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Right To Health And Health Care

As human beings, our health and the health of those we care about is a matter of daily concern. Regardless of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and essential asset. At the same time, we are willing to make many sacrifices if only that would guarantee us and our families a longer and healthier life. In short, when we talk about well-being, health is often what we have in mind.

The right to health is a fundamental part of our human rights and of our understanding of a life in dignity. The right to the enjoyment of the highest attainable standard of physical and mental health. Internationally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

The preamble further states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living. The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights. The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognizing the right to health.

Introduction
In a welfare, state health and health care of the people are of prime importance. It presupposes that the state to ensure conditions congenial to good health. Maintenance and improvement of public health have to rank high as these are indispensable condition required in the modern state. Right to health is a necessity for rich and poor. The right to health is concerned with various factors such as housing, food, water, sanitation, and environment.

Health is a vital indicator of human development and human development is the basic ingredient of economic and social development. In India, the right to Health care and protection has been recognized, since early times, Independent India approached the public as the right holder and the state as the duty-bound primary provider of Health for all. As our country is a founder member of the United Nations, it has ratified various international conventions promising to secure Health care right of individuals in society. In Indian Constitution does not expressly recognize the fundamental right to Health.

However, Article 21 of the Constitution of India guarantees a fundamental right to life & personal liberty. The expression ‘life in this article means a life with human dignity & not mere survival or animal existence. It has a much wider meaning which includes right to livelihood, better standard of life, hygienic condition in workplace & leisure.

The right to Health is inherent to a life with dignity. In this paper we will be discussing about core elements and components of right to health, right to health in other countries, Constitution of India on right to health, implementation of right to health in India. Also, we will be explaining a contemporary issue in relation with this pandemic situation.

Core elements of a right to health
  1. Progressive realization using maximum available resources
    No matter what level of resources they have at their disposal, progressive realization requires that governments take immediate steps within their means towards the fulfilment of these rights. Regardless of resource capacity, the elimination of discrimination and improvements in the legal and juridical systems must be acted upon with immediate effect.
     
  2. Non-retrogression
    States should not allow the existing protection of economic, social, and cultural rights to deteriorate unless there are strong justifications for a retrogressive measure. For example, introducing school fees in secondary education which had formerly been free of charge would constitute a deliberate retrogressive measure. To justify it, a State would have to demonstrate that it adopted the measure only after carefully considering all the options, assessing the impact and fully using its maximum available resources.
     
Core components of the right to health
The right to health (Article 12) was defined in General Comment 14 of the Committee on Economic, Social and Cultural Rights – a committee of Independent Experts, responsible for overseeing adherence to the Covenant. (4)

The right includes the following core components:
  • Availability
    Refers to the need for a sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes for all. Availability can be measured through the analysis of disaggregated data to different and multiple stratifies including by age, sex, location and socio-economic status and qualitative surveys to understand coverage gaps and health workforce coverage.
     
  • Accessibility
    Requires that health facilities, goods, and services must be accessible to everyone. Accessibility has four overlapping dimensions:
    • Non-discrimination
    • physical accessibility
    • economical accessibility (affordability)
    • information accessibility.

      Assessing accessibility may require analysis of barriers – physical financial or otherwise – that exist, and how they may affect the most vulnerable, and call for the establishment or application of clear norms and standards in both law and policy to address these barriers, as well as robust monitoring systems of health-related information and whether this information is reaching all populations.
       
  • Acceptability
    Relates to respect for medical ethics, culturally appropriate, and sensitivity to gender. Acceptability requires that health facilities, goods, services and programmes are people-centered and cater for the specific needs of diverse population groups and in accordance with international standards of medical ethics for confidentiality and informed consent.
     
  • Quality
    Facilities, goods, and services must be scientifically and medically approved. Quality is a key component of Universal Health Coverage, and includes the experience as well as the perception of health care. Quality health services should be:
    1. Safe – avoiding injuries to people for whom the care is intended
    2. Effective – providing evidence-based healthcare services to those who need them;
    3. People-centered – providing care that responds to individual preferences, needs and values;
    4. Timely – reducing waiting times and sometimes harmful delays.
    5. Equitable – providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socio-economic status;
    6. Integrated – providing care that makes available the full range of health services throughout the life course;
    7. Efficient – maximizing the benefit of available resources and avoiding waste

Right to health in other countries
In the international perspective, Right to Health is a very basic fundamental right according to WHO. Right to health for people means that everyone should have access to health services whenever needed in spite of the financial crisis. Right to health is not only about getting timely health care. According to WHO guidelines, RTH also includes safe and potable water, adequate sanitation, healthy occupational and environmental conditions, access to health-related information etc.

Every individual has the right to privacy and to be treated with dignity and respect. Based on this right to privacy no person shall be subjected to medical examinations without consent. These are the basic reasons behind World Health Organization to promote people centered care as a manifestation of human rights.

Discrimination in health care will totally be unfair and will act as a major barrier to develop as a community. So, RTH is acknowledged and is relevant in every state of the world. Every country has ratified at least one international treaty that recognizes the right to health. There is a separate committee to check on how RTH is being implemented and practiced in every county.

China:
In China, the government have been providing health care services for people after Chinese communist revolution in 1949. But during 1990, there was a high point of privatization of healthcare services which led to low life expectancy rate in the country. Then, the government took various measures, introduced various policies to provide healthcare to the people. In 2008 the government declared a reformation plan on playing the dominant role in providing public health and basic medical services. In the next decade, various other schemes were introduced and in the year 2017 almost 97 percentage of the Chinese population were covered under three categories of public health insurance.
  • Urban Employee Basic Medical Insurance
  • Urban Resident Basic Medical Insurance
  • New Corporation Medical Services

People falling under the category can claim insurance for every medical expense even if it is trivial. But even after 2017 the right to health was not actually legalized in the country. During pandemic, in 2020 March the Chinese government legalized basic medical and healthcare. The law stated that health must be prioritized and right to health is a fundamental duty of Chinese population.
United Kingdom:
United Kingdom is a developed country but the right to health is not a recognized protection under law. However, in this country human right is legalized and obliges all public authorities including National Health Services. National Health Services provide public health care to permanent residents of a country. The system was originally designed to provide free healthcare at the point of need and shall be paid in the form of general taxation method. But few changes were made like general taxation method doesn't include prescribed medicines and dentistry. Since human rights is legalized in this country patients get health care benefits like
  • The elderly and vulnerable patients should not be mistreated
  • It is the duty of the hospitals to protect patients at risk and prioritize them
  • Parent’s consent to treat a child was important

France:
France has a system of healthcare largely financed by the government in the form of National health insurance. Even though not all medical expenses can be claimed under this insurance policy, France still manages to be consistently ranked as one of the best in providing healthcare services to the public. The quality of health care in France is par while compared to ither western countries.

Japan:
Japan is one of the most developed countries in the world and it is mandatory for all the residents in this country to have health insurance coverage. People without insurance from their company or from employers can take part in National health insurance program administrated by local government. In such a way, patients have the liberty to choose their doctors and facilities while the government will cover for these people.

USA, MEXICO, SOUTH KOREA, TURKEY:
In these countries Right to Health care can't be actually enjoyed. The country doesn't really have health care but only health insurance system. Right to health has been long recognized internationally but there was never a proper system in these countries. It is not even considered as a basic human right in these countries even though these countries campaign for human rights throughout the world. Even though they have proper medical and health facilities, they are not funded by the government.

Under developed countries:
Underdeveloped countries and developing countries like Congo, Myanmar, Nigeria they have a void in their healthcare services. Developing or underdeveloped countries like Libya Tanzania etc., have 10 doctors available to treat around 1 million people, whereas in developed countries like USA, UK, on average they have 3000 doctors available to treat 1 million people which is a huge difference.

This could be due to deficiency in resources. These countries are mainly lack for doctors. Financial resources are also unevenly distributed as these countries often get affected by natural calamities like famine, drought etc. Apart from that, there also exists inequality in services. Since there are very limited number of health care workers available in these countries, they are often more accessible to people who are capable to pay. So, people with limited financial resources find it difficult to get treated in these countries. As a result of lack of healthcare average expectancy rate of people in these countries are really low.

Fundamental rights
Article 21: Protection of Life and Personal Liberty:
Case Law:
  1. C.E.R.C. V. Union of India
  2. Mr. X. v. Hospital Z,
  3. Parmanand Katara v. Union of India
  4. Paschim Banga Khet Mazoor Samity v. State of W.B.,
  5. State of Punjab v. Ram Bagga

    Article 19(1)(g) in The Constitution Of India 1949
    (g) to practice any profession, or to carry on any occupation, trade or business
    Article 19(6) in The Constitution of India 1949
     
  6. Nothing in sub clause (g) of the said clause shall affect the operation of any existing law in so far as it imposes, or prevent the State from making any law imposing, in the interests of the general public, reasonable restrictions on the exercise of the right conferred by the said sub clause, and, in particular, nothing in the said sub clause shall affect the operation of any existing law in so far as it relates to, or prevent the State from making any law relating to:
    1. the professional or technical qualifications necessary for practicing any profession or carrying on any occupation, trade or business, or
    2. the carrying on by the State, or by a corporation owned or controlled by the State, of any trade, business, industry or service, whether to the exclusion, complete or partial, of citizens or otherwise


Municipal Corporation v. Jan Mohammed
Article 23(1) in The Constitution of India 1949
  1. Traffic in human beings and beggar and other similar forms of forced labor are prohibited and any contravention of this provision shall be an offence punishable in accordance with law.

    Article 24 in The Constitution of India 1949
24. Prohibition of employment of children in factories, etc. No child below the age of fourteen years shall be employed to work in any factory or mine or engaged in any other hazardous employment Provided that nothing in this sub clause shall authorize the detention of any person beyond the maximum period prescribed by any law made by Parliament under sub clause (b) of clause (7); or such person is detained in accordance with the provisions of any law made by Parliament under sub clauses (a) and (b) of clause (7)

DIRECTIVE PRINCIPLES OF STATE POLICY:
38. The State shall strive to promote the welfare of the people by securing and protecting as effectively as it may a social order in which justice, social, economic and political, shall inform all the institutions of the national life.

39. The State shall, in particular, direct its policy towards securing:
  1. that the citizens, men and women equally, have the right to an adequate means of livelihood
  2. that the ownership and control of the material resources of the community are so distributed as best to subserve the common good;
  3. that the operation of the economic system does not result in the concentration of wealth and means of production to the common detriment;
  4. that there is equal pay for equal work for both men and women;
  5. that the health and strength of workers, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength;
  6. that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation

41. The State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want.

42. The State shall make provision for securing just and humane conditions of work and for maternity relief.
P Sivaswamy v. State of Andhra Pradesh

47. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavor to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.

Vincent Panikurlangara v. Union of India
48A. The State shall endeavor to protect and improve the environment and to safeguard the forests and wild life of the country.

51A. It shall be the duty of every citizen of India:
(g) to protect and improve the natural environment including forests, lakes, rivers and wild life, and to have compassion for living creatures;

How far India is successful in implementing Right to health
Health is a vital indicator of human development and human development is the basic ingredient of economic and social development. Health has been acknowledged as a fundamental right of the people. The State priority is reflected through its policies and programmes undertaken by governments. The evolving appropriate laws and enforcement of laws in achieving the goal is an important process. India's poor health indices are cause for concern. The country does not seem to be on track to meet health targets set for the Millennium Development Goals and the 11th Five Year Plan. Nowadays India is facing problem of degradation of health. People are losing their lives.

Providing adequate medical facilities for the people is an obligation undertaken by the government in a welfare state. Article 21 imposes an obligation on the state to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The government hospitals run by the state are duty bound to extend medical assistance for preserving human life.

Failure on the part of a government hospital to provide timely medical treatment to a person in need of such treatment, results in violation of his right to life guaranteed under Article21. Indian courts have held that in emergencies neither government nor even private doctors can insist on payment of money before dealing with the patient in an emergency situation.

In Pravat Kumar Mukerjee vs. Ruby General Hospital, case of a young student whose motorcycle was dashed by a bus in Calcutta. He was brought to the Respondent hospital but the treatment was not continued as Rs.15, 000 as demanded by the hospital were not immediately paid. The boy died.

The National Commission held that though a doctor was not bound to treat each and every patient, in emergencies the doctor was bound to treat the patient and could not insist on delaying treatment until the fees were paid. The Petitioner was awarded a compensation of Rs. 10 lakhs. In conclusion all doctors and hospitals, whether private or government, have to treat emergency patients. If they do not do so, the patient or immediate kin can approach the court for compensation for violating their right to life (Article 21).

Policies:
The condition of health is worsening day by day in spite of various health schemes and policies. Government of India formulated its first National Health Policy in 1983 and released second National Health Policy in 2002, nearly 20 years after the formulation of the first one in 1983. Although the National Health Policy (NHP) in India was not framed until 1983, India has built up a vast health infrastructure and initiated several national health programmes over last five decades in government, voluntary and private sectors under the guidance and direction of various committees (Bore, Mudaliar, Kartar Singh, Srivastava), the Constitution, the Planning Commission, the Central Council of Health and Family Welfare, and Consultative Committees attached to the Ministry of Health and Family Welfare.

However, many states do not have a clear Health Policy. The strategies of the states are mostly guided by the National Health Policy and the National Programs. The period after 1983witnessed several major developments in the polices impacting the health sector by adoption of National Health Policy in 1983 and 2002, 73rd and 74th Constitutional Amendments in 1992, National Nutrition Policy in 1993, National Health Policy in 2002 and the proposed National Health Policy 2011.

However, the State has to play a central role in helping develop an organized system of health care as against the prevailing laissez-faire approach. The existing health care services will have to be restructured under a defined system and its financing organized and controlled by an autonomous body. To facilitate such restructuring a well-defined system of rules and regulations will have to be put in place so that minimum standards and quality care are assured under a system. Public health may receive more attention in the near future.

Role of Government and other local bodies:
The Government is responsible to provide health services to the public. In India the health services are provided both by the Central and State Governments. But the available resources with governments are not enough to cover all citizens under health care services. Hence, services provided by private PR actioner, hospitals and nursing homes are predominant. There is a big difference in availed services. Poor people cannot afford small fees.

As a result, there is a heavy rush of patients at Government hospitals for minor ailments as well as graves one. The outcome is the exploitation of poor and innocent people by the both public and private sectors in the wake of providing health services. Today in the era of globalization where public services are slowly being privately operated and open to market forces, access to them becomes a correlate of income distribution in which the poorer sectors have to fend for themselves in an increasingly unequal society.

Right to Health Care of government employees is integral to right to life: In State of Punjab vs. Mohinder Singh Chawla, which dealt with right to medical treatment of Government employees, the Supreme Court observed: If the Government servant has suffered an ailment which requires treatment at a specialized approved hospital and on reference whereat the Government servant had undergone such treatment therein, it is the duty of the State to bear the expenditure incurred by the Government servant.

Not only the state but also panchayat, Municipalities are liable to improve and protect public health. According to Art 243g The legislature of a state may endow the panchayats with necessary power and authority in relation to matters listed in the eleventh schedule.

The entries in this schedule having direct relevance to health are as follows; [Article 243 G]
  • Drinking water
  • Health and sanitation including hospitals, primary health centers & dispensaries
  • Family welfare
  • Women and child development
  • Social welfare including welfare of the handicapped and mentally retarded
  • Water supply for domestic industrial and commercial purpose
  • Public health, sanitation conservancy and solid waste management
  • Regulation of slaughter – houses and tanneries.

The Institution created at the local and national levels, which can play powerful roles in public health. The Panchayat Raj Act has placed emphasis on building local government, and devolving health activities to them. Through the 73rd and 74th Constitutional Amendment Acts (1992), the local bodies (Municipalities and Panchayat) have been assigned 29 development activities, which have a direct and indirect bearing on health. These include health and sanitation (covering hospitals, PHCs and dispensaries), family welfare, drinking water, women etc. The LSGs and NGOs play a pivotal role in combating various health issues.

Two important schemes
  1. CMCHIS Scheme:
    The Chief Ministers Comprehensive Health Insurance Scheme (CMCHIS) is launched by the government of Tamil Nadu through United Insurance Company Ltd, a public sector insurance company, at Chennai. The CMCHIS delivers equality in the provision of health care to eligible person(s) through the empaneled government and private hospitals with the aim to reduce the financial hardship to the enrolled families. During a medical emergency, the beneficiary should produce the Maruthuva Kapitu Thittam Card or the smart card to the hospital. The hospital authorities will send the related information to the Third-Party Administrator (TPA) or insurance company. The CMCHIS claim amount will be settled directly between the hospital and the insurance company.
     
  2. Pradhan Mantri Jan Arogya Yojana:
    On 23 September 2018, the Government of India introduced an ambitious government-sponsored health scheme, termed the Pradhan Mantri Ayushman Bharat Yojana (now called the Pradhan Mantri Jan Arogya Yojana (PMJAY)). The program was introduced with the intent to reduce the financial burden on poor and vulnerable groups as a result of hospitalization and ensure they get access to quality healthcare.

    The Ayushman Bharat health scheme offers financial protection to 10.74 crore poor, rural families and identified occupational categories of urban workers’ families. The project offers an annual health cover of Rs. 5,00,000 per family (on a family floater basis). It covers medical and hospitalization expenses for nearly all secondary care and tertiary care procedures. The government-backed program has defined 1,350 medical packages covering surgery, medical and day care treatments, including medicines and transport.


State Performance:
Kerala has occupied the top slot in terms of health performance among large states followed by Andhra Pradesh and Maharashtra, whereas Uttar Pradesh and Bihar remained at the bottom, according to the Niti Aayog's second round of Health Index. The ranking was done under three categories -- larger states, smaller states and Union territories (UTs) -- to ensure comparison among similar entities.

The Index ranks the States and Union Territories based on 23 health-related indicators, including neonatal mortality rate, under-five mortality rate, proportion of low birth weight among new-borns, proportion of districts with functional Cardiac Care Units, full immunization coverage and proportion of specialist positions vacant at district hospitals. Some States such as Rajasthan have improved their health status, but what is worrisome is that States such as Madhya Pradesh, Odisha, Uttarakhand, Uttar Pradesh and Bihar have not improved at all, it said.

As of 2020 news Only six states have enacted a public health law, nine are in the process of formulating one, while eight have no plans to bring in any such law oriented towards providing protection and fulfilment of rights related to health and well-being. A bench led by Chief Justice S.A. Bobde had directed the central government to advise all states and Union Territories (UTs) to formulate a legal framework, similar to the National Health Bill, 2009, which focuses on marginalized sections of society.

In the same order, the court had also asked the ministry to convene a meeting of all state health ministers or secretaries, and collate information regarding the steps taken by the states and UTs to frame the public health law.

According to the ministry’s affidavit, Andhra Pradesh, Tamil Nadu, Goa, Uttar Pradesh, Madhya Pradesh and Assam have their own public health acts. Both Tamil Nadu and Andhra Pradesh enforced the law in 1939 and have amended it from time to time. Madhya Pradesh’s law was put in place in 1949 whereas Goa formulated a public health act in 1985.

In Uttar Pradesh, the law was framed in 2020, after the Covid breakout. Meanwhile, Karnataka, Punjab, Sikkim, Odisha, Manipur, Jharkhand, Meghalaya, Maharashtra and the UT of Dadra and Nagar Haveli and Daman and Diu plan to enact such a law in the near future, the affidavit stated. But West Bengal, Chandigarh, Jammu and Kashmir, Uttarakhand, Mizoram, Nagaland, Haryana and Andaman and Nicobar Islands have no plans to legislate a public health law. Both Nagaland and Haryana had, however, proposed adopting the central government’s Act. The affidavit doesn’t mention the remaining states and UTs.

Mental healthcare act
India's Mental Healthcare Act 2017 was designed ‘to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services’ (Preamble). According to the World Health Organization (WHO), health is a state of complete physical, mental and social well-being, and not merely the absence of disease. This holistic approach is relatively new and is indicating a shift in how the right to a standard of living adequate for health and well-being, first enshrined in the Universal Declaration of Human Rights 70 years ago, is now understood.

In a recent report on the right to mental health, the UN right to health expert, Mr. Dainius Pūras, pointed out that despite evidence that there cannot be health without mental health, nowhere in the world does mental health enjoy parity with physical health in terms of budgeting, or medical education and practice. As human beings, our health and the health of those we care about is a matter of daily concern. Regardless of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and essential asset. A user of psychiatric services sits in a yard and looks in through one of the windows of a mental healthcare centre in Herat, Afghanistan, March 2017. Ill health, on the other hand, can keep us from going to school or to work, from attending to our family responsibilities or from participating fully in the activities of our community. Similarly, we are willing to make many sacrifices if only that would guarantee us and our families a longer and healthier life.

COVID And Constitution
In Re: The Proper Treatment of Covid 19 Patients and Dignified Handling of Dead Bodies in The Hospitals Etc.
(Ashok Bhushan)
(R. Subhash Reddy)
(M.R. Shah)

"Right to health is a fundamental right guaranteed under Article 21 of the Constitution of India. Right to health includes affordable treatment. Therefore, it is the duty upon the state to make provisions for affordable treatment and more and more provisions in the hospitals to be run by the state and/or local administration are made.

It cannot be disputed that for whatever reasons the treatment has become costlier and costlier and it is not affordable to the common people at all. Even if one survives from COVID-19, financially and economically he is finished. Therefore, either more and more provisions are to be made by the state government and the local administration or there shall be cap on the fees charged by the private hospitals, which can be in exercise of the powers under the Disaster Management Act," said the bench in its detailed order.

We with regard to above, issue following directions:
All States/Union Territories should appoint one nodal officer for each Covid hospital, if not already appointed, who shall be made responsible for ensuring the compliance of all fire safety measures.

In each district, State Government should constitute a committee to carry fire audit of each Covid hospital at least once in a month and inform the deficiency to the management of the hospital and report to the Government for taking follow up action.

The Covid hospital who have not obtained NOC from fire department of the State should be asked to immediately apply for NOC and after carrying necessary inspection, decision shall be taken. Those Covid hospitals who have not renewed their NOC should immediately take steps for renewal on which appropriate inspection be taken and decision be taken. In event, Covid Hospital is found not having NOC or not having obtained renewal, appropriate action be taken by the State.

Karnataka HC said that proper supply of oxygen is the most basic of what the court must do in view of upholding A 21 of the constitution

Chief Justice Abhay and Justice Aravind Kumar directed:
Delhi HC not inclined to go any further in regard to pleas challenging that MLA Imran Hussain hoarding oxygen cylinders.SC to centre when they lost the case challenging the Karnataka hcs order "When we say 700 metric tons, it means (the amount of medical oxygen to be supplied) every day to Delhi. Please do not drive us to a situation to take coercive steps... We are clarifying that it will be 700 MT every day," the top court said sternly, a day after prolonged arguments in court.

The Delhi High Court on Saturday warned Centre that it will face contempt charges if Delhi doesn't get enough oxygen supply today. The Delhi govt has attacked the Centre saying oxygen has become an ego issue.

You have your own state-run steel plants and petroleum industries. Why can’t you curtail it? Why can’t you stop it? Why can’t you minimize it to whatever is absolutely critical? We can understand that you cannot shut down petroleum production completely in the country because it is a critical thing by itself, but you can reduce it. We are sure that if you were to divert their oxygen for medical use, you would be able to meet the requirement.

here are many provisions in the Law that monitor and regulate the price of medical equipment and medicines. The Drugs Pricing Control order (DPCO) 2013, issued by the National Pharmaceutical Pricing Authority (NPPA), which comes under the Ministry of Chemicals and Fertilizers has set limits on prices of Drugs-- which include medicines and several classes of medical equipment. NPPA has the authority to set maximum pricing for drugs and to monitor the current prices without setting limits. It can also make rules to control prices.

The Essential Commodities Act 1955 also allows the Government to pass orders classifying any commodity, agricultural or manufactured as an essential commodity.. The Government can then pass directions for controlling the price at which essential commodity may be bought or sold; regulating by licenses, permits or otherwise the storage, transport, distribution, disposal, acquisition, use or consumption of, any essential commodity; and for prohibiting the withholding from sale of any essential commodity ordinarily kept for sale. Any violation of the government orders would lead to punishment of up to 7 years, in addition to fines, seizure of property, and other penalties.

Another law for regulating black-marketing is the Prevention of Black marketing and Maintenance of Supplies of Essential Commodities Act, 1980. This act allows government officials-- of the rank of District Magistrate, Police commissioner, or a Secretary of the State government to pass orders for preventive detention of any person who is acting in any manner prejudicial to the maintenance of supplies of commodities essential to the community.

This Act allows for preventive detention of any person who could be either themselves committing or instigating someone to commit an offence under the Essential Commodities Act or could be dealing in the Commodities that have been classed as essential commodities.
However, for any of these provisions to apply, the first requirement is that the commodity must be notified as an essential commodity by the government.

On March 31, 2020, the NPPA, issued an order stating that medical devices would be reclassified as drugs, which can be regulated under the Drugs Pricing Control Order (DPCO) 2013 read with the Essential Commodities Act 1955.

Under this provision, the MRP of the medical devices would be monitored, to ensure that no manufacturer/importer increases the MRP of a drug by more than 10% of the MRP during one year. If anyone does so, they would be faced with a penalty.

Following this order, on June 29, 2020, the NPPA issued an Office Memorandum (OM) to monitor MRP of Pulse Oximeters and Oxygen concentrators. A Notice was issued to all importers/manufacturers to submit MRP details under the DPCO 2013. The OM also reiterated that the price of medical devices cannot be increased more than 10% in a year.
However, while the hike in prices is being monitored, the two medical devices have not yet been declared as essential commodities under the specific provisions.

Even, in the now highlighted Navneet Kalra oxygen concentrator hoarding case, the plea taken by Kalra in his anticipatory bail plea is that the provisions under the Essential Commodities Act cannot apply, since the concentrators are not a notified essential commodity. You must cut the pandemic at the threshold. In cities, these issues can be managed, treatments can be given, but not the case with rural areas.

Your priority should be villages now. In the first wave, villages were not affected, now they are. Kusum was being provided with oxygen while sitting on a bench at a local hospital as there were no beds available. After almost five hours, she had managed to get a bed after the journalist had spoken to the hospital administration. And it is not just the case of Kusum, several patients could not get beds as the administration was not ready for so many of them in the first place. India Today journalists Pankaj Upadhyay and Mohammad Hussain travelled to the interior of Palghar to look at the grim situation in the neighboring district.
  • CMCHIS Scheme:
    The Chief Ministers Comprehensive Health Insurance Scheme (CMCHIS) is launched by the government of Tamil Nadu through United Insurance Company Ltd, a public sector insurance company, headquartered at Chennai. The CMCHIS delivers equality in the provision of health care to eligible person(s) through the empanelled government and private hospitals with the aim to reduce the financial hardship to the enrolled families.

What is covered in the CMCHIS?
  • Hospitalisation
  • Diagnostic procedures
  • Follow up procedures

Who can avail the services under the CMCHIS?
  1. All the registered members of an eligible family can avail health insurance benefits under this plan.
  2. There is no cap on the income of a Sri Lankan refugee to enrol under the CMCHIS.
  3. Migrants from other states can also join the CMCHIS based on the request letter along with a list of eligible members from the labour department, provided they have resided for more than 6(six) months in the state as certified by the suitable authority.
  4. Orphans residing in any registered/ unregistered organisation can be given a single card. This also includes the rescued girl children and any other person(s) defined as orphan by the government.

Is the CMCHIS subject to automatic renewal?
No, the policy period of the CMCHIS is one year after which the policy holder needs to get the policy renewed.

How does it work?
During a medical emergency, the beneficiary should produce the Maruthuva Kapitu Thittam Card or the smart card to the hospital. The hospital authorities will send the related information to the Third-Party Administrator (TPA) or insurance company. The CMCHIS claim amount will be settled directly between the hospital and the insurance company. Usually, no additional intervention from the beneficiary is required.

AB-PMJAY:
Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a scheme that aims to help economically vulnerable Indians who are in need of healthcare facilities. The AB-PMJAY beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country.

Note: As per a recent government order, with regard to non-critical COVID 19 cases, a package is to be enabled under AB-PMJAY. The expenditure towards this will be reimbursed to only empanelled private hospitals.

The state government will have to take a stand on the issue of compensating families of the victims it is needless to add that right from the decision of the apex court in the case of Eidul Sah v state of Bihar 1983 and followed by Nilabati Behra v State of Orissa and various decisions rendered subsequently which hold that while dealing with the petition under article 226 of the constitution of India writ court can grant compensation for violation of fundamental rights guaranteed to citizens under article 21 of the constitution we put the state to note is that the question of granting compensation will be considered on the next date.

Order to provide for immediate isolation of residents who are tested covid positive the Delhi High court on Thursday may 13th yishu direction to set up a covid care centre inside the Jawaharlal Nehru University the bench of justice prathiba m Singh observed that setting up dedicated covid care centre would enable search affected persons to immediately isolate and for their basic parameters to be monitored.

Allahabad High court on Tuesday observed that the state must grant at least one crore has ex-gratia compensation to the families of polling officers who died due to covid-19 while after the up-Panchayat polls. To compensate the loss of the life of the brand owner of the family and that too because of the deliberate act on the part of the state and the state election commission to force them to perform duties in the absence of a r t p c r support the compensation must be at least to the tune of rupees 1 crore. Karnataka High court on Thursday observed that not giving second dose of covid-19 vaccine will be a violation of the fundamental right to life under article 21 of the constitution.

Conclusion
The term Right to Health is nowhere mentioned in the Indian Constitution yet the Supreme Court has interpreted it as a fundamental right under Right to Life enshrined in Article 21. It is a significant view of the Supreme Court that first it interpreted Right to Health under Part IV i.e., Directive Principles of State Policy and noted that it is the duty of the State to look after the Health of the people at large. In its wider interpretation of Article 21, it was held by the Supreme Court that, the Right to Health is a part and parcel of Right to Life and therefore one of fundamental rights provided under Indian Constitution.

In the real sense, the court has played a pivotal role in imposing positive obligations. The basic right of access to health care of appropriate quality is a fundamental humanitarian principle that should be enjoyed by all citizens of all countries, and the international community should recognize the obligation to promote these ideals by any means available. Indeed, although social rights such as health care demand citizens’ solidarity to be enjoyed, only with the universalization of social rights will humanity be more equal in the future.

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