There is a proposal to include healthcare in fundamental rights as enshrined in the Constitution. The Government would first need to define ‘health' and ‘health services' that would eventually be part of the Rights mandate
The Union Government is embarking on an ambitious plan to revamp the health sector, with staged reforms to help create a health system in tune with the 21st century needs of India. The reforms being undertaken can be bucketed under four broad categories. First, is the creation of additional capacity through the setting up of AIIMS-like institutions across the country. This will help augment the infrastructure gap in provisioning of quality tertiary care healthcare across the country.
It will further reduce the burden on the existing infrastructure, which has led to poor service delivery and a ‘post-code’ lottery system, where the location of a citizen decides the type of healthcare he or she receives. Second, is the availability of essential medicines and price controls. This move, though opposed by a large section of the pharmaceutical industry, is to help improve access and equity to essential medicines for an ever-wider section of the population. In fact, the price control regime through the National Pharmaceutical Pricing Authority (NPPA), has put caps on an increasing list that includes devices and consumables across the private and public sectors. The third has been the reform of medical education through the dissolution of the erstwhile Medical Council of India and the constitution of the National Medical Council as its successor entity. This, along with uniformity in entrance examinations through the National Eligibility & Entrance Test (NEET) is aimed at reforming the way medical education is dispensed and how medical graduates are prepared for a career in medicine.
The fourth and most ambitious has been the new vision document for the health sector as a whole. The Government, last year, released the National Health Policy 2015, for public discussion. This document enshrines the vision and mission of the Government to create a system that is accessible, equitable and affordable to all Indians. It further reiterates the national consensus on the Alma Ata Declaration of 1978 to make ‘health for all’ a reality. The major departure has been a proposal to make health for all a fundamental right.
This marks a new, bold and some would say controversial addition to what the Government has been trying to achieve through the reforms process. A fundamental right is embedded into the Constitution as “basic human freedoms that every Indian citizen has the right to enjoy for proper and harmonious development”. It is, therefore, enforceable and open to reinforcement through laws and appeals in courts of law. Currently, cultural and educational rights are part of the Rights under the Constitution, while many petitions have previously asked for health to be made a fundamental right. Courts have usually been reticent to state their views on the subject, but have entertained appeals on health subjects under the Right to life. A new Right to Health would be a new paradigm for citizens and the state of India.
To see this vision through, the Government would first need to define ‘health’ and ‘health services’ that would be part of the Rights mandate. Further, the provisioning of these ‘services’ as a Right would need to be planned for. Third, the mechanics of its delivery and financial provisioning would need a clear roadmap. Fourth, measures to ensure that the delivery of the basic package of health services under the Right being delivered would need to be created and monitored. last and most crucially, health is a State subject and the delivery of health remains in the hands of State Governments. The provision of basic health services as a Right would therefore need to be cadenced across the country, which would need bipartisan political will and clear definitions of fiduciary responsibilities. The challenge is, therefore, indeed daunting.
As a first step, the Government must make access to health services a reality. The need for universal health coverage through mandatory health insurance is one such step that needs immediate attention and action. This single step would help ensure that all Indians are protected of a health calamity by a financial umbrella that can help provide for treatment costs and related expenditures. Another idea is to provide a health insurance of, say, one lakh rupees, to every child that is born. Since medical treatment, vaccinations and other health costs are free for the first five years, the likelihood of the insurance amount being claimed is low. This will help mandate health insurance coverage for future generations right from the day a new Indian comes into the world.
This generation, with health coverage from birth can lead a new health system where access — financial and of delivery — is available to all Indians.
(The writer is general manager, Operations and Public Affairs, Indraprastha Apollo Hospitals)