Health for all: A long road to the promised right

The Karnataka government has framed a Draft Karnataka Right to Health and Emergency Medical Service Bill, 2025, but its moves ahead of enacting the Bill create doubts about intent. Whether the effect of a recent policy, to rationalise care by reallocation of staff to busier taluk hospitals, will result in some closures of low-volume primary and community health centres remains to be seen.

The irony cannot be missed when the state’s 2026-27 budget document says: “In health, the focus will remain on expanding primary healthcare networks, upgrading district and tertiary care facilities”. The Bill must be passed with standards for the right to health set before these changes are enforced.

Given the current standards of health services, the government has a long way to go to fulfil the right to health. Despite being one of India’s richest states, Karnataka falls behind on key indicators, such as maternal and infant mortality rates, levels of anaemia, and child under-nutrition. Karnataka has allocated 4.3% of its expenditure towards health for 2026-27, lower than the average allocation for health by states in 2025-2026 (6.2%; PRS India analysis).

The state is also grappling with poor infrastructure in its healthcare institutions, large-scale vacancies at all levels, a lack of medicines and preventive screening systems, and inefficient early management of diseases and disorders. Multi-morbidity is on the rise, while the increasing incidence of Non-Communicable Diseases (NCDs) – accounting for over 60% of the state’s disease burden – indicates an epidemiological crisis.

Karnataka Janaarogya Chaluvali (KJC) has noted the risks of the Draft Bill legitimising large-scale privatisation by empanelling hospitals and outsourcing ambulance services, but without effective regulation of private hospitals and their costs. Sarvatrika Arogya Andolana Karnataka (SAAK) says the entitlements defined in the Bill are not comprehensive and lack the minimum features of an effective Right to Health Act.

For instance, the Bill fails to incorporate what percentage of the state budget is needed to provide ‘health for all’; the human resources policy to ensure the availability of doctors and staff; the standards for infrastructure and the geographical/demographic criteria for providing healthcare facilities, etc. The Bill states that these will be determined according to standards “as may be prescribed.”

In effect, the Bill is only an enabling legislation, expressing an aspirational wish-list and commits to no standards of service that a rights-based law should have prescribed. The state plans to frame these standards on the advice of the State Health Authority. There is no mention of adherence to the Indian Public Health Standards (IPHS).

KJC has demanded that the Bill “explicitly provide the right to universal, free healthcare services... for ALL citizens for ALL health conditions,” without exceptions. The Bill proposes free healthcare only to “eligible households,” as defined in the National Food Security Act.

In most countries with free healthcare, the models are based on the ILO Social Security Convention. The National Health Service (NHS) of England is primarily funded by the government, through deductions from wages of employees earning above a certain level,and equal contributions from employers, which makes the employers accountable for the health of their workforce. Karnataka can enact a similar law to finance a universal right to health. In this scenario, the government would have to contribute on behalf of those earning below threshold levels. The Draft Bill does not discuss potential financing models along these lines.

While regulating the private sector, a provision that private entities provide at least 25% of their services free to the poor may be incorporated, in line with a similar provision in the RTE Act, as many hospitals have received land from the government at subsidised rates.

Accountability is missing

Strikingly, there is no mention of community-level participation platforms such as the Arogya Raksha Samitis and the Mahila Arogya Samitis. These are important stakeholders, similar to the school management committees in the RTE Act and vigilance committees in the Food Security Act. Forging active linkages between patients, the public, and health professionals is key to designing, evaluating, and improving healthcare.

Another feature missing in the Draft Bill is the role of local authorities – the Gram Panchayats and municipal councils – in ensuring decentralised implementation of the right to health, which is essential for democratic self-determination and accountability. The RTE Act, in comparison, has assigned duties on local authorities to provide the necessary infrastructure, ensure implementation of the functions devolved to them, and provide grievance redress at the local level.

Instead of making local authorities accountable, given their responsibility in planning for their areas and localising the achievement of Sustainable Development Goals (SDGs), the Draft Bill assigns the responsibility of social audits, too, to the State Health Authority, denoting a conflict of interest. Social audits require independent teams with experts and community members, functioning under the guidance of the CAG.

The role of the final appeals authority for grievance redress, assigned in the Bill to the State Health Authority (which appears to be an advisor, executor, and regulator), also presents a conflict. This is contrary to provisions in the RTE Act or the Right to Food Act, where the ultimate appeals authority is an autonomous body outside the government, namely, the State Commission on Child Rights and the State Commission on Right to Food.

Unless these gaps are closed and the principles of universal healthcare are meaningfully embedded, the Bill risks projecting ambition while falling short of delivering the very right it claims to uphold.

Kathyayini is executive trustee of CIVIC-Bangalore; Asha is founder- trustee of CIVIC-Bangalore, a public health specialist, and member, Jan Swasthya Abhiyan [People’s Health Movement].

(Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.)