Dr Arun Mitra
Health is the basic human right. Every person has the right to live a healthy life and contribute effectively to the society’s development. As right to health is included in the directive principles, it becomes the duty of state to provide comprehensive universal healthcare to all citizens. It has to ensure prevention of disease, promotion of good health and rehabilitation of the diseased and the infirm.
Nutrition is the key to health. A poorly nourished person is more likely to be taken ill. Therefore prerequisites for a healthy life are safe drinking water, proper sewerage facilities, balanced nourished food with sufficient calories and other nutrients, proper housing and healthy environmental surroundings. There is need for special care for women, children and the elderly. Unfortunately we are far from meeting these requirements. Our hunger index is 103 out of 118 countries. This is a serious matter. How do we expect children with stunted growth to build a healthy developed nation?
Various studies have concluded that to ensure comprehensive primary healthcare there is need to enhance public health spending on health to minimum of 5 per cent of the GDP. As per the National Health Accounts (NHA) Estimate for 2014-15, the Government Health Expenditure (GHE) per person per year is just Rs.1108/-. This is in contrast to the Out of Pocket Expenditure (OPE) of Rs.2394/- which comes out to be 63 per cent of total health expenditure which is Rs.3286/- per person. Even this expenditure is not homogenous. The spending on health varies on socio-economic status, gender, religion, caste and geography.
The average share of OPE on health care as a proportion of total household monthly per capita expenditure was 6.9 per cent in rural area and 5.5 per cent in urban area. This led to an increasing number of households facing catastrophic expenditure due to health costs. More than 40 per cent of the population has to borrow or sell assets for treatment. This is totally against the principles of equity and justice. Already marginalised sections, Dalits, Muslims and other socio-economically weaker groups are worst affected.
Flaws in planning and implementation of the policies have been pointed out by the Comptroller and Auditor General of India (CAG) in 2017. The audit pointed towards inadequate funding, under-spending of available financial resources, delays in transfer of funds, diversion of allocated programme funds, limited capacity to spend due to shortages in infrastructure and human resources among other issues.
The recently launched National Health Protection Scheme (NHPS) aims to cover almost half the population with publicly funded health insurance. The private health insurance companies and health care providers are already expecting huge dividends from NHPS. There is also proposal for Health and Wellness Centres (HWC) to deliver preventive, promotive, curative and rehabilitative services. With a low financial allocation this will not take up. There is shift from public provisioning of health towards privatisation.
To improve the health of the people drastic steps need to be taken at various levels. Health should be declared a fundamental rights irrespective of religion, age, sex, cast and socio economic status. The government owes its responsibility to deliver health to all by ensuring universal access to quality healthcare, education and other day to day needs. For this they should be continuous evaluation of health status of the people. Health should get proper place in the political agenda and the policy making bodies.
Certain steps that need urgent action is the rationalization of drug prices. Regulate drug prices in line with the rationalization of trade margins in medical devices. The ex-factory cost of the drugs should be actual cost based. Cap trade margin on drugs and medical devices to a maximum of 30 per cent.
Provide free medicines and investigations in all public hospitals on the lines of Tamil Nadu, Kerala and Rajasthan. Pledge to increase the public expenditure on healthcare from 1.1 per cent to 2.5 per cent of GDP immediately and then increase it to 5 per cent in subsequent five years.
Medical education has to be revamped and within approach of all sections. Regulate tuition fees of 100 per cent seats in private medical colleges.
The Constitution guarantees six fundamental rights to Indian citizens as follows: (i) right to equality, (ii) right to freedom, (iii) right against exploitation, (iv) right to freedom of religion, (v) cultural and educational rights, and (vi) right to constitutional remedies.
Fundamental Rights are justiciable, as they can be enforced, whereas the directive principles are non-justiciable, in that, they are not enforceable in the court of law. It is high time the health is included as one of the fundamental rights. (IPA Service)