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Vol VIII, Issue 2
Date of Publication: April 30, 2023
DOI: https://doi.org/10.20529/IJME.2023.028
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Editorials
Rajasthan’s Right to Health Act, 2022: Gaps and opportunities
Abstract:
On March 21, 2023, Rajasthan became the first state in the country to pass an Act implementing the right to health, titled “Rajasthan Right to Health Act, 2022” [1]. This is the realisation of a long standing demand of civil society groups and can be considered a landmark initiative by any state government towards guaranteeing “health for all”. While the Act cannot be considered very robust, given some of its shortcomings discussed later, there is no denying that, if implemented in its true spirit, it will give the public healthcare system a huge boost, and lead to reducing out-of-pocket expenditure on healthcare, and safeguarding patients’ rights.
Copyright and license ©Indian Journal of Medical Ethics 2023: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0), which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.
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Chhaya Pachauli’s article is the first hand authentic account about the Right to Health Act in Rajasthan. It deals with different aspects of this process of enacting this act and the content of the act itself in a dispassionate, objective manner. I think 3 points need to be added in this account in order to make it fully comprehensive.
1) one important advantage of enactment of this act is – activists of social organisations in Rajasthan can go to the court and point out that the government is not fulfilling it’s duty as per the act making it compulsory for the government to move forward. This is not possible in any other state.
2) The point that the health budget of the Rajasthan government has not increased during 2022 and 2023 needs to be given adequate space and emphasis. Same is the case with the point that there is no concrete plan for long awaited strengthening of human power and facilities in public health services in Rajasthan. This lends support to the view that this act is a mere election tactic. With no substantial increase in the health budget and with majority of private clinics and hospitals are out of the provision for mandatory accidental emergency care, from the point of view of the people they have gained nothing in practical terms. We have the example of right to education act which is simply a mockery of right to education.
3) The only provision that is directly affecting the private practitioners is making mandatory to private clinics abd hospitals to treat accidental and some other, specified emergency cases approaching them for care. But the definitions of emergency and emergency care have been muddled up. It is not clear, up to what kind of accidental emergencies will be expected to be treated in private clinical enterprises and at what levels. Cases with suspected injury to lungs, liver, brain etc cannot of course be entertained in clinics and small hospitals. Same is the case with obstetric emergencies. Absence of clarity on this issues is not a minor deficiency. To say that these will be taken care in the rules is to try to hide the incompetence and or lack of application of mind by the bureaucrats who drafted this act.
Anant Phadke [email protected]
This is a well-drafted Act on Public Health as a Citizen’s Right and a Government’s Duty. It is a milestone in India’s Public Health history. Much remains to be clarified in the details of the Rules and Regulations to be drafted under this Act. Jan Swasthya Abhiyan, Rajasthan has done tremendous hard work and sustained its contribution to the government in drafting and facilitating the Act, in spite of the difficulties and limitations of the Covid Pandemic and Lockdowns.
The biggest setback to the Act was the pressure tactics IMA tried, to modify the Act through its State-wide strike and later sympathetic protest in other states. IMA has exposed its true colour of safeguarding the business interest of a lobby of doctors engaged in running Nursing Homes and Private hospitals vis a vis its leadership role in ensuring First Aid after accidents and disasters and Emergency care to stabilize a patient before transportation to a higher center. That is a life-saving measure and in the true spirit of Medical Ethics under the Hippocratic Oath, they have undertaken when any doctor entered the profession. Monetary considerations and who will pay the bill must not have been a point of contention. There is a commitment that government will reimburse but the mechanism will be worked out later under Section 3 (c) and (d) Right to Health. That did not satisfy IMA which was deplorable. They wanted a Rollback of such a progressive Act, outright condemning it as “draconian” and “anti-patient”! The implementation authorities under RTH Act must oversee the promptness, efficiency, and transparency of that reimbursement mechanism through an IT-enabled mechanism that is accessible under RTI Act provisions to any citizen. On the contrary, Private hospitals are now exempted from providing lifesaving care, which is a shameful position, not to be proud of.
Remember IMA was started by legendary Cardiologist and Chief Minister of Bengal (1948-1960), Dr B.C. Roy was so much for People’s Health at an affordable cost. Is it not an ethical compromise and a case of Conflict of Interest, if IMA insist on their members in “Grievance redressal systems” under the Act? Instead, such a grievance redressal system set up should be represented by Consumer/Patient representatives in an inclusive manner.
We need to move beyond Comprehensive Primary Health to addressing determinants of Health under Universal Health Care for All as a Human Right.