INTRODUCTION
The spread of COVID-19 across the country has exposed the healthcare sector in India. With lack of medical facilities and healthcare infrastructure, the challenge to fight this widespread disease becomes tougher. While corona cases are piling up day by day India has jumped to second position in terms of number of people infected with the novel coronavirus. More than 41.13 lakh people have so far been found to have been infected with the virus, while the US Still leads the figures where more than 60 lakh people infected so far. India has also overtaken Brazil in the number of cases detected in a single day on 5 September with more than 90,000 new cases.
On 24 March the Indian government ordered a nationwide lockdown barring the movement of the public from one place to another as a preventive measure against the COVID-19 disease. The lockdown was ordered to slow down the growth rate of the pandemic which it did. But it couldn’t prove to be of great help as the prolonged lack of medical funding and healthcare infrastructure made the situation worse in India.
United Nations in its report stated that 75 percent of the Indian healthcare infrastructure including medical specialists and doctors are centered in urban areas wherein only 27 percent of the country’s population resides. With a population of approximately 1.3 billion people living across both urban and rural area, India faces a unique healthcare challenge.
WHY IS INDIA LAGGING BEHIND?
In a country like India where almost 70 percent of its population lives on less than $2 a day, public expenditure on healthcare remains one of the lowest. Countries like the U.S, China, Germany, France and Japan spend 16.9 percent, 5 percent, 11.2 percent and 10.9 percent of their GDP respectively on health infrastructure; India can’t even come close to competing with COVID-19 as well as these countries can, also having the second largest population in the world drags India a bit further into the abyss.
LACK OF HEALTH INFRASTRUCTURE
Health infrastructure can be defined as the number of institutions present and functional for working towards the health welfare of the country. It includes public health organizations, resources and research.
1. PUBLIC HEALTH ORGANIZATION
In our country, the healthcare facilities are just inadequate with only 0.9 doctors per 10000 people. Also, we should understand that there is no uniformity in these numbers amongst different places like more remote places will have a fewer number of healthcare facilities than the urban or more developed area, it’s very important to understand that the lockdown is extremely important to stop the sudden rapid increase in the number of cases as at a time only a limited number of patients can be dealt with. Also, not only the number of doctors per person is low but the bed count is equally problematic.
Currently, we are at 0.55 beds per 10000 people and in this pandemic situation, we aspire to achieve at least 2 beds per 10000 people. Also the healthcare is not affordable for all the people, because government hospitals are already filled and private hospitals charge a hefty amount per bed, where they take extra charge to book the private bed beforehand even in these severe conditions when all should be served with the required facilities to fight this deadly disease, but yet again rich have a major advantage over poor even in the basic necessities. Private hospitals account for 55% of the total number of cases and 42% are being treated by the government hospitals and the rest 3% resort to home quarantine and treatment at home. But the problem which is even more severe is that not even all the rich and middle-class people are able to ensure proper treatment for them if and when they’ll catch the virus.
In the recent news, we saw how hospitals in Delhi are overflowing with the number of patients reporting the cases of corona virus. Whereas we are hoping to give the best fight against the disease, the private hospitals and doctors continue to make money amidst the pandemic. Initially these private hospitals were for the purpose of serving more people with better health facilities but over the time the focus of these hospitals has shifted towards corporatization leaving lesser opportunities for social good.
The major problem at hand is not investing the required amount in healthcare and not enough doctors, as of now we only spend 1.3 percent of the total GDP in healthcare, with a population of 130 crores which is not enough money to invest properly in Infrastructure and the healthcare force, also a major chunk of it goes in payment of the salary of these healthcare workers (mainly doctors) after which only a little is left to actually invest in healthcare infrastructure and equipment.
2. RESOURCES AND RESEARCH
The main issue is that the pandemic took us by surprise only to realize later that are we really ready for something like this, if we would have invested enough and started preparing early for conditions like this which is not really foreseeable, but yes everyone knew that this could happen, that amongst those billions of undiscovered viruses one could possibly find it’s way in the human system and could be really dangerous for us creating such situations as we are facing in the current scenario, has there been a bit more preparedness and little more vision we would be able to battle it in a way more better situation than we are at now.
Also, a major point, not only the healthcare infrastructure and healthcare force is less, but the lack of infrastructure of science labs and lack in funding took us few more steps back in fighting in the way better way, there were cases of H1N1 virus few years back popularly known as swine flu at that time some scientists started working on a vaccine but due to lack of funding they were not able to develop it and reach to a conclusion (vaccine). To develop vaccines we do need a certain kind of equipment and specialized labs, if we would have really put in the required funding in developing the vaccine, it would have really felt useful in the current situation also, as that was actually a similar vaccine than what we would need for COVID-19.
RIGHT TO HEALTH
Health is an important factor of human development and human development is the basic of economic and social development. As our country is one of the founding members of the United Nations, it has agreed to different international conventions to secure the right to health of the people around the world. Article 25 of the Universal Declaration of Human Rights (1948) by the United Nations provides the right to a standard of living including food, clothing, housing and medical facilities.
International Covenant on Economic, Social and Cultural Rights (1996) in Article 12 states that states shall recognize the right of every individual to the enjoyment of the highest attainable standard of physical and mental health, clause (c) of which spells that steps must be taken for the prevention, treatment and control of epidemic, endemic, occupational and other diseases
1. DIRECTIVE PRINCIPLE OF STATE POLICY
Part IV of the constitution Directive Principle of State Policy imposed some duties on the states. If we look at them then we can find that there are some provisions that are related to public health. Article 38 imposes a liability on the State to secure a social order for the promotion of the welfare of the people. Article 41 also imposes a duty on the state to provide assistance to those who are sick and disable. Article 42 declares that it’s a primary duty of the state to protect the health of infant and mother by maternity benefit.
Article 47 of the Indian Constitution imposes some Directive principles on the state that “the raising of the nutrition level and the standard of living of its people and improving public health and to bring about prohibition of the consumption of drugs and intoxicating drinks except for medicinal purposes should be among the primary duties of the State. But this, of course, is a directive principle and hence, is not enforceable against the State.” The DPSP are only directive to the state and are non-justifiable. While directive principles are not enforceable against the state, they can still be binding.
2. RIGHT TO HEALTH AS A FUNDAMENTAL RIGHT
The Right to Healthcare is not clearly expressed to be a Fundamental Right under the Constitution of India, however, the Supreme Court, along with other High Courts, have created a group of some specific rights related to healthcare under Right to Life lay down in Article 21 which states that “no person shall be deprived of his life or personal liberty except according to procedure established by law”.
Since health is essential for making the life of people meaningful and correspondent with personal liberty, it is considered to be a right of every citizen under Article 21 which was further emphasized by the Supreme Court. It was held that “Article 21 imposes a constitutional obligation on the State to safeguard the right to life of every person. The State run hospitals and the medical staff is duty bound to provide adequate medical services to the people. Failure to do this would result in the violation of Right to Life guaranteed to the person under Article 21.”
This explicitly shows that Right to health and medical care is guaranteed under Article 21. The lack of proper medical facilities and the lack of investment in public healthcare during this pandemic and previously is a violation of the Fundamental rights of the people. Yet people over here face a hard time even in accessing the most necessary services when it comes to healthcare.
3. CONSIDERATION OF RIGHT TO HEALTH BY THE JUDICIARY
The Supreme Court in various cases has considered right to health as a fundamental right under Article 21 of the Indian constitution and directed the state to implement and execute adequate measures in public welfare.
The Supreme Court in Paschim Bangal Khet Mazdoor Samity & Ors v State of West Bengal & Anor held that if no scale or rate is fixed then in case private hospitals increase their rate to exorbitant scales, the state would be bound to reimburse the same. The court further said that the state can neither urge nor say that it has no liability to provide medical facilities.
Furthermore, the apex court in Pt. Parmanand Katara vs Union Of India & Ors ruled that every sector whether a government hospital or a private has the professional obligation to extend its medical services with due proficiency. Similarly,in C.E.S.C. Ltd. v. Subhash Chandra Bose and Ors the Supreme Court also held that the health and strength of worker is an integral facet of the right to life.
Despite of this, the migrant workers were denied their right to health during the lockdown period. Government hospitals are not able to provide beds to the infected people and private hospitals have been charging a hefty amount per bed.
NEGLECT OF POLICYMAKING
India is yet to have a new and upgraded pharmaceutical policy, whose draft is still pending in its 2017 iteration. This pandemic has exposed the fragility in the public healthcare system of India and the persistent denial of public health by the successive Governments.
In a reply to a question in Lok Sabha, Ashwini Kumar Choubey, MOS, Ministry of health and family welfare said that the public expenditure on health for 2017-18 was merely 1.28 percent of the GDP. Shockingly, India is ranked 170 out of 188 countries in domestic general government health expenditure as a percentage of GDP, as per the global Heath Expenditure report 2016 of WHO. The government has increased the budget for the Ministry of Health and Family Welfare from 37,061 crore in 2017 to 65,001 crore in 2021 and also aims to raise the public health expenditure to 2.5% of the GDP by 2025 however, it is still very low in comparison to the peer countries. If we include the private sector, then the total healthcare spending in India rose to 3.6% in 2016 which is still very low compared to other countries.
This covid-19 pandemic has created a need to introduce a strong and progressive policy to bring the deteriorating condition of the Indian public healthcare system on track.
CONCLUSION
Although we are facing a hard time right now because of this unprecedented situation and lack of readiness our government has really come out with some of the very quick and reliable ways to tackle this situation and be ready for any sudden increase in the number of cases. The important thing to understand is that healthcare facilities will not increase in a couple of months or things will not be solved overnight but the real problem should be understood and targeted which is happening right now, one such example is getting the railway coaches ready for covid care, over 20,000 train coaches have been modified to accommodate 3 Lakh beds for accommodating corona patients, also north-western Railways has planned to convert 266 train coaches as isolation facility, not only this, people have been availing free medical treatment in hospitals of COVID-19 under Ayushman Bharat Pradhan Mantri Yojna, but the number of people who received this treatment for free is only 2300. Thus, this tells us we are trying, in some things we are succeeding and in other places there is still a long way to go, it’s just that we’ll have to keep trying and striving for better.
This article has been written by Sakshi Singh Barfal and Shreya Soni, second year students of B.A.LLB (Hons.) at Dr. Ram Manohar Lohiya National Law University, Lucknow.
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