Towards complete right to health

The government should strive to provide free consultation, diagnostic tests and medicines at its hospitals.

The Centre has done well to start the year with a proposal for citizens' right to health, as a part of an overall draft of its new health policy. Comments of citizens and experts have been invited. This is a good time for a broadbased debate on right to health and health policy.

For citizens to get right to health in effective terms, there should be significant progress simultaneously on two aspects – preventive/protective and curative aspects. Both aspects are equally important. In some situations, the first aspect can be even more important even though it is often neglected. Without giving attention to preventive/protective aspects the curative aspect can become prohibitively expensive.

A many-sided, well-planned and comprehensive effort is needed for providing adequate protection from and prevention of diseases, chronic health problems and serious injuries. Clean environment and minimising pollution provide a base for good health. Sanitation at all levels including provision of clean drinking water and healthy housing for all is also a basic pre-condition for health. Perhaps the most basic condition for good health is adequate and balanced nutrition.

More specific and seasonal prevention steps are needed for some diseases like malaria which need to be taken adequately at the proper time. In addition reduction of all accidents including transport, industrial and domestic accidents is important. All forms of violence and crime should be reduced, as also various causes of stress and depression. Addictions and substance abuse have to be significantly reduced.

Health education on all these aspects as well as first-aid and basics of health is important. In all these areas the situation at present is deeply worrying and there are many disturbing trends. In this way, the number of people needing curative care can be drastically reduced. Once the disease and injury burden in a society is significantly reduced by adopting adequate preventive and protective steps, it becomes comparatively easier to provide curative care to all.

To provide medicare to all, adequate number of doctors, specialists, nurses, lab-technicians and other medical staff are needed. Apart from ensuring their adequate overall numbers we’ve to ensure that they are available where they are most needed. At present, about 70 per cent people live in villages but only about 30 per cent doctors work in villages.

Hence, clearly, there is greater need for doctors and other medical staff in villages. In addition, in countries like India with high levels of poverty, it is important that doctors and medical staff should have a strong inclination for serving truly needy people.
To ensure the adequate availability at the right places of doctors and medical staff or proper orientation, medical education has to be in tune with the objective of health for all. Unfortunately, medical education in India has been moving in the opposite direction due to the domination of profit-motive and corrupt practices.

In this system, most of the students are forced into paying huge sums for their education, and they later are motivated to adopt high-profit earning approach to recover their investment and much more. On the other hand, students who have a service-oriented approach, find themselves increasingly isolated. Clearly, basic and wide ranging reforms in medical education are needed. The government should accept the main responsibility for strong base of medical education and research keeping in view  the real needs and priorities of the country.

To ensure curative care to all and also to ensure prevention of some diseases, adequate availability of medicines at a fair price is extremely important. If medicines have too high a profit margin, then it will not be possible for all patients to obtain these and it will be too burdensome for the government to make available such expensive medicines to all people.

Encourage public sector

The government, in order to ensure adequate availability of all essential medicines at fair price, should also retain an important role for the public sector in the production and availability of medicines, vaccines and essential medical equipment. Patent laws should be in tune with this wider objective.

As a democratic country with a mixed economy, India always has adequate room for creative contribution from the private sector. However, keeping in view the higher profit orientation of the private sector, recent experience of escalating costs and the limited economic capacity of the overwhelming majority of our patients, in India the government’s predominant emphasis and budget-use should be on strengthening government hospitals and health centres.

These will combine preventive and curative role. The government should strive to make available free consultation, diagnostic tests and medicines at its hospitals, while charging modest rates for other expenses of hospitalisation.

The private health and medicine sector should be regulated properly and with transparency. The overall health budget should be increased significantly to 5-7 per cent of the GDP while at the same time, ensuring that it is used for people’s real needs and
not for profit and plunder. The government should involve citizen and public spirited institutions in improving health care at all levels with emphasis on rural health care and reduction of child/infant/maternal mortality. Health for all should become a people’s movement.

To achieve the objective of health for all and right to health, overall poverty should be reduced significantly and for this, socio-economic inequality at all levels including gender inequality, should also be reduced significantly.