The Supreme Court has repeatedly interpreted Article 21 to include the Right to Health, yet India spends only 2% of GDP on health as per the Economic Survey 2023–24, among the lowest in the world igniting the debate on making the Right to Health enforceable.
Constitutional & legal Basis for the Right to Health:
1. Article 21: Right to life includes timely access to healthcare (Paschim Banga Khet Mazdoor Samity case, 1996).
2. DPSPs: Articles 38, 39(e)(f), 41, 42, 47 mandate raising nutrition, improving public health.
3. Judicial interventions: Parmanand Katara vs Union of India: doctors must provide emergency care in critical situations.
4. International commitments: UDHR (Art. 25), ICESCR (Art. 12).
Issues Constraining Realisation of the Right to Health:
- Chronic Underfunding: India’s public health expenditure remains less than 2% of GDP. High reliance on out-of-pocket expenditure (48% of total health spending) continues while Weak primary healthcare infrastructure limits universality.
- Over-commercialisation: PPP expansion and corporate hospitals shifting healthcare into a market model leading to high, unregulated pricing which violate patient rights.
- As per NSSO data, 70% of urban hospitalisations occur in private sector with significantly higher costs.
- Inequitable Access: Marginalised groups and women face discrimination in terms of access, treatment, and health outcomes. For e.g., as per NFHS-5, Women’s anaemia rates at 57%, tribal IMR 30% higher than general population.
- Inadequate Health Workforce: India faces a shortage of 6 lakh doctors and 20 lakh nurses as per WHO norms while Contractualization, low wages, lack of social security worsen morale.
- Limited social Protection: Schemes like Ayushman Bharat cover hospitalisation but not preventive health and social determinants of health. E.g., OPD and medicines constitute 65–70% of household health expenses, areas where insurance gives no relief.
Roadmap to Operationalise the Right to Health:
- Enact a National Right to Health Act: On the lines of Rajasthan’s Right to Health Act, define enforceable entitlements: emergency care, essential drugs, diagnostics. Create grievance redressal authorities and patient rights charter compliance.
- Strengthen Public Health Financing: Increase public expenditure to 2.5% of GDP by 2025 as per National Health Policy target.
- Build Robust Primary Healthcare Infrastructure:
- Scale up Health & Wellness Centres to provide preventive and promotive services.
- Deploy community health workers & digital health tools. For e.g., Kerala’s family health centres model offers 24×7 comprehensive care.
- Regulate Private Healthcare: Mandate transparent pricing, standard treatment guidelines, and audit mechanisms. For e.g., SC in Indian Medical Association v. V.P. Shantha classifies healthcare as a “service” under Consumer Protection Act.
- Ensure Equitable Access: Introduce targeted schemes for marginalised persons through community-led monitoring and participatory governance. For e.g., Maharashtra’s Community-Based Monitoring under NHM improved accountability.
- Secure Health Workforce Rights: Standardise wages, ensure job security, strengthen occupational safety and expand training institutions and fill sanctioned posts.
Conclusion:
Realising the Right to Health requires shifting from a market-driven, insurance-dominated model to a publicly funded, equity-centred health system. There is a need to transform health care from a privilege into an enforceable right for all Indians.
‘+1’ Value Addition:
- Out-of-pocket expenditure (OOPE) at 48% of total health expenditure pushes 55 million Indians into poverty annually as per Lancet, 2023.
- 80% of outpatient care and 60% of inpatient care is provided by the private sector.
- Doctor-population ratio is at 1:1,511, far below WHO norm of 1: 1,000.
- World Bank estimates every $1 invested in health yields $3–4 in economic returns through productivity gains.
- “Health is not merely the absence of disease, but the ability to lead a socially and economically productive life.” – Dr. Halfdan Mahler, former WHO DG.
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