RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

“HOW COVID-19 LOCKDOWN HAS RAISED PUBLIC HEALTH ISSUES IN

INDIA”

Submitted by:

Aakash Batra

(Intern at MARG)

(Symbiosis Law School, Pune)

 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

INTRODUCTION

It is well known fact that the public healthcare system in India is not developed enough to deal
with a pandemic such as the one in the present scenario. COVID-19 outbreak has raised several
concerns and issues concerning public health like the need for adopting preventing measures and
hygienic lifestyle, need for restructuring the public healthcare system etc. The pandemic of
COVID-19 has engulfed the entire world and has posed serious challenges for the health and
economic security of millions of people worldwide. In India too, the spread of coronavirus has
been alarming and is posing severe health and economic ramifications for our country. A disease
which has a high infection rate that produces mostly mild symptoms and a mortality rate lower
than the common flu is not a non-issue, but it’s not a cause for the levels of panic and paranoia
that we’re witnessing around the world, including in India. The obvious issue is that a disease
with high infection rates requiring people with even mild symptoms to seek medical help will be
a huge burden on the public health system. There has been a mass exodus of migrant workers
and concerns are rising about starvation among people who work in the informal economy.
Implementing public health measures is difficult in places with overcrowded living conditions
and inadequate hygiene and sanitation.

RIGHT TO HEALTH

Though the Indian Constitution has not included the right to health care as a constitutional right,
the Supreme Court in its judgments has interpreted Article 21 (Fundamental right to life) and
Article 47 of the Directive Principles (which mentions improving health of the citizens as
one of the duties of the government) to mean the right to life as right to life with dignity,
including access to basic health care as a right. 1 But all these declarations and judgments have
not been taken up seriously either by the state officials nor by the civil society actor.2  Further, it
has also been held that the right to health is integral to the right to life and the government has a
constitutional obligation to provide health facilities.

1
Anant Phadke, Right to Health Care: Towards an Agenda, Economic and Political Weekly, Vol. 38, No. 41 (Oct.
11-17, 2003), pp. 4308
2
State of Punjab v. Mohinder Singh Chawla (1997) 2 SCC 83.
 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

Failure of a government hospital to provide a patient timely medical treatment results in violation
of the patient’s right to life. Similarly, the Court has upheld the state’s obligation to maintain
health services.3

CRITICAL ANALYSIS

The proportion of central government's expenditure on health care as proportion of GDP,

reduced from 1.3 per cent to 0.9 per cent during 1990 to 1999, while the WHO recom-
mendation has been 5 percent! Maharashtra government's health expenditure too has declined
from 1 per cent to 0.6 per cent of State Domestic Product. during 1985-86 to 2002-03. The
Indian health care system is the most privatised in the world, with 83 per cent of health care
expenses being borne privately, mostly out-of-pocket, compared to 6 per cent in UK and 56 per
cent in the US. No wonder, that even those 20 per cent of patients who seek medical care in the
public health facilities are increasing getting less and less quality care there. With private health
care being ex- pensive and often exploitative, people are finding it more and more difficult to
financially core up with illness-episodes. Studies have shown that 40 per cent of patients
admitted in hospitals have to take loans or sell precious belongings to pay for medical expenses.
Given this further worsening, it is no wonder that ordinary people and activists strongly feel that
"something needs to be done”.

International Covenant on Economic, Social and Cultural Rights (1966) further state in Article
12 that the States recognize the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health, and the steps to be taken to achieve the full realization of
this right include those necessary for:

 The provision for the reduction of the stillbirth-rate and of infant mortality and for the
healthy development of the child,

 The improvement of all aspects of environmental and industrial hygiene,

 The prevention, treatment and control of epidemic, endemic, occupational and other
diseases; and

3
State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117
 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

 The creation of conditions which assure to all medical service and medical attention in
the event of sickness.4

SUGGESTIONS

50 per cent, of all sickness is preventable, and it is the duty of the State to guard the health of its
citizens through the prevention of disease. The people should be made to understand that the
State is culpable if its citizens are allowed to become ill through manifest neglect. It is probable
that such an understanding by the people would result in greater good through new legislation
than all the work and all the sacrifices of the medical profession who have secured the present
laws. In the great work of the future, hospitals must play an important part. They are necessary to
group medicine and they must be adequately equipped and properly conducted. When the people
as a whole once understand that they have a right to health.

We need to identify the gaps in public services, and these gaps need to be plugged rather than
experimenting with costly tertiary care medical insurance purchased by the govt. and services
mainly bought from the private corporate hospitals. Hard political choices need to be made now.
A concerted effort by academia and civil society should be launched to engage with union and
state governments. A comprehensive public health law incorporating the right to health should be
passed by the Parliament. The right to health cannot be guaranteed in isolation; already right to
education, right to livelihood, food security, and right to information exist on the statute.
Addition of right to health will make the entitlements of Indian citizen more complete as was
envisaged by our forefathers while preparing Indian constitution.

COVID-19 AND HEALTHCARE ISSUES

COVID-19 has shown the urgent need for stringent measures to be taken for implementing the
right to health for citizens everywhere and for restructuring the healthcare system. WHO’s
response to the COVID-19 pandemic requires collaboration between experts in several
departments and teams. From supportive health financing initiatives to a globalized research
network, a coordinated effort is essential to limit the scope and impact of the disease.

HEALTH SYSTEM GOVERNANCE AND FINANCING COVID-19

4
United Nations. International Covenant on Economic, Social and Cultural Rights. [Last accessed on 2nd May 2020].
Available from: http://www.ohchr.org/Documents/ProfessionalInterest/cescr.pdf .
 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

Strengthening frontline services for pandemic response, the current priority for governments
given the COVID-19 virus outbreak, requires supportive health financing policies. WHO’s
guidance on health financing policy is ultimately focused on strengthening health system
resilience, health security and universal health coverage (UHC). Our thinking focuses on raising
adequate revenues for health systems, organizing those revenues in order to maximize risk-
sharing across the entire population, and spending those funds in the best way to improve the
health of all citizens of a country. Public financial management is a cross-cutting theme across
these core functions. Short-term measures in response to COVID-19 must be carefully
streamlined, and WHO is heavily involved with colleagues to provide comprehensive guidance
to countries on the types of actions and adjustments needed to support the response.

ANALYSIS

Universal coverage is being increasingly considered as the holy grail of health policy worldwide,
and is regarded as the ultimate goal for health systems aiming at equity and promoting
responsiveness. Universal health coverage (UHC), with its roots dating back to the 'Health for
All' declaration of Alma-Ata way back in 1978, repositions health as a basic, undeniable human
right - an entitlement which is obligatory for the state to provide to all citizens irrespective of
income, social groups, localities or social class. In India, the health policy discourse in recent
years have also veered towards the notions of universal coverage; the draft 12th Plan document
on health devotes a fair length to emphasize the virtues of universal coverage, drawing on
comparative international experiences, and puts forward the recommendations of a High-Level
Expert Group constituted by the Planning Commission to review and suggest the modalities of
moving towards universal coverage (Planning Commission 2013). It is thus, natural that health
policy and systems research in India is waking up to assess performances and impact of health
programmes and interventions viewed with the UHC lens. However, comprehensive reviews of
the roadmap towards universal coverage have been rare.

The COVID-19 pandemic has brought into sharp focus the need for health care reforms that
promote universal access to affordable care. Healthcare leaders face a multifaceted challenge:
combating the healthcare crisis on the frontlines while also tackling similar issues as other
industries, such as employee safety and economic challenges.
 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

RAPID CHANGE REQUIRED

Most healthcare leaders have already assembled high-functioning teams to respond to the
immediate crisis resolving to manage the immediate need to care for the surge of COVID-19
patients. They also have demonstrated the resilience required to deal with fast-moving liquidity,
solvency, and economic sustainability challenges. Given the urgency and the rapidly evolving
scenario, we need to first and foremost ensure that a steady supply of essential inputs is available
beyond metros and Tier-I cities. This includes testing kits, personal protective equipment (PPE),
drugs, and adequate health infrastructure, such as hospitals, with necessary treatment facilities
and quarantine facilities. We need to do much more testing, better contact tracing, and ensure
quarantine measures are followed, especially in hotspots and high-risk clusters.

ANALYSIS OF PUBLIC HEALTH IN INDIAN SCENARIO

India must also pay much greater attention to the health sector and recognize the importance of
having strong public sector capacity, especially in primary care and at the district level. India's
public health-care system is chronically underfunded (at just 1·28% of GDP), leaving primary
care weak. This pandemic could be the much needed wake-up call to the necessity of long-term
changes to India's health system. Public health measures include personal protective measures
(hand hygiene, respiratory etiquette), environmental measures, physical distancing measures, and
travel-related measures. Physical distancing measures apply to individuals (e.g. isolation of cases
and quarantine of contacts) or to communities, specific segments of the population, or to the
population as whole. These measures are not mutually exclusive. Individual measures,
including medical masks for symptomatic people, isolation and treatment of ill individuals, and
hygiene measures (hand hygiene, respiratory etiquette) should be sustained.

What India can learn from such a scenario is that it needs to make sure that sufficient public
health workforce and health system capacities are in place to enable the major shift from
detecting and treating mainly serious cases to detecting and isolating all cases, irrespective of
severity. Ensure that systems are in place to identify and break chains of transmission through
detecting, testing, isolating, and treating all cases. A sufficient and trained workforce needs to be
in place to find cases, test cases, and care for cases in medical facilities. The health workforce
and hospital capacity will need to be assessed, and possibly enhanced and in place to care for any
 RIGHT TO HEALTH AND ANALYSIS OF PUBLIC HEALTH ISSUES IN INDIA

resurgence in cases. The health workforce should be trained and provided with appropriate
personal protective equipment.

The major issues which are raised and have to be taken care of after the COVID-19 lockdown
are as follows –

1. Is the public health system able to identify, isolate, and care for cases and
quarantine contacts?
2. Is the public health system able to rapidly detect a resurgence of cases?
3. Is the health care system able to absorb an extra patient load and provide medical
care in case of resurgence?

These issues need to be taken care of, for fighting back the pandemic in an effective and efficient
manner as there are no vaccines available yet and it is very difficult to build up herd immunity
without a vaccine.

A few indicators which can be used to understand the public health issues are as follows –

1. Confirmed and probable COVID-19 cases

2. Rate of hospitalizations and ICU admissions
3. Number of deaths; percent positive among people tested
4. Health system (hospital and non-hospital) functions and capacity (admissions and
discharges)
5. Health care workers
6. ICU and non-ICU bed capacity
7. Stocks of personal protective equipment
8. Public health capacities: rate of identification and testing of new suspected cases,
isolation of new confirmed cases, identification and quarantine of contacts, number of
public health rapid response teams to investigate suspect cases and clusters