Rajasthan’s Right to Health Bill

Context

• The Right to Health Bill was recently approved by the Rajasthan legislative assembly. Rajasthan would become the first state in India to guarantee its citizens’ right to healthcare once the bill is announced.
• Being a torch-bearing step in providing better healthcare, this edition of the burning issue will elaborate on this new law and its criticalities. The topic is relevant for the GS-2 mains paper.

The Right to Health

• The World Health Organization (WHO) says that everyone has the right to health, which means they should be able to get the health care they need, when and where they need them, without having to worry about money. No one should get sick and die because they can’t get the health care they need or because they don’t have enough money.
• RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
• It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.
• Other fundamental human rights, such as having access to clean water and sanitation, nutritious food, adequate housing, education, and safe working conditions, clearly determine good health.

Scope of RTH

RTH covers various health-related issues, including-

• Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
• Accessible, affordable, and quality healthcare services,
• Eliminating barriers to healthcare access
• Informed consent to medical treatment and accessing information about their health.

Right to Health relating to India

Provisions of the Constitution:

• The Constitution of India doesn’t explicitly ensure a basic right to well-being. However, the Constitution makes numerous mentions of public health and the state’s role in providing healthcare to citizens.

Under Directive Principles of State Policy:

• DPSPs: To a limited extent IV of the Indian Constitution gives a premise to one side of wellbeing.
• The State is obligated by Article 39 to ensure the health of workers.
• Article 47 imposes a responsibility on the state to raise people’s nutrition levels, the standard of living, and public health. Article 42 requires the state to provide maternity relief and just and humane working conditions.

Under Fundamental rights:

• Article 21 The Supreme Court of India in Bandhua Mukti Morcha v. Union of India & Ors. found that the Constitution of India did not explicitly recognize the right to health care. interpreted Article 21’s guarantee of the right to life, which covers the right to health.
• In the Territory of Punjab and Ors. In the case of Mohinder Singh Chawla, the Supreme Court reiterated that the right to health is essential to the right to life and that the government was obligated by the Constitution to provide health services.

Article 243G: The Role of Panchayats and Municipalities

• The Constitution does not just oblige the State to upgrade general well-being, yet additionally blesses the Panchayats and Districts to fortify general well-being under Article 243G.

15th Commission on Finances:

• The 15th Finance Commission’s High-Level Group on the Health Sector recommended declaring the right to health a fundamental right in September 2019.
• Additionally, it proposed putting health on the Concurrent List rather than the State List.

Genesis of Right to Health

• In 1996, the Supreme Court held that the right to life (Article 21) included the right to health within its fold, and also pointed out the obligation of state governments to provide health services.
• Under the Constitution, public health and sanitation, including hospitals and dispensaries, come under the State List.
• In 2018, the National Commission on Human Rights (NHRC) drafted the Charter of Patient Rights to be implemented by state governments.
• Rajasthan runs certain schemes to ensure health coverage, including the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, under which health coverage is provided in over 1,550 private and public hospitals across the state. Under the Yojana, insurance coverage is also provided for certain types of treatment.

Features of the Rajasthan Right to Health Bill

• Free treatment: RTH gives every resident of the state the right to avail of free Out Patient Department (OPD) services and In-Patient Department (IPD) services at all public health facilities and select private facilities.
• Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
• Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
• No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
• State reimbursement of charges: After emergency care and stabilization, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.

Significance of the Bill

Frees from Unnecessary obligations:

• The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.

Eliminates discriminatory healthcare structures:

• Article 15’s right to equality upholds non-discrimination based on religion, race, caste, gender, place of birth, and other factors. However, healthcare has become a privilege for a select few due to decades of inadequate investment in public health.
• To end discriminatory structures that will otherwise continue to perpetuate inequality in all spheres of life, including education, opportunity, wealth, and social mobility, the constitutional right to health is essential.

Enhance the health ecosystem as a whole:

• By passing a law that makes healthcare a right for everyone, the government would make it easier for people to demand better care and hold the government and healthcare workers accountable if they don’t get it.

Unique regulation and different instruments to fortify medical services:

• Special legislation, capable institutions, increased budgets, medical training and research, wellness and prevention, and service outreach will all be made possible by the Constitution’s right to health; thereby enhancing the health ecosystem as a whole.
• For instance, before the constitutional amendment that made it a fundamental right in and of itself, the right to education had also been held to be implicit in the right to life. 15 years ago, the primary school enrollment rate was thought to be impossible; today, it is over 95%.

Reduce expenses incurred out of pocket:

• The Economic Survey for 2022–23 reveals that patients continue to directly pay for almost half of all healthcare costs in India. The Right to Health aims to increase public spending while decreasing individual healthcare costs.

Challenges with the Right to Health ‘Pill’

• Insufficient infrastructure: India’s healthcare system lacks the fundamental infrastructure necessary to meet the needs of a large population. India, for instance, has only 8.5 beds for every 10,000 people. Also, the doctor-to-patient and nurse-to-patient ratios are significantly lower than WHO standards, which are 1/1000 for doctors and 3/1000 for nurses, respectively (1 per 1456 patients).
• The existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
• Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
• Saving money on health care: India has the lowest public health spending as a percentage of GDP (1.6 percent). Among the BRICS nations, India has the lowest public health spending. Brazil has 3.96 percent, Russia has 3.16 percent, South Africa has 4.46 percent, and China has 3.02 percent.
• No detailing of the process: To the charge that there is no detailing of the process, health rights activists have pointed out that it would be a function of the Rules, not the law itself.
• Concerns about compensation: Healthcare providers have a problem with reimbursement delays. Additionally, there are complaints that the predetermined package rates for various medical procedures and treatments are not sufficiently profitable or do not cover the actual cost.
• A high rate of disease: Both communicable and non-communicable diseases like malaria, diabetes, and tuberculosis are prevalent in India. Healthcare infrastructure and resources require significant investment to combat these diseases.

Way Forward

• A fundamental shift in approach is required: We must fundamentally alter our healthcare approach. We must view it as a high-yield investment that can significantly reduce future out-of-pocket costs and also increase output rather than spending.
• Coordination among states and the center: Without hindering cooperative federalism, which is an essential component of the Indian Constitution, there must be coordination between the center and the states on a crucial subject like health.
• More authority and assistance for states: The COVID-19 response by the Center and states reveals that health must remain on the State List, despite the importance of seamless coordination between the centers and states. Therefore, it is necessary to devolve authority and resources to states to improve their respective public health systems.
• Boost public spending: By 2025, India must increase its investment in healthcare resources and infrastructure to at least 2.5% of GDP.
• Improve transparency and accountability: Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.

Conclusion:

• Given the contentious nature of the Bill, all stakeholders need to come to the table and engage in constructive dialogue to resolve the issues at hand. It should involve liaisons between the government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
• This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
• “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 condition, or social status,” as stated in the WHO constitution.

ISRO succeeds in landing RLV

The Indian Space Research Organisation (ISRO) successfully conducted the Reusable Launch Vehicle (RLV) Autonomous Landing Mission (LEX) at the Aeronautical Test Range of the Defence Research and Development Organisation (DRDO) in Karnataka’s Chitradurga. According to ISRO, the RLV took an under-slung load of a Chinook Helicopter of the Indian Air Force and flew to a height of 4.5 km.

More about the news:

• The technique adopted to launch the vehicle was “a first in the world” where a winged body was carried to an altitude of 4.5 km by helicopter and released for carrying an autonomous landing on a runway.
• The autonomous landing was carried out under the exact conditions of the Space Re-entry vehicle’s landing (such as) high speed, unmanned, precise landing from the same return path as if the vehicle arrived from space.
• The RLV is essentially a space plane with a low lift-to-drag ratio, requiring an approach at high glide angles that necessitated a landing at high velocities of 350 km.
• ISRO said the LEX utilized several indigenous systems such as Localized Navigation systems based on pseudolite systems, instrumentation, and sensor systems, etc. developed by ISRO.
• According to the space agency, an adaptation of contemporary technologies developed for RLV LEX turns other operational launch vehicles of ISRO more cost-effective.
• ISRO first demonstrated the re-entry of its winged vehicle RLV-TD in its HEX Mission in May 2016.
• During that experiment, the vehicle had landed on a hypothetical runway over the Bay of Bengal as “precise landing on a runway was an aspect not included in the HEX mission.
• The LEX mission achieved the final approach phase that coincided with the re-entry flight path exhibiting an autonomous, high-speed (350 kmph) landing.
• More experiments are in the pipeline to ensure that the RLV succeeds in payload delivery to low earth orbit, as ISRO plans to reduce the cost of the process by 80 percent. The Return Flight Experiment and other related tests of the RLV are also being planned.

Flashback:

Reusable Launch Vehicle:

• It is one of the most technologically challenging endeavors of ISRO towards developing essential technologies for a fully reusable launch vehicle to enable low-cost access to space.
• With this various technology, namely, hypersonic flight, autonomous landing, and powered cruise flight can be attained.
• The selection of materials like special alloys, composites, and insulation materials for developing an RLV.
  •  The crafting of its parts is very complex and demands highly skilled manpower.
    
    
    Britain joining a trans-Pacific trade pact

Britain agreed to join the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP), a trade pact based around the Pacific Rim, as it seeks to build ties around the world after leaving the European Union.

More about the news:

Britain seeks post-Brexit trade wins in geographically distant but faster-growing economies.

About CPTPP:

• It is a free trade agreement (FTA) that was agreed upon in 2018 between 11 countries – Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam.
• Britain will become the 12th member, and the first to join the partnership since its inception.
• CPTPP countries will have a combined GDP of 11 trillion pounds ($13.6 trillion) once Britain joins, or 15% of global GDP.
• It does not have a single market for goods or services, and so regulatory harmonization is not required, unlike the European Union, whose trading orbit Britain left at the end of 2020.

Britain’s trade with CPTPP:

• Its exports to CPTPP countries were worth 60.5 billion pounds in the twelve months to end-Sept. 2022. Membership of the grouping will add another 1.8 billion pounds each year in the long run, and possibly more if other countries join.
• Early analysis of CPTPP operations suggested that it was making little difference to trade flows, and adding it did little for Britain’s service sectors but imports from countries like Vietnam would grow over time.

Rules of Origin Benefits:

• It said that exporters could benefit from CPTPP membership even when trading with countries where there is a bilateral FTA.
• To benefit from preferential tariffs, exporters must demonstrate a product as a sufficient proportion of “locally” sourced parts.
• Rules of origin under rolled-over post-Brexit free trade agreements with Japan, Mexico, and Canada, for instance, allow exporters to count EU inputs as “local”.
• Under CPTPP, inputs from CPTPP members can usually be considered local, giving exporters another option if it is beneficial.

Sectoral Impact:

•  Britain has agreed on a quota on beef imports but did not agree to lower food standards, under which hormone-treated beef is banned.
• Tariffs on palm oil from Malaysia will be liberalized, and Britain also agreed on tariff reductions on bananas, rice, and crab sticks following requests from Peru, Vietnam, and Singapore respectively.
• Britain highlighted that 99% of exports to CPTPP would be eligible for zero tariffs, including cheese, cars, chocolate, machinery, gin, and whisky,
• The UK’s accession to CPTPP will open up new opportunities for Scotch Whisky and other UK products in key markets in the region.”
  
  Geopolitical factors:
• The long-term benefit for Britain’s economy is set to be modest; its accession was a big geopolitical strategy gain with a small economic gain.
• The CPTPP could enable the UK to enhance strategic ties with like-minded countries to protect a free and open Indo-Pacific region.

 UN resolution for climate extremities

The United Nations General Assembly passed a resolution that asked the International Court of Justice at The Hague to provide an opinion on what kind of obligations countries have towards climate change reduction, based on the promises they have made to the U.N. Framework Convention for Climate Change (UNFCCC).

More about the news:

It was particularly important because the resolution passed by consensus had been pushed through by one of the smallest countries in the world, the Pacific Island of Vanuatu.

What does the resolution seek?

The draft resolution (A/77/L.58) invoked article 96 of the U.N. Charter to ask the ICJ to deliberate on two questions:

• About the obligations of states under international laws to ensure the protection of the climate system for present and future generations.
• About the legal consequences under these obligations for states where they, by their acts and omissions, have caused significant harm to the climate system, particularly for Small Island Developing States (SIDS) and for people who are harmed.

It refers to several international protocols including the Paris Agreement (2015), the United Nations Convention on the Law of the Sea, and even the Universal Declaration of Human Rights

What is India’s position?

• India has thus far been cautiously silent about the move, although it is generally supportive of the need for climate justice, and holding the developed world accountable for global warming.
• The government is understood to have referred the resolution to legal authorities in the country who will look into the implications and international ramifications of the ICJ opinion.
• India has updated its NDC (nationally determined contribution) commitments, as required by the 2015 Paris Agreement, and has said it’s on its way to sourcing half its electricity from renewable sources by 2030.
• It is significant that India did not join the overwhelming majority of countries that co-sponsored the draft resolution.
• In the neighborhood, the list of co-sponsors included Bangladesh, Maldives, Nepal, Sri Lanka, and several island countries in the Indian Ocean Region (IOR).
• India is also watching how global powers like the U.S. and China respond to the resolution, as without their support, it will be hard to implement.
• Pointing to the Paris agreement as a landmark shift towards a “bottom-up” approach, where states themselves determine their ability to mitigate climate change, they also said any attempt to impose an opinion in a “top-down” manner would be resisted.

What do sponsors of the resolution want?

• A legal opinion from the ICJ, the highest global court recognized by all 193 UN members is expected to bolster the efforts under the UNFCCC to ensure all countries work towards mitigating climate change and global warming to the suggested 1.5-2°C limit.
• According to the latest IPCC “Synthesis report”, global climate levels have already increased 1.1 degrees since pre-industrial levels in the past century, and deep cuts in greenhouse gas emissions reductions, as much as by a half are required by 2030 to keep this goal.
• UN Secretary-General Antonio Guterres who has called for measures to defuse the “climate-time bomb” said that the ICJ opinion was “essential”, and would “guide the actions and conduct of states in their relations with each other, as well as towards their citizens.”
• The UNGA route adopted by Vanuatu and its supporters also appears to have been more inclusive than two other attempts for an Advisory Opinion sought in December 2022 by the Small Island States to the International Tribunal for the Law of the Sea specifically asking about marine environment commitments.

What sparked the idea for the resolution?

• The original idea for taking the case for climate obligations to the highest legal court came from a group of 27 Pacific Island law students, who set up a campaign and brought it to the Pacific Islands Forum.
• Since 2019, the Vanuatu government, with the support of an 18-member “core group” of countries, has been promoting the idea of an Advisory Opinion from the ICJ.

Is the advisory opinion of the ICJ binding?

• The ICJ is being asked for an “advisory opinion”, which by definition would not be legally binding as an ICJ judgment.
• Its clarification of international environmental laws would make the process more streamlined, particularly as the COP (Conference of the Parties) process looks at various issues like climate finance, climate justice, and the most recently agreed “loss and damages” fund at the COP27 in Sharm El-Sheikh last year.
• The ICJ carries “legal weight and moral authority”, said the sponsors of the resolution, and gave as examples advisory opinions given in the past on the Palestinian issue (Construction of the Wall), nuclear threats, and the dispute between the U.K. and Mauritius over the Chagos Islands, that have been respected.