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Source- The post is based on the article “Here’s How To Make India’s Health Sector Fighting Fit” published in the “The Times of India” on 3rd June 2023.
Syllabus: GS2- Issues related to development and management of health
Relevance- Governance structure of healthcare system in India
News– On almost all health indicators, India ranks last among G20 countries.
Why is colonial legacy responsible for poor health indicators in India?
The Government of India Acts of 1919 and 1935 established health as a state subject.
The India Act of 1919 granted provinces autonomy over health. The Act of 1935 demarcated subjects into federal, provincial, and concurrent lists. It designates health as a provincial subject. The Indian Constitution retained health as a state subject.
During the Constituent Assembly’s debate, Hari Vishnu Kamath and Brajeshwar Prasad had opposed the inclusion of health on the state list.
Kamath argued “national health” had declined under British rule and the government’s goal should be to elevate it to A-1 standards. Health should be a Union subject to protect the nation from diseases and epidemics. But the Assembly rejected the proposals.
What are the consequences of health being a state subject under the constitution?
The constitutional structure hampers nationwide public health strategies. It restricts Centre’s ability to enforce uniform standards and guidelines.
Unequal sector development makes for a stark contrast between states. UP and Bihar have some of the world’s worst health indicators. Health in states such as Tamil Nadu and Kerala is comparable to upper-middle-income countries.
The central health budget remained negligible since Independence, stagnating at around 2% over several Five-Year Plans. As the Constitution did not mandate an equal role for the Centre, the health infrastructure gap between states widened.
Regulations were uneven. GoI enacted the Clinical Establishments Act in 2010 to improve quality and protect patients’ rights. It has largely been ineffective as many states and UTs have not implemented it.
State-level drug and device regulations have obstructed uniform drug regulation. The Drugs and Cosmetics Act has a fragmented regulatory approach.
The Centre makes rules for manufacture of drugs but states grant the licences. States have uneven regulatory oversight, variable drug quality, inconsistent standards enforcement, and insufficient protection from unsafe drugs.
What is the way forward to reduce disparities in healthcare across the various regions in India?
The Supreme Court mandated the government implement the right to emergency and critical care regardless of people’s ability to pay.
Rajasthan has passed a Right to Health Act, that provides citizens free emergency care at public or private hospitals. Yet Rajasthan cannot achieve the objective of this legislation on its own.The state doesn’t control hospitals outside its boundaries.
Such a basic right should be available to all. But individual states making such laws may not be the most efficient. A piecemeal approach by various states will lead to fragmentation and confusion.
The right-to health approach may increase costs and lead to potential relocation of private hospitals to states where their obligations with respect to emergency care are weaker.
A uniform definition of emergency care and role of hospitals countrywide is essential. It should be decided by the Centre.
Over 75 years, there have been advances in technology and innovative approaches. There is a dominant role of the private sector, and increased reliance on third-party healthcare payment systems. It is unfeasible for states to manage and regulate health services.
The 15th Finance Commission also recommended health be transferred to the concurrent list allowing for uniform policy formulation and implementation.
