Roobina’s Republic

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In the bitter cold of January 20th, Roobina, a young woman, was forced to deliver her baby on a pavement in Bhopal because she was not able to pay the thousand-rupee bribe allegedly demanded at a free government-run hospital. The baby boy died minutes after being born.

While hospital authorities have denied all allegations and the matter is being investigated by the local police, the incident is deeply symptomatic of a failing health system and its unsuspecting victims. Gandhi may have someone like Roobina and her dead infant in mind when he gave the famous dictate to the drafters of the Indian Constitution, saying “Recall the face of the poorest and weakest man you have seen, and ask yourself if this step you contemplate is going to be any use to him.”

In another India, far from Roobina’s, the private healthcare industry is valued at $40 billion and is projected to grow to $280 billion by 2020. The current growth rate of this perennially and most rapidly growing area of the economy is now 14%; it is projected to be 21% in the next decade. Even during the global recession of 2008, this sector remained relatively recession-proof.

According to media reports, Roobina and her child were denied their right to health and life, and denied the justice which all citizens engaged in the practice of democracy consider their due. This and other similar incidents raise important questions in relation to access to affordable and quality health care at the point of need, especially for the poor and among them, women.

The National Health Policy 2002 announced that Government of India would increase public health expenditure to about 2-3 % of the GDP. In reality, it went no further than about 1.04 % of the GDP. This translates in absolute terms to Rs 957 per capita at current market prices. The Central Government share of this is Rs 325 (0.34% GDP), while State Government share is Rs 632 on per capita basis at base line scenario.

Of developing countries, two nations, Brazil and Thailand, are considered to have achieved close to universal health coverage. Thailand’s public health expenditure is at 3.2 % of the GDP. Brazil’s public health expenditure constitutes 4.1 % of the GDP. India’s Draft National Health Policy 2015, which is currently available for feedback, states, “It would be ambitious if India could aspire to a public health expenditure of 4% of the GDP, but most expert groups have estimated 2.5 % as being more realistic.”

Both Brazil and Thailand have another thing in common – they have instituted the Right to Health as a fundamental right. Analysts have found that this has contributed significantly to these countries achieving better health outcomes.

On this Republic Day, lawmakers face a challenge that goes to the heart of the Constitution. Can the Constitution be suitably amended not only to include the Right to Health but also ensure its full implementation down to the last mile? Can the might of the Indian state, its galloping economy and its glorious history of science and service ensure that no health provider refuses quality assistance citing the excuse of lack of resources?

While legal experts have often stated that the Right to Health cannot be conceived of as a traditional right enforceable against the state, several Supreme Court judgements have, by recognizing a governmental obligation to provide medical facilities, created a justiciable “right to health.” Can these rulings be made the basis for India’s new Right to Health Act?

Here it would be worthwhile to remember that the broader notion of the Right to Health emphasises its inter-linkages with rights and regulations relating to the protection of life and liberty, privacy, education, housing, transport, environmental protection and labour standards among others. That said, when Gandhi nursed people with leprosy in the Harijan colonies of Delhi, he did not need a legal framework that persuaded him to service. His deep commitment to fundamental human dignity was his lasting persuasion.

The United Nation’s Universal Declaration of Human Rights begins by stating that, “All human beings are born free and equal in dignity and rights.” All rights derive from the “inherent dignity of the human person.” The challenge before India today is whether and to what measure its lawmakers will hark back to the fundamentals of legislative processes.

Justice ought not to be a mere receivable once the violation has occurred. Justice ought to be an inviolable promise on which Roobina could have gone to hospital to deliver a healthy child.

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The author of this post, Mona Mishra, is a consultant with India HIV/AIDS Alliance and the UN.

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