December 10 was Human Rights Day. Let’s take the opportunity to talk about the most important pillar of all human rights: " Right to Healthcare".

Healthcare is a fundamental Right, but it is not fundamentally right.

The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution but due to differential distributions of services, power, and resources it has resulted in inequalities in healthcare access. Access and entry into hospitals depends on gender, socioeconomic status, education, wealth, caste and location of residence. Large numbers of tribes and lower castes that live in isolated and dispersed areas often have low numbers of professionals. Those with the greatest need often do not have access to healthcare.

The World Bank estimates that 90% of all healthcare needs can be met at the primary healthcare level. India has grossly under-invested in the area that should matter the most.

You don't need a coronavirus epidemic, for the public health system to collapse. Today when I am writing this article the coronavirus has taken approximately 0.15 million Indian lives. But as all the resources are diverted for combating Covid-19, around 28000 people are dying every day because Non-Covid reasons. The coronavirus pandemic has pushed fragile India's public health system which was already overstretched, overburdened and on the verge of collapse. Healthcare in India has been in deep shambles and needs deep introspection.

After the BRD oxygen tragedy I started touring all over India conducting 100s of free medical camps and realized that BRD oxygen tragedy was just another brutal face of our broken health system. I started collecting data from the National Family Health Survey (NFHS), different government health agencies, World bank, WHO, UNICEF, UN and the data was so staggering that it shocked me to the core. Here are few points which highlight the shocking status of our Health System:

1. Public spending stagnated to 1.2% of total GDP, compared to world average of 6-8%, India ranks 170 out of 188 countries in domestic general government health expenditure as a percentage of GDP.
2. India, ranks 145th among 195 countries in terms of quality and accessibility of healthcare — Lancet.
3. India ranks 94th out of the 107 countries in Global Hunger Index (GHI).
4. India ranks 144 out of the 156 countries in world happiness Index.
5. India ranks 129 among 189 countries human development index (HDI)-UN.
6. India ranks 150th in female health and survival among 153 countries — Gender Gap Index.
7. The fundamental aspect of healthcare — primary healthcare is in shambles. There is only one primary healthcare centre (often manned by one doctor) for more than 51,000 people in the country.
8. 40% of people(around 63 millions ) that are hospitalized are pushed either into lifelong debt or below the poverty line — Medical debt is a major cause of poverty in India.
9. 50% of children are malnourished and only 62% are immunized. Malnutrition caused 69% of deaths of children below the age of five in India, according to UNICEF One in two women of reproductive age is anaemic.
10. India reported 8.82 lakhs under 5 years child deaths, the highest in the world. UNICEF 2018.
11. 4.5 lakh people die of tuberculosis every year.
12. India had the third-largest number of people living with HIV in the world.
13. India is the diabetes capital of the world—India is home to 77 million diabetics.
14. Doctors without formal training provide up to 75% of primary care visits.
15. According to the State of Global Air (SOGA) Report, 2020, long-term exposure to outdoor and household air pollution—contributed to 16,67,000 deaths in India in 2019.
16. There is a stark divergence in healthcare-74% of doctors are in urban areas that serve 28% of the population.
17. Private sector consists of 58% of the hospitals in the country, and 81% of doctors.
18. Post Covid mental health crisis is looming.
19. India faces oxygen scarcity, PPE kits, ICU equipments, Medicine, Sanitizer as cases surge.
20. About 10.5% of medicines sold are substandard and falsified-WHO.
21. At present, there are 541 medical colleges (280 government and 261 private-total 80,312 undergraduate seats ) but only 64 PG Institutes (36,192 seats).
22. Most hospitals in India are overburdened, understaffed and ill-equipped-but medical tourism is booming which is expected to reach 372 billion USD by 2022.

We can't afford to be silent spectators. In the time when India is struggling with the dual burden of corona pandemic and economic slowdown, it's time to make a fresh beginning for healthcare. Healthcare reforms need a thorough introspection, debate and corrective measures. Mere cosmetic changes won't help, we need immediate actions, bold reforms and sustained campaign to deliver healthcare to rural India.

What are the solutions and what should be the Approach ?

1. Universal access to good quality health care services without anyone having to face financial hardship - for all at all irrespective of caste /religion /region /gender /disability /economic status. Free consultation/drugs/diagnostics and free emergency care services in all public hospitals.
2. Make the "Right to Healthcare" a justifiable right through the enactment of appropriate legislation.
3. Increase public health expenditure to 5% of the GDP.
4. Uninterrupted supply of Oxygen, PPE kits, ICU equipment, Medicine, Sanitizer.
5. Training of Doctors/Paramedics in Intensive care.
6. Immediate and legible Compensation in case death of corona warriors.
7. Increase free testing capacity to 1 lakh/million population, Immediate Sero-Survey of Covid-19 Antibodies to all over India to know the real extent of the disease.
8. Curb rumours, unscientific views.
9. Re-distribution of all resources taking care of Non Covid diseases.
10. Fill all the existing vacancies and create new jobs every year.
11. Post Covid Care Clinic at each PHCs.
12. Universal Immunization - including MMR, Pneumococcal, Typhoid, Hepatitis-A, HPV, Chickenpox, Rota Virus, JE, Influenza , COVID-19 vaccine
13. Universalize and expand the ICDS programme to effectively cover under-5 children and universalize community-owned CMAM (community based management of malnutrition) programmes and daycare services as important intervention in malnutrition.
14. Decentralization- 60% of the expenditure being borne by the Centre and 40% by states.
15. To have at least 5 beds per thousand population distributed in such a way that it is accessible within golden hour rule.
16. Regularize all contractual health workers (e.g.-NHM employees) including ASHA, Anganwadi and helpers involved in delivery of public health services.
17. Universalize Maternity Benefits.
18. GST exemption for OPD/IPD Products and drugs for serious ailments .
19. Strengthening of Health Management Information system.
20. Strengthening Medical Disasters and Health epidemics system.
21. Population Stabilization should be on priority list.
22. Control of Tuberculosis ,HIV/AIDS , Vector Borne Disease ,Non-Communicable Diseases.
23. Clinical Psychologist/Psychiatrist/Counselor at each PHCs.
24. Measures-Formulate long-term plans to reduce Air pollution.
25. Enhancing the validation, evidence and research of the different health care systems as a part of the common pool of knowledge. Formulate and implement a comprehensive policy on occupational health and adolescent/ sexual health.

Let's demand “Right to Healthcare”
Let's build a strong India and a healthier India

Dr Kafeel Khan is twice suspended lecturer, Department of Pediatrics, BRD Medical College, Gorakhpur, U.P