JSA Urges Raj Govt to Make Clarifications in Health Bill to Ensure Effective Implementation

New Delhi: Jan Swasthya Abhiyan (JSA) released a press statement welcoming the Rajasthan Right to Health Act passed in the State Legislative Assembly on  March 21, 2023, and congratulated the State government of Rajasthan for achieving an important milestone in the history of Health policy in India. 

JSA is a joint platform of hundreds of grassroots organisations and state and national level networks that work for the health and related rights of the people and is affiliated with the Global People’s Health Movement. 

While the platform has welcomed the Act, it has also criticised the misinformation spread by certain lobbies claiming that it is an anti-private sector, linked with their politically motivated demand that the Act be withdrawn. At the same time, JSA is also concerned that despite several strengths, some provisions in this Act need clarifications or modifications to ensure optimally effective implementation.

After passing the Right to Health Act last week, an unprecedented kerfuffle followed, with doctors in the State vehemently protesting what they called a ‘draconian law’. 

The Right to Health is in sync with the constitutional guarantee of the right to life and other components of the Directive Principles. This means that no person seeking health care should be denied it on the grounds of access and affordability.

The Rajasthan Right to Health Act, 2022, addresses these critical issues of access and affordability. It “seeks to provide protection and fulfilment of rights, equity in relation to health and well-being for achieving the goal of health care for all through guaranteed access to quality health care for all residents of the State, without any catastrophic out-of-pocket expenditure”. The law, which also provides for a social audit and grievance redress, gives every resident of the State the right to emergency treatment without paying a single paisa to any healthcare institution and specifies that private healthcare institutions would be compensated for the charges incurred for such treatment.

However, Agitating doctors are worried about financial losses and dread humiliation at authorities' hands.

Civil society groups, including JSA Rajasthan, had a significant role in pushing for this Act. In their press release, JSA National Coordination Committee and JSA Rajasthan state unit have offered their full support and solidarity to the Government of Rajasthan towards realising health rights for all people of the state. They have also urged the government for speedy implementation of the Act after making necessary clarifications to address the misinformation campaign against this law. They have also urged the government to ‘build the trust of all constituencies and uphold Rajasthan as a model state in achieving health rights for all,  which could become an example for other forms of India.’ 

The complete press statement is given below: 

“Jan Swasthya Abhiyan welcomes Rajasthan Government’s Right to Health  Act - a landmark in ensuring people’s access to healthcare 

Along with its overall support, JSA recommends improved drafting of certain provisions, to be  clarified and strengthened during further legislative processes 

JSA appeals to private medical professionals to recognise the importance of this Act, and to  positively engage with streamlining of the Act and Rules, while avoiding misinformation 

Jan Swasthya Abhiyan welcomes the Rajasthan Right to Health Act passed in the State Legislative Assembly on  21st March 2023, and congratulates the State government of Rajasthan for achieving an important milestone  in the history of Health policy in India. Rajasthan has initiated the process of making basic health services a  justiciable right, based on providing legal guarantee of public health services and emergency healthcare in the  state, setting a historical example for the rest of the country. 

JSA criticises the misinformation being spread by certain lobbies which are claiming that the act is anti-private  sector, linked with their politically motivated demand that the Act should be withdrawn. At the same time,  Jan Swasthya Abhiyan is also concerned that despite several strengths, some provisions in this Act need  clarifications or modifications to ensure optimally effective implementation of this Act. This would ensure  realization of health rights for people of the state, while also being fair to healthcare providers. We  recommend that the following issues should be addressed by the State government: 

1. Greater clarity and specificity are required regarding the definition of “emergency care”, keeping  in view the complexities of emergency management, and the limited set of first aid measures which can be offered by most healthcare providers 

2. Larger private hospitals (those having over 50 beds) should have broader provisions for providing  emergency services, while smaller health care providers and clinics should have restricted  obligations in this regard, in keeping with their limited capacities  

3. Ensuring that reimbursement to private providers for providing emergency healthcare would be  transparent, hassle-free, corruption free and time-bound 

4. Majorly increasing the State health budget, to provide the substantial additional resources which  must accompany expansion and strengthening of public health services in the state, required for fulfilling all the provisions under this Act 

5. Strengthening mechanisms to ensure accountability of regulatory authorities to people as well as  involved healthcare providers  

The Rajasthan Government has agreed to address many of these issues on the floor of the State Legislative  Assembly, or in their other public communications. These concerns should be addressed by the Government  during further deliberations involving associations of private healthcare professionals as well as civil society  networks and NGOs. However we are concerned that entities like the Indian Medical Association (IMA) have been engaging in agitations aimed at pulling down the Act itself, perhaps without realising the fact that such a  stand goes against the ethos of the medical profession, and the duties of healthcare providers to fulfil  people’s right to health care. We urge the IMA and involved medical professionals to reconsider their  position, and to positively engage with, support the further rolling out of the Act and its Rules.

JSA realises that the Government has been consultative in the process of developing this legislation and has  already accommodated many suggestions from associations of private doctors. After the State Government  first introduced the draft bill in the Legislative Assembly in September 2022, it was sent to a Select Committee  of the Assembly, keeping in view concerns of private doctors’ associations. Then there were several rounds of  discussions with various groups, leading to a series of amendments to the earlier draft of the bill. Given this  background of consultations, JSA strongly criticises the misleading campaigning by certain lobbies which claim  that doctors’ concerns have not been considered. JSA hopes that such pressure will not lead to any weakening  of the provisions for Right to Healthcare.  

JSA strongly welcomes the current Act as a major step forward for ensuring the right to health services for  people in the state. However, we urge the State government to address the following issues in further  processes, to ensure the full effectiveness of this initiative:  

• The current Act mainly ensures Right to healthcare; to move towards comprehensive Right to Health,  further concrete steps are needed by the state to ensure entitlements to determinants of health (such as  food security and nutrition, water supply and sanitation, healthy environmental conditions etc.);  

• The State and District level health authorities are presently limited to government officials and doctors  affiliated with IMA, however public health experts, PRI members, and civil society representatives also  need to be represented;  

• Provisions for helpline and web-based grievance redressal systems for patients which were made in earlier  versions of the Act need to be restored; 

• The Act must ensure health rights for all persons present in the state, not only permanent residents but  also migrants, nomadic persons, visitors from others states etc. 

JSA reiterates that the Right to healthcare can be achieved only through a strong public health system, and we  hope that Rajasthan government will take all necessary steps to ensure public health system strengthening. 

In conclusion, JSA calls for speedy implementation of various further steps required for rolling out this  important legislation, including early formulation of clear and implementable rules for the Act, while  addressing all the mentioned concerns. This would ensure clarity on various critical issues, while addressing  genuine concerns of private healthcare providers and adding strength to the Act so that it can be  implemented most effectively for ensuring people’s health rights. JSA urges the state government of  Rajasthan to take immediate measures to:  

1. Consider necessary amendments to the Act as required, in order to address the gaps and concerns as  mentioned above, towards strengthening health rights for all in Rajasthan; 

2. Urgently prepare and introduce necessary Rules for the Act, in order to concretise various provisions  and to roll out the implementation of the Act; 

3. Set up strong oversight and accountability bodies so that the services to ordinary people are  guaranteed to be provided with dignity, while reimbursements to the private sector providers are  ensured in a transparent corruption free environment, within stipulated time frame; 

4. Adopt a well-defined plan for substantially enhancing the State health budget in line with the  obligations and enhanced requirements being generated through this Act, in order to ensure overall  expansion and strengthening of government provided health services in the state; 

5. Make necessary clarifications to address the misinformation campaign against this law, building the  trust of all constituencies and upholding Rajasthan as a model state in achieving health rights for all,  which could become an example for other states of India.  

Jan Swasthya Abhiyan’s National Coordination Committee and JSA Rajasthan state unit offer their full support  and solidarity to the Government of Rajasthan towards realising health rights for all people of the state.