'Private lobbies at work': Rajasthan health rights Act politically motivated, says JSA

Counterview Desk 
Top health rights network Jan Swasthya Abhiyan (JSA), even as welcoming the enactment of Rajasthan Right to Health Act, 2022 as a “ in ensuring people’s access to healthcare”, has objected to entities like the Indian Medical Association (IMA) for “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.”
Appealing to agitating medical professionals and their associations such as IMA “to recognise the importance of this Act, and to positively engage with streamlining of the Act and Rules”, JSA said in a statement, the misinformation is being spread by certain lobbies which are claiming that the Act is anti-private sector, calling the demand to withdraw the Act as “politically motivated.

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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are claiming that the act is anti-private sector, linked with their politically motivated demand that the Act should be withdrawn.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 appeals to private medical professionals to recognise importance of the Act, and positively engage to streamline it

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.