“The future beckons to us. Whither do we go and what shall be our endeavour? To bring freedom and opportunity to the common man, to the peasants and workers of India; to fight and end poverty and ignorance and disease.” - Nehru Tryst w/ destiny
The ideals of socialism and the idea to provide equally to all were the basis of the foundation of this very nation, prior our experiences with the British exposed us to gross inequality therefore we changed the very essence of British rule to make every human irrespective of any parameter ‘equal’.
Hence our constitution is filled with Articles that encourage equality
Article 38 of Indian Constitution impose liability on State that states will secure a social order for the promotion of welfare of the people but without public health we cannot achieve it. It means without public health welfare of people is impossible.
Article 39(e) related with workers to protect their health.
Article 41 imposed duty on State to public assistance basically for those who are sick and disable.
Article 42 makes provision to protect the health of infant and mother by maternity benefit.
In the India the Directive Principle of State Policy under the Article 47 considers it the primary duty of the state to improve public health, securing of justice, human condition of works, extension of sickness, old age, disablement and maternity benefits and also contemplated. Further, State’s duty includes prohibition of consumption of intoxicating drinking and drugs are injurious to health.
Article 48A ensures that State shall Endeavour to protect and impose the pollution free environment for good health.
Article 47 makes improvement of public health a primary duty of State. Hence, the court should enforce this duty against a defaulting authority on pain of penalty prescribe by law, regardless of the financial resources of such authority.
The DPSP are only the directives to the State. These are non-justifiable. No person can claim for non-fulfilling these directives. But the Supreme Court has brought the right to health under the preview of Article 21. The scope of this provision is very wide. It prescribes for the right of life and personal liberty. The concept of personal liberty comprehended many rights, related to indirectly to life or liberty of a person. And now a person can claim his right of health. Thus, the right to health, along with numerous other civil, political and economic rights, is afforded protection under the Indian Constitution.
In 1995, the Supreme Court held that right to health and medical care is a fundamental right covered by Article 21 since health is essential for making the life of workmen meaningful and purposeful and compatible with personal dignity. The state has an obligation under Article 21 to safeguard the right to life of every person, preservation of human life being of paramount importance.
Even after these big words as a part of our constitution we are lacking every basic necessity rather the unit to cure the sick is itself a ‘sick’ industry.
In the midst of so many health issues in our country the government has done almost nothing to solve these problems. The problem of rural-urban divide, accessibility and affordability continues to haunt this nation. Health is the most important factor for a population. According to the World Bank India loses 6% GDP each year due to preventive illness and death and yet our government is only investing a mere 1.2% of our GDP into healthcare whereas the US spends 19% and the difference clearly shows.
Oxfam reports clearly show us the pitiful state of the Indian healthcare where 60% do not even have basic access to necessary medical facilities. Health insurance is an alien term to most of the Indian population and only 17% are covered by it.
With this idea in mind our healthcare is outsourced 80% to the private players and our rural population is 72% with this any common man can think of problems arising such as accessibility, affordability etc. Our government has not solved the issue but given us another potential businessman to charge money for their responsibility.
This can be seen by their mantra of needing to contain the fiscal deficit was invoked to slash committed funds to the health sector by 20% towards the end of 2014. The Union budget of 2015-'16 was equally harsh, and effected a 5.7% cut in total allocation to the health sector – down from Rs.35,163 crores in 2014-15 to Rs.33,152 crores.
Simultaneously, allocation for the flagship Integrated Child Development Scheme to the Ministry of Women and Child Development was halved, from around Rs.16,000 crores to a meagre Rs.8,000 crores.
Also slashed was the budget for Human Immunodeficiency Virus infection and Acquired Immune Deficiency syndrome, or HIV/AIDS, with the National Aids Control Organisation’s budget plummeting from Rs1,785 crores to Rs1,395 crores.18.8% of sanctioned posts for specialists in rural public facilities had been filled. Infrastructure creation through the National Rural Health Mission is also slowing down and only 288 new Primary Health Centres and 33 new Community Health Centres were set up in 2014-2015 against 572 and 176 respectively in the corresponding period in 2013-2014. 70% out of pocket spending by the patient.
These private players perform operations as if only to earn profit not as their duty to serve being a part of the healthcare and making the process expensive is part of the directions given to them. In private hospitals for instance caesarean deliveries are 30% more than government hospitals. Each doctor for them is a profit making entity, they must make a certain ratio of profit.
The whole concept of Corporate hospitals has removed affordability to poor and their turnover is ecstatic. For example Apollo Hospitals recorded a 3.2 million dollar turnover back in 1988 their first year of inception.
The various studies conducted have revealed that households spend a substantial amount on health care and the poorer class spends more on health care in terms of their proportion to consumption expenditure and income. A study conducted in two backward districts of Madhya Pradesh, in 1991 showed that the per capita expenditure incurred by the household on health worked is approximately $ 9 per year with 74% of the expenditure going into doctors fees and medicines. Household health expenditure works out to 8.4%. The upper class spends only 4% of their consumption expenditure, while the lowest and lower middle classes spend as much as 8% and 10% respectively on health care. A study in rural Kerala in 1987 found that the per capita cost per year incurred by the household on health was $ 5. The percentage of the reported income spent on health was found to be around 7%. Comparing it across class it found that the lowest class spends as high as 14% of their income on health as compared to the highest class which spent only 4.4% s.
Findings from various studies make it evident that a substantial financial burden of the household is borne for meeting health care needs. Compared to government expenditure on health the private household expenditure is nearly 4 to 5 times more. A substantial portion of their income and consumption expenditure is spent on health. This certainly is not a happy state of affairs, since such expenditure on health care would mean cutting down on the household food consumption. This gains significance when we realize that nearly half of the country's population does not have enough resources to meet their food requirements, and worse still the capacity to earn if the patient happens to be the sole earning member. Given this socio economic situation in the country the purchasing power becomes a crucial factor. As we have seen above the accessibility of the public health service is poor especially in rural areas of the country. The private health sector becomes unaffordable for the vast majority of the poor. There is impoverishment of the lower class or middle class due to illness which could be of a chronic nature or that involving hospitalization or surgery. The high cost of health care makes the poor more marginalised. There is a need to question the dominant role of the private health sector and the consequently high health care expenditure.
The government has not been able to get laws to make the private sector accountable only recently have they been made a part of the Consumer Protection Act that too is only implemented to a certain extent in Delhi, Bombay and Madras.
The idea of money making has seeped into our medical institutions as well where privatisation of medical education has erased the uniformity in the syllabus. Further even if we agree that there are not enough colleges for our students which holds true as India has only 398 medical colleges for a population of 1.2 billion with only 22,000 post graduate seats but still the government has failed in quality control. Teachers in these institutions are mostly proxy and a student pays 10-30 lakhs on an average due to which he obviously wants a job in the private sector to remake the amount spent.
An area which was to be protected by the government today has become a money making racquet where at the expense of our health money is being made by the private players. In 2012 the issue of medication was taken up by a Parliamentary Panel of the Rajya Sabha that in its report mentioned the problem of dumping of foreign medicine. There is a lot of corruption but what everyone needs to realise that healthcare is the most essential needs that a government must fulfil in a democracy. It is time this actually happens.
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