The fight for health rights
Dr. Satyavan Saurabh
The direction and structure of healthcare in India is rapidly changing. Medical care, once considered a public obligation and a fundamental responsibility of the welfare state, is increasingly being taken over by the private sector.
On the one hand, the government health system struggles with limited budgets, limited human resources, and poor infrastructure; on the other, the reach and influence of private hospitals and corporate medical chains is steadily increasing.
In the midst of this, ordinary citizens, especially the poor, rural residents, Dalits, tribals, minorities, and marginalized communities, are increasingly burdened by rising healthcare costs and unequal access.
In this changing landscape, the debate in India has intensified over whether health should be made a justifiable and enforceable fundamental right. Can the judiciary enforce this right when the system itself is fundamentally unequal, expensive, and privatized?
This question is not merely legal; it is deeply political, social, and economic. Because a right is meaningful only when the state has both the capacity and the willingness to provide it.
In India, the right to health is implicitly recognized by the courts under Article 21, but it has not yet been explicitly made an independent fundamental right. A major reason for this is that the state is not yet in a position to accept the binding responsibility of ensuring equal, accessible, and quality treatment for every citizen. But it is equally true that until it is made an enforceable right, issues like inequality, exploitation, and arbitrary fee-charging will continue to grow.
The greatest irony of India’s public health system is that while the country is on track to become the world’s fifth-largest economy, public spending on health remains among the lowest in the world. When the state doesn’t allocate adequate budgets for healthcare, the private sector naturally fills the void—and this leads to inequality, uncontrolled fees, unnecessary medical procedures, and economic devastation for the common man.
Another aspect of the expanding privatization is that it’s not limited to the operation of healthcare facilities; it’s also influencing health policy, drug prices, insurance schemes, and the direction of public-private partnerships (PPPs).
When health becomes a profit-driven industry, the nature, cost, access, and quality of treatment all become subject to market rules. In such a situation, the right to health may exist on paper, but it’s not widely implemented on the ground.
Another serious problem is the poor implementation of the Clinical Establishments Act, 2010. Even in states where it is in place, regulation and transparency are extremely weak. Issues such as arbitrary patient fees, unnecessary testing recommendations, expensive packages, and surgeries at exorbitant rates have become commonplace. This situation is further compounded by the weak and ineffective mechanisms for patient complaints and justice.
Additionally, out-of-pocket expenditure in India still accounts for around 40% of total health expenditure, meaning patients have to spend a significant amount out of their own pockets. While government insurance schemes—such as Ayushman—intend to provide financial security, the procedures covered are limited, and their use by private hospitals is often arbitrary. The insurance-based model has not solved the root problem of health expenditure; instead, it has often become a new source of customers for the private sector.
Another level of inequality is social exclusion. Dalits, tribals, Muslims, women, transgender people, and citizens with disabilities—these individuals face even more difficult access to healthcare. Often, lack of sensitivity in government hospitals, discrimination, communication gaps, or structural barriers deprive them of quality care. Therefore, the right to health should not remain merely a matter of legal language; it must be understood from the perspective of social justice.
The right to health can only be implemented judiciously if the health system is strong. This first requires the government to increase public health spending. According to the World Health Organization, health should account for at least 5% of GDP; India currently spends less than 2%. Without strengthening the primary health infrastructure, increasing the number of specialist doctors, nurses, and community health workers, making medicines and tests affordable, and strengthening accountability in health institutions—the implementation of any right will remain merely theoretical.
High drug prices and the influence of pharmaceutical companies are another cause of health inequality in India. Nearly 80% of medicines are still price-controlled. Until strict price controls are imposed on essential medicines and the Jan Aushadhi system is expanded, poor and middle-class families will continue to be burdened by expensive medications.
Furthermore, the conditions of health workers are a significant aspect of this crisis. Temporary appointments, low salaries, workload pressure, and unsafe working environments—all these factors impact the quality of medical care. Strong public health services are only possible if the government invests adequately in human resources.
In all these circumstances, the right to health can only be truly implemented when governance structures become more transparent, decentralized, and accountable. Community-based monitoring mechanisms, strengthening district health committees, digital transparency, and effective grievance redressal mechanisms can ensure that citizens can assert their rights and governments are held accountable.
Policy change, as well as political will, is essential. Improving the health system is a long-term task; but it can begin immediately by increasing budgets, bringing private hospitals under stricter regulatory frameworks, controlling drug prices, and strengthening the primary health infrastructure. This will not only make the health sector more equitable but also lay the foundation for a healthy and productive society for the future.
Ultimately, making health judicially enforceable would reaffirm India’s constitutional philosophy—specifically, social justice. But this is only possible if the public health system is strong enough to ensure this right reaches every citizen. If the state’s priorities remain focused on promoting a market-based model rather than health security, the term ‘right’ will lose its relevance, and citizens’ suffering will continue to increase.
India must recognize today that health is not merely a product of economic growth, but the foundation of human dignity. And until this foundation is strengthened equitably, the right to health will remain on paper, but not in the lives of the people.
(The author is a poet, freelance journalist and a columnist)
