Introduction
A robust healthcare infrastructure is very important
for the development and growth of any nation. In most of the developed nations,
great care has been given towards creating an inclusive and all-encompassing
system to make sure that every citizen gets treated for their ailment.
Since the conception of the Constitution of India,
deep significance has been given to Healthcare. Even before the independence,
the leaders of the era knew that an independent nation would need good
healthcare facilities. The Nehru report viewed healthcare as an important
constitutional right. A similar provision was presented in the Karachi
Resolution which stated that industrial workers had to be provided with the ‘healthy
condition of works’. Both Nehru Report & Karachi Resolution primarily
viewed healthcare as a problem related to ‘work’ and ‘worker’.[1]
Article 39(e) of the Indian Constitution provides that
the State shall direct its policy towards securing the health and strength of
workers, men, and women, ensure that the tender age of children is not abused
and that citizens are not forced by economic necessities to enter avocations
unsuited to their age or strength. Article 47 of the Constitution provides the
state with a duty of the state to raise the level of nutrition and the standard
of living and to improve public health.
In 2014, it was decided by the Supreme Court in the
case of Balram Prasad v. Kunal Saha (2014) 1 SCC (Civ) 327 that the Right to
health is a fundamental right under Article 21 and the right of patients to b
treated with dignity, is both their fundamental right under Article 21 and the
right of patients to be treated with dignity, is both their fundamental right
as well as a human right. Hospitals, nursing homes, and clinics are liable to
provide treatment to the best of their capacity to all patients.[2]
Healthcare and Insurance
Over the years in India, several steps have been taken
toward making sure that healthcare is available to all. Still, many pressing
issues need to be resolved to ensure full coverage for every citizen. In recent
years, multiple new legislations have been introduced by the government to
improve the condition of the healthcare infrastructure in the country. In 2018
the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PM-JAY) was introduced as
a National Health Insurance Fund to provide free access to almost 50 crore
people, it is supposed to be the world’s largest government-funded healthcare programme.[3]
It has been very effective by bringing healthcare
coverage to more people but still, some challenges need to be addressed to
ensure that all the beneficiaries get the benefits. There have been instances
of misuse of the scheme. According to the PM-JAY Annual Report for 2019, nearly
3,000 suspicious cases amounting to 4.5 crores have been sent to the states for
investigation. Further, almost ₹ 2.29 crore worth of fraudulent claims has been
recovered by NHA from the hospitals after audits.[4] 338
hospitals were issued show-cause notices or were suspended/de-empaneled till
August 2019 by various state governments after inspection for fraud.[5]
Many hospitals are profiteering from the scheme and some people are not getting
the envisioned benefits.
Even after the introduction of PM-JAY, the high
out-of-pocket expenditure remain a reality for a lot of people. It is estimated
that 63% of medical expenses in India are paid out-of-pocket by patients.[6]
While public hospitals offer free health services, these facilities are
understaffed, poorly equipped, and located mainly in urban areas. It is not
mandatory
in India for every resident to get health insurance. Due to poor infrastructure
and lack of adequate staff, many avoid going to government hospitals, which
leads to instances where people have to take a loan for paying the hospital
bills. Many government schemes cover the lower-income household but still, many
middle-income families are not covered under any of these schemes. These
families are at a very high risk to end up in debt to a sudden but inevitable
visit to the hospital. Approximately 3.14 crore employees get coverage through
insurance provided by the employers under Employee State Insurance.[7] Still, such setups do not
cover most of the households in the country.
Nutrition
India lacks in
providing adequate nutrition to the general population which leads to
malnutrition and a population prone to diseases. The Diet of most people lacks
sufficient micro-nutrient which are required for healthy living. Its most dire
effects can be seen in the stunting of growth in children. Stunting is the
impaired growth and development that children experience from poor nutrition,
repeated infection and inadequate psychological stimulation. India has an
alarming rate of malnutrition among its growing age population, 35.7% of
children under the age of 5 were found to be underweight in the National Family
Health Survey (NHFS) of 2015-16.[8] Of the 22 states surveyed
in NHFS 2019-2021, only 9 states showed a decline in the number of stunted
children.[9] The crisis of child
malnutrition in India has often been attributed to historical antecedents such
as poverty, inequality and food shortage. India ranked 101 out of 116 in the
Global Hunger Index 2021 ranking.[10] However, countries with
similar historical, societal makeup and comparable per capita income have fared
much better. Countries such as Sri Lanka, Nepal, Bangladesh, Myanmar and
Pakistan have been ranked higher than India on the Global Hunger Index.
Integrated Child Development Services facilitates a supplementary nutrition
programme, growth monitoring and promotion, nutrition and health education,
immunisation, health check-ups and health referrals, as well as pre-school
education. It operates through a network of Aaganwadi Centres and is connected
to 8.36 crores beneficiaries. In 2017 POSHAN Abhiyaan was launched by the
government as a National Nutrition Mission (NNM) to improve nutrition among
children, pregnant women and lactating mothers. This scheme consisted of
various proposals which included setting up a real-time monitoring system, the
introduction of measurement of the height of children at the Aanganwadi
Centres. It also included incentives for the states and UTs for meeting the
targets.[11]
It is important to
address the gaps and inefficiencies in the present setup through public
awareness, community engagement and empowerment. Over the years it has been
realised that India’s reliance on fewer crops which limits the number of
nutrients in the diets of average people has led to an unhealthy population.
Also, to increase the productivity in the farmlands an excess of fertilizers
and pesticides are used which has made the food toxic and has led to an
increase in cases of cancer and other deadly diseases. Sustainable and Zero
Waste Farming is being adopted in many parts of the world, which involves
copying natural food chains, biological processes and doesn’t use chemicals and
toxins for cultivation in order to the natural balance of the farms.
Maternal Care
India has shown
exponential improvement when it comes to infant and maternal mortality. The
infant mortality rate has gone down from 50 in 2009 to 30 in 2019. Similarly,
the maternal mortality rate has gone down form 130 per lakh in 2016 to 113 per
lakh in 2018.[12]
India has closed the urban-rural divide traditionally seen in institutional
births. Approximately 75% of rural births are now supervised, as compared to
89% of rural deliveries.[13] It has been achieved with
schemes such as Janani Shishu Suraksha Karyakram, which allowed all pregnant
women delivering in public health institutions free transport and no-expense
deliveries. It is also true that over the years more women are getting educated
and this has brought some major changes. As women are getting married late and
are taking a more active part in family planning, fertility rates have
significantly come down. This can be seen in NHFS 2019-2021 report which showed
that for the first time in India the fertility rate has gone down to 2 births
per woman as compared to 2.2 in 2015-2016.[14] Still, it can be observed
that the conditions are not the same in all states and there are some states
such as Delhi, Punjab and Kerela which are performing very well, compared to
others that are relatively lagging.[15]
Pandemic and
Present
During the
COVID-19 pandemic, India recorded the world’s second-highest infections and
third highest deaths. India needs a strong legal framework to manage any such
outbreaks as it is very important in providing adequate response to tackle the
crisis. The Epidemic Diseases Act of 1897 which was enacted to control the
outbreak of the deadly bubonic plague in Bombay, is one of the shortest
legislation in the country with just four sections. The act empowers the state
governments to take such measures and prescribe temporary regulations as may be
required to control an epidemic. It also empowers the central government to
inspect any ship and detain any person arriving in the territory. It also
provides for the punishment under section 188 of IPC for any person disobeying
the act.[16]
It was this 123 years old act along with the Disaster Management Act that was
used to contain the spread of the virus. Even the recent amendments do not help
with the shortcomings, the act fails to define a “dangerous epidemic disease”.
The world is getting more connected and globalised, more people are travelling
internationally. Without the provisions for defining a pandemic, the act leads
to delay in responding to any new spread. Furthermore, there are no provisions
talking about quarantine measures that can be put in place in case of another
breakout.
Rising Population
& Future Challenges
Over the past 7
decades, the population of India has increased four-folds. According to recent
estimates, the population of India is about 1.3 billion. In 2016 the fertility
rate in India was estimated at 2.2 births per woman. As per the NHFS data in
2019-21 for the first time in India, the fertility rate has reached below 2.1.[17] This means that women in
India are having lesser kids, although it shows the success of the Family
Planning Program it also means that in the future the average age of the
population will go up. As the health risks are higher in an older population,
so the burden on the hospitals is expected to increase in the future.
Conclusion
Although India has
made progress towards universal health coverage with PM-JAY further legislation
can reduce its misuse and increase the number of beneficiaries. At the same
time by creating a more competitive insurance market, providing subsidies and
tax exemptions can help more people get health insurance at affordable rates.
With all the achievements in reducing maternal mortality and infant mortality,
there is still space for improvement. Focusing on states with higher maternal and
infant mortality by introducing better monitoring can bring them on par with
developed states. Gathering and maintaining data about periodic demographical
changes will help in coming up with the legislations to keep up with the
healthcare needs of the rising population. By encouraging and incentivising the
farmers to adopt more sustainable farming the government can help in reducing
their dependency on fertilizers and pesticides. It can also make our diet more
nutrient-rich which shall lead to healthier population.
With the still ongoing pandemic, we have realised many of the shortcomings of the present legislations. The introduction of an effective disease monitoring programme can ensure effective containment of another viral spread. Over the years India has achieved great feats such as eradicating Small Pox and Polio, through a national vaccination programme, so by introducing new legislations it is possible to solve the underlying problems and provide better healthcare to everyone.
About the author
Akshay Sahay is a
second-year student at Law Centre II, Faculty of Law. He has graduated in
commerce from the University of Delhi. He is interested in Corporate Law and wants
to learn about Alternate Dispute Resolution.
[1] Public
Health in Indian Constitutional History
[2] Balram
Prasad v. Kunal Saha (2014) 1 SCC (Civ) 327.
[3] About PM-JAY.
[4] Annual Report 2018-19
[5] “Nearly
3,000 fraud cases detected under Ayushman Bharat health insurance scheme.”
[6] Out-of-Pocket
expenditure (% of current health expenditure)
[7]
ESIC and its applicability
[8] National
Family Health Survey 4
[9] National
Family Health Survey 5
[10] Global
Hunger Index, India.
[11] Press
Information Bureau, “Cabinet approves setting up of National Nutrition Mission”
[12] Press Information Bureau,
“Maternal Mortality Rate (MMR)”
[13] India has
achieved ground-breaking success in reducing maternal mortality
[14] National
Family Health Survey 4
[15] National
Family Health Survey 5
[16] The
Epidemic Diseases Act, 1897. Section 3
[17] National
Family Health Survey 5
Comments
Post a Comment