Charting an Agenda on the Right to Health

LINK: https://www.thehindu.com/opinion/op-ed/charting-an-agenda-on-the-right-to-health/article70377433.ece

Why in the News?

• Recently, the National Convention on Health Rights (NCHR) was convened in New Delhi, timed between Human Rights Day (December 10) and Universal Health Coverage Day (December 12).
• Organized by Jan Swasthya Abhiyan (JSA), the gathering offered a significant platform for health professionals, community leaders, and activists to address India’s major health challenges and chart an agenda on the right to health.
• The convention focused on drawing lessons from the COVID-19 crisis, strengthening right to health initiatives, and presenting alternatives to the commercialisation of health care.

Background and Context

• The convention was organised by Jan Swasthya Abhiyan (People’s Health Movement – India), a network comprising diverse civil society organisations from over 20 States.
• The gathering brought together around 400 health professionals, community leaders, and health activists.
• A key message of the convention remains clear: health care for people, not for profits, affirming that health must be a basic human right.
• This year marks the 25th anniversary of Jan Swasthya Abhiyan (JSA).

Major Themes and Issues to be Addressed

Addressing Privatisation and Public Systems

• Challenge of Privatisation: A major issue addressed is the push for privatisation of public health services, where public–private partnerships are leading to the handover of medical colleges and health facilities to private players across India.
  • This process threatens to dismantle already weakened public services and render health care unaffordable for the crores of Indians who rely on public health-care provisioning.
• Critique and Strategy: Leaders from movements against privatization in various states, including Andhra Pradesh, Karnataka, Mumbai, Madhya Pradesh, and tribal districts of Gujarat, were to share insights and strategies critiquing the impacts of privatization on health systems.

Regulating Commercial Private Health Care

• Unregulated Commercial Boom: Commercial private health care has rapidly expanded, fueled by domestic and foreign investments and pro-corporate policies, but this boom has not been matched by necessary regulation.
• Failure of Clinical Establishments Act: The Clinical Establishments (Registration and Regulation) Act, enacted in 2010, remains only nominally implemented.
• Consequences for Patients: This regulatory lapse leads to frequent overcharging, unnecessary medical procedures (such as caesarean sections), opaque pricing, and violations of patient rights.
• Advocacy for Regulation: The convention was to advocate for effective implementation of regulatory frameworks, including:
  • Rate standardisation and transparent pricing.
  • Mandatory observance of the Charter of Patient’s Rights.
  • Accessible grievance redress systems.

Financing Public Health

• Low Public Allocation: India has among the lowest financial allocations for public health globally, with just 2% of the Union Budget allocated for health services, resulting in annual per capita public spending of only $25.
• Out-of-Pocket Expenses: Out-of-pocket expenses remain high, despite disproportionate attention being given to government-supported health insurance schemes.
• Alternative Frameworks: Participants were to examine the gap between claims and ground realities of these schemes and explore alternative financing frameworks centered on enhanced government spending, reduced out-of-pocket costs, and equitable access.

Justice for Health Workers

• Indispensable Role: The COVID-19 pandemic underscored the indispensable roles of frontline doctors, nurses, paramedics, and support staff.
• Inadequate Conditions: Many health workers still face low wages, insecure employment, and inadequate social security and working conditions.
• Advocacy: Health worker associations were to highlight the need for justice to health workers and the establishment of resilient health systems.

Access to Medicines

• High Cost and Low Price Control: Medicines constitute up to half of a household’s medical spending, yet more than 80% of medicines in India remain outside price control.
• Persisting Issues: Irrational drug combinations, unethical marketing, and high retail markups persist in the pharmaceutical market.
• Session Focus: The session on access to medicines was to examine regulatory gaps, pricing barriers, the proposed removal of GST on medicines, and expanding public sector production of essential medicines.

Vision for Universal Quality Services

• Affirming Health Care as a Right: The convention aimed to affirm health care as a fundamental right anchored in robust, responsive public systems.
• Necessity of Public Provisioning: With over 80 crore people in India dependent on public provisioning, strong public health services are deemed essential.
• Revitalising Public Systems: Participants were to highlight community-led models and successful state-level initiatives for revitalizing public systems, emphasizing decentralised planning and community engagement.

Eliminating Discrimination and Intersectoral Links

• Social Hierarchies: Entrenched social hierarchies continue to influence access to health care.
• Special Session on Social Justice: A special session on gender and social justice was to foreground the experiences of Dalits, Adivasis, Muslims, LGBTQ+ persons, and persons with disabilities to embed inclusion and non-discrimination in health systems.
• Broader Determinants of Health: The convention links health to broader determinants, with a session covering food security, environmental pollution, and climate change, exploring intersectoral strategies for health.

Political Advocacy

• Dialogue with Members of Parliament during the ongoing winter session will be facilitated to place key health policy demands on the legislative agenda.

Renewing Alliances

• The convention intended to celebrate the 25th anniversary legacy of the JSA and renew long-standing alliances with diverse groups, including women’s organisations, science groups, rural movements, and patient groups.

Shaping Future Demands

• Lessons from past campaigns will meet present energies to shape a popular narrative and demands for policies to ensure the right to health for all in the decade ahead.

Way Forward

• Strengthen public health systems by increasing government investment and reducing reliance on commercial private care.
• Ensure implementation of regulatory frameworks, including Clinical Establishments Act and Charter of Patient’s Rights.
• Promote equitable access to medicines, rational drug use, and expansion of public sector production.
• Improve working conditions, social security, and wages for frontline health workers.
• Embed community participation and decentralised planning for sustainable public health outcomes.
• Address social inequalities and discrimination to ensure health care for all marginalized groups.
• Integrate intersectoral strategies covering food security, environmental protection, and climate resilience to strengthen health outcomes.
• Advocate health care as a fundamental right, moving away from profit-driven approaches.

Conclusion

• The National Convention on Health Rights 2025 represents a crucial milestone in the quarter-century journey of Jan Swasthya Abhiyan and the broader people’s health movement in India.
• By bringing together diverse voices to confront privatisation, inadequate financing, regulatory failures, worker injustice, and social discrimination, the convention is poised to revitalize the demand for healthcare for people, not for profit.
• It underscores that the right to health can be realised only through robust, accountable, and equitable public health systems rather than market-driven models.

RIGHT TO HEALTH IN INDIA

The right to health stands as a cornerstone of human dignity, encompassing the entitlement to the highest attainable standard of physical, mental, and social well-being, rather than mere absence of disease.

• Enshrined in international instruments like the WHO Constitution (1946) and ICESCR Article 12 (1966), it imposes obligations on states to ensure access to healthcare, underlying determinants such as clean water and sanitation, and protection from health threats.
• In India, this right derives from Article 21 of the Constitution, interpreted by the Supreme Court as integral to the right to life, amid persistent challenges like low public spending and infrastructure gaps.

Concept of Right to Health

The right to health includes freedoms—like protection from forced medical procedures—and entitlements to timely, affordable healthcare of acceptable quality. It extends beyond treatment to determinants including safe water, nutrition, housing, and health education, accommodating individual biology, social conditions, and state resources.

• Key components as per General Comment No. 14 (UN Committee on ESC Rights): This authoritative interpretation details the core features of the right, known as the 4 A’s:
• Availability: Health facilities, goods, and services must be available in sufficient quantity.
• Accessibility: Must be physically, financially (affordability), and informationally accessible, and accessible without discrimination.
• Acceptability: Must be culturally appropriate and ethically sound.
• Quality: Must be medically and scientifically appropriate and of good quality (e.g., trained personnel, unexpired drugs).

Evolution of Right to Health

Global Evolution

The concept traces to early industrial laws like the UK’s Health and Morals of Apprentices Act (1802) and Public Health Act (1848), addressing factory health hazards. Globally, the WHO Constitution (1946) first formalized it as a fundamental right, defining health as complete well-being.

Milestones:

• WHO Constitution (1946) recognized health as a “fundamental right of every human being.
• 1948: Universal Declaration of Human Rights (UDHR): Article 25 affirms everyone’s right to a standard of living adequate for the health and well-being of himself and his family, including medical care.
• 1966: International Covenant on Economic, Social and Cultural Rights (ICESCR): Article 12 provides the most comprehensive treaty articulation, recognizing the right to the highest attainable standard of physical and mental health.
  • State Action: Requires States to take steps for:
    • The prevention, treatment, and control of epidemic, endemic, occupational, and other diseases.
    • The creation of conditions which would assure all medical service and medical attention in the event of sickness.
• Alma-Ata Declaration (1978): Emphasized primary health care for “Health for All” via community participation.
• Post-1990s: Expanded to reproductive rights via Cairo (1994) and Beijing (1995) conferences.
• SDGs (2015–30), especially SDG-3: Good Health and Well-Being, call for universal health coverage and reduction in mortality rates.

Indian Evolution

• Post-Independence, India gradually expanded its commitment to public health through Five-Year Plans, National Health Policies, and Primary Health Care approaches.
• Over time, judicial interpretation and legislative initiatives strengthened the Right to Health as a core element of Article 21.

Constitutional Framework Supporting the Right to Health

In India, the Right to Health is not explicitly enumerated as a fundamental right but has been powerfully incorporated into the core of the Constitution through expansive judicial interpretation.

Fundamental Rights

• Article 21: The Supreme Court has interpreted the Right to Life to include the Right to Health, Right to Clean Environment, and Right to Live with Dignity.

Directive Principles of State Policy

• Article 38: State must secure a social order for welfare of people.
• Article 39(e)(f): Protection of health of workers, children, and youth.
• Article 41: Right to public assistance, including sickness.
• Article 42: Provision for humane working conditions and maternity relief.
• Article 47: Duty of the State to raise the level of nutrition and standard of living and improve public health.

Local Self-Governance

• 73rd & 74th Constitutional Amendments delegated public health responsibilities to Panchayats and Urban Local Bodies.

Landmark Judicial Precedents on the Right to Health

Case Name	Year	Core Principle Established	Key Impact on Right to Health
1. Paschim Banga Khet Mazdoor Samity v. State of West Bengal	1996	State’s Absolute Duty for Emergency Medical Aid	Violation of Article 21 if government hospitals deny or fail to provide timely, necessary emergency treatment. State cannot cite lack of funds as an excuse.
2. Parmanand Katara v. Union of India	1989	Preservation of Life is Paramount	Mandated that all medical professionals (private or public) must render immediate aid to accident victims to save life, overriding legal/police formalities.
3. C.E.S.C. Ltd. v. Subash Chandra Bose	1992	Occupational Health as a Fundamental Right	Explicitly declared the Right to Health and medical facilities for workers (in-service and post-retirement) to be an integral part of Article 21.
4. Francis Coralie Mullin v. UT of Delhi	1981	Expansive Interpretation of Right to Life	Established that the Right to Life (Article 21) means living with human dignity, which served as the foundational premise for including health as an essential component of life.
5. Vincent Panikulangara v. Union of India	1987	State’s Duty on Public Health Regulation	Affirmed the State’s positive obligation to take steps, including regulatory measures (e.g., controlling harmful drugs), to ensure the protection of public health.

Present Status of Health in India

Key Indicators (NFHS-5, NHP 2023, WHO)

• Life Expectancy: ~70.1 years
• Infant Mortality Rate: 27 per 1,000 live births
• Maternal Mortality Ratio: 97 per 100,000 live births
• Health Expenditure: Only 2.1% of GDP (below global average of 6%)
• Out-of-Pocket Expenditure (OOPE): ~47% of total health expenditure
• Doctor–Population Ratio: Approx. 1:834 (WHO norm: 1:1000)
• Hospital Bed Density: 1.5 beds per 1000 population (Global avg: 3)

Major Achievements

• Ayushman Bharat – PMJAY: World’s largest health assurance scheme; covers 55+ crore individuals; over 7 crore hospital admissions availed free treatment till 2025.
• 1.7 lakh+ Health and Wellness Centres (HWCs) operational for comprehensive primary healthcare.
• Ayushman Bharat Digital Mission (ABDM) – Over 50 crore Health IDs created.

Significance of the Right to Health

The recognition and enforcement of the Right to Health are profoundly significant because they transform healthcare from a charitable service or a market commodity into an enforceable legal entitlement. This shift has far-reaching consequences for social justice, economic development, and human dignity.

• The Right to Health is the foundation of human dignity, as no individual can live a life of respect and fulfilment without physical and mental well-being.
• It serves as an essential precondition for the enjoyment of all other human rights including the right to life, education, work, and freedom of expression.
• A realized Right to Health significantly enhances economic productivity and national development; the World Bank and WHO estimate that poor health costs India 4–5% of GDP annually.
• It acts as the most powerful tool for social justice by reducing inequalities based on income, gender, caste, geography, and disability.
• The Right to Health is indispensable for achieving gender equality and women’s empowerment, particularly through maternal health, reproductive rights, and protection against gender-based violence.
• It plays a critical role in national security and pandemic preparedness, as demonstrated by COVID-19, making health security an integral part of sovereign strength.
• Realization of this right strengthens democratic legitimacy of the State, as the inability to provide basic healthcare erodes public trust in governance.
• Ultimately, the Right to Health transforms health from a privilege of the affluent into a universally guaranteed entitlement, paving the way for an inclusive and equitable society.

Challenges in Realizing the Right to Health in India

Despite judicial directives and policy initiatives, several systemic challenges impede the practical realization of this right.

• Chronically low public health expenditure remains the biggest bottleneck; even in 2024–25, India spends only 1.9% of GDP on health against the declared target of 2.5% by 2025, resulting in overburdened public facilities and high dependence on the private sector.
• Severe urban-rural and rich-poor divide persists; nearly 75% of healthcare infrastructure and qualified doctors are concentrated in urban areas that house only 27–30% of the population, leaving rural citizens with inadequate or distant services (Example: A villager in Bihar’s Araria district has to travel 80–100 km for basic emergency obstetric care).
• Catastrophic out-of-pocket expenditure continues to push millions into poverty every year; despite PMJAY, 39.4% of total health expenditure is still paid directly by households, often leading to sale of assets or indebtedness (Example: Cancer or cardiac treatment in private hospitals frequently costs ₹15–40 lakh, far beyond most families’ reach).
• Acute shortage and maldistribution of human resources for health cripples service delivery; India faces a deficit of over 24 lakh doctors, nurses, and midwives, with specialist posts in CHCs vacant up to 80–90% in states like Uttar Pradesh, Bihar, and Jharkhand.
• Weak regulation of the private healthcare sector allows overcharging, unnecessary procedures, and unethical practices; absence of a strong Patients’ Rights Charter and effective price capping results in widespread exploitation (Example: Wide variations in cost of the same surgical procedure across hospitals in the same city).
• Non-justiciability at the statutory level limits enforcement; while courts have repeatedly upheld health under Article 21, there is still no dedicated national legislation making the Right to Health a directly enforceable fundamental right, weakening accountability.

• Rising burden of non-communicable diseases (NCDs) and emerging threats is outpacing system preparedness; NCDs account for 63% of all deaths, yet screening, early detection, and affordable long-term care remain grossly inadequate (Example: Only 10–12% of hypertensives and diabetics in India are under proper control).
• Impact of climate change and environmental degradation on health is rapidly escalating (heat waves, vector-borne diseases, air pollution-related respiratory illnesses), but the health system lacks a robust One Health framework and climate-resilient infrastructure to respond effectively.

Key Government Policies and Initiatives on the Right to Health

The Indian government’s framework for realizing the Right to Health (Article 21) is implemented through flagship schemes that holistically cover financial protection, primary care strengthening, disease control, and affordable medicines.

Policy	Launch Year	Target Area	Key Objectives
Ayushman Bharat – PM-JAY (Pradhan Mantri Jan Arogya Yojana)	2018	Financial Protection (Secondary & Tertiary Care) for the poor and vulnerable.	Provides ₹5 lakh health cover per family per year approx 55 crore beneficiaries. Aims to drastically reduce Out-of-Pocket Expenditure (OOPE) and prevent medical impoverishment. Ensures cashless access to services at empanelled hospitals.
Ayushman Bharat – Health & Wellness Centres (HWCs) / Ayushman Arogya Mandirs (AAMs)	2018	Comprehensive Primary Health Care (CPHC)	Transforms sub-centres and PHCs into AAMs. Provides an expanded range of services (maternal health, NCD screening, mental health) closer to people’s homes. Focuses on preventive and promotive health.
National Health Policy (NHP)	2017	Policy Direction & Fiscal Commitment	Primary goal is to attain the highest possible level of health and well-being for all. Sets the ambitious target to increase Public Health Expenditure to 2.5% of GDP by 2025. Promotes a Universal Health Coverage (UHC) approach.
National Health Mission (NHM)	2013 (Continuation of NRHM/NUHM)	Strengthening the Health System (Rural & Urban) and Disease Control.	Improves Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR). Focuses on infrastructure, human resources, and disease control (Tuberculosis, Malaria). Umbrella framework for State health plans.
Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)	2008 (Revamped 2015)	Affordable Quality Medicines (Jan Aushadhi Kendras)	Provides quality generic medicines at much lower prices to reduce costs for patients. Addresses the economic accessibility component of the right to health, especially for chronic diseases.
Janani Shishu Suraksha Karyakram (JSSK)	2011	Maternal and Child Health	Guarantees free and cashless services for pregnant women and sick infants (up to one year) in public facilities. Includes free diagnostics, free drugs, free blood, and free transport (home to facility, inter-facility, and drop-back home).

Global Best Practices

Reviewing successful models provides actionable strategies for India to strengthen its health system.

Country/Model	Key Feature	Learning for India
UK – National Health Service (NHS)	Beveridge Model (Tax-funded, comprehensive coverage)	Emphasis on healthcare being free at the point of use and maximizing public financing.
Thailand – Universal Coverage Scheme (UCS)	Near-universal coverage achieved through strong Primary Health Care and a pooled government fund.	Demonstrates that UHC is achievable even with moderate resources through political commitment and PHC focus.
Brazil – Sistema Único de Saúde (SUS)	Constitutionally guaranteed, decentralized, and integrated system with strong public participation.	Focus on equity and linking healthcare to community-level health determinants.

Indian Best Practices

• Tamil Nadu: Robust public health system, efficient drug procurement (TNMSC).
• Kerala: Strong primary health care, high human development index.
• Maharashtra: Community health officers and digital health innovations.
• Gujarat: Improved maternal health via “Chiranjeevi Yojana”.
• Assam: Reduction in maternal mortality through institutional deliveries.

Way Forward

• Enact a National Right to Health Act that explicitly makes health a justiciable fundamental right under the Constitution, defining enforceable entitlements, grievance redressal mechanisms, and time-bound obligations for both Centre and States.

• Increase public health expenditure to at least 2.5% of GDP by 2027 and progressively to 5% by 2035, with a legally mandated minimum allocation to ensure predictable and protected funding for health.
• Declare Health a Concurrent Subject through constitutional amendment to enable stronger Centre–State coordination, unified policy framework, and faster crisis response during pandemics or disasters.
• Establish independent National and State Health Rights Commissions empowered to monitor violations, impose penalties, and provide speedy remedies, similar to NHRC or State Human Rights Commissions.
• Strengthen regulation of the private healthcare sector by making the Charter of Patients’ Rights legally binding, enforcing transparent and standardized pricing, and capping profit margins on essential drugs and procedures.
• Massively expand human resources for health by doubling the number of medical, nursing, and allied health seats in the next decade, introducing compulsory rural service bonds, and creating a dedicated Indian Public Health & Medical Service Cadre on the lines of IAS.
• Achieve full operationalization of 2 lakh Ayushman Arogya Mandirs by 2027 with guaranteed availability of 12 packages of comprehensive primary healthcare services, free essential medicines, and diagnostics at every centre.
• Fully integrate and scale the Ayushman Bharat Digital Mission (ABDM) to create a seamless, interoperable, paperless, cashless, and consent-based digital health ecosystem covering 100% of the population by 2030.
• Adopt a legally backed One Health approach by establishing an inter-ministerial National Centre for Disease Control & Climate Health to tackle emerging threats from antimicrobial resistance, zoonotic diseases, and climate-induced health risks.
• Introduce a universal, tax-funded Essential Health Package (EHP) that guarantees every citizen free access to a defined set of primary, secondary, and preventive services — irrespective of PM-JAY eligibility — thereby eliminating financial barriers once and for all.

Conclusion

• The Right to Health in India is a constitutional imperative and a moral obligation. Translating the judicially-recognized right into an accessible, affordable, and high-quality reality requires an unwavering commitment to public health financing and systemic equity.
• Only by guaranteeing this fundamental right can India truly secure the dignity, productivity, and well-being of its vast population and achieve its aspirations for inclusive growth.