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TBA Exclusive: Can we make Health a Fundamental Right in India? An in-depth analysis

In this week’s episode, we explore whether Health could be made a fundamental right in India. Will that allow better access to healthcare for all? Let’s find out.
 
For starters, Article 21 of the Indian Constitution guarantees every Indian citizen the right to life. Now, part of what “Right to Life” includes is "Right to Health”. But, under this, a person or a citizen cannot hold the government responsible if they are unable to get access to good medical facilities or healthcare. That way, Article 21 is restrictive when it comes to health.
 
But, did you know that the National Health Policy of 2015 released by the NDA government actually proposes to make Health a fundamental right? What that means is if you are denied access to good healthcare when you are sick, then can sue the state in such cases. Making health a fundamental right would, therefore, give citizens the power to hold the state accountable for fulfilling its responsibility towards them.
 
The good thing about the NHP is that, on paper, it has noble intentions and strives to ensure universal and affordable healthcare for all. Now…the idea of making health a fundamental right is an old but feel-good debate.
 
If one were to make Health a Fundamental Right, there are a few challenges one needs to look at: 
 
1. Resources and support: What is the capacity of the state to deliver on such a promise? Where is the money going to come from? Where are the hospitals, where are the trained health workers and are there enough doctors and medical personnel to serve people? How will this be met? 
 
2. State’s planning and responsibility: For example, Delhi is the world’s most polluted city. In winter especially, you can barely venture out in the morning smog without catching an infection. Isn’t the state responsible for controlling pollution? If health was a fundamental right, then the government would be compelled to think seriously about the pollution aspect or the environmental impact when, say, granting permissions for new industries or framing development policies. So, the responsibility of such deep and broad thinking also falls directly on governments. 
 
3. Pricing control means pharma control: Making health a fundamental right means a state needs to think twice before giving a free run to the pharma lobby on drug pricing. So basically, the government will be responsible to ensure affordable pricing of drugs, treatment costs and other medical resources while also ensuring that the supply chain is streamlined and demand is met as per needs. But, in a globalised world, is that possible? Can good healthcare be offered to people with the government's interference? Is such a thing possible in India where government’s interference actually complicates processes and makes life more difficult for the common man? 
 
4. Budget allocation: If Health becomes a legally binding principle, then the government needs to ensure that all ministries (not just the health ministry but even the finance ministry) will need to take into account a significant health budget allocation (which is usually on the lower side in India) and approve it. 
 
For instance: Public spending on health has been stuck at around 1% of GDP for close to 15 years in India. In 2004, the Government of India made a commitment to raise public spending on health to at least 2-3% of GDP over the next five years. That did not happen. A similar commitment was reiterated in the National Health Policy in 2015, which commits to increasing public spending on health to 2.5% of GDP by 2025. 
 
India’s public expenditure on health is way lower than the average expenditure by countries clubbed as among the "poorest". Our public health expenditure is lower when compared with other South-East Asian countries like Nepal, Sri Lanka, Bhutan, Indonesia, Thailand and the tiny island country of Timor-Leste.
 
Unfortunately, our country’s poor focus on health pushes nearly 5.5  crore Indians into poverty because of huge expenditure on healthcare from their own pockets. And, to top it off, healthcare in government-run hospitals, which is free for everyone, is plagued by long queues, poor quality of care, and a lack of adequate human resources.
 
Meanwhile, the private sector has grown exponentially over the past decade and currently provides almost 80 percent of outpatient and 60 percent of inpatient care in India. Most of us use the private sector healthcare thinking it’s better than the public system. And, that is the truth. 
 
It is not that our country hasn’t done anything with respect to health. We have some good public health achievements since independence like eradication of smallpox, Guinea worm disease and recently Polio. 
 
But, in the last 15 years, our health infrastructure has crumbled and there is absolutely no planning to bridge the gaps in our dysfunctional public healthcare system or meet the demands of a growing population that relies on inefficient government systems and red tape at every level. 
 
The pandemic has exposed our country’s healthcare system to the world. Despite being the sixth-largest economy in the world, we spend just 1% of our GDP on health. In comparison, Brazil spent 9.5% of its GDP on health, China and Mexico 5.4%, and the UK 10%. Most of the money spent on health in India comes directly out of people’s own pockets, with government spending on health being one of the lowest in the world.
 
But, the point is, are we as a country really serious about health outcomes  through committed political leadership rather than being content with policies on paper? 
 
This may be sounding like a Utopian idea but do we really have political leadership that could actually think of investing in healthcare and thinking long-term? Can our political leaders at least consider the proposal to make healthcare and education free for all, while getting rid of the culture of unnecessary freebies? 
 
Instead of distributing liquor and other materialistic items for every election and spending so much money on momentary happiness of voters, why can’t the political leadership of this country think of making health and education free for all? That will not only save poor people from financial burden, but it will also create many opportunities for poorer families which makes them less reliant on the government. 
 
Such a positive step will also create a win-win situation for the government because once education and healthcare needs are met by the government, people will hardly have anything to complain about. That will eventually benefit political parties in the form of votes too, if done right! 
 

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