The Supreme Court issued notices to the central and state governments yesterday on July 27 to respond to a petition filed by public health activists seeking affordable healthcare for all in the country. The PIL has also asked for the implementation of the Clinical Establishment Act, 2010, and regulation of the ‘unregulated’ private health sector.

Health is the constitutional right of citizens. It should ensure all medical services and medical attention in the event of sickness to the patient. However, the recent petition claims that a large chunk of the population is dependent on the profit-driven private sector owing to lack of healthcare in public hospitals.

The petition, filed by non-profit Jan Swasthya Abhiyan, Patients’ Rights Campaign and activist KM Gopakumar in February-end this year, informed that more than 70 per cent of patient care in the country was provided by private sector and less than 30 per cent by the public sector. 

The petitioners alleged that private health sector facilities have been promoted shifting focus from the public health sector. This was one of the factors which caused the public health sector to ‘suffer’, claim the petitioners, who have sought implementation of the Clinical Establishments (Registration and Regulation) Act 2010, the Clinical Establishment (Central Government) Rules, 2012 and the Patients’ Rights Charter.

“… transparency in rates charged by clinical establishments is the most necessary reform needed in the opaquely functioning private healthcare sector in India and one that is most frequently demanded by citizens,” reads the petition.

What is the Clinical Establishment Act, 2010?

This decade-old Act directs every clinical establishment in the country to display the rates charged for each type of service provided and facilities available, for the benefit of the patients. Besides, the Act mandates provisions of maintenance of records and reporting.

“We have seen during COVID second wave, how the right to health was compromised in the private health sector. The implementation of the Clinical Act is important but even after a decade this has not been implemented by many states so far,” Amulya Nidhi, who is representing the petition through Jan Swasthya Abhiyan, told Gaon Connection.

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At present, there are 11 states and six Union Territories including Arunachal Pradesh, Himachal Pradesh, Mizoram and Sikkim, where the Act is applicable. However, the petitioners pointed out that this Act and its rules exist only on paper without actual implementation, particularly in terms of quality and affordability of healthcare by all.

“Time to time drafts have been made by states such as Maharashtra and Madhya Pradesh, but still the Act was not implemented,” said Nidhi.

Regulation of standards in clinical establishments, which had been adopted as a national policy goal by the Indian government nearly two decades ago, is yet to be effectively implemented across the country. This is a ‘denial’ of the right to a dignified life, where minimum healthcare services are ensured, the petitioners complain.

In addition, the petitioners also laid emphasis on protection of patients’ rights in clinical establishments, including the right to information, access to medical records and reports, informed consent, confidentiality and privacy.

Unregulated private sector

The petition has referred to the inadequacies, which exist in the public health care system, such as lack of sufficient infrastructure, lack of human resources, non-availability of medicines, inadequate public investment, and ‘forced’ dependency on the private sector.

“For the last twenty-thirty years, the private sector has been encouraged even in rural areas. Standard care was not maintained even during COVID second wave when steroids (responsible for rising black fungus cases) were given in an unregulated approach,” said Nidhi.

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The public health activist highlighted the profit-driven treatment at private hospitals in the pandemic. “There should be regulation on private facilities. Cost of the treatment should also be regulated. People have spent as much as fifteen lakh for COVID treatments in private centres. It is very important to regulate costs for the private sector or you run the public sector with better facilities. It is also important to protect patients rights such as informed consent,” he added.

According to the Operational Guidelines for the Clinical Establishments Act, by the Ministry of Health and Family Welfare, out-of-pocket payments still account for up to 71 per cent of total health spending in India.

The petitioners pointed out that there is unprecedented growth of the private sector but it largely remains unregulated. Thus, health regulation continues to be unresolved.

The petitioners are also seeking that a grievance redressal mechanism should exist at the district, state and national level.

This mechanism provides feedback on the working of the administration. 

“This mechanism would look into grievances of the patients at different levels, including denial of patients’ rights by the hospitals/ clinics, and failure to provide minimum care and facilities as provided under the Clinical Establishments Act and Rules,” read the petition.

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