• Maternal care: Encouraging adequate rest and improved nutrition during pregnancy.

National Digital Health Mission (NDHM)

Launched: 2020 Objective: To create a digital health ecosystem to support universal health coverage. Key Features:

• Health ID: Providing a unique health ID for every citizen.
• Digital records: Facilitating the creation and access of health records digitally.
• Telemedicine: Promoting remote consultations and digital healthcare services.

Pradhan Mantri Ayushman Bharat Health Infrastructure Mission

Launched: 2021 Objective: To strengthen critical healthcare infrastructure across the country. Key Features:

• Disease surveillance: Enhancing capabilities for disease detection and response.
• Healthcare facilities: Building and upgrading healthcare facilities, including critical care hospital blocks.
• Laboratory network: Expanding and upgrading diagnostic laboratory infrastructure

Q. What are the major issues facing the Indian healthcare system and what steps can be taken to address them, with a focus on increasing access to healthcare for marginalized communities?