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INDIA’S HEALTH CARE SYSTEM: FINAL NAIL IN THE COFFIN

THE HEALTH CARE CRISIS AND ITS EFFECT ON RIGHT TO LIFE

ABSTRACT

“Healthcare Infra AT The Stage Of Imminent Collapse”: Delhi High Court Directs Govt. To State Beds, Oxygen Availability On Affidavit
India along side many countries faced corona but the immense negligence of the authorities towards right to life remained apologetic. This is the state in which people lived their lives and died due to avoidable circumstances as the healthcare infrastructure and facilities in the country were too weak to handle the burden.

When the pandemic hit it only showed the on-ground reality of our underfunded and overburdened healthcare system. Whose responsibility is it to give the people of this nation a healthcare system which can triumph the standing obstacles in times? The laws must be understood for the implementation of right procedural establishment of sound and working healthcare facilities.

KEYWORDS
Health care system, right to life, Pandemic, State, Centre

Introduction

India is facing a pandemic and the only thing which is going to help this country is a sound and well-functioning healthcare infrastructure. Since independence India has grown immensely but the importance to its healthcare remained astonishingly minimal. The rural parts of the country face a crisis due to immense shortage of medical help which cause death and that to because of avoidable causes. Article 21 gives right to every citizen the right to life, and it includes right to have a proper healthcare.

But then too it is something which is neglected at par. Countries like U.S. and Switzerland spends around 16 and 12 % of its GDP on healthcare whereas India with a much larger population spends only around1% of its GDP on health care. Thus, the situation of our Health care deteriorates.
“Right to health is a fundamental right guaranteed under Article 21 of the Constitution of India. Right to Health includes affordable treatment. Therefore, it is the duty upon the State to make provisions for affordable treatment,” the court said.

A three-judge bench of Justices Ashok Bhushan, R Subhash Reddy and MR Shah had taken up the issue of healthcare during the time of the pandemic on its own and also looked at instances where bodies of coronavirus casualties were not handled with dignity.
The government should work on the directions given by the courts of the country and ensure affordable and accessible health care for each member of the society.

The budget should consider enough funding for the healthcare and the officials should take proper inspection of the on-ground reality of facilities. The rapid response team should be made in order to provide quick medical assistance in the rural part of the country.

In this research paper the main motive is to look at the cases that the court took via Suo motto cognizance and the lapses which are founded in the system. Inspecting the reality of on ground healthcare facility and their funding. The hoarding up of medical supply and selling it to the market which are supposed to go for the public for free. All these issues which make the healthcare of this country weak and unresponsive. And the methods by which the situation can be handled and at the same time improved. We will also discuss and compare different states and countries as how they treat their healthcare system. It further illustrates why the government should focus on improving the current situation of healthcare and how it would be catastrophic if it will not.

Research Methodology

The descriptive analysis of cases with different research papers and articles with quantitative data base analysis provide understanding of the legal provisions and laws which ensures society’s wellbeing and the implementation of those by the courts and administration. The data collected is from various articles, annual reports, books, journals from government and non-government publications.

Review of Literature

Article 21 of the Indian Constitution, right to life not expressly but does includes feasible and accessible health care for everybody. Thus, it is an obligation of the government to provide health care for its citizen. OECD countries the full form of which is org. for economic cooperation and development. This organisation works towards creating enhanced policies as to increase the standards of living. It is estimated that the average of the OECD countries expenditure from their GDP on health care is around 8.8% as per 2018 which is unchanged from 2013. The most amount which is spent on the healthcare is from countries like the U.S which spends almost around 16.9% of its GDP on Healthcare. This amount is far preceding to the next country which spent on healthcare that is Switzerland. It spends around 12.2% of its GDP. Whereas India spends around 1.29% of its GDP which is considerably lower than most of the countries. This is a clear reason for the situation but what really cause the framework of our healthcare to be hollow is that it lags a framework which is statutory, and which guarantees right to health as a fundamental right. What can really help India is the theory of human rights principles of solidarity, proportionality, and transparency in a framework. Implementation of the rights with regard to health in India’s framework of co-operative federalism will build capacities where they are most needed – at the grassroots. The constitution indirectly expresses the right to health via article 21 and DPSPs in part IV of the constitution: Article 39 (e) which direct the state to secure health of workers and Article 42 which direct the state to provide just and humane condition for works to work, Article 47 which instruct the state to better the nutrition and living standards of people. The obligation is on municipalities and panchayats too via Article 243G (read with 11th schedule, Entry 23) to make sure that health care facility can be provided. Healthcare is the responsibility of the state as per the constitution of India rather than the central government. Thus, the states are dependent for raising the nutrition levels and standard of living for its citizens. It is also responsible for a better public health infrastructure. Even then the private health care plays the leading role when it comes to health care. Most of the expenses thus comes out of the pockets of the patient who also does pay tax to get public healthcare. These dual expenses take a toll on affordable healthcare in India. We can see that different states in the country performs drastically different in providing healthcare to its people.

As we can see that Kerala is among the top performer and Uttar Pradesh equally performs worse through this quantitative analysis prepared by the World Bank and Niti Aayog. Kerala achieved the status through different approaches which ranged from decentralizing to community engagement. It has a history of health focused policies and with that it emphasised majorly on a system which consist of primary or public health care, which is also known as PHC, infrastructure of health facilities, etc. Community participation and a willingness to improve systems in response to identified gaps also helped in preparing a woke system among the general public.

The trust was eroding for the public health care sector in 1996 when the Kerala government decided to decentralise. Through the people’s campaign for decentralization planning movement which relinquished a significant amount of power from the state. In the new budget the local government let go of 35-40% of the state budget which emphasized on improving care and access for all sections of society and at the level of panchayat, blocks, and district level sub-primary health care centres were established which gave access for public healthcare to the whole state.

This model is an excellent example how the states should enhance its public health care sector but states need help of the centre as the budget allocation does not fulfil the entire demand of the states. Because of which the 14th finance commission has recommended that the state and centre should work hand in hand and that a greater share must be allocated to the states. The Indian state spends just 1% of its GDP on health (Ministry of Health and Family Welfare), of which 80% is collected through states and spent on states. This gives only 20% of the leftover for the centre to deal with.

The strategy which is at play is called ‘cooperative federalism’ which can be wonderful and work for states like Kerala but in spite that most of the states are lacking in their duties. The states have underperformed and are chronically deteriorating as we speak plagued by poor quality and corruption.

Now that the time of pandemic has struck the healthcare shave seen increased investment by the state but as we say this these are not enough to put together the collapsing system. Not only budgetary but also administrative reforms are a need of the hour.
There has been a surge in life expectancy over the past decade, but improvement of healthcare system cannot be directly linked to the healthcare in accordance with the spending.

In all this chaos the courts have said that there is no legislature that can be found with respect to safeguard the right to health in Delhi. For this situation to be dealt Supreme Court must take Suo motto cognizance of the matter to interpret the ambit of the right. In this the court dealt with two important issues which are economic aspect where the court inspect the costing of COVID19 testing and an administrative one. In which the court underlined the failure of the state government for the implementation of the guidelines about patient’s care, hospital management and infrastructure. in this case the court not only delt with the failure due to budget but also administrative failure. The court then made sure that the committee which include doctors to have power to give direction with regards to covid protocol and taking care of COVID-19 patients.

With this extension of power to the committee the court has given administrative power to the committee to fill the gaps of the existing system. This jurisprudence is a result of a case which can be dated back to 1988. Where in the case of Rakesh Chandra Narayan the supreme court held that the government has the obligation to provide medical assistance to every citizen of the country. This case was the first case in which the judiciary merged non- justiciable Directive Principles of the state policy with justiciable Fundamental rights. In this case petition was filed as a under Article 32 of the Indian constitution about depleting health condition in a mental hospital in Ranchi.

The entire medical system of Uttar Pradesh in smaller cities and villages is ‘Ram Bharose’ (at God’s mercy), the Allahabad High Court said on Monday as it took note of a case of egregious medical negligence at a government hospital in Meerut.

These statement makes it clear that the states are in dire need of a proper framework which will ensure its citizen to have right to health. When the country’s capital is facing such a crisis it would be laughable to presume that the smaller cities are in any good condition. Reports of hospitals facilities being inhabitable and staff less hospital are common. All of this show the carefree attitude of the government toward the healthcare. Hospitals have shortage of oxygen and ICU beds which must be imported during this pandemic also show the lack of necessities in the hospitals.

Cases
If we must decipher one of the fundamental rights which is Right to life under Article 21 of the Constitution it basically melts down to the fundamental that the presence of mere human life is not enough but the right to live with dignity is as equivalent. Hon’ble Supreme Court while discussing the case of Parmanand Katara stated that one who is revealed into the calling of clinical has the responsibility in order to provide health care services. Further if we put a glance on the case of Spring Meadow Hospital we can understand the courts decision which stated that the need for law which will strengthen the right to health is a necessity. With that the regulation on transplantation market helped right to health as well. These cases dealt with the framework of law making to strengthen the system of healthcare.

Now let’s look at the case of Bandhua Mukti Morcha v. Association of India in which the court stated that even though the DPSPs are only of influential worth doesn’t mean that they must not be properly used by the states. It was because of this judgement that the court could decipher the poise and health inside the ambit of the article 21 of the Indian constitution which is Right to life.

In another case of Consumer Education and Research Centre v. Association of India the court stated explicitly that the right to health is a fundamental factor which is inherited in the part III of the constitution Article 21 right to life.

For the case of Ram Lubhaya, the court while capturing the issue of right to health alongside Article 21, 41 and 47 of the Indian constitution stated that the association of these rights are such that they are obligated to one another. Which meant that when Article 21 oblige the state Article 47 further strengthens the obligation for right to health. Even if there are a few schools which are installed by the administration however the obligation is not fulfilled unless they can be facilitated to all the population the court also stated that health is utmost important and holy.
Now in the case of Paschim Banga Khet Mazdoor Samity, the extension of Article 21 was done. The court in its judgement held that the responsibility of legislature is that it should provide sufficient clinical guidance to everyone. With that through Article 21 it made sure that the right of everyone is ensured by the state. For another instance, the supreme court stated that health is one of the central right and it can not be limited to the nonattendance of ailment or affliction.

Also, in the case of T. Ramakrishna Rao case the high court said that the the conditions that is the environment are the responsibility of residents and state. And Article 21 thus include the security and conservation of earth as we can understand that as the environment sees a deterioration it will be a moderate but sure demise and thus it is an infringement of article 21 of the Indian constitution. And further in the instance of Ratlam Municipal Corporation the court took up Article47 of the Indian constitution which obligates the state to keep everyday environment to be health and take action against any body which tends to default at keeping the environment in the preferred condition.

The Supreme Court, in Paschim Banga Khet mazdoor Samity and ors v. The State of West Bengal and Ors, while stating Article 21 and broadening it extended the administration’s obligation which includes giving guidance to each person in the country. The administration has to provide clinical satisfaction to individuals. This obligation of the administration can be fulfilled consideration of those people who are trying to profit from those offices. There is an obligation which is on the administration put through Article 21 which forces the state to defend the right to life of everyone. The central significance should be given to the protection of human life. The clinics which are administratively run by state are compelled by an obligation to provide clinical help to save human life. In case of failure to provide medical support by the administrative emergency clinic will be considered as an infringement of right under Article 21.

now at the end one of the landmark judgement In CESC Ltd. versus Subash Chandra Bose, by the supreme court states that when international instruments are reasoned it is found that right to health is one of the most important rights there are. This observation took it further and stated that not only nonattendance of ailment is not just health. The clinics are a investment or saving of government which helps in time of need and thus it must not be lessened to a level that its of no use. However, there is not adequate result from the government from this area.

Conclusion

Through this deep analysis of the Indian healthcare system, we can understand that it is of utmost importance that the right to health must be explicitly provided as a fundamental right. The two aspects which are economic as well as administrative implementation must be guided through a substantive framework under a committee. The need for strong and standing healthcare will bear fruits at times like now when pandemic hit the very core of the societal existence. The COVID19 experience has also demonstrated the importance of a decentralized/polycentric response – India’s co-operative federalism, therefore, must be strengthened. The centre must step up its contribution for the country in health care with proper funding and administrative help to those in need. Health is a priority, and the findings should also show the commitment to fulfil the priorities. Comparison between countries must also be taken as a quantitative goal to reach. Public sector healthcare sector should have its reach till the very stand of society and for that the policies are to be made and followed by both the state and individual.

AUTHOR:

Ayush Chaudhary