Charting an agenda on the right to health

The Hindu

I. AUTHOR’S CENTRAL ARGUMENT

The article argues that India urgently needs to adopt a rights-based, publicly funded, and equitably accessible healthcare system, especially after the COVID-19 pandemic exposed deep inequalities in health provisioning. The upcoming National Convention on Health Rights seeks to resist privatisation, strengthen public systems, regulate private healthcare, ensure justice for health workers, and eliminate discrimination.

The central thesis is that health must be recognised as a fundamental right, supported by strong public health systems and regulatory frameworks, rather than left vulnerable to commercialisation.

II. KEY ARGUMENTS PRESENTED

1. Privatisation Is Undermining Healthcare Access
   – Rising costs of medical education create incentives for commercialised medical practice.
   – The Clinical Establishment Act and NMC Act are inadequately implemented.
   – High out-of-pocket expenditure pushes families into poverty.
2. Public Health Spending Is Inadequate
   – India allocates only 2 percent of GDP to public health.
   – Central allocations and per-capita spending remain low, weakening the system’s ability to deliver equitable care.
3. Need for Regulation of the Private Sector
   – The convention advocates transparent pricing, regulation of malpractices, grievance redress, and implementation of patient rights.
4. Strengthening Public Systems
   – The article argues that robust public provisioning is the best route to equity.
   – Calls for community-based monitoring and decentralised governance.
5. Justice for Health Workers
   – COVID-19 exposed the precarious conditions of ASHAs, nurses, sanitation workers, and hospital staff.
   – Advocates regularisation, fair wages, and safe working conditions.
6. Eliminating Discrimination in Healthcare Access
   – Marginalised groups—Dalits, Adivasis, persons with disabilities, LGBTQIA+ persons, women, religious minorities—face entrenched barriers.
   – Healthcare must centre gender justice, social justice, and intersectional equity.
7. Health as a Fundamental Right
   – The article urges legislation to make health a justiciable right, enabling accountability and measurable commitments.

III. AUTHOR’S STANCE AND POSSIBLE BIASES

1. Strong Pro-Public Sector Orientation
   The article strongly favours public provisioning and views privatisation as inherently problematic, offering limited space for private sector efficiencies or innovation.
2. Ideological Leaning Toward Rights-Based Activism
   The framing reflects civil society and activist perspectives, emphasising public accountability over market-based approaches.
3. Underplays Fiscal and Administrative Constraints
   Achieving high-quality universal public healthcare requires major investments, systemic reforms, and capacity building—these challenges are not deeply explored.
4. Limited Engagement With Hybrid Models
   Many countries combine public funding with regulated private delivery; this nuance is missing.
5. Minimal Discussion on Health Insurance Models
   The complexities of government-supported insurance (like PM-JAY) are acknowledged but not analysed in depth.

IV. PROS OF THE ARTICLE (Strengths)

1. Strong Rights-Based Framework
The article articulates clearly why health should be considered a fundamental right in India.

2. Highlights Critical Post-COVID Lessons
Draws attention to systemic weaknesses exposed during the pandemic—an important public policy insight.

3. Addresses Social Inequities in Healthcare
Intersectional barriers, discrimination, and marginalisation are well captured.

4. Advocates for Health Workforce Reforms
The recognition of ASHA workers, nurses, and frontline health staff is timely and crucial.

5. Focus on Regulation and Accountability
Emphasises patient rights, grievance mechanisms, and pricing transparency.

6. Emphasises People’s Participation
Encourages decentralisation and community-based monitoring, aligning with democratic governance models.

V. CONS OF THE ARTICLE (Critical Gaps & Limitations)

1. Limited Economic Analysis
The article does not assess the fiscal feasibility of large-scale public health expansion.

2. Oversimplifies Privatisation
The narrative frames privatisation only as exploitation, not acknowledging contexts where private hospitals supplement government capacity.

3. Insufficient Focus on Systemic Governance Challenges
Issues like corruption, absenteeism, procurement inefficiencies, and HR shortages in public systems are under-discussed.

4. Lack of Discussion on Public–Private Partnerships (PPP)
PPP mechanisms, which are widely used globally, receive no attention.

5. No Concrete Roadmap for Transition
A shift from the current mixed system to a fully rights-based public system requires phased implementation, which is not detailed.

6. Technological and Digital Health Elements Are Missing
Telemedicine, digital platforms, supply-chain management, and data governance are key contemporary aspects.

VI. POLICY IMPLICATIONS (UPSC GS-II & GS-III Relevance)

1. Constitutional Right to Health
– Would require legislation, budget allocation, and justiciable standards.
– Aligns with Article 21 interpretations by the Supreme Court.

2. Strengthening Public Health Infrastructure
– Upgrading PHCs, CHCs, district hospitals
– Ensuring adequate staffing, medicine supply, diagnostics

3. Regulatory Reform
– Transparent pricing
– Patient rights charter enforcement
– Independent regulatory authorities for private sector oversight

4. Addressing Inequity and Discrimination
– Health policies must integrate social justice, gender sensitivity, and disability rights.

5. Workforce Management
– Regularisation and training for ASHAs, ANMs, nurses, sanitation workers
– Occupational safety and health (OSH) standards

6. Improved Public Financing
– Increasing public health expenditure to at least 3 percent of GDP
– Rebalancing resources from insurance-based models to primary health strengthening

7. Decentralised Governance and Community Monitoring
– Panchayati Raj institutions and local health committees must be empowered.

 VII. REAL-WORLD IMPACT ASSESSMENT

1. Improved Health Equity
   A rights-based approach could dramatically reduce disparities in access.
2. Reduction in Catastrophic Health Expenditure
   Stronger public provisioning can reduce out-of-pocket spending.
3. Better Working Conditions for Frontline Staff
   Health workforce reforms could improve morale and efficiency.
4. Higher Fiscal Burden on Government
   Universal health provisioning requires sustained investment.
5. Potential Resistance from Private Healthcare Lobbies
   Regulation and price caps may face opposition.
6. Demand for Multi-Level Governance Reform
   Implementation success depends on centre–state coordination, local governance, and administrative capability.

VIII. BALANCED CONCLUSION

The article presents a compelling, rights-driven vision for India’s health system—one rooted in equity, public provisioning, and social justice. It rightly highlights the dangers of unregulated privatisation and the urgent need to strengthen public health infrastructure, workers’ rights, and patient protections.

However, its perspective is largely activist and normative, offering limited engagement with the fiscal realities, administrative challenges, and potential efficiency gains from regulated private sector involvement. A balanced health agenda for India must integrate rights with pragmatic policy design, robust funding, and mixed-model delivery systems.

Ultimately, moving toward a right-to-health framework will require political will, sustained public investment, regulatory overhaul, and inclusive governance.

IX. FUTURE PERSPECTIVES (UPSC Mains-Ready Insights)

1. Craft legislation making health a justiciable right with clear state obligations.
2. Increase public health spending and strengthen preventive & primary care.
3. Develop independent health regulatory authorities.
4. Implement mandatory charter of patient rights.
5. Improve working conditions and career pathways for frontline health workers.
6. Promote decentralised health governance and community monitoring.
7. Foster synergy between public and private sectors through ethical, regulated partnerships.
8. Ensure equitable access for marginalised communities using intersectional frameworks.

India’s health future depends on building a system that is publicly accountable, equitably accessible, financially sustainable, and rights-based—not merely commercially driven.