Past several months India has been undergoing this horrendous pandemic with lockdowns and restrictions, possibly with the hope to curb the spread of this highly contagious virus – COVID 19 in the absence of a vaccine. As the economy started crumbling, “the welfare state” of India went into phases of unlocks, also unlocking the floodgates to the spread of the virus as masks, sanitizers or “do gaz ki doori” does not seem to be working. This bombarded the hospitals with an unprecedented influx of patients. This article draws attention to the flaws in the present healthcare system of India and on-ground challenges faced by healthcare facilities.
Keywords: Healthcare, Maintenance, Improvise,
On 24th March 2020, A Lockdown and extensions to the same were imposed by the Union to curb the spread of the virus under the Disaster Management act of 2005 under section 6(2)(i) and section 10(2)(1) via order no. 40-3/2020-DM-1-A issued by the Ministry of Home Affairs. But as the effects of lockdown were not much evident as the cases were on a rise even during the lockdown and whatever little effect the lockdown had was negated by the unlocks to stabilize the economy.
The healthcare system was not prepared for this.
Right to health of citizens:
Article 21 provides the right to health and life as fundamental rights to Indian citizens. Article 21 is the only Article after article 20 which cannot be suspended even in a time of national emergency. The State under Articles 38, 39, 41, and 42 of the Constitution has to ensure the welfare of the people, and article 47 talks about the health aspect directly as a DPSP.
Despite being a welfare state, can India actually provide for the welfare the constitution promises?
Art. 21 of the constitution of India grants every citizen the right to health, the same has been reiterated by the Supreme Court of Klindia time and again. The landmark Judgement of Pt. Parmanand Katara vs Union Of India established that Art. 21 casts the obligation on the State to preserve life and there can be no second opinion that preservation of human life is of paramount importance.
Further, the Charter of Patient’s Rights also lends the Right to Emergency Medical Care to patients in an emergency under its Section 3 and The MCI Code of Ethics Sections 2.1 read with section 2.4 lays the Duty on the Doctors and Hospitals to treat and admit the patients in case of emergency.
The government’s take on the health sector.
The article 21 does provide the right to health to the citizens but it is the responsibility of the state and centre to implement the same.
Over the years public health services have been neglected politically, as a result Kerala has been far more successful in containing covid-19 in comparison with the richest states like Maharashtra and Gujarat which have understaffed public health systems.
The Union health budget allocated for national health mission, was focused to support primary and secondary healthcare, it was reduced to 49% in 2020 -21 from 56 % in 2018-19. The declining trend for support to PHC must be reversed and at least 70% of all health budgets must be marked for this frontline level of care. Our cities can’t be considered developed without developing their health related systems.
‘Niti Aayog’ recently proposed to privatize large district hospitals. Now, if we imagine hundreds of district hospitals across the country had been managed by a large number of disconnected, profit oriented private medical colleges, will the condition get any better?
In 2009 the National health bill was proposed, but unfortunately till date it hasn’t turned into an act. The Bill was aimed to protect rights in relation to health and wellbeing. Also, in 2017-Public Health Bill was proposed to address the same issue, but unfortunately, the bill lapsed.
The sub-humane quarantine centres.
COVID-17 pandemic has been notified as a “disaster” under the Disaster Management Act, 2005.
Under Section 12 of the Disaster Management Act, 2005, the state under a National disaster management plan is bound to provide the minimum requirements in the relief camps or quarantine institutions concerning shelter, food, drinking water, medical cover, and sanitation.
But these quarantine centres for isolation of infected patients tell a different story altogether.
Lakhs of COVID infected people that have been moved into numerous quarantine institutions have been coming about the lack of hygiene and sanitation, nonavailability of edible food and clean drinking water in the quarantine institutions. It is submitted that in absence of such minimum requirements being meted out, these quarantine institutions have become hotbeds for the spread of COVID-19 infection
People are escaping the quarantine institutions fearing that they would die due to poor hygiene. This amounts to a betrayal of the obligations of the State under Articles 38, 39, 41, and 42 of the Constitution to ensure the welfare of the people. It is for this reason, and no other reason that large numbers of these people are escaping the quarantine institutions in fear of their death as respondents fail to provide even the basic hygiene for a human. In the supreme court cases of Maneka Gandhi v. Union of India and Consumer Education and Research Centre v. Union of India the bare minimum standard of health for humans was held as a part of article 21 of the constitution.
Escaping of COVID-19 patients from quarantine facilities and likewise incidences is of gross negligence on the part of the administrative authorities has to be taken care of with great caution.
The “on-ground problems” faced by healthcare facilities.
In the case of Paschim Banga Khet Mazdoorsamity … vs State Of West Bengal the honorable Supreme Court held that Hospitals whether private or governmental, have to admit the patients in case of emergency if the adequate facilities are available.
But, do hospitals have the adequate facilities to tackle the situation?
Due to a high surge of COVID 19 cases hospitals and healthcare facilities were bombarded with patients. While there is a need to increase the treatment capacity for COVID-19 given the rising number of Infections. Not every hospital has the infrastructure to treat non-COVID and COVID positive patients under one facility. Treating both kinds of patients only risks the exposure and spread of the virus to non-infected patients. It does not achieve the stated objective of treatment and containment of COVID-19, thereby violating Article 14, and further, it results in endangering public health, which is a violation of Article 21 of the Constitution of India. This will be arbitrary and will not achieve the desired objective. If there is intermingling then there is a definite increase in the risk of spreading the infection.
Most of the hospitals/nursing homes are constructed as a single building, and not as separate blocks where COVID-19 patients can be housed. In such buildings, the challenges start from common entry and exit points, common lobby, common lifts, common washrooms, etc. All patients whether COVID-19 or not will be using the common facilities which definitely increases the risks of infection, despite the facility taking all possible care of reducing intermingling. In such a case, the hospitals/nursing homes themselves will become centers for the spread of COVID-19, which will defeat the very purpose for which the state is responsible under Article 47 and entry 81 of the Union List of the constitution of India. Most of the hospitals are designed in terms of air conditioning, other supplies like pharma, engineering services, oxygen supply, etc. to achieve segregation. Because such proper segregation can be achieved only if a separate physical block can be dedicated to COVID-19 patients, or the entire facility is declared as dedicated for COVID-19 treatment. The healthcare facilities need at least three separate blocks or buildings for the COVID positive – the non COVID – and the patients awaiting results of COVID infection.
Also, numerous cases of doctors and medical workers being infected and ultimately succumbing to COVID-19 because of lack of PPE kits have surfaced over the time.
The govt. suffers from availing adequate testing kits to examine patients with Covid-19 and other basic necessities. But, it’s worse for healthcare workers, who haven’t been given adequate Personal Protective Equipment (PPEs). So, we are moved to ask ourselves, who will protect our life savers?
The Covid-19 pandemic has highlighted the poor medical infrastructure within the States where there are only a few Hospitals or Primary Health care centers, only a few Doctors and nurses in Government sector, lack of medicines and poor quality medical infrastructure.
The coronavirus pandemic reveals the dire need of a separate public health law. So, we must revise the 2009 Bill and pending health policies and reintroduce them as strongpublic health laws. Thus, India needs to provide adequate health service to people, not by stating it merely under art 21, but by ensuring the same practically.