Right to health laws need political support
The last two years have exposed several shortcomings of the Indian health care system. Now, in a move welcomed by many, Rajasthan has circulated a draft right to health bill for public comments. Tamil Nadu is also planning a similar law. But will mere legal entitlement lead to better resource allocation and systemic reforms by the State?
Tamil Nadu performs better than the national average on several health indicators, including the provision of antenatal care, institutional deliveries, and full immunisation of children. The Dravidian movement and philosophy, with which both the Dravida Munnetra Kazhagam and the All India Dravida Munnetra Kazhagam are ideologically aligned, have influenced the state’s focus on health care from the 1920s.
Rajasthan had the infamy of being among the least developed states in the 1980s and was disparaged for faring badly on several socio-economic indicators. However, today, the state performs better than the national average on key indicators such as institutional births and infant mortality. It also boasts a rejuvenated government health care network on the back of schemes for free medicines and diagnostics started in 2011.
These states will now provide a justiciable entitlement to health service delivery by guaranteeing the right to health. However, there are questions about these states’ ability to take prompt corrective action in the face of political and economic hurdles. Realising the right to health requires a system that enables quality and affordable access to health services for citizens. This implies reforms targeted at the institutional capacity, accountability, and processes for the financing, delivery, and regulation of health care. The extent to which these legislations promote such reforms will determine their success.
For instance, Rajasthan’s draft law empowers citizens to file complaints against health institutions, leading to penalties against erring officials. But it is unclear if this will lead to systemic change that disincentivises such behaviour. The obligation on the state government to provide an “appropriate budget”, to “enact a human resource policy for health” within six months of the notification of the law, to “guarantee availability of government healthcare services, free medicines, test & diagnostics…and ambulance services”, are examples of such acts promoting systemic changes. Legal rights through justiciable entitlements made it difficult to remove programmes that previously provided these rights. They also increased awareness, which, in turn, enhances demand and seeks accountability. However, these have not automatically enabled access to essential services without increased resources or systemic reforms. For example, the right to food and the right to education both witnessed progress, but continue to face challenges in food security and the realisation of education.
The right to health laws should be seen in this larger context. For instance, addressing doctor absenteeism in a primary health centre may require political will to upend the existing local arrangements that provide political patronage to doctors. Likewise, the provision of free drugs and diagnostics may face resistance from the large private industry that provides these. To give effect to the legal guarantee honestly, states must find mechanisms that address the influence of local leaders and other stakeholders. Additionally, for those living in remote areas, realising the right to health may require interventions outside the scope of health policy, such as incentivising the health workforce to reside in remote, rural areas through better living conditions.
In the 70 years since Independence, scholars have diagnosed health system problems and suggested solutions. The legal guarantees in the bills in Rajasthan and Tamil Nadu may set the groundwork to put some of these ideas into motion. However, we now need a strong political will to see through the necessary reforms to improve access, affordability, and quality health care.
Sandhya Venkateswaran is commissioner, Lancet Citizens’ Commission on Reimagining India’s Health System and a senior fellow with the Centre for Social and Economic Progress. Nikhil Iyer is senior policy analyst, The Quantum Hub Consulting The views expressed are personal