A national television channel had a 30-minute special recently on how private hospitals are denying free medical treatment to poor patients. Under a quota, private hospitals are expected to provide medical treatment at concessional rates for patients from economically weaker sections. This has been observed more in the breach, according to the special report. Shocking as this was, what was more horrific to read at the same time was the news of the death of a pregnant woman buried on page 3 as a single column. Twenty-four-year-old Reema Bhardwaj, who was nine-months pregnant, died after she was denied admission at a government hospital in Ghaziabad. The baby could not be saved either.
At a public hearing recently in the national capital, women from poor communities came on stage to recount their experience of either denial of treatment at government hospitals, delayed treatment or callous treatment by hospital staff. We are making impressive progress on so many fronts. Why, even within healthcare, India has the best to offer, on par with some of the most advanced countries. It is possible to have a heart transplant here or treatment for malignancy. This is, of course, at considerable cost.
Plenty of paradoxes
Yet, it remains a country of paradoxes. Despite having the tag of being known as the destination for medical tourism, India has been apathetic, even callous, about the health needs of its poor. Despite having cutting-edge medical technology, we appear to have scant regard for life. Reema could probably have been saved with timely treatment and more importantly, some humane behaviour in accordance with the sacred Hippocratic Oath.
There is no dearth of good guidelines or good intentions safeguarding life and health in India. We have a Constitutional guarantee protecting an individual's right to life. In response to public interest litigations, the Supreme Court has, on several occasions, interpreted the Right to Life as spelt out in Article 21 as the right to live with dignity. The apex court has held the right to health as being integral to the right to life. In one landmark judgment, the Court rapped the Government of Orissa for failure to provide a primary health centre in a village! The court said: “In a country like ours, it may not be possible to have sophisticated hospitals but definitely villagers within their limitations can aspire to have a primary health centre.”
Legal interpretations are fine and much needed to safeguard rights. However, the Constitutional provisions regarding the right to health are outlined in the Directive Principles of State Policy and, as such not justiciable. A Constitutional amendment guaranteeing the fundamental Right to Health will, on the other hand, make the State accountable for violations of the right.
The Right to Health should have focus on primary healthcare for women and children. And, for very obvious reasons too. Every year, nearly two million children under the age of five die in India. These children are dying not because of complicated, incurable diseases. They are dying of causes like diarrhoea which can be so easily treated and are preventable in the first place. Similarly, thousands of mothers are dying every year because they cannot access basic healthcare. This is a silent epidemic that has plagued India for years now and yet we have been lethargic in finding the political will and the resources to implement existing good schemes. The flagship National Rural Health Mission has an ambitious target of bringing down infant mortality (IMR) to 30 per 1000 by 2012. The IMR now stands at 53. Without going into what's missing in the NRHM service delivery, a pertinent question would be: why the delay in introducing an equivalent for the urban poor? Policymakers have dragged their feet for years now on introducing the National Urban Health Mission.
Reema's story is not a case in isolation. The public hearing was a telling indicator of how large pockets of slums in Delhi have little or no access to primary health services. India's economic growth has been impressive even when other world economies have remained sluggish. But this growth has not translated into equitable progress for all its people. Given this context, the State cannot abdicate its role of being the primary health provider for the most marginalised and vulnerable communities.
Under threat
This is another reason why it is extremely worrying that India appears to be not taking its obligation to protect the poor seriously. A possible outcome of the ongoing India-EU talks on the Free Trade Agreement could see a gradual whittling away of the crucial role that India plays as the “pharmacy to the developing world”. Activists fear that the free trade agreement could radically restrict access to cheap, generic drugs across the developing world and this will particularly hit children and mothers the most. Only 10 years ago, patented drugs for HIV/AIDS cost more than $10,000 per year before generic manufacturers in India started making anti-retrovirals, bringing down the prices to less than $100 a year.
India hankers for international stature with a permanent seat on the UN Security Council. If it does manage to get into the exclusive club, the victory will be pyrrhic unless India sheds the dubious tag of having the highest child mortality rate in the world in sheer numbers. India must first strive to ensure and uphold the most basic of rights for its people – the right to health – before it can be given veto power to judge gross human rights violations elsewhere in the world.
Ananthapriya Subramanian is Media and Communications Manager with Save the Children ( >www.savethechildren.in ).
