Time for a serious rethink

One of the prime sectors fighting tooth and nail against the present pandemic is the health sector; though the same is not equipped with enough facilities and infrastructure, like their counterparts in European and other developed nations. But still kudos to our health workers, who are into their services, day in and day out, since the outbreak of Corona pandemic in India. Just some days back, it was reported in the news that around 600 health workers in India, which includes Doctors, Nurses and Paramedics were found to be infected from corona virus while being in the service of infected patients. Once a health worker gets infected, then unknowingly he becomes a carrier of infection for his family also and the  chain continues.

The government has left no stone unturned to fight against this pandemic, but still we are not in a situation to take a sigh of relief, when day by day the number of infected persons is increasing. The only thought which bring goose bump is; will we be able to tackle the situation if it worsens like in Italy, Spain or USA? . It is a known fact that the hereinbefore mentioned countries are world superpowers and have a very robust health care system, with all latest facilities and good infrastructure in their hospitals, but still they are brought on their knees, as hospitals were found to run out of beds and ventilators, when the number of patients increased. Whereas in India the doctors were found to be struggling for PPE (Personal Protection Equipment) kits and other accessories to tackle this situation. Many doctors and hospitals came up with innovative ideas also, like; one doctor at some far flung hospital was found to be checking patients through a transparent sheet barrier, with patient standing on other side of transparent curtain and in another case, our own GMC Jammu, has developed two covid-19 dedicated stretchers, which are covered from above with transparent plastic sheet. But, this jugad technology is not going to help us forever and time has come to strengthen the health sector and invest in the same, to face the tough times in near future.

Loopholes

Nevertheless, WHO recommends 5% of GDP investment over Health sector, at present only 1.4 % of the our GDP is invested for health sector, which is not proportional to the population of our country. As a result, the health sector is in shambles, which needs a serious relook and proper investments over the infrastructure and medical equipments of hospitals. The hospitals do not only lack in proper infrastructure, patient beds, medical equipments, but also have deficiency of health workers, among which the less ratio of doctors makes situation quite grim. As per WHO  report, there shall be 1 doctor for a population of 1000 people, whereas, in capital itself the ratio is 1 doctor for 2028 people and the worst case is in Bihar, where ratio is 1 Doctor for 43,788 people. Due to this, there is too much burden over the doctors in government hospitals and even the salary is not handsome. So, most of the young doctors after completing their studies prefer to be in private sector, rather than being in government sector, ignoring their Hippocratic Oath.

In J&K also, the situation is no different; as most of the health centres in far flung regions either have less doctor or no doctor at all. As most of the young doctors after getting into government services, either seek study leave for pursuing further studies or they get themselves attached at some roadside hospital, preferably somewhere in Jammu District. In a PIL with number PIL No. 16/ 2018, pending before the High Court of J&K, Jammu, a shocking revelation was made in the pleadings that, the most of Primary Health Centres in far flung places and even in some district hospitals of Jammu division, there are no doctors or not enough as per vacancy available and in Jammu district alone there are 103 surplus doctors attached at the behest of  some influential persons. Doctors get appointed in government services under RBA categories, but when comes to service, they usually prefer to be posted in cities.

Moreover, lack of infrastructure can be seen in most of the government hospitals and situation is no different with the medical equipments, as either the machinery is in poor condition or defunct. In the prevalent situation, ventilators are indispensable, but the government hospitals across India do not have enough ventilators to meet the needs, if the curve of COVID-19 patients does not flatten. Like, in all J&K hospitals there are only 210 ventilators, where the number of covid-19 patients has crossed 800 mark and the population of Union Territory is around 1.5 crores. Moreover, there are not enough beds in hospitals to deal with the situation, thus, the government has made arrangements in other places like hotels, schools buildings etc.

Though, many new Govt. Medical College (GMCs) Hospitals are opened in various districts of J&K, but they are still running in District Hospital buildings, with most staff of district hospital. Condition of government hospitals can be seen from the aspect that, whenever some influential person gets unhealthy, he prefers to be admitted at AIIMS or in some reputed private hospital, rather than some routine government hospital.

Due to all these factors, India with 7% of total world population carries 20% of world diseases burden, ranking India at serial number 143/188  as per Global burden of diseases report. Countries like, Sri-lanka and Syria are at better positions, ranking  at serial no. 79 and 117.

Legislation

Though, there are private hospitals also with good facilities, but they are not in the reach of every person, especially in our country where BPL category constituteing 42% of the total population. Thus, in order to deal with this complex situation and due to booming private hospital industry, the government in the year 2017 has come up with a New Health Policy, with the name; “Ayushman Bharat”, under National Health Protection Mission. The scheme of ‘Ayushman Bharat’ is basically based on health insurance cover upto 5 lacs/per family, which will cover around 10 crore families, which means around 50 crore people in India. Under the scheme of ‘Ayushman Bharat’, no premium is to be given, as the same will be borne by the government. Most of the poor people will be covered under this scheme and there will be socio-economic caste census to do the needful for the implementation of scheme. The scheme of ‘Ayushman Bharat’ is on the lines of Obama Care enacted in USA.

One of the  peculiar things about this scheme is that, under ‘Ayushman Bharat’ an insured family will be able to get treatment not only in government hospitals, but also in private hospitals empanelled under the said scheme and many reputed private hospitals are also empanelled under this policy. The said scheme can be seen as a initiative measure taken by government under the Sustainable Development Goals, 2015; vow of which is taken at international forum by various nations to fight against the new problems of health, faced by human kind on this planet.

Being a promising scheme it shall not be forgotten that most of the India resides in rural areas, easy access to which is only the government hospital. Moreover, the procedure for treatment under said scheme in private hospitals is quite tedious. Therefore, the government hospitals and research institutions are still the most reliable and dependent centres, upon which the most of population depends and they need keen relook.

The increase in GDP for health sector is a contemporary debate among the legislatures, but it is also said, that hike in GDP from 1.4.%  to 2.5% will take place by 2025, which is still a long way to go. As, we are already facing a huge problem and we are oblivious about the coming times.

Health as Fundamental Right

At present Right to Health is not recognized as a fundamental right and comes under Article 47 of Directive Policy Part of the Constitution of India. Therefore, making health as a non-justiciable right, resultantly cannot be enforced through writ courts. However, from time to time the Apex Court in many landmark judgments had said that, “Right to Life and Dignity” under Article 21 of the Indian Constitution also includes well being of a person.

One of the beauties of law is being dynamic, just like a living being; changing with the course of time and as per the necessity of society, like; “Right to Education” was made a fundamental right after 86th Amendment, in 2002, in the Constitution of India. After which, it was made compulsory to provide education to the children in the age group of 6 -14 years.

The WHO recognizes health as a fundamental right and India is a signatory to Universal Declaration of Human Rights and International Covenant on Economic, Civil and Political rights, that recognize health as a fundamental right. Therefore, definitely the government will also give a look to this aspect, so that there will be more accountability in setting the things right.

Thus time has come not to see contemporary situation as a one time burden over the health institutions and health workers and be ready for the times to come, by having a relook to health sector. It is a moral obligation of a government to provide proper medical facilities to all its nationals, as the citizens are the real assets of a nation who work tirelessly to build nation’s economy.

As per National Sample Survey Office (NSSO) 2015 report, hospitalisation expenditure has increased to 300 % during last 10 years, which puts burden over people and indirectly impacts the economy of a country. A good health index will definitely result in healthy economy.

Author is a practising Advocate at High Court of J&K, Jammu and a Human Rights Activist, with PGD in HRDE

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