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This article on ‘Healthcare challenges in India: In the wake of Covid-19’ is written by Akriti Raina and reflects on the major challenges in the healthcare system of India and looks at the possibility of developing an affordable healthcare regime in India.
I. Introduction: Healthcare challenges in India (In the wake of Covid-19)
In the wake of the recent Covid-19 pandemic and the failure of healthcare systems to accommodate and tackle the challenges posed by the global pandemic, as fatal as the Coronavirus, one couldn’t help but look at the loopholes in the healthcare systems. Pandemics such as coronavirus, reflect the reality of the healthcare system in any given country. It not only brings out the failure of policies, poor implementation on part of executive authorities and agencies but also make visible the stark contrasts in the lives of the poor and rich.
The infamous parliamentary speech by Professor Manoj Kumar Jha, brings out certain fundamental questions about access to free healthcare and its possibility in India. In the context of India, with an overflowing population of which huge numbers are surviving with minimal income and low purchasing power, access to costly health facilities becomes nearly impossible.
For most of the population, even a visit to a good doctor and timely checkups depends on how hefty their pockets are. The lack of awareness about the available health facilities, long waiting periods, combined with fewer doctors to cater to the poor population, profit-making and corrupt practices in the medical field, push the already disadvantaged population to the margins of the system.
The directive principles of the state policy lay down directions in the form of Articles 39 (E), 42 and 47, for the State to provide secure living conditions, humane working conditions as well as the possibility for healthy growth and development. Article 21 of the Constitution provides for the Right to life and liberty, it includes within its ambit rights such as that of food, shelter, healthcare, privacy etc.
The courts have emphasized the importance of accessible healthcare for all through their judgements. But perhaps, the sorry state of healthcare is a result of an absence of any statutory law mandating accessibility of healthcare facilities.
II. Laws and Policies
1. Bhore Committee Report
The first nationwide report on the ‘Health Survey and Development Committee Report’ was prepared by the Bhore Committee (appointed in 1943 and prepared the report in 1946) under the chairmanship of Sir Joseph Bhore. The report suggested massive changes in the existing public health facilities and advocated for free and affordable healthcare for all citizens. It further recommended special healthcare measures for women, children, senior citizens etc.
2. National Health Policy
Prior to 1983, the health-related activities were governed by the Five Year Plan (FYP), but after 1983 India adopted a National Health Policy. The National Health Policy of 2002 is by far one of the most comprehensive health policies adopted.
It acknowledged the sorry state of the healthcare sector in India and suggested reforms such as decentralizing the public healthcare system and increasing the role of private players for those who could pay for the same along with goals for eradication of various diseases such as polio and yaws, elimination of leprosy, reduction of mortality from water-borne diseases etc. Further, National Health Policy 2017 also aims to achieve major reforms in the health sector of the country by strengthening the role of government as a player in the domain of healthcare. 
3. National Health Mission
The National Health Mission was launched in 2015 and subsumed the National Rural Health Mission and National Urban Health Mission to provide accessible and affordable healthcare services to masses in both urban as well as rural areas of India such as building more toilets, launching the Swachh Bharat Abhiyaan (Clean India Mission) (2014), Ayushman Bharat Yojna (2018) and achieve universal immunization etc.
The National Rural Health Mission instituted the ASHA or Accredited social health activist are members of a community in rural areas that assist in the health sector by raising awareness in the community, teaching about safe health care practices, sanitation and bringing children for immunization drives. In these challenging times, the Governments have also made efforts to provide free vaccination to all the citizens for Coronavirus.
III. Right to Health as a Fundamental Right
In Bandhua Mukti Morcha v. Union of India & Others 1984 SCR (2) 67, the supreme court while entertaining a writ petition filed under Article 32 on the issue of bonded labour held that:
“This right to live with human dignity, enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and particularly clauses (e) and (f) of Article 39 and Article 41 and 42 and at the least, therefore, it must include protection of the health and strength of workers men and women, and of the tender age of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work and maternity relief.”
This establishment of the link between Article 21 (Right to life) and the Right to health was further strengthened in State of Punjab & Ors v. Mohinder Singh Chawla Etc on 17 December 1996 the court observed that it is now settled law that right to health is integral to right to life.
In State of Punjab & Ors. v. Ram Lubhaya Bagga Etc. on 26 February 1998 the supreme court observed that the right to life includes the right to live with dignity.
Dignity does not imply a mere animal-like survival but rather a meaningful life that is worth living.
The court further held that human health is the pith and substance of life and is the nucleus of all activities of humans. If health crumbles, everything else will crumble. Thus, it is the duty of the Governments and other authorities to prioritize on providing adequate health facilities. The court affirmed that the Right to Health is not a mere obligation but is a sacrosanct right under Articles 21 and 47 of the Constitution and obliges the state to improve public health as its primary duty.
In the backdrop of the Covid-19 pandemic the court in SUO MOTU WRIT PETITION (CIVIL) NO.7 OF 2020, IN RE: THE PROPER TREATMENT OF COVID 19 PATIENTS AND DIGNIFIED HANDLING OF DEAD BODIES IN THE HOSPITALS ETC. stressed the integral relationship between the Right to life and the Right to health. Holding the right to health as a sacred right, the court in its order directed that the State and Central governments should take appropriate measures to ensure that healthcare facilities are accessible and cap the exorbitant amounts charged by private hospitals from patients.
IV. International treaties and Conventions
India became a signatory to the Alma Ata Declaration, 1978, adopted in the Primary Health Care Conference (PHC). It aimed at providing affordable healthcare to all by 2000. India also ratified the Millennium Development Goals, 2000 of the United Nations to be achieved by 2015. Some of the goals are: To achieve universal primary education, eradicate poverty and hunger, promote gender equality, improve maternal health, sustainability of environment etc. Sustainable Development Goals (SDG), 2016 are seventeen goals to be achieved by the year 2030 and include issues related to health, poverty, hunger, education, water, sanitation, energy. Ensuring wellbeing and good health for people of all ages is the third goal of SDG.
V. Problems and challenges
A cursory look at the existing universal health care providing regimes such as Australia where there is an amalgamation of public and private insurance to provide universal healthcare, the Netherlands where private health coverage is ensured to everyone or Taiwan which uses the single-payer model to provide health facilities to it citizens, makes us reflect on our own healthcare regime.
“Health is wealth”, a slogan imprinted on our minds since a very young age, stands in contrast to the reality of the healthcare system in India. What is evident perhaps is that “Wealth ensures Health” or “No wealth, No health”. The population is often the concern of those who see the impracticability of a universal or affordable healthcare system in India. But, the population is an ever-increasing phenomenon in a country this big in size, there have to be efforts on the level of policymaking and diplomacy to accommodate these challenges and achieve effective policy outcomes.
A few of the problems where the healthcare system can start from are:
Firstly, the budget allocated to the healthcare sector is significantly less in India, this is reflected in India’s poor performance in terms of healthcare ranking at the global level. India needs to evaluate its taxation policies and focus on spending handsomely on its health policies and budget.
Secondly, there is a dearth of hospitals and basic infrastructure such as beds, machines, wards etc. The chaotic situation of helpless patients during the pandemic was a reflection of the same.
Thirdly, access to doctors especially for the poor, illiterate and rural masses is no less than a challenge.
Fourthly, the hapless conditions of government hospitals, observing minimal up to mark standards of healthcare, puts patients, especially those who are incapable of affording private help, in danger.
Fifth, there is a major loophole in policy implementation and thus, the benefits of these policies most often do not percolate to the unaware and deprived masses. While the literate and financially sound population can afford quality health services, it is the economically weaker sections that are put in the dilemma of either losing their health or money. Faced with such choices, those short on financial backing are likely to surrender to their illness than burden their families with hefty loans.
Sixth, the practices of corruption prevalent in healthcare needs to be countered by regulating the fees charged, regular inspections of hospitals, patient feedbacks and disallowing the use of personal contacts to get priority over the others.
Seventh, increasing the seats in medical colleges and providing medical training to the youth through short term skill-based courses. This can be done by regulating the cut-offs in medical institutions and allowing more students to have access to medical training and filtering their skills based on their performance in medical school and not based on high scores in competitive exams.
Finally, developing a universal healthcare model which is accommodative of the realities of the Indian society, and includes the lessons from the past experiences and directions for the future of healthcare in India.
VI. The way ahead
Given the challenges that the country faced in the pandemic, particularly in the healthcare system, calls for some major reforms in our healthcare sector. Developing a foolproof health care policy is not an easy task but a country has to start somewhere. Any policy, no matter how sound, goes through the stage of failure, indeed a stage of major importance in the life circle of policymaking. This failure is not to be confused with the failure of the whole system, rather be viewed as a mirror of our shortcomings and a guiding force for formulating much more well-developed policies.
At the starting point free healthcare may seem utopian but what we can strive to achieve at the beginning is affordable healthcare for all.
Thus, the need of the hour is to shift our focus on the well being of our masses and developing avenues for access to easy, affordable and quality healthcare services by proactive role on the part of government agencies.