Hon.
Chairperson, when I look at this Private
Member's Bill saying that this Bill is to provide for health as a Fundamental
Right to all citizens, I think that universal health coverage has already
been included in Article 21. Therefore, a separate Right to Health Bill
makes no sense. Now, I come to another structural defect in the Bill.
Clause 5 of the Bill mentions right to food, right to water, right to
sanitation, right to therapy, right to healthcare services, right to
road safety, right to occupational safety, protection, etc. Everything is
already covered under separate legislations. Bringing100 in more legislations or more provisions
will not really solve the problem. The problem is that health has been an120 issue in the country since
Independence, and that is because the resources for generating this kind of
health infrastructure have140
not been available. None can deny the fact that the life expectancy since
Independence has climbed up from 35 to160
75. It has been possible only
because every Government has created the health infrastructure. But, at a time
when we are discussing this, India has one doctor for every 1,511 people
whereas WHO recommends one doctor200
per 1,000 people. So, we are way off the mark, and if we talk about specialists,
the situation is far worse. If we look at the nurse to population ratio, it is
one nurse to 670 patients240
whereas the WHO norm is one nurse to 300 patients. The most important fact is
that even today, the out-of-pocket expenses on health for a household in India
is about 54 per cent, which is very high.280
Therefore, there is a need for universal health coverage.
Sir,
I recently attended a Global Conference of Parliamentary Union. There,300 ‘health for all’ was expressed as the aspiration
for every global citizen, not just for Indian citizen. This has been320 accentuated by the fact that
post-pandemic, the people have realized that none is safe until everyone
is safe. Therefore, when I say that we have to ensure right to health,
we have to ensure that this infrastructure, first of all,360 is available. How can we achieve this? There
has been a suggestion in this Bill that it will be through a
Central legislation whereas health is a State subject. I will not get into the
fact whether it can be400
legislated Centrally because it is a State subject. Education is a State
subject but a Bill relating to right to420
education has been passed by the Centre, enabling the States to make separate
rules and spend money. But what is important is that the health expenditure
that we do is only 1.5 to 1.7 per cent even after 75 years, whereas the WHO
norm is 2.5 per cent of your GDP480
and our own National Health Policy norm is 2.5 per cent of our GDP. I
think, this is a500 matter
of concern. The real concern is where will the States get the money
from? Where will the State resources come from? But, then, I must say that
despite resource constraints, take the case of Odisha. In Odisha, we are not
subscribing to Ayushman Bharat because our scheme ensures health for all in a
true sense.560 Every APL or BPL family member can walk into a
Government hospital and he will get all kinds of treatment free of cost. If he
has to get service from outside the State, there are 200 hospitals which
have been empanelled. This is600
an ideal model, but it requires resources. Not all the States could probably
afford it, but this is where the Centre should move from an insurance model to
a rights-based health model where every citizen of India can walk into640 a hospital and get free medical
treatment. Ayushman Bharat is only for indoor healthcare services, not
for outdoor services.
Sir,
I come to a very salient point and this is relating to the figures of National
Family Health Survey. My honourable friend talked about life
expectancy. Now I come to the pandemic. If you look at the pandemic, it
overwhelmed700 the health
infrastructure of advanced countries too. No country can provide for reserves
or a redundant health infrastructure to such720
an extent that it can meet any pandemic, but what we can do is to be
prepared for it. We have to follow the disaster management model that
we have already shown. In Odisha, we have done it. The whole world
is talking about pandemic preparedness treaty. When we talk about
pandemic preparedness, we will naturally be looking into both the human
infrastructure as well as the physical infrastructure. Our emphasis in
policy has always been on outputs, not on800
outcomes, and that is the biggest bane. When we are talking about
setting up of hospitals, we say that we have set up hospitals without
doctors and nurses. That is why, it is important to emphasize
only on outcomes. Let840
outcomes be the criteria of all our policies, particularly health and
education.
Another
point which I will talk about is the responsibility or the ownership
that the community can take in health-related matters. We have seen
during the pandemic that the community rose to the occasion to communicate
ideas relating to prevention and preparedness of the first wave of the900 pandemic. Therefore, I harp on a
pandemic treaty or I harp on health preparedness scheme. If you emphasize on
preparedness, I am sure everything will be taken care of. Lastly, while
talking about the Bill, this is an umbrella legislation for which separate
legislations already exist. There is no point having another Act when
the basic question of supply and960
distribution is not addressed. Both these things can happen. It has happened over
a period of time. It is not980
that it has not happened in the last 75 years, but what has happened is
at a very slow1000 pace. We
need to move very fast because health is already accepted as an inalienable
fundamental right of every Indian citizen.
Sir,
before I really get into the Bill, let me say one thing to my honourable friend
who spoke before me. It is true that the Supreme Court had given
its judgment. Hence, according to me, there is no need for
this Bill. But we have not yet passed any legislation. The States
have not taken cognizance of what1080
the Supreme Court had said. What the Supreme Court had said has not been
taken cognizance of by the States. 1100
Health continues to be a State Subject. Therefore, on a Bill like this,
there is a scope for States to1120
step in. It will then help the States. We are talking here of three things. The
first one is conditions, the second is funds, and the third is accessibility.
These three things are entirely different and fall within the domain of the
States. Anyhow, I only wanted to say one thing. It is true
that the Supreme Court had made a pronouncement and there is not
much to talk about national policy. But when I have a right to
birth,1200 I must have the
right to life. It is already there. You need not give it to me through
legislation. So, right to life is intrinsic to right to health. These
two things are intertwined. You cannot separate them. Once you
agree to the first one, the second one will automatically follow. Let
us understand what exactly its needs are.1260
Today, we have the Right to
Education. It is for betterment of life. You have said something about
developmental activities,1280
corporate activities and infrastructure activities. They are for the betterment
of life. So, the Bill today talks about how exactly1300 life has to be. Hon. Member tried to
make the Bill comprehensive and tried to include many things in it. But,
nonetheless, it does suffer with some deficiencies. You cannot expect a
comprehensive Bill, because the mover of the Bill himself said that he is
apprehensive whether it will be passed or not. He is apprehensive whether
the Bill will be accepted by the Government. But the question is
whether it is acceptable or not. The very fact you are trying to say, and what
this House is trying to say or focus on, is the point that the Government
must take1400 cognizance of it
and try to incorporate important points from the Bill in their policy.
That is exactly what our point of view is. Therefore, I am taking it as
a fundamental thing. The right to life is a part1440 of Article 21. We wanted this as a right so that
there is a scope for legislation by the States and, at the same time,
the Centre can also legislate without disturbing the rights of the States.
Then, Madam, you have Articles 39, 42 and 47. They are taken care of once you
make this right1500 to life a
fundamental right through legislation. There are three things. One is this. When
we talk about the Bill, we must talk about law and talk about the spirit of
the Bill. But, my learned friend from the other side wanted to talk about
politics. He has a right to talk. But, let us not politicize the issue
of health. The subject ‘health’ is something which should not be
politicized. He mentioned about The Lancet. That has nothing to do with it,
although the Chairperson might agree with what the hon. Member has said.1595
